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  • 1. Abbas, S
    et al.
    Linseisen, J
    Rohrmann, S
    Beulens, JWJ
    Buijsse, B
    Amiano, P
    Ardanaz, E
    Balkau, B
    Boeing, H
    Clavel-Chapelon, F
    Fagherazzi, G
    Franks, Paul W
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gavrila, D
    Grioni, S
    Kaaks, R
    Key, TJ
    Khaw, KT
    Kuehn, T
    Mattiello, A
    Molina-Montes, E
    Nilsson, PM
    Overvad, K
    Quiros, JR
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sacerdote, C
    Saieva, C
    Slimani, N
    Sluijs, I
    Spijkerman, AMW
    Tjonneland, A
    Tumino, R
    van der A, DL
    Zamora-Ros, R
    Sharp, SJ
    Langenberg, C
    Forouhi, NG
    Riboli, E
    Wareham, NJ
    Dietary vitamin D intake and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition: the EPIC-InterAct study2014In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 68, no 2, p. 196-202Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Prospective cohort studies have indicated that serum vitamin D levels are inversely related to risk of type 2 diabetes. However, such studies cannot determine the source of vitamin D. Therefore, we examined the association of dietary vitamin D intake with incident type 2 diabetes within the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study in a heterogeneous European population including eight countries with large geographical variation.

    SUBJECTS/METHODS: Using a case-cohort design, 11 245 incident cases of type 2 diabetes and a representative subcohort (N = 15 798) were included in the analyses. Hazard ratios (HR) and 95% confidence intervals (CIs) for type 2 diabetes were calculated using a Prentice-weighted Cox regression adjusted for potential confounders. Twenty-four-hour diet-recall data from a subsample (N = 2347) were used to calibrate habitual intake data derived from dietary questionnaires.

    RESULTS: Median follow-up time was 10.8 years. Dietary vitamin D intake was not significantly associated with the risk of type 2 diabetes. HR and 95% CIs for the highest compared to the lowest quintile of uncalibrated vitamin D intake was 1.09 (0.97-1.22) (P-trend = 0.17). No associations were observed in a sex-specific analysis. The overall pooled effect (HR (95% CI)) using the continuous calibrated variable was 1.00 (0.97-1.03) per increase of 1 mg/day dietary vitamin D.

    CONCLUSIONS: This observational study does not support an association between higher dietary vitamin D intake and type 2 diabetes incidence. This result has to be interpreted in light of the limited contribution of dietary vitamin D on the overall vitamin D status of a person.

  • 2. Al-Delaimy, W K
    et al.
    Slimani, N
    Ferrari, P
    Key, T
    Spencer, E
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Odontology, Cariology.
    Johansson, G
    Mattisson, I
    Wirfalt, E
    Sieri, S
    Agudo, A
    Celentano, E
    Palli, D
    Sacerdote, C
    Tumino, R
    Dorronsoro, M
    Ocké, M C
    Bueno-De-Mesquita, H B
    Overvad, K
    Chirlaque, Ma D
    Trichopoulou, A
    Naska, A
    Tjonneland, A
    Olsen, A
    Lund, E
    Skeie, G
    Ardanaz, E
    Kesse, E
    Boutron-Ruault, M-C
    Clavel-Chapelon, F
    Bingham, S
    Welch, A A
    Martinez-Garcia, C
    Nagel, G
    Linseisen, J
    Quirós, J R
    Peeters, P H M
    van Gils, C H
    Boeing, H
    van Kappel, A L
    Steghens, J-P
    Riboli, E
    Plasma carotenoids as biomarkers of intake of fruits and vegetables: ecological-level correlations in the European Prospective Investigation into Cancer and Nutrition (EPIC).2005In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 59, no 12, p. 1397-408Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to assess the ability of a single 24-h dietary recall (24HDR) and food questionnaires (FQ) to predict plasma carotenoid levels at the ecological level by assessing the relationship between mean plasma carotenoid levels and mean intake of fruit and vegetables measured by 24HDR and FQ across 16 European regions. DESIGN: A random subsample of 3089 subjects was included, stratified by age and gender. They provided blood samples and dietary information between 1992 and 2000 as part of the European Prospective Investigation into Cancer and Nutrition. RESULTS: Using Spearman's correlation coefficients, the correlations between mean regional 24HDR fruit and vegetable variables and corresponding mean plasma carotenoid levels were generally higher than the correlations using FQ means. The highest correlation was between the 24HDR citrus fruit variable and beta-cryptoxanthin (r = 0.90). For 24HDR, total fruits and vegetables were highly correlated with lutein, zeaxanthin, and beta-cryptoxanthin (r = 0.83-0.87), while vegetables were more closely related with lutein (r = 0.69) and zeaxanthin (r = 0.68), and fruits correlated with zeaxanthin (r = 0.87) and beta-cryptoxanthin (r = 0.84). Root vegetables (r = 0.81) and total carrots (r = 0.71) were well correlated with alpha-carotene. In the multivariate models adjusting for age, body mass index, and season, and using observations of means stratified by sex and region, the association was generally higher for 24HDR compared to FQ. CONCLUSION: Mean regional intakes of fruits and vegetables in several European countries were closely correlated with corresponding mean plasma levels of individual carotenoids. Fruits and vegetables measured by 24HDR were generally better able to predict plasma carotenoids at the ecological level.

  • 3. Al-Delaimy, WK
    et al.
    Ferrari, P
    Slimani, N
    Pala, V
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Odontology, Cariology.
    Nilsson, S
    Mattisson, I
    Wirfalt, E
    Galasso, R
    Palli, D
    Vineis, P
    Tumino, R
    Dorronsoro, M
    Pera, G
    Ocké, MC
    Bueno-de-Mesquita, HB
    Overvad, K
    Chirlaque, M
    Trichopoulou, A
    Naska, A
    Tjonneland, A
    Olsen, A
    Lund, E
    Alsaker, EH
    Barricarte, A
    Kesse, E
    Boutron-Ruault, MC
    Clavel-Chapelon, F
    Key, TJ
    Spencer, E
    Bingham, S
    Welch, AA
    Sanchez-Perez, MJ
    Nagel, G
    Linseisen, J
    Quirós, JR
    Peeters, PH
    van Gils, CH
    Boeing, H
    van Kappel, AL
    Steghens, JP
    Riboli, E
    Plasma carotenoids as biomarkers of intake of fruits and vegetables: individual-level correlations in the European Prospective Investigation into Cancer and Nutrition (EPIC).2005In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 59, no 12, p. 1387-1396Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim in this study was to assess the association between individual plasma carotenoid levels (alpha-carotene, beta-carotene, lycopene, beta-cryptoxanthin, lutein, zeaxanthin) and fruit and vegetable intakes recorded by a calibrated food questionnaire (FQ) and 24-h dietary recall records (24HDR) in nine different European countries with diverse populations and widely varying intakes of plant foods. DESIGN: A stratified random subsample of 3089 men and women from nine countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC), who had provided blood samples and dietary and other lifestyle information between 1992 and 2000, were included. RESULTS: beta-Cryptoxanthin was most strongly correlated with total fruits (FQ r = 0.52, 24HDR r = 0.39), lycopene with tomato and tomato products (FQ r = 0.38, 24HDR r = 0.25), and alpha-carotene with intake of root vegetables (r = 0.39) and of total carrots (r = 0.38) for FQ only. Based on diet measured by FQ and adjusting for possible confounding by body mass index (BMI), age, gender, smoking status, alcohol intake, and energy intake, the strongest predictors of individual plasma carotenoid levels were fruits (R(partial)(2) = 17.2%) for beta-cryptoxanthin, total carrots ((partial)(2) = 13.4%) and root vegetables (R(partial)(2) = 13.3%) for alpha-carotene, and tomato products (R(partial)(2) = 13.8%) for lycopene. For 24HDR, the highest R(partial)(2) was for fruits in relation to beta-cryptoxanthin (7.9%). CONCLUSIONS: Intakes of specific fruits and vegetables as measured by food questionnaires are good predictors of certain individual plasma carotenoid levels in our multicentre European study. At individual subject levels, FQ measurements of fruits, root vegetables and carrots, and tomato products are, respectively, good predictors of beta-cryptoxanthin, alpha-carotene, and lycopene in plasma.

  • 4. Arsov, S.
    et al.
    Trajceska, L.
    van Oeveren, W.
    Smit, A. J.
    Dzekova, P.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Sikole, A.
    Rakhorst, G.
    Graaff, R.
    The influence of body mass index on the accumulation of advanced glycation end products in hemodialysis patients2015In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 69, no 3, p. 309-313Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: The level of skin autofluorescence (AF) at a given moment is an independent predictor of mortality in hemodialysis (HD) patients. Skin AF is a measure of the accumulation of advanced glycation end products (AGEs). The aim of the study was to estimate the influence of nutrition on the 1-year increase of skin AF (Delta AF) in HD patients.

    SUBJECTS/METHODS: A total of 156 HD patients were enrolled in this study. Skin AF, body mass index (BMI), superoxide dismutase, myeloperoxidase, C-reactive protein, inter-cellular adhesion molecule-1, von Willebrand factor and heart-type fatty acid-binding protein were measured four times at intervals of approximately half a year. Data from the monthly routine blood analysis were also used. Daily calorie, protein and AGE intakes were assessed from food recordings over a period of 1 week.

    RESULTS: A J-shaped relation was found between baseline BMI and Delta AF (P = 0.01). The lowest point of the J-shaped curve is found for BMI = 24.3 kg/m(2). In the univariate analysis of the contributors to the 1-year Delta AF, we found that beside BMI = 24.3 kg/m(2), AGE and calorie intakes, as well as myeloperoxidase and HD vintage, had a P < 0.10. The sole independent predictor of the 1-year Delta AF was BMI = 24.3 kg/m(2) (P = 0.01).

