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Diet and Cardiometabolic Disease: Dietary trends and the impact of diet on diabetes and cardiovascular disease
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cardiovascular diseases are the leading cause of death in most industrialised countries and in developing countries the trend in cardiovascular-related deaths is increasing. World-wide, type 2 diabetes mellitus (T2DM) is an emerging cause of disability and premature death. Both these conditions are closely associated with the consumption of energy-dense foods and food products that are poor in nutrients, as well as with a sedentary lifestyle. Pharmacological and surgical interventions can improve the outcome and delay the progression of the disease, but in terms of population-level prevention there is no substitute for the adoption of a healthy lifestyle.

SETTING

The underlying studies were conducted in Västerbotten (the VIP study), and in Norrbotten and Västerbotten combined (the MONICA Project). Norrbotten andVästerbotten are the two northernmost counties in Sweden. Since the mid-1980sthe prevalence of cardiovascular disease has decreased and diabetes rates haveremained stable in this region, despite of an unbroken trend of increasing body weight.

OBJECTIVE

The aim of this thesis is to describe changes in reported dietary habits, estimatetheir relative importance as risk factors for diabetes and cardiovascular disease, and finally to identify lifestyle components as potential targets for intervention.

RESULTS

The first paper describes changes in self-reported food consumption between 1986 and 1999. During this period, the population in question switched from products with high saturated fatty acid content (e.g. milk containing 3% fat, butter) to foods containing less saturated fat (e.g. milk containing 1.5% fat, vegetable oil, low-fat margarine); pasta and rice were consumed more often, and potatoes were consumed less. Convenience foods (e.g. hamburgers, snacks, sweets) became more popular, whilst traditional dishes (e.g. potato dumplings, black pudding, blöta) decreased in popularity. Fruit and vegetable intake remained low. In paper two we study the effects of these changes in food intake on the risk of developing T2DM using body fat distribution as an early indicator. Increased consumption of convenience foods was associated with unfavourable changes (smaller hip circumference and larger waist circumference), whereas the increased consumption of vegetable oil and pasta was associated with low-risk fat distribution. In the third paper we report studies on the association between fat consumption and T2DM. We used the pattern of fatty acids in the membranes of red blood cells as a marker of fat intake. In addition to confirming earlier findings (markers of the intake of saturated fat are associated with increased risk of T2DM and markers of unsaturated fat are associated with reduced T2DM risk), we also identified associations between two markers of milk-derived saturated fat intake and enterolactone, a biomarker of dietary fibre intake, and the risk of developing myocardial infarction. Our results indicate that moderately high levels of enterolactone intake in men are associated with lower risk of experiencing myocardial infarction. Manuscript 5 ranks education level, physical activity, smoking status, and self-reported intake of dietary fibre and fatty acids according to their effects on body fat distribution. Increased levels of physical activity, a higher education level and a reduced intake of saturated fat from meat were ranked as the most strongly associated factors in both men and women. Increased intake of dietary fibre from grains in women, and increased intake of dietary fibre from fruits and vegetables in men, was also inversely associated with average waist circumference.

CONCLUSION

Both questionnaire-based and biological markers of the risk of developing diabetes or cardiovascular disease have been identified. Based on available population level measurements, reduced consumption of convenience foods, increased consumption of whole-grain products, fruits and vegetables, vegetable oil and pasta as well as increased physical activity are potential goals for interventions in northern Sweden.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin , 2007. , 81 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1108
Keyword [en]
Medicine, Cross-sectional study, Cross-sectional survey, Diet, Dietary intake, Dietary survey, Food consumption, Food frequency, Milk, MONICA, Sweden, Body Mass Index, Hip circumference, Waist circumference, Diabetes, Metabolic syndrome, Cardiometabolic syndrome, Cardiovascular disease, Erythrocyte Membrane, Fatty Acids, Membrane Lipids, Fatty acid desaturases, Pentadecanoic acid, Heptadecanoic acid, Lignan, Enterolactone, Dietary Fibre, Physical activity, Education, Smoking, Alcohol
Keyword [sv]
Medicin
Research subject
Medicine
Identifiers
URN: urn:nbn:se:umu:diva-1369ISBN: 978-91-7264-354-3 (print)OAI: oai:DiVA.org:umu-1369DiVA: diva2:140781
Public defence
2007-10-12, sal B, 1 D, Tandläkarhögskolan, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2007-09-19 Created: 2007-09-19 Last updated: 2009-05-27Bibliographically approved
List of papers
1. Trends in food intakes in Swedish adults 1986-1999: findings from the Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) Study.
Open this publication in new window or tab >>Trends in food intakes in Swedish adults 1986-1999: findings from the Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) Study.
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2005 (English)In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 8, no 6, 628-635 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To determine changes in reported food frequency in adults between 1986 and 1999. DESIGN: Four consecutive cross-sectional surveys. SETTING: Counties of Norrbotten and Västerbotten, Northern Sweden. SUBJECTS: The Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) population, four independent cross-sectional surveys in 1986, 1990, 1994 and 1999. Randomly selected age-stratified samples of the population aged 25-64 years. Analysis is based on 2982 males and 3087 females who completed an 84-item food-frequency questionnaire. RESULTS: Between 1986 and 1999, average reported consumption of 3%-fat milk decreased from 42 to 7 intakes month(-1) in men and from 28 to 4 intakes month(-1) in women. Reported use of 1.5%-fat milk increased from 6 to 27 intakes month(-1) in men and from 6 to 24 in women. Monthly intakes of potatoes and root vegetables decreased from 38 to 27 in men and from 39 to 32 in women. Consumption of pasta increased from 4 to 7 intakes month(-1) in both sexes. Intakes of solid fats with 80% fat content dropped from 92 to 62 per month in men and from 78 to 52 per month in women, whereas use of 40%-fat spread increased from 12 to 22 intakes month(-1) in men and from 5 to 26 in women. Monthly intakes of vegetable oil increased from 3 to 12 in men and from 3 to 15 in women. The percentage of overweight or obese individuals (body mass index >25 kg m(-2)) increased from 52 to 65% in men and from 41 to 52% in women (P for linear trend in all these changes, <0.001). CONCLUSIONS: Our data indicate reduced consumption of foods with a high content of saturated fats. In spite of that, there is an unbroken trend towards increased obesity.

National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-16045 (URN)10.1079/PHN2004710 (DOI)16236192 (PubMedID)
Available from: 2007-12-12 Created: 2007-12-12 Last updated: 2017-12-14Bibliographically approved
2. Reported food intake and distribution of body fat: a repeated cross-sectional study
Open this publication in new window or tab >>Reported food intake and distribution of body fat: a repeated cross-sectional study
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2006 (English)In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 22, no 5, 34- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Body mass, as well as distribution of body fat, are predictors of both diabetes and cardiovascular disease. In Northern Sweden, despite a marked increase in average body mass, prevalence of diabetes was stagnant and myocardial infarctions decreased. A more favourable distribution of body fat is a possible contributing factor.This study investigates the relative importance of individual food items for time trends in waist circumference (WC) and hip circumference (HC) on a population level. METHODS: Independent cross-sectional surveys conducted in 1986, 1990, 1994 and 1999 in the two northernmost counties of Sweden with a common population of 250,000. Randomly selected age stratified samples, altogether 2982 men and 3087 women aged 25-64 years. Questionnaires were completed and anthropometric measurements taken. For each food item, associations between frequency of consumption and waist and hip circumferences were estimated. Partial regression coefficients for every level of reported intake were multiplied with differences in proportion of the population reporting the corresponding levels of intake in 1986 and 1999. The sum of these product terms for every food item was the respective estimated impact on mean circumference. RESULTS: Time trends in reported food consumption associated with the more favourable gynoid distribution of adipose tissue were increased use of vegetable oil, pasta and 1.5% fat milk. Trends associated with abdominal obesity were increased consumption of beer in men and higher intake of hamburgers and French fried potatoes in women. CONCLUSION: Food trends as markers of time trends in body fat distribution have been identified. The method is a complement to conventional approaches to establish associations between food intake and disease risk on a population level.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-12190 (URN)10.1186/1475-2891-5-34 (DOI)17187681 (PubMedID)
Available from: 2007-11-23 Created: 2007-11-23 Last updated: 2017-12-14Bibliographically approved
3. Fatty acid profile of the erythrocyte membrane preceding development of Type 2 diabetes mellitus.
Open this publication in new window or tab >>Fatty acid profile of the erythrocyte membrane preceding development of Type 2 diabetes mellitus.
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2008 (English)In: Nutrition, metabolism, and cardiovascular diseases : NMCD, ISSN 1590-3729, Vol. 18, no 7, 503-510 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: The respective roles of dietary fatty acids in the pathogenesis of diabetes are as yet unclear. Erythrocyte membrane fatty acid (EMFA) composition may provide an estimate of dietary fatty acid intake. This study investigates the relation between EMFA composition and development of Type 2 diabetes mellitus. METHODS AND RESULTS: In a nested case-referent design we studied 159 individuals tested as non-diabetic at baseline who after a mean observation time of 5.4+/-2.6years were diagnosed with Type 2 diabetes mellitus and 291 sex- and age-matched referents. Higher proportions of pentadecanoic acid (15:0) and heptadecanoic acid (17:0) were associated with a lower risk of diabetes. In accordance with earlier findings, higher proportions of palmitoleic (16:1 n-7), dihomo-gamma-linolenic (20:3 n-6) and adrenic (22:4 n-6) acids were associated with increased risk, whereas linoleic (18:2 n-6) and clupanodonic (22:5 n-3) acids were inversely associated with diabetes. After adjustment for BMI, HbA1c, alcohol intake, smoking and physical activity the only significant predictors were 15:0 and 17:0 as protective factors and 22:4 n6 as risk factor. CONCLUSION: In accordance with previous studies, our results indicate that EMFA-patterns predict development of Type 2 diabetes mellitus. The inverse association with two saturated fatty acids, previously shown to reflect consumption of dairy products, is a new finding.

National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-19668 (URN)10.1016/j.numecd.2007.04.005 (DOI)18042359 (PubMedID)
Available from: 2009-03-09 Created: 2009-03-09 Last updated: 2015-04-29
4. Risk of myocardial infarction according to serum concentrations of enterolactone
Open this publication in new window or tab >>Risk of myocardial infarction according to serum concentrations of enterolactone
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(English)Manuscript (Other (popular science, discussion, etc.))
Identifiers
urn:nbn:se:umu:diva-2581 (URN)
Available from: 2007-09-19 Created: 2007-09-19 Last updated: 2010-01-14Bibliographically approved
5. Population-wide changes in reported lifestyle are associated with redistribution of adipose tissue.
Open this publication in new window or tab >>Population-wide changes in reported lifestyle are associated with redistribution of adipose tissue.
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2009 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 5, 545-553 p.Article in journal (Refereed) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-11606 (URN)10.1177/1403494808099971 (DOI)19141545 (PubMedID)
Available from: 2009-01-23 Created: 2009-01-23 Last updated: 2017-12-14Bibliographically approved

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