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Bjermo H, Patterson E, Petrelius Sipinen J, Lignell S, Stenberg K, Larsson E, Lindroos AK, Ottoson J, Warensjö Lemming E, Moraeus L. Design, Methods, and Participation in Riksmaten Young Children-A Swedish National Dietary Survey. Curr Dev Nutr 2024; 8:102150. [PMID: 38774498 PMCID: PMC11107201 DOI: 10.1016/j.cdnut.2024.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 05/24/2024] Open
Abstract
Background National dietary surveys provide essential data for risk benefit assessments of foods and nutrients, for management and policy development. Physical activity measurement and biomonitoring can provide important complementary data but are less commonly included. Objectives This study aimed to describe the study design and methods of the cross-sectional Swedish national dietary survey Riksmaten Young Children (Riksmaten småbarn), of children aged 9 mo, 18 mo, and 4 y. Participation/dropout rates for the 2 older age groups are also presented. The impact of different recruitment strategies is discussed. Methods Children (N = 16,655) were randomly selected from the population register; invitations to guardians were sent by post and where possible, followed up by telephone. Food intake was assessed by a 2-d food diary and/or questionnaire. Height and weight were reported after measurement. Physical activity (accelerometery, 7 d) and stool, blood, and urine samples were assessed in subgroups. Results Food consumption data were collected in 1828 children (11% of the invited; 18 mo: n = 1078, and 4 y: n = 750). Of participants also in subgroups, 71% provided physical activity data (n = 1307), 60% stool samples (n = 630), and 51% blood and/or urine samples (n = 593). The study population represented all geographic regions and types of municipalities in Sweden, but participating households had both higher education level and higher income than the target population. Only minor differences were seen in participation rates between recruitment via post and telephone compared with those through post only (12% compared with 10%). Repeated contact attempts were needed for the majority of participants (65%). Despite the low-participation rate, 99% of the participants completed the study once started. Conclusions Although it was a challenge to recruit participants, Riksmaten Young Children provides a substantial amount of information at national level, representative in terms of sex, geography, and family structure. The underrepresentation of households with lower socioeconomic position must be considered when generalizing results.
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Affiliation(s)
- Helena Bjermo
- Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Emma Patterson
- Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Sanna Lignell
- Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Karin Stenberg
- Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Elin Larsson
- Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Anna Karin Lindroos
- Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jakob Ottoson
- Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Eva Warensjö Lemming
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Lotta Moraeus
- Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
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Eustachio Colombo P, Elinder LS, Nykänen EPA, Patterson E, Lindroos AK, Parlesak A. Developing a novel optimisation approach for keeping heterogeneous diets healthy and within planetary boundaries for climate change. Eur J Clin Nutr 2024; 78:193-201. [PMID: 37990128 DOI: 10.1038/s41430-023-01368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Current dietary habits have substantial negative impacts on the health of people and the planet. This study aimed to develop a novel approach for achieving health-promoting and climate-friendly dietary recommendations for a broad range of consumers. SUBJECTS AND METHODS Hierarchical clustering analysis was combined with linear programming to design nutritionally adequate, health-promoting, climate-friendly and culturally acceptable diets using Swedish national dietary data (n = 1797). Diets were optimised for the average consumption of the total population as well as for the dietary clusters. RESULTS Three dietary clusters were identified. All optimised diets had lower shares of animal-source foods and contained higher amounts of plant-based foods. These dietary shifts reduced climate impacts by up to 53% while leaving much of the diet unchanged. The optimised diets of the three clusters differed from the optimised diet of the total population. All optimised diets differed considerably from the food-group pattern of the EAT-Lancet diet. CONCLUSIONS The novel cluster-based optimisation approach was able to generate alternatives that may be more acceptable and realistic for a sustainable diet across different groups in the population.
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Affiliation(s)
- Patricia Eustachio Colombo
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK.
| | - Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Esa-Pekka A Nykänen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Functional Foods Forum, University of Turku, Turku, Finland
| | - Emma Patterson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Swedish Food Agency, Uppsala, Sweden
| | - Anna Karin Lindroos
- The Swedish Food Agency, Uppsala, Sweden
- Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alexandr Parlesak
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
- Personalized Nutrition, Duale Hochschule Baden-Württemberg, Heilbronn, Germany
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Lindroos AK, Hallström E, Moraeus L, Strid A, Winkvist A. Dietary Greenhouse Gas Emissions and Diet Quality in a Cross-Sectional Study of Swedish Adolescents. Am J Clin Nutr 2023; 118:956-965. [PMID: 37678640 DOI: 10.1016/j.ajcnut.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/25/2023] [Accepted: 09/02/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Interventions to improve dietary intake and reduce dietary greenhouse gas emissions (dGHGE) are urgently needed. Adolescence presents a unique time in life to promote sustainable diets. Detailed dietary data are needed to inform public health strategies aiming at improving adolescents' diet quality and reducing dGHGE. OBJECTIVE This study aimed to describe dGHGE in Swedish adolescents' diets by socio-demographic characteristics, evaluate how food groups contribute to dGHGE, and examine dGHGE in relation to diet quality. METHODS Data come from the national, school-based, cross-sectional dietary survey Riksmaten Adolescents 2016-17 of 3099 females and males attending school grades 5 (11-12 y old), 8 (14-15 y old) and 11 (17-18 y old). Participants completed 2 web-based 24-h recalls and questionnaires on lifestyle factors. dGHGE was estimated based on life cycle assessment data. Diet quality was estimated using NRF11.3 (Nutrient Rich Food Index) and SHEIA15 (Swedish Healthy Eating Index for Adolescents 2015). RESULTS dGHGE were higher in males than females (medians 4.2 versus 3.8 kg CO2e/10 MJ, P < 0.001). In females, dGHGE were highest in grade 5 (4.0 kg CO2e/10MJ), whereas in males, emissions were highest in grade 11 (4.4 kg CO2e/10MJ), P < 0.001 for the sex/grade interaction. Overweight/obesity was positively associated with CO2e/10MJ, but parental education, birthplace, and degree of urbanization were not. In females, the proportion of dGHGE from animal-based foods was lowest in grade 11, whereas the proportions from plant-based foods and sweet foods/beverages were highest. In males, these proportions were similar across grades. NRF11.3 was not associated with CO2e/10MJ, whereas healthier eating, according to SHEIA15, was inversely associated with CO2e/10MJ. CONCLUSIONS Food choices and dGHGE per calorie differ by sex in adolescents. Thus, intervention strategies to improve dietary sustainability need to be tailored differently to females and males. Diet quality should also be considered when promoting reduced GHGE diets.
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Affiliation(s)
- Anna Karin Lindroos
- Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden; Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Elinor Hallström
- Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Research Institutes of Sweden (RISE), Department of Food and Agriculture, Lund, Sweden
| | - Lotta Moraeus
- Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Anna Strid
- Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sustainable Health, Department of Public Health and Clinical Medicine, Umea University, Umea, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cox B, Wauters N, Rodríguez-Carrillo A, Portengen L, Gerofke A, Kolossa-Gehring M, Lignell S, Lindroos AK, Fabelova L, Murinova LP, Desalegn A, Iszatt N, Schillemans T, Åkesson A, Colles A, Den Hond E, Koppen G, Van Larebeke N, Schoeters G, Govarts E, Remy S. PFAS and Phthalate/DINCH Exposure in Association with Age at Menarche in Teenagers of the HBM4EU Aligned Studies. Toxics 2023; 11:711. [PMID: 37624216 PMCID: PMC10459167 DOI: 10.3390/toxics11080711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
Early puberty has been found to be associated with adverse health outcomes such as metabolic and cardiovascular diseases and hormone-dependent cancers. The decrease in age at menarche observed during the past decades has been linked to an increased exposure to endocrine-disrupting compounds (EDCs). Evidence for the association between PFAS and phthalate exposure and menarche onset, however, is inconsistent. We studied the association between PFAS and phthalate/DINCH exposure and age at menarche using data of 514 teenagers (12 to 18 years) from four aligned studies of the Human Biomonitoring for Europe initiative (HBM4EU): Riksmaten Adolescents 2016-2017 (Sweden), PCB cohort (follow-up; Slovakia), GerES V-sub (Germany), and FLEHS IV (Belgium). PFAS concentrations were measured in blood, and phthalate/DINCH concentrations in urine. We assessed the role of each individual pollutant within the context of the others, by using different multi-pollutant approaches, adjusting for age, age- and sex-standardized body mass index z-score and household educational level. Exposure to di(2-ethylhexyl) phthalate (DEHP), especially mono(2-ethyl-5-hydroxyhexyl) phthalate (5OH-MEHP), was associated with an earlier age at menarche, with estimates per interquartile fold change in 5OH-MEHP ranging from -0.34 to -0.12 years in the different models. Findings from this study indicated associations between age at menarche and some specific EDCs at concentrations detected in the general European population, but due to the study design (menarche onset preceded the chemical measurements), caution is needed in the interpretation of causality.
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Affiliation(s)
- Bianca Cox
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (N.W.); (A.R.-C.); (A.C.); (G.K.); (G.S.); (E.G.); (S.R.)
| | - Natasha Wauters
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (N.W.); (A.R.-C.); (A.C.); (G.K.); (G.S.); (E.G.); (S.R.)
| | - Andrea Rodríguez-Carrillo
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (N.W.); (A.R.-C.); (A.C.); (G.K.); (G.S.); (E.G.); (S.R.)
- Toxicological Centre, University of Antwerp, Universiteitsplein, 1, 2610 Wilrijk, Belgium
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, 3584 Utrecht, The Netherlands;
| | - Antje Gerofke
- German Environment Agency, Umweltbundesamt (UBA), 14195 Berlin, Germany; (A.G.); (M.K.-G.)
| | - Marike Kolossa-Gehring
- German Environment Agency, Umweltbundesamt (UBA), 14195 Berlin, Germany; (A.G.); (M.K.-G.)
| | - Sanna Lignell
- Swedish Food Agency, 751 26 Uppsala, Sweden; (S.L.); (A.K.L.)
| | | | - Lucia Fabelova
- Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University, 831 01 Bratislava, Slovakia; (L.F.); (L.P.M.)
| | - Lubica Palkovicova Murinova
- Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University, 831 01 Bratislava, Slovakia; (L.F.); (L.P.M.)
| | - Anteneh Desalegn
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, 0456 Oslo, Norway; (A.D.); (N.I.)
| | - Nina Iszatt
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, 0456 Oslo, Norway; (A.D.); (N.I.)
| | - Tessa Schillemans
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (T.S.); (A.Å.)
| | - Agneta Åkesson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (T.S.); (A.Å.)
| | - Ann Colles
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (N.W.); (A.R.-C.); (A.C.); (G.K.); (G.S.); (E.G.); (S.R.)
| | - Elly Den Hond
- Provincial Institute of Hygiene, Provincial Research Centre for Environment and Health, 2023 Antwerp, Belgium;
| | - Gudrun Koppen
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (N.W.); (A.R.-C.); (A.C.); (G.K.); (G.S.); (E.G.); (S.R.)
| | - Nicolas Van Larebeke
- Analytical, Environmental and Geo-Chemistry, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
| | - Greet Schoeters
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (N.W.); (A.R.-C.); (A.C.); (G.K.); (G.S.); (E.G.); (S.R.)
- Department of Biomedical Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Eva Govarts
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (N.W.); (A.R.-C.); (A.C.); (G.K.); (G.S.); (E.G.); (S.R.)
| | - Sylvie Remy
- VITO Health, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400 Mol, Belgium; (N.W.); (A.R.-C.); (A.C.); (G.K.); (G.S.); (E.G.); (S.R.)
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Vogel N, Schmidt P, Lange R, Gerofke A, Sakhi AK, Haug LS, Jensen TK, Frederiksen H, Szigeti T, Csákó Z, Murinova LP, Sidlovska M, Janasik B, Wasowicz W, Tratnik JS, Mazej D, Gabriel C, Karakitsios S, Barbone F, Rosolen V, Rambaud L, Riou M, Murawski A, Leseman D, Koppen G, Covaci A, Lignell S, Lindroos AK, Zvonar M, Andryskova L, Fabelova L, Richterova D, Horvat M, Kosjek T, Sarigiannis D, Maroulis M, Pedraza-Diaz S, Cañas A, Verheyen VJ, Bastiaensen M, Gilles L, Schoeters G, Esteban-López M, Castaño A, Govarts E, Koch HM, Kolossa-Gehring M. Current exposure to phthalates and DINCH in European children and adolescents - Results from the HBM4EU Aligned Studies 2014 to 2021. Int J Hyg Environ Health 2023; 249:114101. [PMID: 36805185 DOI: 10.1016/j.ijheh.2022.114101] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 02/19/2023]
Abstract
Phthalates are mainly used as plasticizers for polyvinyl chloride (PVC). Exposure to several phthalates is associated with different adverse effects most prominently on the development of reproductive functions. The HBM4EU Aligned Studies (2014-2021) have investigated current European exposure to ten phthalates (DEP, BBzP, DiBP, DnBP, DCHP, DnPeP, DEHP, DiNP, DiDP, DnOP) and the substitute DINCH to answer the open policy relevant questions which were defined by HBM4EU partner countries and EU institutions as the starting point of the programme. The exposure dataset includes ∼5,600 children (6-11 years) and adolescents (12-18 years) from up to 12 countries per age group and covering the North, East, South and West European regions. Study data from participating studies were harmonised with respect to sample size and selection of participants, selection of biomarkers, and quality and comparability of analytical results to provide a comparable perspective of European exposure. Phthalate and DINCH exposure were deduced from urinary excretions of metabolites, where concentrations were expressed as their key descriptor geometric mean (GM) and 95th percentile (P95). This study aims at reporting current exposure levels and differences in these between European studies and regions, as well as comparisons to human biomonitoring guidance values (HBM-GVs). GMs for children were highest for ∑DEHP metabolites (33.6 μg/L), MiBP (26.6 μg/L), and MEP (24.4 μg/L) and lowest for∑DiDP metabolites (1.91 μg/L) and ∑DINCH metabolites (3.57 μg/L). In adolescents highest GMs were found for MEP (43.3 μg/L), ∑DEHP metabolites (28.8 μg/L), and MiBP (25.6 μg/L) and lowest for ∑DiDP metabolites (= 2.02 μg/L) and ∑DINCH metabolites (2.51 μg/L). In addition, GMs and P95 stratified by European region, sex, household education level, and degree of urbanization are presented. Differences in average biomarker concentrations between sampling sites (data collections) ranged from factor 2 to 9. Compared to the European average, children in the sampling sites OCC (Denmark), InAirQ (Hungary), and SPECIMEn (The Netherlands) had the lowest concentrations across all metabolites and ESTEBAN (France), NAC II (Italy), and CROME (Greece) the highest. For adolescents, comparably higher metabolite concentrations were found in NEB II (Norway), PCB cohort (Slovakia), and ESTEBAN (France), and lower concentrations in POLAES (Poland), FLEHS IV (Belgium), and GerES V-sub (Germany). Multivariate analyses (Survey Generalized Linear Models) indicate compound-specific differences in average metabolite concentrations between the four European regions. Comparison of individual levels with HBM-GVs revealed highest rates of exceedances for DnBP and DiBP, with up to 3 and 5%, respectively, in children and adolescents. No exceedances were observed for DEP and DINCH. With our results we provide current, detailed, and comparable data on exposure to phthalates in children and - for the first time - in adolescents, and - for the first time - on DINCH in children and adolescents of all four regions of Europe which are particularly suited to inform exposure and risk assessment and answer open policy relevant questions.
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Affiliation(s)
- Nina Vogel
- German Environment Agency (UBA), Berlin, Germany.
| | | | - Rosa Lange
- German Environment Agency (UBA), Berlin, Germany
| | | | | | - Line S Haug
- Norwegian Institute of Public Health, Oslo, Norway
| | - Tina Kold Jensen
- IST - Clinical Pharmacology, Pharmacy and Environmental Medicine, Odense, Denmark
| | - Hanne Frederiksen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Zsófia Csákó
- National Public Health Center, Budapest, Hungary
| | | | | | - Beata Janasik
- Nofer Institute of Occupational Medicine, Lodz, Poland
| | | | - Janja Snoj Tratnik
- Jozef Stefan Institute, Department of Environmental Sciences, Ljubljana, Slovenia
| | - Darja Mazej
- Jozef Stefan Institute, Department of Environmental Sciences, Ljubljana, Slovenia
| | - Catherine Gabriel
- Environmental Engineering Laboratory, Department of Chemical Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece; HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Thessaloniki-Thermi, Greece
| | - Spyros Karakitsios
- Environmental Engineering Laboratory, Department of Chemical Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece; HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Thessaloniki-Thermi, Greece
| | - Fabio Barbone
- Department of Medicine-DAME, University of Udine, Udine, Italy
| | - Valentina Rosolen
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Loïc Rambaud
- Santé publique France, Environmental and Occupational Health Division, Saint-Maurice, France
| | - Margaux Riou
- Santé publique France, Environmental and Occupational Health Division, Saint-Maurice, France
| | | | - Daan Leseman
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Gudrun Koppen
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Adrian Covaci
- Toxicological Center, University of Antwerp, Wilrijk, Belgium
| | | | | | - Martin Zvonar
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Lenka Andryskova
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Lucia Fabelova
- Slovak Medical University, Faculty of Public Health, Bratislava, Slovakia
| | - Denisa Richterova
- Slovak Medical University, Faculty of Public Health, Bratislava, Slovakia
| | - Milena Horvat
- Jozef Stefan Institute, Department of Environmental Sciences, Ljubljana, Slovenia
| | - Tina Kosjek
- Jozef Stefan Institute, Department of Environmental Sciences, Ljubljana, Slovenia
| | - Denis Sarigiannis
- Environmental Engineering Laboratory, Department of Chemical Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece; HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Thessaloniki-Thermi, Greece; Environmental Health Engineering, Institute of Advanced Study, Pavia, Italy
| | - Marios Maroulis
- Environmental Engineering Laboratory, Department of Chemical Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece; HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Thessaloniki-Thermi, Greece
| | - Susana Pedraza-Diaz
- National Centre for Environmental Health, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Ana Cañas
- National Centre for Environmental Health, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Veerle J Verheyen
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | | | - Liese Gilles
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Greet Schoeters
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium; University of Antwerp, Dept of Biomedical Sciences and Toxicological Centre, Antwerp, Belgium
| | - Marta Esteban-López
- National Centre for Environmental Health, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Argelia Castaño
- National Centre for Environmental Health, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Eva Govarts
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Holger M Koch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
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Buekers J, Baken K, Govarts E, Martin LR, Vogel N, Kolossa-Gehring M, Šlejkovec Z, Falnoga I, Horvat M, Lignell S, Lindroos AK, Rambaud L, Riou M, Pedraza-Diaz S, Esteban-Lopez M, Castaño A, Den Hond E, Baeyens W, Santonen T, Schoeters G. Human urinary arsenic species, associated exposure determinants and potential health risks assessed in the HBM4EU Aligned Studies. Int J Hyg Environ Health 2023; 248:114115. [PMID: 36689783 DOI: 10.1016/j.ijheh.2023.114115] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/21/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
The European Joint Programme HBM4EU coordinated and advanced human biomonitoring (HBM) in Europe in order to provide science-based evidence for chemical policy development and improve chemical management. Arsenic (As) was selected as a priority substance under the HBM4EU initiative for which open, policy relevant questions like the status of exposure had to be answered. Internal exposure to inorganic arsenic (iAs), measured as Toxic Relevant Arsenic (TRA) (the sum of As(III), As(V), MMA, DMA) in urine samples of teenagers differed among the sampling sites (BEA (Spain) > Riksmaten adolescents (Sweden), ESTEBAN (France) > FLEHS IV (Belgium), SLO CRP (Slovenia)) with geometric means between 3.84 and 8.47 μg/L. The ratio TRA to TRA + arsenobetaine or the ratio TRA to total arsenic varied between 0.22 and 0.49. Main exposure determinants for TRA were the consumption of rice and seafood. When all studies were combined, Pearson correlation analysis showed significant associations between all considered As species. Higher concentrations of DMA, quantitatively a major constituent of TRA, were found with increasing arsenobetaine concentrations, a marker for organic As intake, e.g. through seafood, indicating that other sources of DMA than metabolism of inorganic As exist, e.g. direct intake of DMA or via the intake of arsenosugars or -lipids. Given the lower toxicity of DMA(V) versus iAs, estimating the amount of DMA not originating from iAs, or normalizing TRA for arsenobetaine intake could be useful for estimating iAs exposure and risk. Comparing urinary TRA concentrations with formerly derived biomonitoring equivalent (BE) for non-carcinogenic effects (6.4 μg/L) clearly shows that all 95th percentile exposure values in the different studies exceeded this BE. This together with the fact that cancer risk may not be excluded even at lower iAs levels, suggests a possible health concern for the general population of Europe.
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Affiliation(s)
- Jurgen Buekers
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium.
| | - Kirsten Baken
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Eva Govarts
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | | | - Nina Vogel
- German Environment Agency (UBA), Berlin, Germany
| | | | | | | | | | | | | | - Loïc Rambaud
- Department of Environmental and Occupational Health, Santé publique France, Saint-Maurice, France
| | - Margaux Riou
- Department of Environmental and Occupational Health, Santé publique France, Saint-Maurice, France
| | - Susana Pedraza-Diaz
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Esteban-Lopez
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Argelia Castaño
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Elly Den Hond
- Provincial Institute of Hygiene (PIH), Antwerp, Belgium
| | - Willy Baeyens
- Analytical, Environmental & Geo-Chemistry, Free Universtiy of Brussels (VUB), Brussels, Belgium
| | - Tiina Santonen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Greet Schoeters
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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8
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Schillemans T, Iszatt N, Remy S, Schoeters G, Fernández MF, D'Cruz SC, Desalegn A, Haug LS, Lignell S, Lindroos AK, Fábelová L, Murinova LP, Kosjek T, Tkalec Ž, Gabriel C, Sarigiannis D, Pedraza-Díaz S, Esteban-López M, Castaño A, Rambaud L, Riou M, Pauwels S, Vanlarebeke N, Kolossa-Gehring M, Vogel N, Uhl M, Govarts E, Åkesson A. Cross-sectional associations between exposure to per- and polyfluoroalkyl substances and body mass index among European teenagers in the HBM4EU aligned studies. Environ Pollut 2023; 316:120566. [PMID: 36334774 DOI: 10.1016/j.envpol.2022.120566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 05/26/2023]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are widespread pollutants that may impact youth adiposity patterns. We investigated cross-sectional associations between PFAS and body mass index (BMI) in teenagers/adolescents across nine European countries within the Human Biomonitoring for Europe (HBM4EU) initiative. We used data from 1957 teenagers (12-18 yrs) that were part of the HBM4EU aligned studies, consisting of nine HBM studies (NEBII, Norway; Riksmaten Adolescents 2016-17, Sweden; PCB cohort (follow-up), Slovakia; SLO CRP, Slovenia; CROME, Greece; BEA, Spain; ESTEBAN, France; FLEHS IV, Belgium; GerES V-sub, Germany). Twelve PFAS were measured in blood, whilst weight and height were measured by field nurse/physician or self-reported in questionnaires. We assessed associations between PFAS and age- and sex-adjusted BMI z-scores using linear and logistic regression adjusted for potential confounders. Random-effects meta-analysis and mixed effects models were used to pool studies. We assessed mixture effects using molar sums of exposure biomarkers with toxicological/structural similarities and quantile g-computation. In all studies, the highest concentrations of PFAS were PFOS (medians ranging from 1.34 to 2.79 μg/L). There was a tendency for negative associations with BMI z-scores for all PFAS (except for PFHxS and PFHpS), which was borderline significant for the molar sum of [PFOA and PFNA] and significant for single PFOA [β-coefficient (95% CI) per interquartile range fold change = -0.06 (-0.17, 0.00) and -0.08 (-0.15, -0.01), respectively]. Mixture assessment indicated similar negative associations of the total mixture of [PFOA, PFNA, PFHxS and PFOS] with BMI z-score, but not all compounds showed associations in the same direction: whilst [PFOA, PFNA and PFOS] were negatively associated, [PFHxS] associated positively with BMI z-score. Our results indicated a tendency for associations of relatively low PFAS concentrations with lower BMI in European teenagers. More prospective research is needed to investigate this potential relationship and its implications for health later in life.