    CONCLUSIONS: It appears that calorie, protein and AGE intakes hardly influence the 1-year Delta AF in HD patients. BMI of HD patients of around 24 kg/m(2) resulted in a lower 1-year Delta AF.

  • 5. Benetou, V
    et al.
    Orfanos, P
    Zylis, D
    Sieri, S
    Contiero, P
    Tumino, R
    Giurdanella, M C
    Peeters, P H M
    Linseisen, J
    Nieters, A
    Boeing, H
    Weikert, C
    Pettersson, U
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Bueno-de-Mesquita, H B
    Dorronsoro, M
    Boffetta, P
    Trichopoulou, A
    Diet and hip fractures among elderly Europeans in the EPIC cohort2011In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 65, no 1, p. 132-139Article in journal (Refereed)
    Abstract [en]

    In a prospective study of the elderly, diet, including consumption of dairy products, alcohol and vitamin D, did not appear to play a major role in hip fracture incidence. There is however, weak and statistically non-significant evidence that vegetable and fish consumption and intake of polyunsaturated lipids may have a beneficial, whereas saturated lipid intake a detrimental effect.

  • 6. Buijsse, B.
    et al.
    Boeing, H.
    Drogan, D.
    Schulze, M. B.
    Feskens, E. J.
    Amiano, P.
    Barricarte, A.
    Clavel-Chapelon, F.
    de Lauzon-Guillain, B.
    Fagherazzi, G.
    Fonseca-Nunes, A.
    Franks, Paul
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Huerta, J. M.
    Jakobsen, M. U.
    Kaaks, R.
    Key, T. J.
    Khaw, K. T.
    Masala, G.
    Moskal, A.
    Nilsson, P. M.
    Overvad, K.
    Pala, V.
    Panico, S.
    Redondo, M. L.
    Ricceri, F.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sanchez, M-J
    Sluijs, I.
    Spijkerman, A. M.
    Tjonneland, A.
    Tumino, R.
    van der A, D. L.
    van der Schouw, Y. T.
    Langenberg, C.
    Sharp, S. J.
    Forouhi, N. G.
    Riboli, E.
    Wareham, N. J.
    Consumption of fatty foods and incident type 2 diabetes in populations from eight European countries2015In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 69, no 4, p. 455-461Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES:

    Diets high in saturated and trans fat and low in unsaturated fat may increase type 2 diabetes (T2D) risk, but studies on foods high in fat per unit weight are sparse. We assessed whether the intake of vegetable oil, butter, margarine, nuts and seeds and cakes and cookies is related to incident T2D.

    SUBJECTS/METHODS:

    A case-cohort study was conducted, nested within eight countries of the European Prospective Investigation into Cancer (EPIC), with 12 403 incident T2D cases and a subcohort of 16 835 people, identified from a cohort of 340 234 people. Diet was assessed at baseline (1991-1999) by country-specific questionnaires. Country-specific hazard ratios (HRs) across four categories of fatty foods (nonconsumers and tertiles among consumers) were combined with random-effects meta-analysis.

    RESULTS:

    After adjustment not including body mass index (BMI), nonconsumers of butter, nuts and seeds and cakes and cookies were at higher T2D risk compared with the middle tertile of consumption. Among consumers, cakes and cookies were inversely related to T2D (HRs across increasing tertiles 1.14, 1.00 and 0.92, respectively; P-trend <0.0001). All these associations attenuated upon adjustment for BMI, except the higher risk of nonconsumers of cakes and cookies (HR 1.57). Higher consumption of margarine became positively associated after BMI adjustment (HRs across increasing consumption tertiles: 0.93, 1.00 and 1.12; P-trend 0.03). Within consumers, vegetable oil, butter and nuts and seeds were unrelated to T2D.

    CONCLUSIONS:

    Fatty foods were generally not associated with T2D, apart from weak positive association for margarine. The higher risk among nonconsumers of cakes and cookies needs further explanation.

  • 7. Cameron, AJ
    et al.
    Soderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Magliano, DJ
    Comment on 'General and abdominal obesity parameters and their combination in relation to mortality: a systematic review and meta-regression analysis'2014In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 68, no 1, p. 140-140Article in journal (Refereed)
  • 8. Cooper, A. J.
    et al.
    Forouhi, N. G.
    Ye, Z.
    Buijsse, B.
    Arriola, L.
    Balkau, B.
    Barricarte, A.
    Beulens, J. W. J.
    Boeing, H.
    Buchner, F. L.
    Dahm, C. C.
    de Lauzon-Guillain, B.
    Fagherazzi, G.
    Franks, Paul W.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gonzalez, C.
    Grioni, S.
    Kaaks, R.
    Key, T. J.
    Masala, G.
    Navarro, C.
    Nilsson, P.
    Overvad, K.
    Panico, S.
    Ramon Quiros, J.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Roswall, N.
    Sacerdote, C.
    Sanchez, M-J
    Slimani, N.
    Sluijs, I.
    Spijkerman, A. M. W.
    Teucher, B.
    Tjonneland, A.
    Tumino, R.
    Sharp, S. J.
    Langenberg, C.
    Feskens, E. J. M.
    Riboli, E.
    Wareham, N. J.
    Fruit and vegetable intake and type 2 diabetes: EPIC-InterAct prospective study and meta-analysis2012In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 66, no 10, p. 1082-1092Article, review/survey (Refereed)
    Abstract [en]

    Fruit and vegetable intake (FVI) may reduce the risk of type 2 diabetes (T2D), but the epidemiological evidence is inconclusive. The aim of this study is to examine the prospective association of FVI with T2D and conduct an updated meta-analysis. In the European Prospective Investigation into Cancer-InterAct (EPIC-InterAct) prospective case-cohort study nested within eight European countries, a representative sample of 16 154 participants and 12 403 incident cases of T2D were identified from 340 234 individuals with 3.99 million person-years of follow-up. For the meta-analysis we identified prospective studies on FVI and T2D risk by systematic searches of MEDLINE and EMBASE until April 2011. In EPIC-InterAct, estimated FVI by dietary questionnaires varied more than twofold between countries. In adjusted analyses the hazard ratio (95% confidence interval) comparing the highest with lowest quartile of reported intake was 0.90 (0.80-1.01) for FVI; 0.89 (0.76-1.04) for fruit and 0.94 (0.84-1.05) for vegetables. Among FV subtypes, only root vegetables were inversely associated with diabetes 0.87 (0.77-0.99). In meta-analysis using pooled data from five studies including EPIC-InterAct, comparing the highest with lowest category for FVI was associated with a lower relative risk of diabetes (0.93 (0.87-1.00)). Fruit or vegetables separately were not associated with diabetes. Among FV subtypes, only green leafy vegetable (GLV) intake (relative risk: 0.84 (0.74-0.94)) was inversely associated with diabetes. Subtypes of vegetables, such as root vegetables or GLVs may be beneficial for the prevention of diabetes, while total FVI may exert a weaker overall effect.

  • 9. Crowe, F. L.
    et al.
    Key, T. J.
    Appleby, P. N.
    Overvad, K.
    Schmidt, E. B.
    Egeberg, R.
    Tjonneland, A.
    Kaaks, R.
    Teucher, B.
    Boeing, H.
    Weikert, C.
    Trichopoulou, A.
    Ouranos, V.
    Valanou, E.
    Masala, G.
    Sieri, S.
    Panico, S.
    Tumino, R.
    Matullo, G.
    Bueno-de-Mesquita, H. B.
    Boer, J. M. A.
    Beulens, J. W. J.
    van der Schouw, Y. T.
    Quiros, J. R.
    Buckland, G.
    Sanchez, M-J
    Dorronsoro, M.
    Huerta, J. M.
    Moreno-Iribas, C.
    Hedblad, B.
    Jansson, J. H.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Khaw, K-T
    Wareham, N.
    Ferrari, P.
    Illner, A-K
    Chuang, S-C
    Norat, T.
    Danesh, J.
    Riboli, E.
    Dietary fibre intake and ischaemic heart disease mortality: the European Prospective Investigation into Cancer and Nutrition-Heart study2012In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 66, no 8, p. 950-956Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Evidence from prospective studies is consistent in showing an inverse association between dietary fibre intake and risk of ischaemic heart disease (IHD), but whether dietary fibre from various food sources differ in their effect on IHD risk is less clear. The objective of this study was to assess the associations of total and food sources of dietary fibre with IHD mortality in the European Prospective Investigation into Cancer and Nutrition-Heart study. SUBJECTS/METHODS: Participants were 306 331 men and women from eight European countries. Dietary fibre intake was assessed using centre or country-specific diet questionnaires and calibrated using a 24-h diet recall. RESULTS: After an average follow-up of 11.5 years, there were 2381 IHD deaths among participants without cardiovascular disease at baseline. The calibrated intake of dietary fibre was inversely related with IHD mortality; each 10 g/day was associated with a 15% lower risk (relative risk (RR) 0.85; 95% confidence interval (CI): 0.73-0.99, P = 0.031). There was no difference in the associations of the individual food sources of dietary fibre with the risk of IHD mortality; RR for each 5 g/day higher cereal fibre intake was 0.91 (CI: 0.82-1.01), RR for each 2.5 g/day fruit fibre intake was 0.94 (CI: 0.88-1.01) and RR for each 2.5 g/day vegetable fibre intake was 0.90 (95% CI: 0.76-1.07). CONCLUSION: A higher consumption of dietary fibre is associated with a lower risk of fatal IHD with no clear difference in the association with IHD for fibre from cereals, fruits or vegetables.

  • 10. Cust, A E
    et al.
    Skilton, M R
    van Bakel, M M E
    Halkjaer, J
    Olsen, A
    Agnoli, C
    Psaltopoulou, T
    Buurma, E
    Sonestedt, E
    Chirlaque, M D
    Rinaldi, S
    Tjønneland, A
    Jensen, M K
    Clavel-Chapelon, F
    Boutron-Ruault, M C
    Kaaks, R
    Nöthlings, U
    Chloptsios, Y
    Zylis, D
    Mattiello, A
    Caini, S
    Ocké, M C
    van der Schouw, Y T
    Skeie, G
    Parr, C L
    Molina-Montes, E
    Manjer, J
    Johansson, I
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    McTaggart, A
    Key, T J
    Bingham, S
    Riboli, E
    Slimani, N
    Total dietary carbohydrate, sugar, starch and fibre intakes in the European Prospective Investigation into Cancer and Nutrition.2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63 Suppl 4, p. S37-60Article in journal (Refereed)
    Abstract [en]

    Dietary carbohydrate intakes and in particular their food sources varied considerably between these 10 European countries. Intakes also varied according to gender and lifestyle factors. These data will form the basis for future aetiological analyses of the role of dietary carbohydrates in influencing health and disease.

  • 11. Eussen, S J P M
    et al.
    Ueland, P M
    Hiddink, G J
    Schneede, Jörn
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Blom, H J
    Hoefnagels, W H L
    van Staveren, W A
    de Groot, L C P G M
    Changes in markers of cobalamin status after cessation of oral B-vitamin supplements in elderly people with mild cobalamin deficiency2008In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 62, no 10, p. 1248-1251Article in journal (Refereed)
    Abstract [en]

    Mildly cobalamin-deficient elderly were supplemented with 1000 microg cobalamin (group C, n=34), 1000 microg cobalamin with 400 microg folic acid (group CF, n=31) or a placebo (n=30) for 6 months. Participants provided one single blood sample 3, 5 or 7 months after cessation of supplementation to monitor early changes in plasma concentrations of cobalamin, holotranscobalamin (holoTC) and methylmalonic acid (MMA). At the end of supplementation (groups C+CF), one participant met our criteria for mild cobalamin deficiency, as did 13, 14 and 43% of the participants assessed at respectively 3, 5 and 7 months post-supplementation. Cobalamin and holoTC declined on average with 47 and 56% relative to concentrations at the end of supplementation for the group assessed at 7 months post-supplementation. Essentially similar declines were observed for those participants assessed at 3 and 5 months post-supplementation. Mean MMA concentrations increased by 15% (P=0.07) in those participants assessed at 3 and 5 months post-supplementation, and increased by 50% (P=0.002) in those participants assessed at 7 months post-supplementation. Considering MMA as a sensitive tissue marker for cobalamin status, oral supplementation may afford adequate cobalamin status for a period of up to 5 months after cessation in the majority of participants.

  • 12. Ferrari, P
    et al.
    McKay, JD
    Jenab, M
    Brennan, P
    Canzian, F
    Vogel, U
    Tjonneland, A
    Overvad, K
    Tolstrup, JS
    Boutron-Ruault, M-C
    Clavel-Chapelon, F
    Morois, S
    Kaaks, R
    Boeing, H
    Bergmann, M
    Trichopoulou, A
    Katsoulis, M
    Trichopoulos, D
    Krogh, V
    Panico, S
    Sacerdote, C
    Palli, D
    Tumino, R
    Peeters, PH
    van Gils, CH
    Bueno-de-Mesquita, B
    Vrieling, A
    Lund, E
    Hjartaker, A
    Agudo, A
    Suarez, LR
    Arriola, L
    Chirlaque, M-D
    Ardanaz, E
    Sanchez, M-J
    Manjer, J
    Lindkvist, B
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Palmqvist, Richard
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Allen, N
    Key, T
    Khaw, K-T
    Slimani, N
    Rinaldi, S
    Romieu, I
    Boffetta, P
    Romaguera, D
    Norat, T
    Riboli, E
    Alcohol dehydrogenase and aldehyde dehydrogenase gene polymorphisms, alcohol intake and the risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition study2012In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 66, no 12, p. 1303-1308Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Heavy alcohol drinking is a risk factor of colorectal cancer (CRC), but little is known on the effect of polymorphisms in the alcohol-metabolizing enzymes, alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) on the alcohol-related risk of CRC in Caucasian populations.

    SUBJECTS/METHODS: A nested case-control study (1269 cases matched to 2107controls by sex, age, study centre and date of blood collection) was conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC) to evaluate the impact of rs1229984 (ADH1B), rs1573496 (ADH7) and rs441 (ALDH2) polymorphisms on CRC risk. Using the wild-type variant of each polymorphism as reference category, CRC risk estimates were calculated using conditional logistic regression, with adjustment for matching factors.

    RESULTS: Individuals carrying one copy of the rs1229984(A) (ADH1B) allele (fast metabolizers) showed an average daily alcohol intake of 4.3 g per day lower than subjects with two copies of the rs1229984(G) allele (slow metabolizers) (P-diff<0.01). None of the polymorphisms was associated with risk of CRC or cancers of the colon or rectum. Heavy alcohol intake was more strongly associated with CRC risk among carriers of the rs1573496(C) allele, with odds ratio equal to 2.13 (95% confidence interval: 1.26-3.59) compared with wild-type subjects with low alcohol consumption P-((interaction)=0.07).

    CONCLUSIONS: The rs1229984(A) (ADH1B) allele was associated with a reduction in alcohol consumption. The rs1229984 (ADH1B), rs1573496 (ADH7) and rs441 (ALDH2) polymorphisms were not associated with CRC risk overall in Western-European populations. However, the relationship between alcohol and CRC risk might be modulated by the rs1573496 (ADH7) polymorphism. European Journal of Clinical Nutrition (2012) 66, 1303-1308; doi: 10.1038/ejcn.2012.173; published online 14 November 2012

  • 13. Ferrari, P
    et al.
    Roddam, A
    Fahey, M T
    Jenab, M
    Bamia, C
    Ocké, M
    Amiano, P
    Hjartåker, A
    Biessy, C
    Rinaldi, S
    Huybrechts, I
    Tjønneland, A
    Dethlefsen, C
    Niravong, M
    Clavel-Chapelon, F
    Linseisen, J
    Boeing, H
    Oikonomou, E
    Orfanos, P
    Palli, D
    Santucci de Magistris, M
    Bueno-de-Mesquita, H B
    Peeters, P H M
    Parr, C L
    Braaten, T
    Dorronsoro, M
    Berenguer, T
    Gullberg, B
    Johansson, I
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Welch, A A
    Riboli, E
    Bingham, S
    Slimani, N
    A bivariate measurement error model for nitrogen and potassium intakes to evaluate the performance of regression calibration in the European Prospective Investigation into Cancer and Nutrition study.2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63 Suppl 4, no 4, p. S179-87Article in journal (Refereed)
    Abstract [en]

    This study suggests that 24-HDRs can be used as reference measurements at the individual and aggregate levels for potassium intake, whereas, for nitrogen intake, good performance is observed for between-centre calibration, but some limitations are apparent at the individual level.

  • 14.
    Granlund, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Ramnemark, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Andersson, Christer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Fhärm, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Prevalence of vitamin D deficiency and its association with nutrition, travelling and clothing habits in an immigrant population in Northern Sweden2016In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 70, no 3, p. 373-379Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study prevalence and determinants of vitamin D deficiency in immigrants from Africa and the Middle East living in Umeå, Sweden.

    DESIGN: Cross-sectional population based.

    SETTING: Umeå, Sweden (63° N).

    SUBJECTS/METHODS: Immigrants aged 25-65 years from nine countries in Africa or the Middle East (n=1306) were invited. A total of 111 men and 106 women (16.5%) completed the study. S-25-hydroxyvitamin D3 was measured with HPLC. Anthropometry, medical, socioeconomic and lifestyle data were registered.

    RESULTS: Vitamin D status was insufficient or deficient in 73% of the participants. Specifically, 12% had vitamin D deficiency (25(OH)D3<25 nmol/l), and only 3.7% had optimal vitamin D status (25(OH)D3 75-125 nmol/l). Mean 25(OH)D3 level was 41.0 nmol/l (±16.6) with no difference between sexes. Levels of 25(OH)D3 were lower (P=0.030) and vitamin D deficiency was twice as common in immigrants from Africa compared with those from the Middle East. In the multiple regression analysis, vitamin D deficiency was significantly associated with low fatty fish intake (OR 4.31, 95% CI 1.61-11.55), not travelling abroad (OR 3.76, 95% CI 1.18-11.96) and wearing long-sleeved clothes in summer (OR 3.15, 95% CI 1.09-9.12).

    CONCLUSIONS: The majority of immigrants from Africa and the Middle East who live in northern Sweden have vitamin D deficiency or insufficiency. Our results are consistent with sun exposure and a diet with high intake of fatty fish being most important in avoiding vitamin D deficiency.

  • 15.
    Hagfors, Linda
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Westerterp, K
    Sköldstam, L
    Johansson, Gunnar
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Validity of reported energy expenditure and reported intake of energy, protein, sodium and potassium in rheumatoid arthritis patients in a dietary intervention study2005In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 59, no 2, p. 238-245Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of the study was to validate a diet history interview (DHI) method and a 3-day activity registration (AR) with biological markers.

    Subjects and study design: The reported dietary intake of 33 rheumatoid arthritis patients (17 patients on a Mediterranean-type diet and 16 patients on a control diet) participating in a dietary intervention study was assessed using the DHI method. The total energy expenditure (TEE), estimated by a 3-day AR, was used to validate the energy intake (EI). For nine subjects the activity registration was also validated by means of the doubly labelled water (DLW) method. The excretion of nitrogen, sodium and potassium in 24-h urine samples was used to validate the intake of protein, sodium and potassium.

    Results: There was no significant difference between the EI and the TEE estimated by the activity registration or between the intake of protein, sodium and potassium and their respective biological markers. However, in general, the AR underestimated the TEE compared to the DLW method. No significant differences were found between the subjects in the Mediterranean diet group and the control diet group regarding the relationship between the reported intakes and the biological markers.

    Conclusion: The DHI could capture the dietary intake fairly well, and the dietary assessment was not biased by the dietary intervention. The AR showed a bias towards underestimation when compared to the DLW method. This illustrates the importance of valid biological markers.

  • 16.
    Hagfors, Linda
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Westerterp, K.
    Sköldstam, Lars
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Johansson, Gunnar
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Validity of reported energy expenditure and reported intake of energy, protein, sodium and potassium in rheumatoid arthritis patients on a Cretan Mediterranean diet2005In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 59, p. 238-45Article in journal (Refereed)
  • 17. Halkjaer, J
    et al.
    Olsen, A
    Bjerregaard, L J
    Deharveng, G
    Tjønneland, A
    Welch, A A
    Crowe, F L
    Wirfält, E
    Hellström, Veronica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Niravong, M
    Touvier, M
    Linseisen, J
    Steffen, A
    Ocké, M C
    Peeters, P H M
    Chirlaque, M D
    Larrañaga, N
    Ferrari, P
    Contiero, P
    Frasca, G
    Engeset, D
    Lund, E
    Misirli, G
    Kosti, M
    Riboli, E
    Slimani, N
    Bingham, S
    Intake of total, animal and plant proteins, and their food sources in 10 countries in the European prospective investigation into cancer and nutrition2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63 Suppl 4, p. S16-36Article in journal (Refereed)
    Abstract [en]

    This study shows that intake of protein, especially of animal origin, differs across the 10 European countries, and also shows some differences in food sources of protein across Europe.

  • 18.
    Hartini, TNS
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Winkvist, A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lindholm, L
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Persson, V
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Nurdiati, DS
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Surjono, A
    Nutrient intake and iron status of urban and rural poor without access to rice fields are affected by the emerging economic crisis: the case of pregnant Indonesian women2003In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 57, no 5, p. 654-666Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: We evaluated the adequacy of nutrient intake in comparison with the Indonesian Estimated Average Requirement (EARs) among pregnant Indonesian women and explain the short-term effect of economic crisis on nutrient intake and iron status. DESIGN: Cross-sectional study. SETTING: Purworejo District, Central Java, located 60 km west of Yogyakarta Province, Indonesia. SUBJECTS: During the period from 1996 to 1998, up to six 24 h recalls were performed during the second trimester of pregnancy among 450 women. Nutrient intake and iron status was evaluated in relation to date of data collection relative to the economic crisis that emerged in August 1997. A computer program (Inafood) was developed to calculate nutrient intake. RESULTS:: Forty percent of the pregnant women were at risk of inadequate intake of energy and protein, and 70% were at risk of inadequate intake of vitamin A, calcium and iron even before the crisis. Our results also demonstrate an effect of short-term economic crisis on nutrient intake and iron status. When the crisis emerged, urban poor experienced a decrease in intake of most nutrients. During the crisis, rich women experienced a significant decrease in fat (P<0.05). Negative changes in fat density during crisis were experienced by the rich and the rural, poor, and access to rice field subgroups (P<0.01). A significant increase in carbohydrate densities was seen for the rich and rural, poor, and access to rice fields groups (P<0.05). Urban poor experienced decreased serum ferritin concentration (P<0.05), whereas rich women experienced a significant increase (P<0.05). CONCLUSIONS: Urban poor and rural poor landless women were most directly affected by the emerging economic crisis.

  • 19. Heikkila, H. M.
    et al.
    Krachler, Benno
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Savonen, K.
    Hassinen, M.
    Rauramaa, R.
    Schwab, U. S.
    Combined low-saturated fat intake and high fitness may counterbalance diabetogenic effects of obesity: the DR's EXTRA Study2013In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 67, no 9, p. 1000-1002Article in journal (Refereed)
    Abstract [en]

    We report associations of saturated fat (SF) intake with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), concurrent IFG+IGT and type 2 diabetes (T2DM) at different levels of cardiorespiratory fitness and body mass index (BMI). In a population-based sample (n = 1261, age 58-78 years), oral glucose tolerance, 4-day food intake and maximal oxygen uptake were measured. High intake of SF (>11.4 E%) was associated with elevated risk for IFG (4.36; 1.93-9.88), concurrent IFG+IGT (6.03; 1.25-29.20) and T2DM (4.77; 1.93-11.82) in the category of high BMI (>26.5) and high fitness, whereas there was no significantly elevated risk in individuals reporting low intake of SF. Concurrent high BMI and low fitness were associated with elevated risks. In general, SF intake and fitness did not differentiate the risk of abnormal glucose metabolism among subjects with low BMI. Limited intake of SF may protect from diabetogenic effects of adiposity, but only in individuals with high level of fitness.

  • 20. Heikkilä, HM
    et al.
    Schwab, U
    Krachler, Benno
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Männikkö, R
    Rauramaa, R
    Dietary associations with prediabetic states: the DR's EXTRA study (ISRCTN45977199)2012In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 66, no 7, p. 819-824Article in journal (Refereed)
    Abstract [en]

    Background/objectives: Impaired fasting plasma glucose (IFG) and impaired glucose tolerance (IGT) predict development of type 2 diabetes (T2D), but display different pathophysiology for T2D. We studied the association of selected food items and nutrients with IFG, IGT and combined IFG and IGT (IFG+IGT), independent of cardiorespiratory fitness (VO(2max)).

    Subjects/methods: In a population-based sample of 1261 individuals, aged 58-78 years, we identified 126 subjects with IFG, 97 with IGT and 49 with simultaneous IFG and IGT by an oral glucose tolerance test. Dietary intake was assessed by 4-day food records. Cardiorespiratory fitness was assessed by defining maximal oxygen uptake (VO(2max)) from respiratory gas analysis during a maximal symptom-limited exercise stress test on a bicycle ergometer.

    Results: Increased intake of saturated fat was associated with higher odds for IFG (OR 1.07; 1.01-1.14) after adjustment for age, gender, VO(2max) and energy misreporting variable. Consumption of additional whole-grain bread (50 g/1000 kcal) and intake of dietary fiber (g/1000 kcal) were inversely associated with IGT (OR 0.61; 0.41-0.92, OR 0.91; CI 0.85-0.97, respectively).

    Conclusion: Dietary fiber and sources of cereal fiber are negatively associated with IGT, and saturated fat intake is positively associated with IFG, but not with IGT. The present data give practical dietary means at the population level for the elimination of prediabetic conditions. European Journal of Clinical Nutrition advance online publication, 14 March 2012; doi:10.1038/ejcn.2012.23.

  • 21.
    Håglin, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Forsgren, Lars
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Bäckman, L
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Intake of vitamin B before onset of Parkinson's disease and atypical parkinsonism and olfactory function at the time of diagnosis2017In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 71, p. 97-102Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: To investigate whether vitamin-B density in the diet 2-8 years before diagnosis is associated with olfactory function at the time of diagnosis.

    SUBJECTS/METHODS: This prospective nested case-control study included patients with Parkinson's disease (PD), multiple system atrophy and progressive supranuclear paralysis identified between 2004 and 2009 in the county of Västerbotten in northern Sweden. The case database (NYPUM study; Newly Diagnosed Parkinson in Umeå; n=147) was cross-linked to the Northern Sweden Health and Disease Study (NSHDS). Identified patients (n=96) and controls (n=375) were matched for sex, age, year of health survey, sub-cohort and geographical area. Dietary intake was assessed by a food frequency questionnaire, and the brief smell identification test (B-SIT) was used to measure olfactory function at the time of diagnosis.

    RESULTS: There was no difference in vitamin-B or any other macro- or micro-nutrient densities, energy intake or body mass index (kg/m(2); BMI) between patients and controls at baseline at the time of the healthcare survey. A lower thiamin and folate density, amount per 1 megajoule, was reported in patients who scored below median on B-SIT (<7) when compared with that in patients who scored ⩾7 at the time of diagnosis. After adjusting for age, sex and BMI using linear and logistic regressions, an even stronger association was found between thiamin density and olfactory function.

    CONCLUSIONS: A low thiamin and folate density in the reported diet, 2-8 years before PD diagnosis, was significantly associated with olfactory dysfunction at the time of PD diagnosis.European Journal of Clinical Nutrition advance online publication, 5 October 2016; doi:10.1038/ejcn.2016.181.

  • 22. Jenab, M
    et al.
    Salvini, S
    van Gils, C H
    Brustad, M
    Shakya-Shrestha, S
    Buijsse, B
    Verhagen, H
    Touvier, M
    Biessy, C
    Wallström, P
    Bouckaert, K
    Lund, E
    Waaseth, M
    Roswall, N
    Joensen, A M
    Linseisen, J
    Boeing, H
    Vasilopoulou, E
    Dilis, V
    Sieri, S
    Sacerdote, C
    Ferrari, P
    Manjer, J
    Nilsson, S
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Welch, A A
    Travis, R
    Boutron-Ruault, M C
    Niravong, M
    Bueno-de-Mesquita, H B
    van der Schouw, Y T
    Tormo, M J
    Barricarte, A
    Riboli, E
    Bingham, S
    Slimani, N
    Dietary intakes of retinol, beta-carotene, vitamin D and vitamin E in the European prospective investigation into Cancer and nutrition cohort2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63 Suppl 4, p. S150-178Article in journal (Refereed)
    Abstract [en]

    These results show differences by study centre, gender, age and various lifestyle variables in the intake of retinol, beta-carotene, vitamin E and vitamin D between 10 European countries.

  • 23.
    Johansson, Ingegerd
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Johansson, M
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Validity of food frequency questionnaire estimated intakes of folate and other B vitamins in a region without folic acid fortification.2010In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 64, no 8, p. 905-913Article in journal (Refereed)
    Abstract [en]

    Background/Objectives: 

    B vitamins have been implicated in major chronic diseases but results have been inconsistent. This study evaluated the accuracy of dietary intakes of folate, vitamin B12, riboflavin and vitamin B6 as measured by the Northern Sweden Food Frequency Questionnaire (FFQ) against repeated 24-h recalls (24HR) and plasma levels, taking into consideration the MTHFR 677C>T polymorphism.

    Subjects/Methods: 

    B vitamin intakes assessed by a semi-quantitative FFQ designed to measure the intake over the previous year were compared with those from 10 24HR, as well as to plasma levels of folate and vitamin B12, in randomly selected men (n=96) and women (n=99) aged 30–60 years. FFQ-based B-vitamin intakes were also compared with plasma levels of B-vitamins and with MTHFR 677C4T genotype in 878 men, aged 40–61 years.

    Results: 

    Intakes of vitamins B12 and riboflavin were similar, whereas folate and B6 intakes were 16–27% higher, as estimated by FFQ versus 24HR. Spearman correlation coefficients between the two methods ranged from 0.31 to 0.63 (all P0.002), and were lowest for vitamin B12. Intakes estimated by FFQ were correlated with plasma levels, but coefficients were lower (range: 0.13–0.33), particularly for vitamin B12 in men (0.15–0.18). Folate intake was not correlated with plasma levels in subjects with the MTHFR 677 T/T genotype.

    Conclusions: 

    The validity of the Northern Sweden FFQ for assessing B vitamin intake is similar to that of many other FFQs used in large-scale studies. The FFQ is suitable for ranking individuals by intake of folate, riboflavin, vitamin B6 and to a lesser extent vitamin B12.

  • 24.
    Kröger, J
    et al.
    Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany.
    Ferrari, P
    Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France.
    Jenab, M
    Lifestyle and Cancer Group, International Agency for Research on Cancer, Lyon, France.
    Bamia, C
    Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, Medical School, Athens, Greece.
    Touvier, M
    Inserm, ERI 20, Institut Gustave Roussy, Villejuif, France.
    Bueno-de-Mesquita, H B
    National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
    Fahey, M T
    Biostatistics Unit, Medical Research Council and University of Cambridge, Cambridge, UK.
    Benetou, V
    Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, Medical School, Athens, Greece.
    Schulz, M
    Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany.
    Wirfält, E
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Boeing, H
    Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany.
    Hoffmann, K
    Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany.
    Schulze, M B
    Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany.
    Orfanos, P
    Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, Medical School, Athens, Greece.
    Oikonomou, E
    Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, Medical School, Athens, Greece.
    Huybrechts, I
    Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France.
    Rohrmann, S
    Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
    Pischon, T
    Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany.
    Manjer, J
    Department of Surgery, Malmö University Hospital, Malmö, Sweden.
    Ågren, Å
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Navarro, C
    Epidemiology Department, Murcia Health Council, Murcia and CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
    Jakszyn, P
    Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Barcelona, Spain.
    Boutron-Ruault, M C
    Inserm, ERI 20, Institut Gustave Roussy, Villejuif, France.
    Niravong, M
    Inserm, ERI 20, Institut Gustave Roussy, Villejuif, France.
    Khaw, K T
    University of Cambridge School of Clinical Medicine, Addenbrookes Hospital, Cambridge, UK.
    Crowe, F
    Cancer Epidemiology Unit, University of Oxford, Oxford, UK.
    Ocké, M C
    National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
    van der Schouw, Y T
    Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
    Mattiello, A
    Department of Clinical and Experimental Medicine, University of Naples, Federico II, Naples, Italy.
    Bellegotti, M
    Nutritional Epidemiology Unit, Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
    Engeset, D
    Institute of Community Medicine, University of Tromsø, Tromsø, Norway.
    Hjartåker, A
    Cancer Registry of Norway, Oslo, Norway.
    Egeberg, R
    Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
    Overvad, K
    Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
    Riboli, E
    Department of Epidemiology, Public Health and Primary Care, Imperial College, London, UK.
    Bingham, S
    Department of Public Health and Primary Care, MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, University of Cambridge, Cambridge, UK.
    Slimani, N
    Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France.
    Specific food group combinations explaining the variation in intakes of nutrients and other important food components in the European prospective investigation into cancer and nutrition: an application of the reduced rank regression method2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63 Suppl 4, p. S263-S274Article in journal (Refereed)
    Abstract [en]

    A combination of food groups was identified that explained a considerable proportion of the nutrient intake variation in 24-HDRs in every country-specific EPIC population in a similar manner. This indicates that, despite the large variability in food and nutrient intakes reported in the EPIC, the variance of intake of important nutrients is explained, to a large extent, by similar food group combinations across countries.

  • 25. Landberg, R.
    et al.
    Aman, P.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Long-term reproducibility of plasma alkylresorcinols as biomarkers of whole-grain wheat and rye intake within Northern Sweden Health and Disease Study Cohort2013In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 67, no 3, p. 259-263Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OJBECTIVES: Alkylresorcinols (AR) have been suggested as specific biomarkers of whole-grain (WG) and bran intake from wheat and rye. Before using plasma AR as biomarkers in prospective cohort studies, the long-term reproducibility needs to be determined in order to judge how well a single plasma sample reflects the long-term concentration. The objective was therefore to estimate the reproducibility of plasma AR concentrations over 0.1-3.9 years. SUBJECTS/METHODS:The concentrations of AR homologues were analysed in plasma samples, drawn >8 h since last meal, 0.1-3.9 years apart (mean similar to 2 years) in 74 participants in the Swedish prospective Vasterbotten Intervention Project cohort. Reproducibility was estimated by calculating the intra class correlation coefficient (ICC). RESULTS: Fasting plasma AR concentrations were similar between the first and second measurements. The ICC for total AR was 0.54 (95% confidence interval (CI) = 0.38-0.69] overall, 0.34 (95% CI = 0.13-0.64) for men and 0.73 (95% CI = 0.56-0.85) for women, respectively. Somewhat higher ICCs were obtained for shorter AR homologues. CONCLUSION: In summary, the reproducibility of plasma AR over 0.1-3.9 years was high for women and moderate for men within this population. Together with previous data showing high validity of plasma AR as biomarkers of wheat and rye in different populations, the current finding suggest that this biomarker is stable over a long-time period and is therefore probably useful for assessment of long-term WG intake in populations with a wide intake range and a frequent intake.

  • 26. Linseisen, J
    et al.
    Welch, A A
    Ocké, M
    Amiano, P
    Agnoli, C
    Ferrari, P
    Sonestedt, E
    Chajès, V
    Bueno-de-Mesquita, H B
    Kaaks, R
    Weikert, C
    Dorronsoro, M
    Rodríguez, L
    Ermini, I
    Mattiello, A
    van der Schouw, Y T
    Manjer, J
    Nilsson, S
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Jenab, M
    Lund, E
    Brustad, M
    Halkjaer, J
    Jakobsen, M U
    Khaw, K T
    Crowe, F
    Georgila, C
    Misirli, G
    Niravong, M
    Touvier, M
    Bingham, S
    Riboli, E
    Slimani, N
    Dietary fat intake in the European prospective investigation into Cancer and nutrition: results from the 24-h dietary recalls2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63 Suppl 4, p. S61-80Article in journal (Refereed)
    Abstract [en]

    The presented data show differences and similarities in lipid intake across the European EPIC cohorts and also show differences in food sources of dietary lipids.

  • 27. Manousou, S.
    et al.
    Stål, M.
    Larsson, Christel
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition. Department of Food and Nutrition, and Sport Science, University of Gothenburg, Göteborg, Sweden.
    Mellberg, Caroline
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Eggertsen, R.
    Hulthén, L.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ryberg, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Sandberg, Susanne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nyström, H. F.
    A Paleolithic-type diet results in iodine deficiency: a 2-year randomized trial in postmenopausal obese women.2018In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 72, no 1, p. 124-129Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Different diets are used for weight loss. A Paleolithic-type diet (PD) has beneficial metabolic effects, but two of the largest iodine sources, table salt and dairy products, are excluded. The objectives of this study were to compare 24-h urinary iodine concentration (24-UIC) in subjects on PD with 24-UIC in subjects on a diet according to the Nordic Nutrition Recommendations (NNR) and to study if PD results in a higher risk of developing iodine deficiency (ID), than NNR diet.

    SUBJECTS/METHODS: A 2-year prospective randomized trial in a tertiary referral center where healthy postmenopausal overweight or obese women were randomized to either PD (n=35) or NNR diet (n=35). Dietary iodine intake, 24-UIC, 24-h urinary iodine excretion (24-UIE), free thyroxin (FT4), free triiodothyronine (FT3) and thyrotropin (TSH) were measured at baseline, 6 and 24 months. Completeness of urine sampling was monitored by para-aminobenzoic acid and salt intake by urinary sodium.

    RESULTS: At baseline, median 24-UIC (71.0 μg/l) and 24-UIE (134.0 μg/d) were similar in the PD and NNR groups. After 6 months, 24-UIC had decreased to 36.0 μg/l (P=0.001) and 24-UIE to 77.0 μg/d (P=0.001) in the PD group; in the NNR group, levels were unaltered. FT4, TSH and FT3 were similar in both groups, except for FT3 at 6 months being lower in PD than in NNR group.

    CONCLUSIONS: A PD results in a higher risk of developing ID, than a diet according to the NNR. Therefore, we suggest iodine supplementation should be considered when on a PD.

  • 28.
    Mellberg, Caroline
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Sandberg, Susanne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ryberg, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Brage, S
    MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
    Larsson, Christel
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition. Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Long-term effects of a Palaeolithic-type diet in obese postmenopausal women: a 2-year randomized trial2014In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 68, no 3, p. 350-7Article in journal (Refereed)
    Abstract [en]

    Background/Objectives: Short-term studies have suggested beneficial effects of a Palaeolithic-type diet (PD) on body weight and metabolic balance. We now report the long-term effects of a PD on anthropometric measurements and metabolic balance in obese postmenopausal women, in comparison with a diet according to the Nordic Nutrition Recommendations (NNR).

    Subjects/Methods: Seventy obese postmenopausal women (mean age 60 years, body mass index 33 kg/m(2)) were assigned to an ad libitum PD or NNR diet in a 2-year randomized controlled trial. The primary outcome was change in fat mass as measured by dual-energy X-ray absorptiometry.

    Results: Both groups significantly decreased total fat mass at 6 months (-6.5 and-2.6 kg) and 24 months (-4.6 and-2.9 kg), with a more pronounced fat loss in the PD group at 6 months (P<0.001) but not at 24 months (P=0.095). Waist circumference and sagittal diameter also decreased in both the groups, with a more pronounced decrease in the PD group at 6 months (-11.1 vs-5.8 cm, P=0.001 and-3.7 vs-2.0 cm, P<0.001, respectively). Triglyceride levels decreased significantly more at 6 and 24 months in the PD group than in the NNR group (P<0.001 and P=0.004). Nitrogen excretion did not differ between the groups.

    Conclusions: A PD has greater beneficial effects vs an NNR diet regarding fat mass, abdominal obesity and triglyceride levels in obese postmenopausal women; effects not sustained for anthropometric measurements at 24 months. Adherence to protein intake was poor in the PD group. The long-term consequences of these changes remain to be studied.

  • 29.
    Nilsson, Lena Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Winkvist, Anna
    Göteborgs universitet.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lenner, Per
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Low-carbohydrate, high-protein score and mortality in a northern Swedish population2012In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 66, no 6, p. 694-700Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 30. Nöthlings, U
    et al.
    Boeing, H
    Maskarinec, G
    Sluik, D
    Teucher, B
    Kaaks, R
    Tjønneland, A
    Halkjaer, J
    Dethlefsen, C
    Overvad, K
    Amiano, P
    Toledo, E
    Bendinelli, B
    Grioni, S
    Tumino, R
    Sacerdote, C
    Mattiello, A
    Beulens, J W J
    Iestra, J A
    Spijkerman, A M W
    van der A, D L
    Nilsson, P
    Sonestedt, E
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Franks, Paul W
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Vergnaud, A-C
    Romaguera, D
    Norat, T
    Kolonel, L N
    Food intake of individuals with and without diabetes across different countries and ethnic groups.2011In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 65, no 5, p. 635-41Article in journal (Refereed)
    Abstract [en]

    Background/Objectives:Given the importance of nutrition therapy in diabetes management, we hypothesized that food intake differs between individuals with and without diabetes. We investigated this hypothesis in two large prospective studies including different countries and ethnic groups.

    Subjects/Methods:Study populations were the European Prospective Investigation into Cancer and Nutrition Study (EPIC) and the Multiethnic Cohort Study (MEC). Dietary intake was assessed by food frequency questionnaires, and calibrated using 24h-recall information for the EPIC Study. Only confirmed self-reports of diabetes at cohort entry were included: 6192 diabetes patients in EPIC and 13 776 in the MEC. For the cross-sectional comparison of food intake and lifestyle variables at baseline, individuals with and without diabetes were matched 1:1 on sex, age in 5-year categories, body mass index in 2.5 kg/m(2) categories and country.

    Results:Higher intake of soft drinks (by 13 and 44% in the EPIC and MEC), and lower consumption of sweets, juice, wine and beer (>10% difference) were observed in participants with diabetes compared with those without. Consumption of vegetables, fish and meat was slightly higher in individuals with diabetes in both studies, but the differences were <10%. Findings were more consistent across different ethnic groups than countries, but generally showed largely similar patterns.

    Conclusions:Although diabetes patients are expected to undergo nutritional education, we found only small differences in dietary behavior in comparison with cohort members without diabetes. These findings suggest that emphasis on education is needed to improve the current behaviors to assist in the prevention of complications.

  • 31. Ocké, M C
    et al.
    Larrañaga, N
    Grioni, S
    van den Berg, S W
    Ferrari, P
    Salvini, S
    Benetou, V
    Linseisen, J
    Wirfält, E
    Rinaldi, S
    Jenab, M
    Halkjaer, J
    Jakobsen, M U
    Niravong, M
    Clavel-Chapelon, F
    Kaaks, R
    Bergmann, M
    Moutsiou, E
    Trichopoulou, A
    Lauria, C
    Sacerdote, C
    Bueno-de-Mesquita, H B
    Peeters, P H M
    Hjartåker, A
    Parr, C L
    Tormo, M J
    Sanchez, M J
    Manjer, J
    Hellström, Veronica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Mulligan, A
    Spencer, E A
    Riboli, E
    Bingham, S
    Slimani, N
    Energy intake and sources of energy intake in the European prospective investigation into cancer and nutrition2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63 Suppl 4, p. S3-15Article in journal (Refereed)
    Abstract [en]

    These data highlight and quantify the variations and similarities in energy intake and sources of energy intake among 10 European countries. The prevalence of low-energy reporting indicates that the study of energy intake is hampered by the problem of underreporting.

  • 32. Olsen, A
    et al.
    Halkjaer, J
    van Gils, CH
    Buijsse, B
    Verhagen, H
    Jenab, M
    Boutron-Ruault, MC
    Ericson, U
    Ocke, MC
    Peeters, PHM
    Touvier, M
    Niravong, M
    Waaseth, M
    Skeie, G
    Khaw, KT
    Travis, R
    Ferrari, P
    Sanchez, MJ
    Agudo, A
    Overvad, K
    Linseisen, J
    Weikert, C
    Sacerdote, C
    Evangelista, A
    Zylis, D
    Tsiotas, K
    Manjer, J
    van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Riboli, E
    Slimani, N
    Bingham, S
    Dietary intake of the water-soluble vitamins B1, B2, B6, B12 and C in 10 countries in the European Prospective Investigation into Cancer and Nutrition2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63, p. S122-S149Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe the intake of vitamins thiamine (B1), riboflavin (B2), B6 (pyridoxine), B12 (cobalamine) and C (ascorbic acid) and their food sources among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

    Methods: Between 1995 and 2000, 36 034 persons aged between 35 and 74 years were administered a standardized 24-h dietary recall using a computerized interview software programme (EPIC-SOFT). Intakes of the four B vitamins and vitamin C were estimated using the standardized EPIC Nutrient Database (ENDB). Mean intakes were adjusted for age and weighted by season and day of recall.

    Results: Intake of B vitamins did not vary considerably between centres, except in the UK health-conscious cohort, in which substantially higher intakes of thiamine and lower intakes of vitamin B12 were reported compared with other centres. Overall, meat was the most important contributor to the B vitamins in all centres except in the UK health-conscious group. Vitamin C showed a clear geographical gradient, with higher intakes in the southern centres as compared with the northern ones; this was more pronounced in men than in women. Vegetables and fruits were major contributors to vitamin C in all centres, but juices and potatoes were also important sources in the northern centres.

    Conclusions: This study showed no major differences across centres in the mean intakes of B vitamins (thiamine, riboflavin, B6, B12), whereas a tendency towards a north-south gradient was observed for vitamin C.

  • 33. Orfanos, P.
    et al.
    Naska, A.
    Rodrigues, S.
    Lopes, C.
    Freisling, H.
    Rohrmann, S.
    Sieri, S.
    Elmadfa, I.
    Lachat, C.
    Gedrich, K.
    Boeing, H.
    Katzke, V.
    Turrini, A.
    Tumino, R.
    Ricceri, F.
    Mattiello, A.
    Palli, D.
    Ocke, M.
    Engeset, D.
    Oltarzewski, M.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Key, T.
    Trichopoulou, A.
    Eating at restaurants, at work or at home. Is there a difference?: a study among adults of 11 European countries in the context of the HECTOR* project2017In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 71, no 3, p. 407-419Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: To compare macronutrient intakes out of home-by location-to those at home and to investigate differences in total daily intakes between individuals consuming more than half of their daily energy out of home and those eating only at home.

    SUBJECTS/METHODS: Data collected through 24-h recalls or diaries among 23 766 European adults. Participants were grouped as 'non-substantial', 'intermediate' and 'very substantial out-of-home' eaters based on energy intake out of home. Mean macronutrient intakes were estimated at home and out of home (overall, at restaurants, at work). Study/cohort-specific mean differences in total intakes between the 'very substantial out-of-home' and the 'at-home' eaters were estimated through linear regression and pooled estimates were derived.

    RESULTS: At restaurants, men consumed 29% of their energy as fat, 15% as protein, 45% as carbohydrates and 11% as alcohol. Among women, fat contributed 33% of energy intake at restaurants, protein 16%, carbohydrates 45% and alcohol 6%. When eating at work, both sexes reported 30% of energy from fat and 55% from carbohydrates. Intakes at home were higher in fat and lower in carbohydrates and alcohol. Total daily intakes of the 'very substantial out-of-home' eaters were generally similar to those of individuals eating only at home, apart from lower carbohydrate and higher alcohol intakes among individuals eating at restaurants.

    CONCLUSIONS: In a large population of adults from 11 European countries, eating at work was generally similar to eating at home. Alcoholic drinks were the primary contributors of higher daily energy intakes among individuals eating substantially at restaurants.

  • 34. Orfanos, P
    et al.
    Naska, A
    Trichopoulou, A
    Grioni, S
    Boer, JMA
    van Bakel, MME
    Ericson, U
    Rohrmann, S
    Boeing, H
    Rodriguez, L
    Ardanaz, E
    Sacerdote, C
    Giurdanella, MC
    Niekerk, EM
    Peeters, PHM
    Manjer, J
    van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Deharveng, G
    Skeie, G
    Engeset, D
    Halkjaer, J
    Jensen, AM
    McTaggart, A
    Crowe, F
    Stratigakou, V
    Oikonomou, E
    Touvier, M
    Niravong, M
    Riboli, E
    Bingham, S
    Slimani, N
    Eating out of home: energy, macro- and micronutrient intakes in 10 European countries. The European Prospective Investigation into Cancer and Nutrition2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63, p. S239-S262Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess the contribution of out-of-home (OH) energy and nutrient intake to total dietary intake, and to compare out-versus in-home nutrient patterns among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

    Methods: Between 1995 and 2000, 36 034 participants aged between 35-74 years completed a standardized 24-h dietary recall using a software programme (EPIC-Soft) that recorded the place of food/drink consumption. Eating OH was defined as the consumption of foods and beverages anywhere other than in household premises, irrespective of the place of purchase/preparation. Nutrient intakes were estimated using a standardized nutrient database. Mean intakes were adjusted for age and weighted by season and day of recall.

    Results: Among women, OH eating contributed more to total fat intake than to intakes of protein and carbohydrates. Among both genders, and particularly in southern Europe, OH eating contributed more to sugar and starch intakes and less to total fibre intake. The contribution of OH eating was also lower for calcium and vitamin C intakes. The composition of diet at home was different from that consumed out of home in southern countries, but was relatively similar in the north.

    Conclusions: In northern Europe, OH and in-home eating are homogeneous, whereas southern Europeans consider OH eating as a distinctive occasion. In most centres, women selected more fat-rich items when eating out.

  • 35. Rohrmann, S.
    et al.
    Steinbrecher, A.
    Linseisen, J.
    Hermann, S.
    May, A.
    Luan, J.
    Ekelund, U.
    Overvad, K.
    Tjonneland, A.
    Halkjaer, J.
    Fagherazzi, G.
    Boutron-Ruault, M-C
    Clavel-Chapelon, F.
    Agnoli, C.
    Tumino, R.
    Masala, G.
    Mattiello, A.
    Ricceri, F.
    Travier, N.
    Amiano, P.
    Ardanaz, E.
    Chirlaque, M-D
    Sanchez, M-J
    Rodriguez, L.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Hedblad, B.
    Rosvall, M.
    Lund, E.
    Braaten, T.
    Naska, A.
    Orfanos, P.
    Trichopoulou, A.
    van den Berg, S.
    Bueno-de-Mesquita, H. B.
    Bergmann, M. M.
    Steffen, A.
    Kaaks, R.
    Teucher, B.
    Wareham, N. J.
    Khaw, K-T
    Crowe, F. L.
    Illner, A-K
    Slimani, N.
    Gallo, V.
    Mouw, T.
    Norat, T.
    Peeters, P. H. M.
    The association of education with long-term weight change in the EPIC-PANACEA cohort2012In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 66, no 8, p. 957-963Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Cross-sectionally, educational attainment is strongly associated with the prevalence of obesity, but this association is less clear for weight change during adult life. The objective of this study is to examine the association between educational attainment and weight change during adult life in the European Prospective Investigation into Cancer and Nutrition (EPIC). SUBJECTS/METHODS: EPIC is a cohort study with 361 467 participants and up to 10 years of follow-up. Educational attainment was categorized according to the highest obtained school level (primary school or less, vocational secondary training, other secondary education and university). Multivariate mixed-effects linear regression models were used to study education in relation to weight at age 20 years (self-reported), to annual change in weight between age 20 years and measured weight at recruitment, and to annual change in weight during follow-up time. RESULTS: Higher educational attainment was associated with on average a lower body mass index (BMI) at age 20 years and a lower increase in weight up to recruitment (highest vs lowest educational attainment in men: -60 g per year (95% confidence interval (CI) -80; -40), women -110 g per year (95% CI -130; -80)). Although during follow-up after recruitment an increase in body weight was observed in all educational levels, gain was lowest in men and women with a university degree (high vs low education -120 g per year (95% CI -150; -90) and -70 g per year (95% CI -90; -60), respectively). CONCLUSIONS: Existing differences in BMI between higher and lower educated individuals at early adulthood became more pronounced during lifetime, which possibly impacts on obesity-related chronic disease risk in persons with lower educational attainment.

  • 36.
    Sandin, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Annus, T
    Björkstén, B
    Nilsson, L
    Riikjärv, M-A
    van Hage-Hamsten, M
    Bråbäck, L
    Prevalence of self-reported food allergy and IgE antibodies to food allergens in Swedish and Estonian schoolchildren.2005In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 59, no 3, p. 399-403Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare the prevalence of self-reported food allergy and IgE antibodies to food allergens in wheezing and non-wheezing Estonian and Swedish schoolchildren, in the light of the disparities in the standard of living, food consumption and prevalence of respiratory allergies that still exist between Estonia and the Scandinavian countries. DESIGN AND SETTING: As a part of the ISAAC Phase II study, children from a random sample of schools in Tallinn in Estonia and Linköping and Ostersund in Sweden participated in skin prick tests to inhalant allergens and the parents replied to questionnaires. IgE antibodies against a panel of food allergens (egg white, milk, soy bean, fish, wheat and peanut) were taken from children with questionnaire-reported wheezing and a random sample of nonwheezing children. SUBJECTS: Children aged 10-11 y. RESULTS: The prevalence of self-reported food allergy was similar in Estonia and Sweden and about twice as high in wheezing children than in nonwheezing children. In Estonia, however, 3% of the children with perceived food allergy reported reactions from at least four different foods, as compared to 31% in Sweden. The prevalence of sensitisation to food allergens was similar in wheezing and nonwheezing children in Estonia (8%) while, in Swedish children, IgE antibodies to food allergens were more likely among wheezing children (Linköping 38 vs 11%, crude OR 5.1, 95% CI 2.2-11.6, and Ostersund 24 vs 7%, crude OR 4.1, 95% CI 1.9-8.5). CONCLUSION: Our study suggests that IgE-mediated food reactions were less likely in Estonian schoolchildren. Moreover, the perception of food allergy and thereby the meaning of self-reported food allergy appears to be different in the two countries.

  • 37. Sieri, S
    et al.
    Krogh, V
    Saieva, C
    Grobbee, D E
    Bergmann, M
    Rohrmann, S
    Tjønneland, A
    Ferrari, P
    Chloptsios, Y
    Dilis, V
    Jenab, M
    Linseisen, J
    Wallström, P
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Chirlaque, M D
    Sanchez, M J
    Niravong, M
    Clavel-Chapelon, F
    Welch, A A
    Allen, N E
    Bueno-de-Mesquita, H B
    van der Schouw, Y T
    Sacerdote, C
    Panico, S
    Parr, C L
    Braaten, T
    Olsen, A
    Jensen, M K
    Bingham, S
    Riboli, E
    Slimani, N
    Alcohol consumption patterns, diet and body weight in 10 European countries2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63, no Suppl 4, p. S81-S100Article in journal (Refereed)
    Abstract [en]

    Background/objectives: Europe has the highest level of alcohol consumption in the world. As drinking patterns are important determinants of the beneficial and harmful effects of alcohol consumption, we investigated alcohol consumption in relation to nutrient intake, place of consumption, education and body weight in a sample of adults from 10 European countries.

    Methods: A 24-h dietary recall interview was conducted on 13 025 men and 23 009 women, aged 35–74 years, from 27 centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Means and standard errors of alcohol consumption, adjusted for age, were calculated, stratified by gender and centre.

    Results: In many centres, higher level drinkers (males consuming >24 g of ethanol/day, equivalent to >2 standard drinks and females consuming >12 g of ethanol/day equivalent to >1 standard drink) obtained more energy from fat and protein and less from sugar than did abstainers. The proportion of energy from starch tended to be higher for male and lower for female higher level drinkers than for abstainers. Female higher level drinkers had a lower body mass index than did abstainers, whereas male higher level drinkers generally weighed more. Male higher level drinkers were less educated than abstainers in Mediterranean countries, but were more educated elsewhere. Female higher level drinkers were usually more educated than were abstainers. Outside the home, consumption (both genders) tended to be at friends' homes, particularly among men in Northern and Central Europe, and in bars in Spain.

    Conclusions: This study reveals clear geographical differences in drinking habits across Europe, and shows that the characteristics of different alcohol consumption categories also vary.

  • 38. Skeie, G
    et al.
    Braaten, T
    Hjartåker, A
    Lentjes, M
    Amiano, P
    Jakszyn, P
    Pala, V
    Palanca, A
    Niekerk, E M
    Verhagen, H
    Avloniti, K
    Psaltopoulou, T
    Niravong, M
    Touvier, M
    Nimptsch, K
    Haubrock, J
    Walker, L
    Spencer, E A
    Roswall, N
    Olsen, A
    Wallström, P
    Nilsson, S
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Casagrande, C
    Deharveng, G
    Hellström, Veronica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Boutron-Ruault, M-C
    Tjønneland, A
    Joensen, A M
    Clavel-Chapelon, F
    Trichopoulou, A
    Martinez, C
    Rodríguez, L
    Frasca, G
    Sacerdote, C
    Peeters, P H M
    Linseisen, J
    Schienkiewitz, A
    Welch, A A
    Manjer, J
    Ferrari, P
    Riboli, E
    Bingham, S
    Engeset, D
    Lund, E
    Slimani, N
    Use of dietary supplements in the European prospective investigation into Cancer and nutrition calibration study2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63 Suppl 4, p. S226-238Article in journal (Refereed)
    Abstract [en]

    This study indicates that there are wide variations in supplement use in Europe, which may affect individual and population nutrient intakes. The results underline the need to monitor consumption of dietary supplements in Europe, as well as to evaluate the risks and benefits.

  • 39. Slimani, N
    et al.
    Deharveng, G
    Southgate, DAT
    Biessy, C
    Chajes, V
    van Bakel, MME
    Boutron-Ruault, MC
    McTaggart, A
    Grioni, S
    Verkaik-Kloosterman, J
    Huybrechts, I
    Amiano, P
    Jenab, M
    Vignat, J
    Bouckaert, K
    Casagrande, C
    Ferrari, P
    Zourna, P
    Trichopoulou, A
    Wirfalt, E
    Johansson, G
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Rohrmann, S
    Illner, A-K
    Barricarte, A
    Rodriguez, L
    Touvier, M
    Niravong, M
    Mulligan, A
    Crowe, F
    Ocke, MC
    van der Schouw, YT
    Bendinelli, B
    Lauria, C
    Brustad, M
    Hjartaker, A
    Tjonneland, A
    Jensen, AM
    Riboli, E
    Bingham, S
    Contribution of highly industrially processed foods to the nutrient intakes and patterns of middle-aged populations in the European Prospective Investigation into Cancer and Nutrition study2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63, p. S206-S225Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe the contribution of highly processed foods to total diet, nutrient intakes and patterns among 27 redefined centres in the 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).

    Methods: Single 24-hour dietary recalls were collected from 36 034 individuals (aged 35-74 years) using a standardized computerized interview programme (EPIC-SOFT). Centre-specific mean food intakes (g/day) were computed according to their degree of food processing (that is, highly, moderately and non-processed foods) using a specifically designed classification system. The contribution (%) of highly processed foods to the centre mean intakes of diet and 26 nutrients (including energy) was estimated using a standardized nutrient database (ENDB). The effect of different possible confounders was also investigated.

    Results: Highly processed foods were an important source of the nutrients considered, contributing between 61% (Spain) and 78-79% (the Netherlands and Germany) of mean energy intakes. Only two nutrients, beta-carotene (34-46%) and vitamin C (28-36%), had a contribution from highly processed foods below 50% in Nordic countries, in Germany, the Netherlands and the United Kingdom, whereas for the other nutrients, the contribution varied from 50 to 91% (excluding alcohol). In southern countries (Greece, Spain, Italy and France), the overall contribution of highly processed foods to nutrient intakes was lower and consisted largely of staple or basic foods (for example, bread, pasta/rice, milk, vegetable oils), whereas highly processed foods such as crisp bread, breakfast cereals, margarine and other commercial foods contributed more in Nordic and central European centres.

    Conclusions: Highly industrially processed foods dominate diets and nutrient patterns in Nordic and central European countries. The greater variations observed within southern countries may reflect both a larger contribution of non/moderately processed staple foods along with a move from traditional to more industrialized dietary patterns.

  • 40. Sluik, D.
    et al.
    Jankovic, N.
    Hughes, M.
    O'Doherty, M. G.
    Schoettker, B.
    Drygas, W.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Maennistoe, S.
    Ordonez-Mena, J. M.
    Ferrieres, J.
    Bamia, C.
    De Gaetano, G.
    Kiefte-De Jong, J. C.
    Franco, O. H.
    Sluijs, I.
    Spijkerman, A. M. W.
    Sans, S.
    Eriksson, S.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Kromhout, D.
    Trichopoulou, A.
    Wilsgaard, T.
    Brenner, H.
    Kuulasmaa, K.
    Laatikainen, T.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Iacoviello, L.
    Boffetta, P.
    Kee, F.
    Feskens, E. J. M.
    Alcoholic beverage preference and diabetes incidence across Europe: the Consortium on Health and Ageing Network of Cohorts in Europe and the United States (CHANCES) project2017In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 71, no 5, p. 659-668Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: It is unknown if wine, beer and spirit intake lead to a similar association with diabetes. We studied the association between alcoholic beverage preference and type 2 diabetes incidence in persons who reported to consume alcohol. SUBJECTS/METHODS: Ten European cohort studies from the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States were included, comprising participant data of 62 458 adults who reported alcohol consumption at baseline. Diabetes incidence was based on documented and/or self-reported diagnosis during follow-up. Preference was defined when. >= 70% of total alcohol consumed was either beer, wine or spirits. Adjusted hazard ratios (HRs) were computed using Cox proportional hazard regression. Single-cohort HRs were pooled by random-effects meta-analysis. RESULTS: Beer, wine or spirit preference was not related to diabetes risk compared with having no preference. The pooled HRs were HR 1.06 (95% confidence interval (CI) 0.93, 1.20) for beer, HR 0.99 (95% CI 0.88, 1.11) for wine, and HR 1.19 (95% CI 0.97, 1.46) for spirit preference. Absolute wine intake, adjusted for total alcohol, was associated with a lower diabetes risk: pooled HR per 6 g/day was 0.96 (95% CI 0.93, 0.99). A spirit preference was related to a higher diabetes risk in those with a higher body mass index, in men and women separately, but not after excluding persons with prevalent diseases. CONCLUSIONS: This large individual-level meta-analysis among persons who reported alcohol consumption revealed that the preference for beer, wine, and spirits was similarly associated with diabetes incidence compared with having no preference.

  • 41. Song, X.
    et al.
    Jousilahti, P.
    Stehouwer, C. D. A.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
    Onat, A.
    Laatikainen, T.
    Yudkin, J. S.
    Dankner, R.
    Morris, R.
    Tuomilehto, J.
    Qiao, Q.
    Comparison of various surrogate obesity indicators as predictors of cardiovascular mortality in four European populations2013In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 67, no 12, p. 1298-1302Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Body mass index (BMI) is the most commonly used surrogate marker for evaluating the risk of cardiovascular disease (CVD) mortality in relation to general obesity, while abdominal obesity indicators have been proposed to be more informative in risk prediction. SUBJECT/METHODS: A prospective cohort study consisting of 46 651 Europeans aged 24-99 years was conducted to investigate the relationship between CVD mortality and different obesity indicators including BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR). Hazard ratio (HR) was estimated by the Cox proportional hazards model using age as timescale, and compared using paired homogeneity test. RESULTS: During a median follow-up of 7.9 years, 3435 participants died, 1409 from CVD. All obesity indicators were positively associated with increased risk of CVD mortality, with HRs (95% confidence intervals) per standard deviation increase of 1.19 (1.12-1.27) for BMI, 1.29 (1.21-1.37) for WC, 1.28 (1.20-1.36) for WHR, 1.35 (1.27-1.44) for WSR, 1.34 (1.26-1.44) for ABSI and 1.34 (1.25-1.42) for WHHR in men and 1.37 (1.24-1.51), 1.49 (1.34-1.65), 1.45 (1.31-1.60), 1.52 (1.37-1.69), 1.32 (1.18-1.48) and 1.45 (1.31-1.61) in women, respectively. The prediction was stronger with abdominal obesity indicators than with BMI or ABSI (P<0.05 for all paired homogeneity tests). WSR appeared to be the strongest predictor among all the indicators, with a linear relationship with CVD mortality in both men and women. CONCLUSIONS: Abdominal obesity indicators such as WC, WHR, WSR and WHHR, are stronger predictors for CVD mortality than general obesity indicator of BMI.

  • 42. Song, X
    et al.
    Pitkäniemi, J
    Gao, W
    Heine, R J
    Pyörälä, K
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Stehouwer, C D A
    Zethelius, B
    Tuomilehto, J
    Laatikainen, T
    Tabák, A G
    Qiao, Q
    Relationship between body mass index and mortality among Europeans2012In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 66, p. 156-165Article in journal (Refereed)
    Abstract [en]

    Background/Objectives: To investigate the relationship between body mass index (BMI) and mortality from various causes.

    Subjects/Methods: Data of 72 947 European men and 62 798 women aged 24-99 years at baseline were collaboratively analyzed. Both absolute and relative mortality risks were estimated within each BMI categories. The hazard ratio was estimated using Cox regression analysis adjusting for age, cohort and smoking status.

    Results: Over a median follow-up of 16.8 years, 29 071 participants died, 13 502 from cardiovascular disease (CVD) and 8748 from cancers of all types. All-cause and cancer mortality showed a U-shaped relationship: decreased first, leveled off, and then increased with increasing BMI with the lowest mortality risk approximately between 23.0 and 28.0 kg/m(2) of BMI in men and 21.0 and 28.0 kg/m(2) in women. The U-shaped relationship held for all-cause mortality but disappeared for cancer mortality among non-smokers. The CVD mortality was constant until a BMI of approximately 28.0 kg/m(2) and then increased gradually in both men and women, which was independent of age, cohort and smoking status.

    Conclusions: A U-shaped relationship of BMI with all-cause mortality but a graded relationship with CVD mortality at BMI >28.0 kg/m(2) was detected. The relationship between cancer mortality and BMI largely depended on smoking status, and need to be further investigated with site-specific cancers.

  • 43.
    Svensson, Å
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Larsson, C
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Eiben, G
    Lanfer, A
    Pala, V
    Hebestreit, A
    Huybrechts, I
    Fernandez-Alvira, JM
    Russo, P
    Koni, AC
    De Henauw, S
    Veidebaum, T
    Molnar, D
    Lissner, L
    European children's sugar intake on weekdays versus weekends: the IDEFICS study2014In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 68, no 7, p. 822-828Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To compare the intake of total sugars, foods and drinks rich in added sugar, and energy in children on weekdays (Monday Thursday), