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Otten, J., Andersson, J., Ståhl, J., Stomby, A., Saleh, A., Waling, M., . . . Olsson, T. (2019). Exercise Training Adds Cardiometabolic Benefits of a Paleolithic Diet in Type 2 Diabetes Mellitus. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 8(2), Article ID e010634.
Open this publication in new window or tab >>Exercise Training Adds Cardiometabolic Benefits of a Paleolithic Diet in Type 2 Diabetes Mellitus
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2019 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 8, no 2, article id e010634Article in journal (Refereed) Published
Abstract [en]

Background: The accumulation of myocardial triglycerides and remodeling of the left ventricle are common features in type 2 diabetes mellitus and represent potential risk factors for the development of diastolic and systolic dysfunction. A few studies have investigated the separate effects of diet and exercise training on cardiac function, but none have investigated myocardial changes in response to a combined diet and exercise intervention. This 12-week randomized study assessed the effects of a Paleolithic diet, with and without additional supervised exercise training, on cardiac fat, structure, and function.

Methods and Results: Twenty-two overweight and obese subjects with type 2 diabetes mellitus were randomized to either a Paleolithic diet and standard-care exercise recommendations ( PD ) or to a Paleolithic diet plus supervised exercise training 3 hours per week ( PD - EX ). This study includes secondary end points related to cardiac structure and function, ie, myocardial triglycerides levels, cardiac morphology, and strain were measured using cardiovascular magnetic resonance, including proton spectroscopy, at baseline and after 12 weeks. Both groups showed major favorable metabolic changes. The PD - EX group showed significant decreases in myocardial triglycerides levels (-45%, P=0.038) and left ventricle mass to end-diastolic volume ratio (-13%, P=0.008) while the left ventricle end-diastolic volume and stroke volume increased significantly (+14%, P=0.004 and +17%, P=0.008, respectively). These variables were unchanged in the PD group.

Conclusions: Exercise training plus a Paleolithic diet reduced myocardial triglycerides levels and improved left ventricle remodeling in overweight/obese subjects with type 2 diabetes mellitus.

Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01513798.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
cardiovascular magnetic resonance imaging, diet, exercise, myocardial metabolism, type 2 diabetes mellitus
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-157046 (URN)10.1161/JAHA.118.010634 (DOI)000460105800010 ()30652528 (PubMedID)
Available from: 2019-03-07 Created: 2019-03-07 Last updated: 2019-03-27Bibliographically approved
Berggren, L., Olsson, C., Talvia, S., Hörnell, A., Rönnlund, M. & Waling, M. (2019). The lived experiences of school lunch: an empathy-based study with children in Sweden. Children's Geographies
Open this publication in new window or tab >>The lived experiences of school lunch: an empathy-based study with children in Sweden
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2019 (English)In: Children's Geographies, ISSN 1473-3285, E-ISSN 1473-3277Article in journal (Refereed) Epub ahead of print
Abstract [en]

School lunch is in general regulated through policies and agendas constituted by the perspectives of adults. In this article, we focus on children’s lived experiences of school lunch with a special emphasis on emotions and how they relate to social and physical dimensions. This study draws on empathy-based stories written by 10–11 year olds (n = 171) from schools in Sweden. We identified three themes: Interaction and exposure, Routines and restrictions and Food and eating. The children’s lived experiences of school lunch and the emotions attached to them are closely associated and intertwined with the socio-spatial dimension of school lunch. A pleasant meal experience seems to require harmonization between the physical and social space whilst negative experiences contain tensions between them, something that actors working with school lunch and school lunch environments should take in consideration when resourcing, planning and scheduling school lunch, and also when designing new school restaurants.

Place, publisher, year, edition, pages
Routledge, 2019
Keywords
School lunch, lived experiences, empathy-based stories, emotions, children's spaces, Henri Lefebvre
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-161898 (URN)10.1080/14733285.2019.1642447 (DOI)000476147700001 ()2-s2.0-85069037183 (Scopus ID)
Available from: 2019-08-08 Created: 2019-08-08 Last updated: 2019-08-08
Otten, J., Stomby, A., Waling, M., Isaksson, A., Söderström, I., Ryberg, M., . . . Olsson, T. (2018). A heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes: a randomised controlled trial. Diabetologia, 61(7), 1548-1559
Open this publication in new window or tab >>A heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes: a randomised controlled trial
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2018 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 61, no 7, p. 1548-1559Article in journal (Refereed) Published
Abstract [en]

Aims/hypothesis: The aim of the study was to investigate ectopic fat deposition and insulin sensitivity, in a parallel single-blinded randomised controlled trial, comparing Paleolithic diet alone with the combination of Paleolithic diet and exercise in individuals with type 2 diabetes. Methods: Thirty-two individuals with type 2 diabetes with BMI 25-40 kg/m(2) and 30-70 years of age followed a Paleolithic diet ad libitum for 12 weeks. In addition, study participants were randomised by computer program to either supervised combined exercise training (PD-EX group) or standard care exercise recommendations (PD group). Staff performing examinations and assessing outcomes were blinded to group assignment. Thirteen participants were analysed in each group: hepatic and peripheral insulin sensitivity were measured using the hyperinsulinaemic-euglycaemic clamp technique combined with [6,6-H-2(2)]glucose infusion, and liver fat was assessed by proton magnetic resonance spectroscopy; both analyses were secondary endpoints. Intramyocellular lipid (IMCL) content was measured by magnetic resonance spectroscopy as a secondary analysis. All examinations were performed at Umca University Hospital, Umca, Sweden. Results: Both study groups showed a median body weight loss of 7 kg. Fat mass decreased by 5.7 kg in the PD group and by 6.5 kg in the PD-EX group. Maximum oxygen uptake increased in the PD-EX group only. Liver fat showed a consistent reduction (74% decrease) in the PD group, while the response in the PD-EX group was heterogeneous (p < 0.05 for the difference between groups). IMCL content of the soleus muscle decreased by 40% in the PD group and by 22% in the PD-EX group (p < 0.05 for the difference between groups). Both groups improved their peripheral and adipose tissue insulin sensitivity, but not their hepatic insulin sensitivity. Plasma fetuin-A decreased by 11% in the PD group (p < 0.05) and remained unchanged in the PD-EX group. Liver fat changes during the intervention were correlated with changes in fetuin-A (r(S) = 0.63, p < 0.01). Participants did not report any important adverse events caused by the intervention. Conclusions/interpretation: A Paleolithic diet reduced liver fat and IMCL content, while there was a tissue-specific heterogeneous response to added exercise training.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Exercise, Hyperinsulinaemic-euglycaemic clamp, Insulin sensitivity, Intramyocellular fat, Liver fat, Nutrition, Obesity, Paleolithic diet, Proton magnetic resonance spectroscopy, Weight loss
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-150764 (URN)10.1007/s00125-018-4618-y (DOI)000434250500007 ()29696296 (PubMedID)
Available from: 2018-08-27 Created: 2018-08-27 Last updated: 2018-08-27Bibliographically approved
Juniusdottir, R., Hörnell, A., Gunnarsdottir, I., Lagstrom, H., Waling, M., Olsson, C., . . . Olafsdottir, A. S. (2018). Composition of school meals in Sweden, Finland and Iceland: Official guidelines and comparison with practice and availability. Journal of School Health, 88(10), 744-753
Open this publication in new window or tab >>Composition of school meals in Sweden, Finland and Iceland: Official guidelines and comparison with practice and availability
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2018 (English)In: Journal of School Health, ISSN 0022-4391, E-ISSN 1746-1561, Vol. 88, no 10, p. 744-753Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Nutritious and attractive school meals can improve health equality and public health. Current official guidelines and recommendations on food and nutrient composition of school meals in 3 Nordic countries; Sweden, Finland, and Iceland, are described and compared with actual practice, ie, availability of foods and nutrients in served reference meals in 3 selected areas in each country.

METHODS: A country comparison was made between official guidelines, and actual practice was studied in participating schools. Reference portions of school meals (N = 170) provided in 24 compulsory schools were photographed and weighed. Food and nutrient availability were compared with official guidelines in each country.

RESULTS: Emphasis of recommendations on whole‐grain bread in Sweden, whole grains in Finland, and fish in Iceland were reflected in food availability. The energy content of the meals provided was lower than guidelines and there was a large variation in energy content between days.

CONCLUSIONS: The guidelines regarding food availability were quite well followed, but the large variation in energy and nutrient content of provided school meals between days indicates a need for standardization.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
children, school meals, school canteens, energy and nutrients, recommendations and guidelines
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-149103 (URN)10.1111/josh.12683 (DOI)000444228200005 ()30203478 (PubMedID)
Available from: 2018-06-15 Created: 2018-06-15 Last updated: 2018-10-04Bibliographically approved
Bergman, F., Wahlström, V., Stomby, A., Otten, J., Lanthén, E., Renklint, R., . . . Olsson, T. (2018). Treadmill workstations in office workers who are overweight or obese: a randomised controlled trial. The Lancet Public Health, 3(11), Article ID e523-e535.
Open this publication in new window or tab >>Treadmill workstations in office workers who are overweight or obese: a randomised controlled trial
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2018 (English)In: The Lancet Public Health, ISSN 2468-2667, Vol. 3, no 11, article id e523-e535Article in journal (Refereed) Published
Abstract [en]

Background: Treadmill workstations that enable office workers to walk on a treadmill while working at their computers might increase physical activity in offices, but long-term effects are unknown. We therefore investigated whether treadmill workstations in offices increased daily walking time.

Methods: We did a randomised controlled trial of healthy office workers who were either overweight or obese. We recruited participants from 13 different companies, which comprised 17 offices, in Umeå, Sweden. We included people who were aged 40-67 years, had sedentary work tasks, and had a body-mass index (BMI) between 25 kg/m2 and 40 kg/m2. After the baseline measurement, we stratified participants by their BMI (25-30 kg/m2 and >30 to 40 kg/m2); subsequently, an external statistician randomly assigned these participants (1:1) to either the intervention group (who received treadmill workstations for optional use) or the control group (who continued to work at their sit-stand desks as usual). Participants in the intervention group received reminders in boosting emails sent out to them at four occasions during the study period. Researchers were masked to group assignment until after analysis of the primary outcome. After the baseline measurement, participants were not masked to group belongings. The primary outcome was total daily walking time at weekdays and weekends, measured at baseline, 2 months, 6 months, 10 months, and 13 months with the accelerometer activPAL (PAL Technologies, Glasgow, UK), which was worn on the thigh of participants for 24 h a day for 7 consecutive days. We used an intention-to-treat approach for our analyses. This trial is registered with ClinicalTrials.gov, number NCT01997970, and is closed to new participants.

Findings: Between Nov 1, 2013, and June 30, 2014, a total of 80 participants were recruited and enrolled (n=40 in both the intervention and control groups). Daily walking time during total time awake at weekdays increased between baseline and 13 months by 18 min (95% CI 9 to 26) in the intervention group and 1 min (-7 to 9) in the control group (difference 22 min [95% CI 7 to 37], pinteraction=0·00045); for weekend walking, the change from baseline to 13 months was 5 min (-8 to 18) in the intervention group and 8 min (-5 to 21) in the control group (difference -1 min [-19 to 17]; pinteraction=0·00045). Neither measure met our predetermined primary outcome of 30 min difference in total walking time between the intervention and control group, so the primary outcome of the trial was not met. One adverse event was reported in a participant who accidently stepped on their Achilles tendon.

Interpretation: In a sedentary work environment, treadmill workstations result in a statistically significant but smaller-than-expected increase in daily walking time. Future studies need to investigate how increasing physical activity at work might have potentially compensatory effects on non-work activity.

Place, publisher, year, edition, pages
The Lancet Publishing Group, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-152709 (URN)10.1016/S2468-2667(18)30163-4 (DOI)000451514600013 ()30322782 (PubMedID)
Available from: 2018-10-19 Created: 2018-10-19 Last updated: 2019-10-28Bibliographically approved
Otten, J., Stomby, A., Waling, M., Isaksson, A., Tellström, A., Lundin-Olsson, L., . . . Olsson, T. (2017). Benefits of a Paleolithic diet with and without supervised exercise on fat mass, insulin sensitivity, and glycemic control: a randomized controlled trial in individuals with type 2 diabetes. Diabetes/Metabolism Research Reviews, 33(1), Article ID e2828.
Open this publication in new window or tab >>Benefits of a Paleolithic diet with and without supervised exercise on fat mass, insulin sensitivity, and glycemic control: a randomized controlled trial in individuals with type 2 diabetes
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2017 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 33, no 1, article id e2828Article in journal (Refereed) Published
Abstract [en]

Background

Means to reduce future risk for cardiovascular disease in subjects with type 2 diabetes are urgently needed.

Methods

Thirty-two patients with type 2 diabetes (age 59 ± 8 years) followed a Paleolithic diet for 12 weeks. Participants were randomized to either standard care exercise recommendations (PD) or 1-h supervised exercise sessions (aerobic exercise and resistance training) three times per week (PD-EX).

Results

For the within group analyses, fat mass decreased by 5.7 kg (IQR: −6.6, −4.1; p < 0.001) in the PD group and by 6.7 kg (−8.2, −5.3; p < 0.001) in the PD-EX group. Insulin sensitivity (HOMA-IR) improved by 45% in the PD (p < 0.001) and PD-EX (p < 0.001) groups. HbA1c decreased by 0.9% (−1.2, −0.6; p < 0.001) in the PD group and 1.1% (−1.7, −0.7; p < 0.01) in the PD-EX group. Leptin decreased by 62% (p < 0.001) in the PD group and 42% (p < 0.001) in the PD-EX group. Maximum oxygen uptake increased by 0.2 L/min (0.0, 0.3) in the PD-EX group, and remained unchanged in the PD group (p < 0.01 for the difference between intervention groups). Male participants decreased lean mass by 2.6 kg (−3.6, −1.3) in the PD group and by 1.2 kg (−1.3, 1.0) in the PD-EX group (p < 0.05 for the difference between intervention groups).

Conclusions

A Paleolithic diet improves fat mass and metabolic balance including insulin sensitivity, glycemic control, and leptin in subjects with type 2 diabetes. Supervised exercise training may not enhance the effects on these outcomes, but preserves lean mass in men and increases cardiovascular fitness.

Keywords
type 2 diabetes, Paleolithic diet, diet intervention, exercise, glycosyl-ated haemoglobin A, insulin sensitivity, leptin
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-126188 (URN)10.1002/dmrr.2828 (DOI)000397102800010 ()
Available from: 2016-10-03 Created: 2016-10-03 Last updated: 2019-03-14Bibliographically approved
Otten, J., Stomby, A., Waling, M., Isaksson, A., Söderström, I., Ryberg, M., . . . Olsson, T. (2017). Exercise training reverses the effect of a Paleolithic diet on liver fat and intramyocellular lipid content in patients with type 2 diabetes. In: : . Paper presented at Cell Symposia Exercise Metabolism, 21-23 May, 2017, Gothenburg, Sweden.
Open this publication in new window or tab >>Exercise training reverses the effect of a Paleolithic diet on liver fat and intramyocellular lipid content in patients with type 2 diabetes
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2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-135408 (URN)
Conference
Cell Symposia Exercise Metabolism, 21-23 May, 2017, Gothenburg, Sweden
Available from: 2017-05-26 Created: 2017-05-26 Last updated: 2018-08-27Bibliographically approved
Otten, J., Stomby, A., Waling, M., Isaksson, A., Söderström, I., Ryberg, M., . . . Olsson, T. (2017). Exercise training reverses the effect of a Paleolithic diet on liver fat and intramyocellular lipid content in patients with type 2 diabetes. In: : . Paper presented at Endokrindagarna, 1-3 februari 2017, Uppsala, Sweden.
Open this publication in new window or tab >>Exercise training reverses the effect of a Paleolithic diet on liver fat and intramyocellular lipid content in patients with type 2 diabetes
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2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-135409 (URN)
Conference
Endokrindagarna, 1-3 februari 2017, Uppsala, Sweden
Available from: 2017-05-26 Created: 2017-05-26 Last updated: 2018-08-27Bibliographically approved
Berggren, L., Talvia, S., Fossgard, E., Björk Arnfjörð, U., Hörnell, A., Ólafsdóttir, A. S., . . . Olsson, C. (2017). Nordic children's conceptualizations of healthy eating in relation to school lunch. Health Education, 117(2), 130-147
Open this publication in new window or tab >>Nordic children's conceptualizations of healthy eating in relation to school lunch
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2017 (English)In: Health Education, ISSN 0965-4283, E-ISSN 1758-714X, Vol. 117, no 2, p. 130-147Article in journal (Refereed) Published
Abstract [en]

Purpose: Pupils' perspective should be better taken into account when developing nutrition education at school. The purpose of this paper is to explore Nordic children's perspectives on the healthiness of meals in the context of school lunches.

Design/methodology/approach: In total, 78 focus group discussions were conducted with 10-11-year-old girls and boys (n=457) from schools in Finland, Iceland, Norway and Sweden, which were participating in the Nordic school meal project ProMeal during the school year 2013-2014. A flexible discussion guide and stimulus material in the form of 14 photographs displaying different school lunch contexts were used. The discussions were analyzed using thematic analysis.

Findings: These Nordic children seem to share the adult-set aim of healthy eating in the school context as a socio-cultural norm. Although healthy eating was constructed as a rational, normative and acceptable way to eat at school, unhealthy eating was emphasized as negotiably acceptable when eaten occasionally and under certain circumstances (e.g. at special occasions). Unhealthy eating also comprised emotionally laden descriptions such as enjoyment and disgust.

Practical implications: Children's conceptualizations of healthy eating are connected to nutritional, socio-cultural, emotional and normative dimensions, which should be reflected also when developing nutrition education in school.

Originality/value: The need for research exploring children's experiences of, and understandings about, school lunch motivated this unique multicenter study with a large number of participating children. In the focus groups a child-oriented, photo-elicitation method was used.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2017
Keywords
Focus groups, Health education, Schools, Education, Children, Food
National Category
Other Social Sciences not elsewhere specified
Research subject
Food and Nutrition
Identifiers
urn:nbn:se:umu:diva-130988 (URN)10.1108/HE-05-2016-0022 (DOI)000395665600001 ()
Projects
ProMeal
Funder
Nordic Council of Ministers, 54761Forte, Swedish Research Council for Health, Working Life and WelfareMagnus Bergvall Foundation
Available from: 2017-02-02 Created: 2017-02-02 Last updated: 2018-06-09Bibliographically approved
Waling, M. & Olsson, C. (2017). School lunch as a break or an educational activity: a quantitative study of Swedish teacher perspectives. Health Education, 117(6), 540-550
Open this publication in new window or tab >>School lunch as a break or an educational activity: a quantitative study of Swedish teacher perspectives
2017 (English)In: Health Education, ISSN 0965-4283, E-ISSN 1758-714X, Vol. 117, no 6, p. 540-550Article in journal (Refereed) Published
Abstract [en]

Purpose – The purpose of this paper is twofold: first, to explore to what extent teachers eat together withpupils during school lunches and their attitudes toward using these lunches to reach the educational goalsstated in the Swedish compulsory school curriculum; and second, to study to what degree teachers seethemselves and school meal personnel as role models during school lunches.Design/methodology/approach – A questionnaire was completed by 3,629 teachers in Swedish schools.Findings – In total, 90 percent of the teachers ate lunch together with the pupils one or more days per week.The majority reported that meals were fully (54 percent), or partially (40 percent) subsidized when they wereeating with pupils. In total, 72 percent thought that school lunches should be considered part of the school’seducational activities while 28 percent thought that it should be a time to get a break from educationalactivities. Most teachers thought that school lunches could be useful for learning about the issues of foodwaste and healthy eating while there were more diverse views on using lunches for learningabout fundamental values. A majority of the teachers considered themselves to be role models in theschool meal situation.Practical implications – The authors suggest that the educational component of the schoolmeal per se shouldbe regulated in the Educational Act together with guidelines from the Swedish National Agency for Education.Originality/value – This study is unique since it covers a previously little studied area; teachers’ attitudestoward using the school lunch situation for educational purposes.

Keywords
education, food, schools, teachers
National Category
Social Sciences
Research subject
Food and Nutrition
Identifiers
urn:nbn:se:umu:diva-135179 (URN)10.1108/HE-01-2017-0001 (DOI)000411501100002 ()
Available from: 2017-05-21 Created: 2017-05-21 Last updated: 2018-06-09Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-9743-8567

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