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Affiliation(s)
- Tessa Schillemans
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden.
| | - Nina Iszatt
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Norway
| | - Sylvie Remy
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Greet Schoeters
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Mariana F Fernández
- Centre for Biomedical Research (CIBM) and School of Medicine, University of Granada, Granada, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Shereen Cynthia D'Cruz
- Univ Rennes, EHESP, Inserm, Irset (Institut de Recherche en Santé, Environnement et Travail), Rennes, France
| | - Anteneh Desalegn
- Division of Food Safety, Norwegian Institute of Public Health, Norway
| | - Line S Haug
- Division of Food Safety, Norwegian Institute of Public Health, Norway
| | | | | | - Lucia Fábelová
- Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University, Bratislava, Slovakia
| | - Lubica Palkovicova Murinova
- Department of Environmental Medicine, Faculty of Public Health, Slovak Medical University, Bratislava, Slovakia
| | - Tina Kosjek
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Žiga Tkalec
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Catherine Gabriel
- Environmental Engineering Laboratory, Department of Chemical Engineering, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece; HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Balkan Center, Bldg. B, 10th Km Thessaloniki-Thermi Road, 57001, Greece
| | - Denis Sarigiannis
- Environmental Engineering Laboratory, Department of Chemical Engineering, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece; HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Balkan Center, Bldg. B, 10th Km Thessaloniki-Thermi Road, 57001, Greece; Environmental Health Engineering, Institute of Advanced Study, Palazzo Del Broletto - Piazza Della Vittoria 15, 27100, Pavia, Italy
| | - Susana Pedraza-Díaz
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Esteban-López
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Argelia Castaño
- National Centre for Environmental Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Loïc Rambaud
- Department of Environmental and Occupational Health, Santé Publique France, Saint-Maurice, France
| | - Margaux Riou
- Department of Environmental and Occupational Health, Santé Publique France, Saint-Maurice, France
| | - Sara Pauwels
- Department of Public Health and Primary Care, KU, Leuven, Belgium
| | - Nik Vanlarebeke
- Department of Analytical and Environmental Chemistry, Free University of Brussels, Belgium
| | | | - Nina Vogel
- German Environment Agency, Umweltbundesamt (UBA), Berlin, Germany
| | - Maria Uhl
- Environment Agency Austria, Vienna, Austria
| | - Eva Govarts
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Agneta Åkesson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
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9
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Wanselius J, Larsson C, Berg C, Öhrvik V, Lindroos AK, Lissner L. Consumption of foods with the Keyhole front-of-pack nutrition label: potential impact on energy and nutrient intakes of Swedish adolescents. Public Health Nutr 2022; 25:1-12. [PMID: 36178115 PMCID: PMC9991761 DOI: 10.1017/s1368980022002178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 08/17/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The Keyhole is an internationally recognised front-of-pack nutrition label, guiding consumers to healthier food options. It indicates products in accordance with specific criteria for dietary fats, sugars, fibres, salt and wholegrains. The objective of this study was to simulate the potential impact of the Keyhole on adolescents' energy and nutrient intakes by modelling a shift from reported food intakes to foods meeting the Keyhole criteria. DESIGN Self-reported dietary intake data were derived from a cross-sectional survey. Multiple replacement scenarios were calculated, where foods meeting the Keyhole criteria replaced reported non-compliant foods with varying proportions of replacement. SETTING Dietary survey 'Riksmaten Adolescents 2016-2017' in schools across Sweden. PARTICIPANTS A nationally representative sample of 3099 adolescents in school years 5, 8 and 11 (55 % girls). RESULTS Overall, replacement with foods meeting the Keyhole criteria led to more adolescents meeting nutrition recommendations. Largest median intake improvements were seen for wholegrains (+196 %), SFA (-13 %), PUFA (+17 %) and fibres (+15 %). Smallest improvements were seen for free sugars (-3 %) and salt (-2 %), partly explained by the ineligibility of main food sources of free sugars for the Keyhole, and non-inclusion of ready meals that are often high in salt. Most micronutrient intakes were stable or improved. Unintentional effects included decreases in vitamin A, MUFA and energy intakes. Largest potential improvements in fat and fibre sources were observed in the youngest age group. CONCLUSIONS A shift to Keyhole alternatives for everyday foods would improve adolescents' nutrient intakes, even with smaller exchanges.
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Affiliation(s)
- Julia Wanselius
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Läroverksgatan 5 Box 300, SE-405 30, Gothenburg, Sweden
| | - Christel Larsson
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Läroverksgatan 5 Box 300, SE-405 30, Gothenburg, Sweden
| | - Christina Berg
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Läroverksgatan 5 Box 300, SE-405 30, Gothenburg, Sweden
| | - Veronica Öhrvik
- Science Division, Swedish Food Agency, Uppsala, Sweden
- Axfoundation, Torsåker, Sweden
| | - Anna Karin Lindroos
- Science Division, Swedish Food Agency, Uppsala, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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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. Curr Dev Nutr 2022. [PMCID: PMC9193821 DOI: 10.1093/cdn/nzac067.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives To assess 1) the association between adherence to the Swedish dietary guidelines and all-cause mortality, and 2) the difference in greenhouse gas emissions (GHGE) from diets of participants with higher and lower adherence to the Swedish dietary guidelines. Methods Dietary data from the Swedish population-based cohort Västerbotten Intervention Programme (49,124 women and 47,651 men, 35–65 years at baseline), collected between the years 1990–2016, were used. Diet quality was assessed by the Swedish Healthy Eating Index for Adults 2015 (SHEIA15). SHEIA15 is based on the Swedish dietary guidelines from 2015, and includes assessments of intakes of vegetables and fruits, seafood, whole grains, fiber, monounsaturated fatty acids, polyunsaturated fatty acids, saturated fatty acids, red and processed meat and added sugar. GHGE of diets were estimated from life cycle assessment data, including CO2e from primary production to industry gate. Information on all-cause mortality was acquired from registers at the National Board of Health and Welfare in Sweden using personal identification numbers. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards regression, comparing the lowest and highest quintile of SHEIA15 score. Potential confounders were adjusted for. Difference in GHGE of diets was compared between the lowest and highest quintile of SHEIA15 score, using the Mann Whitney U test. Results Median follow-up times were for women 16.0 years and for men 14.7 years, during which time 3074 women and 4212 men died. For women the highest SHEIA15 score was associated with lower mortality compared with the lowest score (HR: 0.87; 95% CI: 0.77, 0.98; P = 0.027). No statistically significant difference in HR of mortality was found for the men with the highest SHEIA15 score compared with the lowest score (HR: 0.91; 95% CI: 0.82, 1.01; P = 0.083). The participants with the highest score of SHEIA15 had lower dietary GHGE compared to those with the lowest score in both women and men (P < 0.001). Conclusions Higher adherence to the Swedish dietary guidelines, estimated by SHEIA15, was associated with lower all-cause mortality for women, but not for men, and indicated lower GHGE from diets for both women and men. Funding Sources The Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (Formas).
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11
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Fröberg A, Kjellenberg K, Lindroos AK, Nyberg G. Self-reported physical activity and sedentary behaviour amongst adolescents in Sweden vary depending on sex, age and parental education. Acta Paediatr 2021; 110:3097-3104. [PMID: 34411339 DOI: 10.1111/apa.16077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/09/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to investigate self-reported physical activity and sedentary behaviour by sex, age and parental education in a large representative sample of Swedish adolescents. METHODS This study is based on data from the national dietary survey Riksmaten Adolescents, which was conducted by the Swedish Food Agency in 2016-2017. In total, 3477 students from grade five (11-12 years), eight (14-15 years) and eleven (17-18 years) were included. A web questionnaire was used to collect information about physical activity and sedentary behaviour. RESULTS In total, 53% reported active transport to and from school, 93% that they usually participate in the physical education, 76% reported a physically active leisure time, and 66% reported that they participated in organised physical activities. In addition, 12% and 6% reported two hours or less of screen time on weekdays and weekends, respectively. Participation in physical activity was generally lower amongst girls, older adolescents and for those from families with low-parental education. CONCLUSION This study provide reference values for self-reported physical activities and sedentary behaviours amongst adolescents in Sweden. Strategies to increase physical activity and reduce screen time are needed, particularly amongst girls, older adolescents and amongst those with low-parental education.
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Affiliation(s)
- Andreas Fröberg
- Department of Food and Nutrition and Sport Science University of Gothenburg Goteborg Sweden
| | | | - Anna Karin Lindroos
- Swedish Food Agency Uppsala Sweden
- Department of Internal Medicine and Clinical Nutrition Sahlgrenska Academy University of Gothenburg Goteborg Sweden
| | - Gisela Nyberg
- The Swedish School of Sport and Health Sciences Stockholm Sweden
- Department of Global Public Health Karolinska Institutet Stockholm Sweden
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12
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Eustachio Colombo P, Elinder LS, Lindroos AK, Parlesak A. Designing Nutritionally Adequate and Climate-Friendly Diets for Omnivorous, Pescatarian, Vegetarian and Vegan Adolescents in Sweden Using Linear Optimization. Nutrients 2021; 13:nu13082507. [PMID: 34444667 PMCID: PMC8398609 DOI: 10.3390/nu13082507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 12/23/2022] Open
Abstract
Low-carbon diets can counteract climate change and promote health if they are nutritionally adequate, affordable and culturally acceptable. This study aimed at developing sustainable diets and to compare these with the EAT-Lancet diet. The Swedish national dietary survey Riksmaten Adolescents 2016–2017 was used as the baseline. Diets were optimized using linear programming for four dietary patterns: omnivores, pescatarians, vegetarians and vegans. The deviation from the baseline Riksmaten diet was minimized for all optimized diets while fulfilling nutrient and climate footprint constraints. Constraining the diet-related carbon dioxide equivalents of omnivores to 1.57 kg/day resulted in a diet associated with a reduction of meat, dairy products, and processed foods and an increase in potatoes, pulses, eggs and seafood. Climate-friendly, nutritionally adequate diets for pescatarians, vegetarians and vegans contained fewer foods and included considerable amounts of fortified dairy and meat substitutes. The optimized diets did not align very well with the food-group pattern of the EAT-Lancet diet. These findings suggest how to design future diets that are climate-friendly, nutritionally adequate, affordable, and culturally acceptable for Swedish adolescents with different dietary patterns. The discrepancies with the EAT diet indicate that the cultural dietary context is likely to play an important role in characterizing sustainable diets for specific populations.
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Affiliation(s)
| | - Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, 113 65 Stockholm, Sweden;
- Centre for Epidemiology and Social Medicine, Region Stockholm, 113 65 Stockholm, Sweden
| | - Anna Karin Lindroos
- The Swedish Food Agency, 751 26 Uppsala, Sweden;
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Alexandr Parlesak
- Baden-Wuerttemberg Cooperative State University, 74076 Heilbronn, Germany;
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1165 Copenhagen, Denmark
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13
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Eustachio Colombo P, Elinder LS, Patterson E, Parlesak A, Lindroos AK, Andermo S. Barriers and facilitators to successful implementation of sustainable school meals: a qualitative study of the OPTIMAT™-intervention. Int J Behav Nutr Phys Act 2021; 18:89. [PMID: 34217304 PMCID: PMC8254978 DOI: 10.1186/s12966-021-01158-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/17/2021] [Indexed: 01/18/2023] Open
Abstract
Background There is an urgent need to align human diets with goals for environmental sustainability and population health. The OPTIMAT™-intervention study was developed to implement and evaluate a nutritionally adequate and climate-friendly 4-week lunch menu in Swedish primary schools. This study aimed to explore pupils’ and kitchen staff’s experiences of the intervention and to identify barriers and facilitators to successful implementation of sustainable school meals. Methods An inductive manifest qualitative method was used. Nine focus group discussions (FGDs) were conducted, six with pupils in grades 5 (ages 10–11) and 8 (ages 14–15) (n = 29) and three with kitchen staff (n = 13). Data were analyzed using qualitative content analysis. Results Five main categories and 11 subcategories at a manifest level emerged. The five main categories were: 1) Experiences with the new menu, unfolding variations in how the new menu was received and kitchen staff’s experiences of working with it; 2) The meaning of diet sustainability, comprising pupils’ and kitchen staff’s perceptions about diet sustainability as a concept and part of their everyday lives; 3) Factors influencing plant-based food acceptance, covering aspects such as the influence of sensory factors, habits and peer pressure; 4) Opportunities to increase plant-based eating, including factors related to pupils’ and kitchen staff’s ideas for how to increase plant-based food acceptance; and 5) Need for a supportive environment to achieve dietary change, comprising pupils’ and kitchen staff’s thoughts on the importance of more knowledge, resources and involvement of stakeholders to eat more plant-based meals in schools. Conclusions Successful implementation of sustainable school meals would require more knowledge among pupils and kitchen staff. Staff also need more training in cooking of sustainable meals. Barriers among pupils could be tackled by introducing new plant-based meals more gradually and by more carefully considering the seasoning, naming and aesthetics of dishes. An increased leadership support for change and involvement of stakeholders from multiple levels within society will be key in the transition to sustainable school meals at scale. Trial registration The trial registration for the OPTIMAT™-intervention may be found at clinicaltrials.gov (NCT04168632 Fostering Healthy and Sustainable Diets Through School Meals (OPTIMAT)). Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01158-z.
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Affiliation(s)
- Patricia Eustachio Colombo
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden. .,, Solnavägen 1E, 11365, Stockholm, Sweden.
| | - Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.,Centre for Epidemiology and Social Medicine, Region Stockholm, 113 65, Stockholm, Sweden
| | - Emma Patterson
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.,The Swedish Food Agency, 751 26, Uppsala, Sweden
| | - Alexandr Parlesak
- Baden-Wuerttemberg Cooperative State University, 74076, Heilbronn, Germany.,Department of Nutrition, Exercise and Sports, University of Copenhagen, 1165, Copenhagen, Denmark
| | - Anna Karin Lindroos
- The Swedish Food Agency, 751 26, Uppsala, Sweden.,Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden
| | - Susanne Andermo
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
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14
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Almerud P, Zamaratskaia G, Lindroos AK, Bjermo H, Andersson EM, Lundh T, Ankarberg EH, Lignell S. Cadmium, total mercury, and lead in blood and associations with diet, sociodemographic factors, and smoking in Swedish adolescents. Environ Res 2021; 197:110991. [PMID: 33705767 DOI: 10.1016/j.envres.2021.110991] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/10/2021] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite their vulnerability to the toxic effects of certain metals, biomonitoring data on adolescents are limited. In the present study, we assessed blood concentrations of toxic metals (cadmium [Cd], total mercury [Hg], and lead [Pb] in a national representative sample of Swedish adolescents. We also examined the associations of Cd, total Hg and Pb with habitual intakes of major energy-providing food groups and other possible determinants such as age, sex, household education, Nordic or non-Nordic origin, and smoking. METHODS We analysed blood concentrations of Cd, total Hg, and Pb in a sample of 1099 adolescents from the Riksmaten Adolescents 2016-17 study in three age groups (mean age of 12, 15, and 18 years) using inductively coupled plasma mass spectrometry. The participants completed web-based questionnaires on food consumption frequency, sociodemographic factors and health status. Dietary data from two web-based 24-h dietary recalls were used to estimate the habitual intake of 10 major food groups. RESULTS Almost all participants had detectable concentrations of Cd, total Hg, and Pb in whole blood. The median blood concentrations were 0.12 μg/L for Cd, 0.72 μg/L for total Hg, and 7.1 μg/L for Pb. Higher blood concentrations of Cd were observed in girls than in boys, whereas concentrations of total Hg and Pb were higher in boys. We observed an inverse association between Cd and meat intake. Total Hg concentrations were positively associated with intakes of fish, eggs, meat, and vegetables, and Pb concentrations were inversely associated with intakes of dairy products. Furthermore, smokers had higher concentrations of Cd and Pb. CONCLUSIONS We found that fish was a potentially important source of exposure to total Hg in Swedish adolescents. No other food group was identified to have a strong impact on the blood levels of Cd, total Hg and Pb. Thirteen per cent of the adolescents had blood Pb concentrations above 12 μg/L, the reference point used in the risk assessment of Pb by the European Food Safety Authority (EFSA).
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Affiliation(s)
- Pernilla Almerud
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Galia Zamaratskaia
- Department of Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Anna Karin Lindroos
- Department of Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden; Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Helena Bjermo
- Department of Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Eva M Andersson
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Lundh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | | | - Sanna Lignell
- Department of Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden.
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15
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Nyberg G, Kjellenberg K, Fröberg A, Lindroos AK. A national survey showed low levels of physical activity in a representative sample of Swedish adolescents. Acta Paediatr 2020; 109:2342-2353. [PMID: 32266736 DOI: 10.1111/apa.15251] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/06/2020] [Accepted: 03/10/2020] [Indexed: 12/26/2022]
Abstract
AIM This study investigated objectively measured physical activity and sedentary time by sex, age and socioeconomic status in a large representative sample of Swedish adolescents. METHODS In this cross-sectional national survey between 2016 and 2017, students aged 11-12, 14-15 and 17-18 years from 131 schools were invited to participate. Physical activity and sedentary time were measured objectively with accelerometers for seven consecutive days. Socioeconomic status (parental education) and country of birth were self-reported in a questionnaire. Weight and height were measured by trained staff. RESULTS A total of 3477 adolescents participated in the study, and 2419 (73%) had at least 3 days of valid accelerometer data. The results showed that 43% of boys and 23% of girls reached the recommendation of 60 minutes of daily moderate-to-vigorous physical activity. Boys were more physically active than girls in all age groups. Girls with high socioeconomic status were more physically active than girls with low socioeconomic status (P < .001), and this difference was not found in boys. CONCLUSION The majority of Swedish adolescents did not reach the physical activity recommendation, and boys were more active than girls. Effective strategies to increase physical activity, especially among girls with low socioeconomic status, are urgently needed.
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Affiliation(s)
- Gisela Nyberg
- Department of Global Public Health Karolinska Institutet Stockholm Sweden
- The Swedish School of Sport and Health Sciences Stockholm Sweden
| | - Karin Kjellenberg
- Department of Global Public Health Karolinska Institutet Stockholm Sweden
- The Swedish School of Sport and Health Sciences Stockholm Sweden
| | - Andreas Fröberg
- Department of Food and Nutrition and Sport Science University of Gothenburg Gothenburg Sweden
| | - Anna Karin Lindroos
- Swedish Food Agency Uppsala Sweden
- Department of Internal Medicine and Clinical Nutrition Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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16
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Eustachio Colombo P, Patterson E, Lindroos AK, Parlesak A, Elinder LS. Sustainable and acceptable school meals through optimization analysis: an intervention study. Nutr J 2020; 19:61. [PMID: 32580743 PMCID: PMC7315552 DOI: 10.1186/s12937-020-00579-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background School meals hold considerable potential to shape children’s diets and reduce food-related greenhouse gas emissions (GHGE)—in the short and long term. This study applied linear optimization to develop a GHGE-reduced, nutritionally adequate, and affordable school lunch menu. The effects on food waste, consumption and pupils’ satisfaction with the meals were evaluated. Methods A pre-post design was employed to assess the effects of implementing an optimized lunch menu on daily food waste, consumption, and pupils’ school meal satisfaction in three schools (grades 0–9) from one Swedish municipality. A food list containing amounts, prices, nutrient content, and GHGE-values of all foods used for a previously served (baseline) four-week lunch menu was created. Using linear programming, this food list was optimized for minimum deviation and constrained to ensure nutritional adequacy and a reduced climate impact. The optimized food list was developed into a new (intervention) four-week lunch menu by a professional meal planner, following the baseline menu as closely as possible. The baseline and intervention menus were served for four weeks, respectively, with a two week break in between. Prepared, wasted and leftover food were weighed daily by the school kitchen staff during both periods. Interrupted time series analysis assessed mean and slope differences in daily food waste and consumption between the two periods. School lunch satisfaction was assessed with an online questionnaire at baseline and during the intervention. Results Optimization resulted in a food list that was 40% lower in GHGE, met all nutrient recommendations for school meals, and cost 11% less compared to baseline. The intervention menu was served as planned, with only minor changes required (for practical reasons). Plate waste, serving waste, consumption and school lunch satisfaction did not differ significantly from baseline, in any of the schools. Conclusions The findings demonstrate that school meals can successfully be improved regarding health and environmental sustainability using linear optimization, without negative effects on food waste, consumption or cost. This approach offers the necessary flexibility to tailor menus towards different priorities and could therefore be transferred to other types of meal services. Trial registration The trial is registered at clinicaltrials.gov (NCT04168632 Fostering Healthy and Sustainable Diets Through School Meals (OPTIMAT).
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Affiliation(s)
| | - Emma Patterson
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.,Centre for Epidemiology and Social Medicine, Region Stockholm, 113 65, Stockholm, Sweden
| | - Anna Karin Lindroos
- The Swedish Food Agency, 753 19 Uppsala, Sweden.,Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden
| | - Alexandr Parlesak
- Global Nutrition and Health, University College Copenhagen, 2200, Copenhagen, Denmark
| | - Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.,Centre for Epidemiology and Social Medicine, Region Stockholm, 113 65, Stockholm, Sweden
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17
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Lindroos AK, Petrelius Sipinen J, Axelsson C, Nyberg G, Landberg R, Leanderson P, Arnemo M, Warensjö Lemming E. Use of a Web-Based Dietary Assessment Tool (RiksmatenFlex) in Swedish Adolescents: Comparison and Validation Study. J Med Internet Res 2019; 21:e12572. [PMID: 31588902 PMCID: PMC6914230 DOI: 10.2196/12572] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 06/14/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background A Web-based dietary assessment tool—RiksmatenFlex—was developed for the national dietary survey of adolescents in Sweden. Objective This study aimed to describe the Web-based method RiksmatenFlex and to test the validity of the reported dietary intake by comparing dietary intake with 24-hour dietary recalls (recall interviews), estimated energy expenditure, and biomarkers. Methods Adolescents aged 11-12, 14-15, and 17-18 years were recruited through schools. In total, 78 students had complete dietary information and were included in the study. Diet was reported a few weeks apart with either RiksmatenFlexDiet (the day before and a random later day) or recall interviews (face-to-face, a random day later by phone) in a cross-over, randomized design. At a school visit, weight and height were measured and blood samples were drawn for biomarker analyses. Students wore an accelerometer for 7 days for physical activity measurements. Dietary intake captured by both dietary methods was compared, and energy intake captured by both methods was compared with the accelerometer-estimated energy expenditure (EEest). Intake of whole grain wheat and rye and fruit and vegetables by both methods was compared with alkylresorcinol and carotenoid concentrations in plasma, respectively. Results The mean of the reported energy intake was 8.92 (SD 2.77) MJ by RiksmatenFlexDiet and 8.04 (SD 2.67) MJ by the recall interviews (P=.01). Intake of fruit and vegetables was 224 (169) g and 227 (150) g, and whole grain wheat and rye intake was 12.4 (SD 13.2) g and 12.0 (SD 13.1) g, respectively; the intakes of fruit and vegetables as well as whole grain wheat and rye did not differ between methods. Intraclass correlation coefficients ranged from 0.57 for protein and carbohydrates to 0.23 for vegetables. Energy intake by RiksmatenFlexDiet was overreported by 8% (P=.03) but not by the recall interviews (P=.53) compared with EEest. The Spearman correlation coefficient between reported energy intake and EEest was 0.34 (P=.008) for RiksmatenFlexDiet and 0.16 (P=.21) for the recall interviews. Spearman correlation coefficient between whole grain wheat and rye and plasma total alkylresorcinol homologs was 0.36 (P=.002) for RiksmatenFlexDiet and 0.29 (P=.02) for the recall interviews. Spearman correlations between intake of fruit and vegetables and plasma carotenoids were weak for both dietary tools. The strongest correlations were observed between fruit and vegetable intake and lutein/zeaxanthin for RiksmatenFlexDiet (0.46; P<.001) and for recall interviews (0.28; P=.02). Conclusions RiksmatenFlexDiet provides information on energy, fruit, vegetables, and whole grain wheat and rye intake, which is comparable with intake obtained from recall interviews in Swedish adolescents. The results are promising for cost-effective dietary data collection in upcoming national dietary surveys and other studies in Sweden. Future research should focus on how, and if, new technological solutions could reduce dietary reporting biases.
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Affiliation(s)
- Anna Karin Lindroos
- Swedish National Food Agency, Uppsala, Sweden.,Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Gisela Nyberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Rikard Landberg
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Per Leanderson
- Occupational and Environmental Medicine Center, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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18
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Eustachio Colombo P, Patterson E, Schäfer Elinder L, Lindroos AK, Sonesson U, Darmon N, Parlesak A. Optimizing School Food Supply: Integrating Environmental, Health, Economic, and Cultural Dimensions of Diet Sustainability with Linear Programming. Int J Environ Res Public Health 2019; 16:ijerph16173019. [PMID: 31438517 PMCID: PMC6747157 DOI: 10.3390/ijerph16173019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 12/20/2022]
Abstract
There is great potential for reducing greenhouse gas emissions (GHGE) from public-sector meals. This paper aimed to develop a strategy for reducing GHGE in the Swedish school food supply while ensuring nutritional adequacy, affordability, and cultural acceptability. Amounts, prices and GHGE-values for all foods and drinks supplied to three schools over one year were gathered. The amounts were optimized by linear programming. Four nutritionally adequate models were developed: Model 1 minimized GHGE while constraining the relative deviation (RD) from the observed food supply, Model 2 minimized total RD while imposing stepwise GHGE reductions, Model 3 additionally constrained RD for individual foods to an upper and lower limit, and Model 4 further controlled how pair-wise ratios of 15 food groups could deviate. Models 1 and 2 reduced GHGE by up to 95% but omitted entire food categories or increased the supply of some individual foods by more than 800% and were deemed unfeasible. Model 3 reduced GHGE by up to 60%, excluded no foods, avoided high RDs of individual foods, but resulted in large changes in food-group ratios. Model 4 limited the changes in food-group ratios but resulted in a higher number of foods deviating from the observed supply and limited the potential of reducing GHGE in one school to 20%. Cost was reduced in almost all solutions. An omnivorous, nutritionally adequate, and affordable school food supply with considerably lower GHGE is achievable with moderate changes to the observed food supply; i.e., with Models 3 and 4. Trade-offs will always have to be made between achieving GHGE reductions and preserving similarity to the current supply.
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Affiliation(s)
| | - Emma Patterson
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
- Centre for Epidemiology and Social Medicine, Stockholm County Council, 112 21 Stockholm, Sweden
| | - Liselotte Schäfer Elinder
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden.
- Centre for Epidemiology and Social Medicine, Stockholm County Council, 112 21 Stockholm, Sweden.
| | - Anna Karin Lindroos
- The National Food Agency, Uppsala, Sweden and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg University, 405 30 Gothenburg, Sweden
| | - Ulf Sonesson
- RISE Research Institutes of Sweden, 420 29 Gothenburg, Sweden
| | - Nicole Darmon
- MOISA, INRA, Univ Montpellier, CIHEAM-IAMM, CIRAD, Montpellier SupAgro, 34060 Montpellier, France
| | - Alexandr Parlesak
- Global Nutrition and Health, University College Copenhagen, 2200 Copenhagen, Denmark
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19
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Landberg R, Wierzbicka R, Shi L, Nybacka S, Kamal-Eldin A, Hedblad B, Lindroos AK, Winkvist A, Forslund HB. New alkylresorcinol metabolites in spot urine as biomarkers of whole grain wheat and rye intake in a Swedish middle-aged population. Eur J Clin Nutr 2018; 72:1439-1446. [DOI: 10.1038/s41430-017-0079-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/09/2017] [Accepted: 11/13/2017] [Indexed: 12/21/2022]
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20
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Marklund M, Pingel R, Rosqvist F, Lindroos AK, Eriksson JW, Vessby B, Oscarsson J, Lind L, Risérus U. Fatty Acid Proportions in Plasma Cholesterol Esters and Phospholipids Are Positively Correlated in Various Swedish Populations. J Nutr 2017; 147:2118-2125. [PMID: 28931585 DOI: 10.3945/jn.117.254250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/07/2017] [Accepted: 08/28/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Fatty acid (FA) proportions in cholesterol esters (CEs) and plasma phospholipids are widely used as dietary biomarkers. Information on how proportions in these fractions correlate could have implications for interpretation and use of FA biomarkers in observational and interventional studies.Objective: We investigated correlations between FA proportions in CEs and phospholipids in free-living individuals and assessed how diet-induced alterations of FA proportions correlate between fractions.Methods: Spearman's rank correlation coefficients (rs) between FA proportions (percentage of total FAs) in circulating CEs and phospholipids were calculated separately in 8 individual study populations including Swedish females and males (N = 2052; age range: 11-84 y), and pooled by inverse-variance weighted meta-analysis. In addition, study populations were stratified by age, sex, body mass index (BMI; in kg/m2), and diabetes status, and strata-specific rs were pooled by meta-analysis. In 2 randomized trials (N = 79) in which dietary saturated FAs were isocalorically replaced with unsaturated FAs, treatment-wise calculations of rs were conducted between FA changes in CEs and phospholipids.Results: Overall, FA proportions in CEs and phospholipids correlated well and especially strongly for polyunsaturated FAs (PUFAs), with pooled rs (95% CIs) ranging from 0.74 (0.72, 0.76) for α-linolenic acid to 0.92 (0.91, 0.93) for eicosapentaenoic acid. Weak correlations (pooled rs < 0.4) were observed only for palmitic acid and stearic acid, with pooled rs (95% CIs): 0.29 (0.24, 0.33) and 0.30 (0.25, 0.34), respectively. Overall, correlations were not affected by age, sex, BMI, or diabetes status. Strong correlations (rs ≥ 0.6) between diet-induced FA changes in CEs and phospholipids were observed for most PUFAs.Conclusions: Proportions of most FAs in CEs and phospholipids ranked individuals similarly, suggesting that FA proportions in these fractions can be used interchangeably in populations of diverse age, sex, body composition, and diabetes status. Caution is advised, however, when comparing results from studies assessing palmitic acid or stearic acid in different lipid fractions.
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Affiliation(s)
- Matti Marklund
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism Unit
| | - Ronnie Pingel
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism Unit
| | - Fredrik Rosqvist
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism Unit
| | - Anna Karin Lindroos
- National Food Agency, Uppsala, Sweden.,Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden; and
| | - Jan W Eriksson
- Department of Medical Sciences, Clinical Diabetes, and Metabolism, and
| | - Bengt Vessby
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism Unit
| | | | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism Unit,
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21
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Larsson I, Lissner L, Näslund I, Lindroos AK. Leisure and occupational physical activity in relation to body mass index in men and women. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/11026480410003785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Lauren Lissner
- Primary Health Care, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
- Nordic School of Public Health, Göteborg, Sweden
| | - Ingmar Näslund
- Department of Surgery, University Hospital of ö rebro, Sweden
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Persson Osowski C, Becker W, Enghardt Barbieri H, Lindroos AK. Energy and nutrient intakes of Swedish children in relation to consumption of and habits associated with school lunch. Scand J Public Health 2016; 45:3-9. [PMID: 27887030 DOI: 10.1177/1403494816680796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS School lunches are provided free in Sweden, although some children choose not to eat school lunch. The aim of this study was to analyse Swedish children's total energy and nutrient intakes on weekdays by the frequency of school lunch consumption and to analyse energy and nutrient intakes from school lunches by sex. Factors associated with children's school lunch habits were also studied. METHODS Children in grades 2 and 5 ( n=1905) completed a food diary (school lunch data available for 1840 children) and the mean energy and nutrient intakes per day and per school lunch were calculated. The children also completed questions on the frequency of school lunch consumption and school lunch habits. Logistic regression was used to assess factors associated with school lunch habits. RESULTS Children who reported eating school lunch every day had significantly higher energy and absolute nutrient intakes than children reporting eating school lunch less than five times a week, but not standardized for energy. Boys had significantly higher energy and absolute nutrient intakes from school lunches than girls, but not standardized for energy. Younger children and children who liked school lunches had higher odds of eating school lunch every day. Children in grade 5, those with a foreign background and those disliking school lunches had higher odds of omitting the main lunch component. CONCLUSIONS Regular school lunch consumption was associated with a higher total intake for most nutrients, but not a better nutrient density. School lunch habits were associated with age, ethnic background and liking school lunches.
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Becker W, Lindroos AK, Nälsén C, Warensjö Lemming E, Öhrvik V. Dietary habits, nutrient intake and biomarkers for folate, vitamin D, iodine and iron status among women of childbearing age in Sweden. Ups J Med Sci 2016; 121:271-275. [PMID: 27560303 PMCID: PMC5098492 DOI: 10.1080/03009734.2016.1201176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Dietary intake and nutritional status are important for pregnancy and pregnancy outcomes. Dietary advice on folate, targeted to women of childbearing age, aims at preventing neural tube defects in the offspring. AIM To describe food and nutrient intake and nutritional status among women of childbearing age in Sweden in relation to current nutrition recommendations. METHODS Dietary intake was assessed using a web-based four-day consecutive food record among adults aged 18-80 years-'Riksmaten 2010-11 adults'. In a subsample, biomarkers of folate, vitamin D, iodine, and iron status were assessed. RESULTS Women of childbearing age had lower intakes of fruit and vegetables, fish, and whole grains, but higher intakes of soft drinks. Macronutrient composition was generally in line with the Nordic Nutrition Recommendations, except for a lower intake of fibre, a higher intake of saturated fatty acids, and added sugars. Mean intakes of vitamin D, folate, and iron were below recommended intakes (RI). Median urinary iodine concentration (UIC) was 74 μg/L, 20% had insufficient vitamin D status, and 3% low folate concentrations with no age differences. Furthermore, 29% of women 18-44 years of age had depleted iron stores. CONCLUSIONS The dietary pattern among women of childbearing age (18-44 years) was less favourable compared to older women. Intakes of some micronutrients were below RI, but no differences in vitamin D, folate, or iodine status between age groups were observed. However, improvements of folate and iodine status among women of childbearing age are warranted. This can be achieved by following dietary guidelines including use of folic acid-containing supplements.
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Affiliation(s)
- Wulf Becker
- CONTACT W. Becker National Food Agency, P.O. Box, 75126 Uppsala, Sweden
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24
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Nybacka S, Bertéus Forslund H, Wirfält E, Larsson I, Ericson U, Warensjö Lemming E, Bergström G, Hedblad B, Winkvist A, Lindroos AK. Comparison of a web-based food record tool and a food-frequency questionnaire and objective validation using the doubly labelled water technique in a Swedish middle-aged population. J Nutr Sci 2016; 5:e39. [PMID: 27752306 PMCID: PMC5048186 DOI: 10.1017/jns.2016.29] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/29/2016] [Accepted: 07/11/2016] [Indexed: 12/11/2022] Open
Abstract
Two web-based dietary assessment tools have been developed for use in large-scale studies: the Riksmaten method (4-d food record) and MiniMeal-Q (food-frequency method). The aim of the present study was to examine the ability of these methods to capture energy intake against objectively measured total energy expenditure (TEE) with the doubly labelled water technique (TEEDLW), and to compare reported energy and macronutrient intake. This study was conducted within the pilot study of the Swedish CArdioPulmonary bioImage Study (SCAPIS), which included 1111 randomly selected men and women aged 50-64 years from the Gothenburg general population. Of these, 200 were enrolled in the SCAPIS diet substudy. TEEDLW was measured in a subsample (n 40). Compared with TEEDLW, both methods underestimated energy intake: -2·5 (sd 2·9) MJ with the Riksmaten method; -2·3 (sd 3·6) MJ with MiniMeal-Q. Mean reporting accuracy was 80 and 82 %, respectively. The correlation between reported energy intake and TEEDLW was r 0·4 for the Riksmaten method (P < 0·05) and r 0·28 (non-significant) for MiniMeal-Q. Women reported similar average intake of energy and macronutrients in both methods whereas men reported higher intakes with the Riksmaten method. Energy-adjusted correlations ranged from 0·14 (polyunsaturated fat) to 0·77 (alcohol). Bland-Altman plots showed acceptable agreement for energy and energy-adjusted protein and carbohydrate intake, whereas the agreement for fat intake was poorer. According to energy intake data, both methods displayed similar precision on energy intake reporting. However, MiniMeal-Q was less successful in ranking individuals than the Riksmaten method. The development of methods to achieve limited under-reporting is a major challenge for future research.
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Affiliation(s)
- Sanna Nybacka
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Heléne Bertéus Forslund
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabet Wirfält
- Department of Clinical Sciences in Malmö, Research Group in Nutritional Epidemiology, Lund University, Lund, Sweden
| | - Ingrid Larsson
- Department of Endocrinology, Diabetology and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulrika Ericson
- Department of Clinical Sciences in Malmö, Diabetes and Cardiovascular Disease, Genetic Epidemiology, Lund University, Lund, Sweden
| | | | - Göran Bergström
- Wallenberg Laboratory, Sahlgrenska Centre for Cardiovascular and Metabolic Research, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bo Hedblad
- Department of Clinical Sciences in Malmö, Cardiovascular Research Group, Lund University, Lund, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Nybacka S, Lindroos AK, Wirfält E, Leanderson P, Landberg R, Ericson U, Larsson I, Warensjö Lemming E, Bergström G, Hedblad B, Orho-Melander M, Melander O, Winkvist A, Bertéus Forslund H. Carotenoids and alkylresorcinols as objective biomarkers of diet quality when assessing the validity of a web-based food record tool and a food frequency questionnaire in a middle-aged population. BMC Nutr 2016. [DOI: 10.1186/s40795-016-0094-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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26
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Osowski CP, Lindroos AK, Barbieri HE, Becker W. The contribution of school meals to energy and nutrient intake of Swedish children in relation to dietary guidelines. Food Nutr Res 2015; 59:27563. [PMID: 26522664 PMCID: PMC4628944 DOI: 10.3402/fnr.v59.27563] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 10/02/2015] [Accepted: 10/02/2015] [Indexed: 12/13/2022] Open
Abstract
Background In Sweden, school meals are served free of charge and Swedish law states that school meals must be nutritious. Nevertheless, data on children's energy and nutrient intake from school meals are scarce. Objective The aim was to describe the contribution of school meals to Swedish children's nutrient and energy intake during weekdays and compare this to the reference values based on the Nordic Nutrition Recommendations (NNR), which have been adopted as the official Swedish recommendations. Design A cross-sectional food consumption survey was performed on 1,840 Swedish children attending Grade 2 (mean age 8.6) and Grade 5 (mean age 11.7). The children's nutrient and energy intake was compared to the reference values based on the NNR. Results The mean intake from school meals of energy, carbohydrates, dietary fiber, polyunsaturated fatty acids (PUFA), and vitamins D and E did not reach the reference values and the intake of saturated fatty acids (SFA) and sodium exceeded the reference values in both age groups (significant differences, all p≤0.001). Additionally, the pupils in Grade 5 did not reach the reference values for folate, potassium, calcium, magnesium, iron, selenium, and zinc (significant differences, all p≤0.001). Standardized for energy, dietary fiber, PUFA, and vitamins D and E did not reach the reference values, whereas the reference values for SFA and sodium were exceeded in both age groups (significant differences, all p≤0.001). Conclusions The study pointed to some central nutrients in need of improvement as regards school meals in Sweden, namely the quality of fat, dietary fiber, sodium, vitamin D, and iron. Some of these results may be attributed to the children not reporting eating the recommended number of calories, the children omitting some components of the meal, or underreporting, as a consequence of which the reference values for several nutrients were not met.
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Sandvik P, Kihlberg I, Lindroos AK, Marklinder I, Nydahl M. Bread consumption patterns in a Swedish national dietary survey focusing particularly on whole-grain and rye bread. Food Nutr Res 2014; 58:24024. [PMID: 25278822 PMCID: PMC4157137 DOI: 10.3402/fnr.v58.24024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/25/2014] [Accepted: 08/11/2014] [Indexed: 11/30/2022] Open
Abstract
Background Bread types with high contents of whole grains and rye are associated with beneficial health effects. Consumer characteristics of different bread consumption patterns are however not well known. Objective To compare bread consumption patterns among Swedish adults in relation to selected socio-demographic, geographic, and lifestyle-related factors. For selected consumer groups, the further aim is to investigate the intake of whole grains and the context of bread consumption, that is, where and when it is consumed. Design Secondary analysis was performed on bread consumption data from a national dietary survey (n=1,435). Respondents were segmented into consumer groups according to the type and amount of bread consumed. Multiple logistic regressions were performed to study how selected socio-demographic, geographic, and lifestyle-related factors were associated with the consumer groups. Selected consumption groups were compared in terms of whole-grain intake and consumption context. Consumption in different age groups was analysed more in detail. Results One-third of the respondents consumed mainly white bread. Socio-demographic, geographic, and healthy-lifestyle-related factors were associated with the bread type consumed. White bread consumption was associated with younger age groups, less education, children in the family, eating less fruit and vegetables, and more candy and snacks; the opposite was seen for mainly whole-grain bread consumers. Older age groups more often reported eating dry crisp bread, whole-grain bread, and whole-grain rye bread with sourdough whereas younger respondents reported eating bread outside the home, something that also mainly white bread eaters did. Low consumers of bread also consumed less whole grain in total. Conclusions Traditional bread consumption structures were observed, as was a transition among young consumers who more often consumed fast food bread and bread outside the home, as well as less rye and whole-grain bread. Target groups for communication strategies and product development of more sensorily attractive rye or whole-grain-rich bread should be younger age groups (18–30 years), families with children, and groups with lower educational levels.
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Affiliation(s)
- Pernilla Sandvik
- Department of Food, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | - Iwona Kihlberg
- Department of Food, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | | | - Ingela Marklinder
- Department of Food, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
| | - Margaretha Nydahl
- Department of Food, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden
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Johns DJ, Lindroos AK, Jebb SA, Sjöström L, Carlsson LMS, Ambrosini GL. Tracking of a dietary pattern and its components over 10-years in the severely obese. PLoS One 2014; 9:e97457. [PMID: 24841709 PMCID: PMC4026226 DOI: 10.1371/journal.pone.0097457] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 04/21/2014] [Indexed: 01/14/2023] Open
Abstract
Understanding how dietary intake changes over time is important for studies of diet and disease and may inform interventions to improve dietary intakes. We investigated how a dietary pattern (DP) tracked over 10-years in the Swedish Obese Subjects (SOS) study control group. Dietary intake was assessed at multiple time-points in 2037 severely obese individuals (BMI 41 ± 4 kg/m(2)). Reduced rank regression was used to derive a dietary pattern using dietary energy density (kJ/g), saturated fat (%) and fibre density (mg/kJ) as response variables and score respondents at each follow-up. Tracking coefficients for the DP, its key foods and macronutrient response variables and corrected for time-dependent and time-independent covariates were calculated using generalised estimating equations to take into account all available data. The DP tracking coefficient was moderate for women (0.40; 95% CI: 0.38-0.42) and men (0.38; 95% CI: 0.35-0.41). Of the eleven foods key to this DP, fruit and vegetable intakes had the strongest tracking coefficient for both sexes. Fast food and candy had the lowest tracking coefficients for women and men respectively. Scores for an energy dense, high saturated fat, low fibre density DP appear moderately stable over a 10-year period in this severely obese population. Furthermore, some food groups appear more amenable to change while others, often the most healthful, appear more stable and may require intervention before adulthood.
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Affiliation(s)
- David J. Johns
- Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | | | - Susan A. Jebb
- Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Lars Sjöström
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Gina L. Ambrosini
- Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom
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Allison KC, Lundgren JD, Stunkard AJ, Bulik CM, Lindroos AK, Thornton LM, Rasmussen F. Validation of screening questions and symptom coherence of night eating in the Swedish Twin Registry. Compr Psychiatry 2014; 55:579-87. [PMID: 24457035 DOI: 10.1016/j.comppsych.2013.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/04/2012] [Accepted: 01/22/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Screening criteria have been used to estimate the prevalence of night eating syndrome (NES), but no validation studies have been conducted. METHOD We examined the validity of two screening questions for NES using a structured interview with adults enrolled in the Swedish Twin Study of Adults: Genes and Environment (STAGE) study. We also examined the coherence of the proposed diagnostic criteria for NES. A total of 416 participants (men=179; women=237) completed the interview and reported complete data for study inclusion. RESULTS The following values were calculated for the screening items after confirmation by interview for men and women, respectively: positive predictive value=.66 and .67, negative predictive value=.52 and .45, sensitivity=.62 and .63, and specificity=.56 and .50. As increasingly stringent diagnostic criteria were applied to the sample, prevalence of NES dropped. Nocturnal ingestions were more likely to co-occur with other NES symptoms than evening hyperphagia, which occurred frequently, but often in isolation; women were more likely to report a co-occurrence of symptoms than men, who were not likely to report distress related to NES symptoms. CONCLUSION In sum, almost two-thirds of participants were correctly identified as having NES (without considering distress or impairment) if they answered positively on the screening questions, and about half of the participants were correctly identified as not having NES when answering negatively on the screening questions. Although self-report questions are somewhat informative, a structured interview remains the gold standard for diagnosing NES.
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Affiliation(s)
- Kelly C Allison
- Perelman School of Medicine, University of Pennsylvania Center for Weight and Eating Disorders, Philadelphia, PA 19104-3309, USA.
| | - Jennifer D Lundgren
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO 64116, USA
| | - Albert J Stunkard
- Perelman School of Medicine, University of Pennsylvania Center for Weight and Eating Disorders, Philadelphia, PA 19104-3309, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Anna Karin Lindroos
- Risk Benefit Assessment Department, National Food Agency, SE-751 26 Uppsala, Sweden
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Finn Rasmussen
- Department of Public Health Sciences, Karolinska Institutet Widerström Building, SE-17177 Stockholm, Sweden; Centre for Epidemiology and Community Medicine Stockholm County Council, Health Care Services, SE-17177 Stockholm, Sweden.
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Aller EEJG, Larsen TM, Claus H, Lindroos AK, Kafatos A, Pfeiffer A, Martinez JA, Handjieva-Darlenska T, Kunesova M, Stender S, Saris WHM, Astrup A, van Baak MA. Weight loss maintenance in overweight subjects on ad libitum diets with high or low protein content and glycemic index: the DIOGENES trial 12-month results. Int J Obes (Lond) 2014; 38:1511-7. [PMID: 24675714 DOI: 10.1038/ijo.2014.52] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/26/2014] [Accepted: 03/17/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND A high dietary protein (P) content and low glycemic index (LGI) have been suggested to be beneficial for weight management, but long-term studies are scarce. OBJECTIVE The DIOGENES randomized clinical trial investigated the effect of P and GI on weight loss maintenance in overweight or obese adults in eight centers across Europe. This study reports the 1-year results in two of the centers that extended the intervention to 1 year. METHOD After an 8-week low-calorie diet (LCD), 256 adults (body mass index >27 kg m(-)(2)) were randomized to five ad libitum diets for 12 months: high P/LGI (HP/LGI), HP/high GI (HP/HGI), low P/LGI (LP/LGI), LP/HGI and a control diet. During the first 6 months, foods were provided for free through a shop system and during the whole 12-month period, subjects received guidance by a dietician. Primary outcome variable was the change in body weight over the 12-month intervention period. RESULTS During the LCD period, subjects lost 11.2 (10.8, 12.0) kg (mean (95% confidence interval (CI))). Average weight regain over the 12-month intervention period was 3.9 (95% CI 3.0-4.8) kg. Subjects on the HP diets regained less weight than subjects on the LP diets. The difference in weight regain after 1 year was 2.0 (0.4, 3.6) kg (P=0.017) (completers analysis, N=139) or 2.8 (1.4, 4.1) kg (P<0.001) (intention-to-treat analysis, N=256). No consistent effect of GI on weight regain was found. There were no clinically relevant differences in changes in cardiometabolic risk factors among diet groups. CONCLUSION A higher protein content of an ad libitum diet improves weight loss maintenance in overweight and obese adults over 12 months.
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Affiliation(s)
- E E J G Aller
- Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - T M Larsen
- Department of Nutrition, Exercise and Sports (NEXS), Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - H Claus
- Institute of Preventive Medicine, Centre for Health and Society, Copenhagen, Denmark
| | - A K Lindroos
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - A Kafatos
- Department of Social Medicine, Preventive Medicine & Nutrition Clinic, University of Crete, Heraklion, Greece
| | - A Pfeiffer
- Department of Clinical Nutrition, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuhetal, Germany
| | - J A Martinez
- 1] Department of Physiology and Nutrition, University of Navarra, Pamplona, Spain [2] CIBERObn, Instituto Carlos III, Madrid, Spain
| | | | - M Kunesova
- Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
| | - S Stender
- Department of Clinical Biochemistry, Gentofte University Hospital, Hellerup, Denmark
| | - W H M Saris
- Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A Astrup
- Department of Nutrition, Exercise and Sports (NEXS), Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - M A van Baak
- Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
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Bjermo H, Darnerud PO, Pearson M, Barbieri HE, Lindroos AK, Nälsén C, Lindh CH, Jönsson BAG, Glynn A. Serum concentrations of perfluorinated alkyl acids and their associations with diet and personal characteristics among Swedish adults. Mol Nutr Food Res 2013; 57:2206-15. [PMID: 23934649 DOI: 10.1002/mnfr.201200845] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 05/05/2013] [Accepted: 05/23/2013] [Indexed: 01/25/2023]
Abstract
SCOPE In this study, food is suggested as a major source of human exposure to perfluorinated alkyl acids (PFAA). We investigated relations between serum levels of PFAA in adults and diet/lifestyle factors nationwide in Sweden. METHODS AND RESULTS In 2010-2011, adults (18-80 years, N = 270) recorded their diet for 4 days and answered a food frequency questionnaire. PFAA were measured in blood serum as well as v-3 fatty acids in plasma phospholipids as a biomarker for fish consumption. Higher levels of PFAA were associated with male sex, increased age, and higher education. Women reporting full breastfeeding for ≥12 months had 32-44% lower levels of perfluorooctane sulfonate, perfluorooctanoic acid, and perfluorohexane sulfonate than women who never nursed their infants full-time. Serum perfluorooctane sulfonate, perfluorononanoic acid, perfluorodecanoic acid, and perfluoroundecanoic acid were positively related to n-3 fatty acids in plasma (partial r = 0.19-0.34, p ≤ 0.05). CONCLUSION The relatively strong correlations between biomarkers of fish consumption and certain PFAA suggest that PFAA exposure should be taken into account in health risk and benefit assessment of fish consumption. Breastfeeding appears to be a major source of elimination of certain PFAA among women, and consequently PFAA exposure of nursed infants could be significant.
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Affiliation(s)
- Helena Bjermo
- Department of Risk and Benefit Assessment, National Food Agency, Uppsala, Sweden
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Bjermo H, Sand S, Nälsén C, Lundh T, Enghardt Barbieri H, Pearson M, Lindroos AK, Jönsson BAG, Barregård L, Darnerud PO. Lead, mercury, and cadmium in blood and their relation to diet among Swedish adults. Food Chem Toxicol 2013; 57:161-9. [PMID: 23537601 DOI: 10.1016/j.fct.2013.03.024] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/05/2013] [Accepted: 03/14/2013] [Indexed: 02/08/2023]
Abstract
The aim of the present study was to examine the body burden of lead (Pb), mercury (Hg), and cadmium (Cd) in blood among Swedish adults and the association between blood levels, diet and other lifestyle factors. The study was based on a subgroup (n=273) of the national survey Riksmaten 2010-2011 (4-day food records and questionnaire). Lead, Hg, and Cd were measured in whole blood, and Cd additionally in urine, by mass or fluorescence spectrometry methods. The median values (5-95th percentiles) of the metals in blood were as follows; Pb: 13.4 (5.8-28.6) μg/L, Hg: 1.13 (0.31-3.45) μg/L, and Cd: 0.19 (0.09-1.08) μg/L. All three metals increased with increasing age. Lead levels in blood were positively associated with intakes of game and alcohol, Hg was related to fish intake, and blood Cd related to smoking and low iron stores and to a low meat intake. Body burdens of the studied metals were generally below health based reference values, but several individuals had blood Pb levels above the reference point for possible nephrotoxic and developmental neurotoxic effects. As health effects cannot be excluded, individuals with high Pb exposure should aim at decreasing their body burden, both from food and from other exposure routes.
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Papadaki A, Linardakis M, Plada M, Larsen TM, van Baak MA, Lindroos AK, Pfeiffer AFH, Martinez JA, Handjieva-Darlenska T, Kunešová M, Holst C, Saris WHM, Astrup A, Kafatos A. A multicentre weight loss study using a low-calorie diet over 8 weeks: regional differences in efficacy across eight European cities. Swiss Med Wkly 2013; 143:w13721. [PMID: 23348658 DOI: 10.4414/smw.2013.13721] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PRINCIPLES The efficacy of low-calorie diets (LCDs) has not been investigated in large-scale studies or among people from different regions, who are perhaps unaccustomed to such methods of losing weight. The aim of the present study was to investigate changes in obesity measures among overweight/obese adults from eight European cities (from Northern, Central and Southern Europe) during the 8-week LCD phase of the DiOGenes study (2006-2007), a family-based, randomised, controlled dietary intervention. METHODS 938 overweight/obese adults completed baseline examinations and underwent an 8-week LCD, providing 3.3-4.2 MJ/day to replace all meals. Anthropometric measurements and body composition were assessed at baseline and post-LCD. RESULTS 773 (82.4%) adults (mean age, 43.1 y) completed the LCD successfully. The highest drop-out rate was observed in Southern (24.9%) and the lowest in Northern (13.3%) European cities. Overall, the LCD induced favourable changes in all outcomes, including an approximate 11.0% reduction in body weight and body fat percentage. Changes in outcomes differed significantly between regions, with North- and Central-European cities generally achieving higher percentage reductions in most anthropometric measurements assessed. Nonetheless, participants in Southern Europe reduced their body fat percentage significantly more than participants in Northern Europe (-11.8 vs. -9.5%, P = 0.017). CONCLUSIONS The LCD significantly improved anthropometric and body composition measurements in all cities participating in DiOGenes.
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Affiliation(s)
- Angeliki Papadaki
- Department of Social Medicine, Preventive Medicine & Nutrition Clinic, University of Crete, Heraklion, Crete, Greece.
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Karason K, Peltonen M, Lindroos AK, Sjöström L, Lönn L, Torgerson JS. Effort-Related Calf Pain in the Obese and Long-Term Changes after Surgical Obesity Treatment**. ACTA ACUST UNITED AC 2012; 13:137-45. [PMID: 15761173 DOI: 10.1038/oby.2005.18] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the prevalence of effort-related calf pain in an obese and a general population and to analyze the incidence of and recovery from such pain after surgical and conventional obesity treatment. RESEARCH METHODS AND PROCEDURES A random sample of 1135 subjects from a general population was compared with 6328 obese subjects in the Swedish Obese Subjects study. Obese subjects were followed longitudinally, and information about calf pain was obtained from surgically and conventionally treated patients for up to 6 years. RESULTS In both sexes, self-reported calf pain was more common in the obese than in the general population [odds ratios (ORs) 5.0 and 4.0 in men and women, respectively, p<0.001]. Obese patients undergoing surgery had a lower 6-year incidence of calf pain compared with the conventionally treated control group (ORs 0.39 and 0.61, p<0.05). Among subjects reporting symptoms at baseline, the 6-year recovery rate was higher in the surgical group compared with the control group (ORs 15.3 and 5.9, p<0.001). DISCUSSION Obese subjects have markedly more problems with effort-related calf pain than the general population. Surgical obesity treatment reduces the long-term risk of developing claudication symptoms and increases the likelihood of recovering from such symptoms.
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Affiliation(s)
- Kristjan Karason
- Department of Cardiology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
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Lundgren JD, Allison KC, Stunkard AJ, Bulik CM, Thornton LM, Karin Lindroos A, Rasmussen F. Lifetime medical and psychiatric comorbidity of night eating behavior in the Swedish Twin Study of Adults: Genes and Environment (STAGE). Psychiatry Res 2012; 199:145-9. [PMID: 22560060 DOI: 10.1016/j.psychres.2012.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 03/06/2012] [Accepted: 04/12/2012] [Indexed: 11/29/2022]
Abstract
The medical and psychosocial comorbidity of two core features of night eating syndrome (NES), evening hyperphagia (EH) and nocturnal awakening and ingestion of food (NI), was evaluated in adults enrolled in the Swedish Twin Study of Adults: Genes and Environment (STAGE) study. As part of the STAGE study, more than 20,000 participants completed assessments of their physical and mental health, which included two night eating screening questions designed to assess EH and NI. STAGE participants who completed a night eating validation interview to confirm the presence or absence of night eating and who had comorbidity data available (n=463) were compared on the lifetime prevalence of several psychiatric and medical conditions. In contrast to previous studies, night eating (EH and/or NI) was not significantly associated with lifetime history of any mental or physical health variable.
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McConnon A, Raats M, Astrup A, Bajzová M, Handjieva-Darlenska T, Lindroos AK, Martinez JA, Larson TM, Papadaki A, Pfeiffer A, van Baak MA, Shepherd R. Application of the Theory of Planned Behaviour to weight control in an overweight cohort. Results from a pan-European dietary intervention trial (DiOGenes). Appetite 2012; 58:313-8. [DOI: 10.1016/j.appet.2011.10.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 06/14/2011] [Accepted: 10/29/2011] [Indexed: 11/28/2022]
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Thompson S, Ekelund U, Jebb S, Lindroos AK, Mander A, Sharp S, Turner R, Wilks D. A proposed method of bias adjustment for meta-analyses of published observational studies. Int J Epidemiol 2011; 40:765-77. [PMID: 21186183 PMCID: PMC3147067 DOI: 10.1093/ije/dyq248] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2010] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Interpretation of meta-analyses of published observational studies is problematic because of numerous sources of bias. We develop bias assessment, elicitation and adjustment methods, and apply them to a systematic review of longitudinal observational studies of the relationship between objectively measured physical activity and subsequent change in adiposity in children. METHODS We separated internal biases that reflect study quality from external biases that reflect generalizability to a target setting. Since published results were presented in different formats, these were all converted to correlation coefficients. Biases were considered as additive or proportional on the correlation scale. Opinions about the extent of each bias in each study, together with its uncertainty, were elicited in a formal process from quantitatively trained assessors for the internal biases and subject-matter specialists for the external biases. Bias-adjusted results for each study were combined across assessors using median pooling, and results combined across studies by random-effects meta-analysis. RESULTS Before adjusting for bias, the pooled correlation is difficult to interpret because the studies varied substantially in quality and design, and there was considerable heterogeneity. After adjusting for both the internal and external biases, the pooled correlation provides a meaningful quantitative summary of all available evidence, and the confidence interval incorporates the elicited uncertainties about the extent of the biases. In the adjusted meta-analysis, there was no apparent heterogeneity. CONCLUSION This approach provides a viable method of bias adjustment for meta-analyses of observational studies, allowing the quantitative synthesis of evidence from otherwise incompatible studies. From the meta-analysis of longitudinal observational studies, we conclude that there is no evidence that physical activity is associated with gain in body fat.
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Wilks DC, Besson H, Lindroos AK, Ekelund U. Objectively measured physical activity and obesity prevention in children, adolescents and adults: a systematic review of prospective studies. Obes Rev 2011; 12:e119-29. [PMID: 20604868 DOI: 10.1111/j.1467-789x.2010.00775.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study aimed at synthesizing the prospective associations between measured physical activity (PA) and change in adiposity in children, adolescents and adults following from two previous reviews. Search terms were adapted and a systematic literature search was conducted (January 2000-September 2008) and later updated (up to October 2009), considering observational and intervention studies of weight gain that measured both PA and body composition. Sixteen observational studies (six comprising adults) and five trials (one comprising adults) were eligible. For consistency, whenever possible either baseline PA energy expenditure or accelerometer output (counts min(-1) ) and change in per cent body fat were the extracted exposure and outcome measures. Results of observational studies suggest that PA is not strongly prospectively related with adiposity: five studies on children and three on adults reported no association between baseline PA and change in adiposity, one study found a weak positive association and the other studies observed a weak negative association. Negative associations were more frequently observed in studies that analysed the association between change in the exposure and outcome. Intervention studies show generally no effect on either PA or adiposity. In conclusion, despite the well-established health benefits of PA, it may not be a key determinant of excessive gain in adiposity.
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Affiliation(s)
- D C Wilks
- Medical Research Council Human Nutrition Research, Medical Research Council Epidemiology Unit, Cambridge, UK
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Wilks DC, Sharp SJ, Ekelund U, Thompson SG, Mander AP, Turner RM, Jebb SA, Lindroos AK. Objectively measured physical activity and fat mass in children: a bias-adjusted meta-analysis of prospective studies. PLoS One 2011; 6:e17205. [PMID: 21383837 PMCID: PMC3044163 DOI: 10.1371/journal.pone.0017205] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 01/25/2011] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Studies investigating the prevention of weight gain differ considerably in design and quality, which impedes pooling them in conventional meta-analyses, the basis for evidence-based policy making. This study is aimed at quantifying the prospective association between measured physical activity and fat mass in children, using a meta-analysis method that allows inclusion of heterogeneous studies by adjusting for differences through eliciting and incorporating expert opinion. METHODS Studies on prevention of weight gain using objectively measured exposure and outcome were eligible; they were adopted from a recently published systematic review. Differences in study quality and design were considered as internal and external biases and captured in checklists. Study results were converted to correlation coefficients and biases were considered either additive or proportional on this scale. The extent and uncertainty of biases in each study were elicited in a formal process by six quantitatively-trained assessors and five subject-matter specialists. Biases for each study were combined across assessors using median pooling. Results were combined across studies by random-effects meta-analysis. RESULTS The combined correlation of the unadjusted results from the six studies was -0.04 (95%CI: -0.22, 0.14) with considerable heterogeneity (I² = 78%), which makes it difficult to interpret the result. After bias-adjustment the pooled correlation was -0.01 (95%CI: -0.18, 0.16) with apparent study compatibility (I² = 0%). CONCLUSION By using this method the prospective association between physical activity and fat mass could be quantitatively synthesized; the result suggests no association. Objectively measured physical activity may not be the key determinant of unhealthy weight gain in children.
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Affiliation(s)
- Desiree C. Wilks
- Medical Research Council Collaborative Centre for Human Nutrition Research, Cambridge, United Kingdom
- Department of Prevention and Sports Medicine, Technische Universität München, Germany
| | - Stephen J. Sharp
- Medical Research Council Epidemiology Unit, Cambridge, United Kingdom
| | - Ulf Ekelund
- Medical Research Council Epidemiology Unit, Cambridge, United Kingdom
| | - Simon G. Thompson
- Medical Research Council Biostatistics Unit, Cambridge, United Kingdom
| | - Adrian P. Mander
- Medical Research Council Biostatistics Unit, Cambridge, United Kingdom
| | - Rebecca M. Turner
- Medical Research Council Biostatistics Unit, Cambridge, United Kingdom
| | - Susan A. Jebb
- Medical Research Council Collaborative Centre for Human Nutrition Research, Cambridge, United Kingdom
| | - Anna Karin Lindroos
- Medical Research Council Collaborative Centre for Human Nutrition Research, Cambridge, United Kingdom
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Sjöström CD, Lystig T, Lindroos AK. Impact of weight change, secular trends and ageing on cardiovascular risk factors: 10-year experiences from the SOS study. Int J Obes (Lond) 2011; 35:1413-20. [PMID: 21266948 DOI: 10.1038/ijo.2010.282] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Many short-term studies indicate that 5% weight loss in the obese is enough to induce significant improvements of cardiovascular risk factors. However, it is not known what degree of weight loss is required to improve risk factors over a more extended period of time or how ageing and secular trends per se are influencing risk factors during long-term follow-up. METHODS Patients examined after 10 years in the intervention study Swedish Obese Subjects were used for the current analysis. Surgically treated subjects (n=959) and conventionally treated obese controls (n=842) were pooled to obtain a study group with a large range of weight changes. The patients were divided in 11 groups based on the amount of weight change. Analysis of covariance was used to determine the necessary weight change over 10 years for a significant alteration of a risk factor. In a linear regression of risk factor change by weight change, the y intercept was interpreted as the effect of 10 years ageing and secular trends on a given risk factor in the absence of weight change. RESULTS The necessary weight loss for significant improvement of risk factors ranged from 10 to 44 kg. At zero weight change, 10 years of ageing was associated with significant increases in systolic blood pressure, pulse pressure, high-density lipoprotein cholesterol and glucose, and with significant decreases in diastolic blood pressure, total cholesterol, triglycerides and insulin. CONCLUSIONS The necessary weight loss to maintain a favourable effect on risk factors in an obese population is larger than previously indicated by short-term studies. Treatment effects are influenced by non-weight change-dependant shifts in risk factor levels.
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Affiliation(s)
- C D Sjöström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
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Wilks DC, Mander AP, Jebb SA, Thompson SG, Sharp SJ, Turner RM, Lindroos AK. Dietary energy density and adiposity: employing bias adjustments in a meta-analysis of prospective studies. BMC Public Health 2011; 11:48. [PMID: 21255448 PMCID: PMC3038903 DOI: 10.1186/1471-2458-11-48] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 01/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dietary studies differ in design and quality making it difficult to compare results. This study quantifies the prospective association between dietary energy density (DED) and adiposity in children using a meta-analysis method that adjusts for differences in design and quality through eliciting and incorporating expert opinion on the biases and their uncertainty. METHOD Six prospective studies identified by a previous systematic literature search were included. Differences in study quality and design were considered respectively as internal and external biases and captured in bias checklists. Study results were converted to correlation coefficients; biases were considered either additive or proportional on this scale. The extent and uncertainty of the internal and external biases in each study were elicited in a formal process by five quantitatively-trained assessors and five subject-matter specialists. Biases for each study were combined across assessors using median pooling and results combined across studies by random-effects meta-analysis. RESULTS The unadjusted combined correlation between DED and adiposity change was 0.06 (95%CI 0.01, 0.11; p = 0.013), but with considerable heterogeneity (I² = 52%). After bias-adjustment the pooled correlation was 0.17 (95%CI - 0.11, 0.45; p = 0.24), and the studies were apparently compatible (I² = 0%). CONCLUSIONS This method allowed quantitative synthesis of the prospective association between DED and adiposity change in children, which is important for the development of evidence-informed policy. Bias adjustment increased the magnitude of the positive association but the widening confidence interval reflects the uncertainty of the assessed biases and implies that higher quality studies are required.
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Affiliation(s)
- Désirée C Wilks
- Medical Research Council Human Nutrition Research, Cambridge, UK
| | - Adrian P Mander
- Medical Research Council Human Nutrition Research, Cambridge, UK
- Medical Research Council Biostatistics Unit, Cambridge, UK
| | - Susan A Jebb
- Medical Research Council Human Nutrition Research, Cambridge, UK
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Papadaki A, Linardakis M, Larsen TM, van Baak MA, Lindroos AK, Pfeiffer AFH, Martinez JA, Handjieva-Darlenska T, Kunesová M, Holst C, Astrup A, Saris WHM, Kafatos A. The effect of protein and glycemic index on children's body composition: the DiOGenes randomized study. Pediatrics 2010; 126:e1143-52. [PMID: 20937657 DOI: 10.1542/peds.2009-3633] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the effect of protein and glycemic index (GI) on body composition among European children in the randomized, 6-month dietary intervention DiOGenes (diet, obesity, and genes) family-based study. PATIENTS AND METHODS In the study, 827 children (381 boys and 446 girls), aged 5 to 18 years, completed baseline examinations. Families with parents who lost ≥ 8% of their weight during an 8-week run-in low-calorie diet period were randomly assigned to 1 of 5 ad libitum diets: low protein (LP)/low glycemic index (LGI); LP/high GI (HGI); high protein (HP)/LGI; HP/HGI; and control diet. The target difference was 15 GI U between the LGI/HGI groups and 13 protein percentage points between the LP/HP groups. There were 658 children examined after 4 weeks. Advice on food-choice modification was provided at 6 visits during this period. No advice on weight loss was provided because the focus of the study was the ability of the diets to affect outcomes through appetite regulation. Anthropometric measurements and body composition were assessed at baseline, week 4, and week 26. RESULTS In the study, 465 children (58.1%) completed all assessments. The achieved differences between the GI and protein groups were 2.3 GI U and 4.9 protein percentage points, respectively. The LP/HGI group increased body fat percentage significantly more than the other groups (P = .040; partial η(2) = 0.039), and the percentage of overweight/obese children in the HP/LGI group decreased significantly during the intervention (P = .031). CONCLUSIONS Neither GI nor protein had an isolated effect on body composition. However, the LP/HGI combination increased body fat, whereas the HP/LGI combination was protective against obesity in this sample of children.
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Affiliation(s)
- Angeliki Papadaki
- Preventive Medicine and Nutrition Clinic, Department of Social Medicine, Faculty of Medicine, University of Crete, Greece, PO Box 2208, Heraklion 710 03, Crete, Greece.
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McAlpine DE, Frisch MJ, Rome ES, Clark MM, Signore C, Lindroos AK, Allison KC. Bariatric surgery: a primer for eating disorder professionals. Eur Eat Disord Rev 2010; 18:304-17. [PMID: 20589766 DOI: 10.1002/erv.1012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Obesity is a public health epidemic with medical, psychological and economic consequences. It continues to increase globally in prevalence and severity. Despite numerous behaviourally, medically or pharmacologically guided treatments, an effective non-surgical long-term treatment approach has not been identified. Bariatric surgery has surfaced as a viable option for a subset of individuals with medically complicated obesity who have failed non-surgical approaches. Pre-operative evaluation followed by post-operative, longitudinal follow-up by a multidisciplinary team specializing in surgery, medicine, psychiatry/psychology, exercise science and nutrition constitutes recognized and necessary standard of care for these complex patients. More information is needed regarding factors that interfere with successful outcomes and mechanisms of optimal follow-up for bariatric surgery patients to prevent and detect post-operative medical, psychological and social difficulties. We will review these issues with a focus on issues relevant to eating disorders professionals.
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Affiliation(s)
- Donald E McAlpine
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, MN 55905, USA.
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Abstract
OBJECTIVE The aim of this study was to explore baseline outcome predictors of a 12-week very-low-energy diet (VLED) treatment. METHODS Obese patients (177 women and 90 men) started treatment. Multivariate linear and logistic regressions were used to predict weight loss (%), successful outcome (>or= 10% weight loss) and attrition. Potential predictors were anthropometry, socioeconomic variables, established questionnaires on health-related quality of life, and eating behavior, and additional questions related to dieting. RESULTS Mean weight loss was 13.5% (standard deviation (SD) 5.6) in women and 15.1% (6.1) in men (p = 0.054). Greater weight loss in women was predicted by having more children, lower education, and better perceived physical health (R-square (R(2)) = 12.7%), and in men by better ambulation capacity, living with a partner/children, and snacking on ice-cream more often (R(2) = 39.4%). Successful outcome in women was predicted by less obesity-related psychosocial dysfunction, and in men by better functioning in social interaction and ambulation capacity. Attrition was predicted by lower age and larger hip circumference in women, and in men by lower perceived general health. Two-week weight loss was independently associated with all outcomes except attrition in women. CONCLUSION Factors related to perceived physical health, social interaction, socio-economic factors, and obesity-related psychosocial problems predicted VLED outcome. The predictors differed by gender.
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Affiliation(s)
- Lena Gripeteg
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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Moore CS, Lindroos AK, Kreutzer M, Larsen TM, Astrup A, van Baak MA, Handjieva-Darlenska T, Hlavaty P, Kafatos A, Kohl A, Martinez JA, Monsheimer S, Jebb SA. Dietary strategy to manipulate ad libitum macronutrient intake, and glycaemic index, across eight European countries in the Diogenes Study. Obes Rev 2010; 11:67-75. [PMID: 19573053 DOI: 10.1111/j.1467-789x.2009.00602.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to describe the development and implementation of a multifaceted, low-fat, weight-loss strategy for a Pan-European randomized controlled dietary intervention study, Diogenes. There were 891 families with at least one overweight/obese parent who underwent screening. Eligible, overweight/obese adults followed an 8-week weight-loss phase with a fixed low-energy diet (800 kcal). On attaining weight loss of > or = 8%, families were randomized to a 6- or 12-month low-fat (25-30%E) diet either based on national dietary guidelines or one of four interventions: low protein (LP)/low glycaemic index (LGI), LP/high GI (HGI), high protein (HP)/LGI and HP/HGI. The impact of each diet in preventing weight (re)gain was tested. A points-based system was used to manipulate dietary protein and carbohydrate. Manipulating carbohydrate composition involved substituting foods with a relatively high or low GI. A questionnaire was designed and completed by study investigators, providing feedback on the dietary intervention methods used to inform future interventions. The points system allowed macronutrient manipulations without compromising dietary flexibility or enforcing energy restrictions. Reported centre/participant differences in the ease of implementing the intervention may reflect dietary diversity and personal preferences for specific weight-management strategies. The points system provides a useful starting point for designing improved experimental paradigms for the manipulation of dietary intake in future trials.
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Affiliation(s)
- C S Moore
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, CB1 9NL, UK.
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Aston LM, Jackson D, Monsheimer S, Whybrow S, Handjieva-Darlenska T, Kreutzer M, Kohl A, Papadaki A, Martinez JA, Kunova V, van Baak MA, Astrup A, Saris WHM, Jebb SA, Lindroos AK. Developing a methodology for assigning glycaemic index values to foods consumed across Europe. Obes Rev 2010; 11:92-100. [PMID: 20653850 DOI: 10.1111/j.1467-789x.2009.00690.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is growing evidence that the glycaemic index (GI) of the diet is important with respect to body weight and metabolic disease risk. However, research is limited by the paucity of GI values for commonly consumed carbohydrate-rich foods in European countries. A new methodology has been developed for consistent assignment of GI values to foods across five European databases used in the Diogenes intervention study. GI values were assigned according to five decreasing levels of confidence (1) Measured values for specific foods; (2) Published values from published sources; (3) Equivalent values where published values for similar foods existed; (4) Estimated values assigned as one of three values representing low/medium/high GI ranges and (5) Nominal values assigned as 70, where no other value could be assigned with sufficient confidence. GI values were assigned to 5105 foods. In food records collected at baseline, the contribution to carbohydrate intake of foods assigned levels 1-2 ranged from 16% to 43% depending on country, and this increased to 53-81% including level 3 foods. The degree of confidence to assigned GI values differed across Europe. This standardized approach of assigning GI values will be made available to other researchers to facilitate further investigation into the effects of dietary GI on health.
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Affiliation(s)
- L M Aston
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK
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Abstract
The association between dietary energy density, increased energy intake and weight gain is supported by experimental evidence, but confirmation of an effect in free-living humans is limited. Experimental evidence supports a role of energy density in obesity through changes in food composition, not drinks consumption. The inclusion of drinks in the calculation creates a variable of questionable validity and has a substantive impact on the estimated energy density of the diet. We posit, based on the experimental evidence, that calculating the energy density of diets by excluding drinks and including calories from drinks as a covariate in the analysis is the most valid and reliable method of testing the relationship between energy density and weight gain in free-living humans. We demonstrate, by systematically reviewing existing observational studies of dietary energy density and weight gain in free-living humans, how current variation in the method for calculating energy density hampers the interpretation of these data. Reaching an a priori decision on the appropriate methodology will reduce the error caused by multiple comparisons and facilitate meaningful interpretation of epidemiological evidence to inform the development of effective obesity prevention strategies.
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Affiliation(s)
- L Johnson
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
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Abstract
The aim of the study was to investigate how soft drink and fruit juice consumption in teenagers is associated with life-style, other food choices, eating behaviour and maternal characteristics. A cross-sectional study of 16-year-old girls (n 275) and boys (n 199) and their mothers was undertaken. Questionnaires were used to assess habitual dietary intake, eating behaviour, physical activity, smoking and educational level. Weight and height were measured. It was found that eating breakfast less than five times per week was independently associated with a high soft drink consumption in both girls and boys. A low intake of cooked meals and milk and a high intake of salty snacks were associated with soft drinks in boys only, and a low intake of fruits in girls only. A high maternal juice intake, low milk and high fruit consumption were independent correlates of fruit juice intake in both girls and boys. In girls, being a smoker, having a smoking mother, a high soft drink intake, scoring low on emotional eating and high on cognitive restraint were also associated with fruit juice intake. A low intake of soft drinks and cooked meals was associated with fruit juice intake in boys only. Neither soft drinks nor fruit juice was associated with BMI. In conclusion, a high intake of both fruit juice and soft drinks were associated with a lower intake of foods such as milk and cooked meals. It might be possible to influence fruit juice intake among teenagers by aiming at their mothers, whereas the adolescents themselves should be targeted when the aim is to reduce soft drink consumption.
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Affiliation(s)
- Karin Vågstrand
- Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Wirfält E, Gullberg B, Wallström P, Lindroos AK. [No respect for different opinions]. Lakartidningen 2008; 105:3461-3462. [PMID: 19112981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Lindroos AK, Wirfält E, Gullberg B, Wallström P. [Time to tidy up the diet debate: scientific evidence--who knows the truth?]. Lakartidningen 2008; 105:2824-2826. [PMID: 19009893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Anna Karin Lindroos
- MRC, Human Nutrition Research, Elsie Widdowson laboratory, Cambridge, Storbritannien
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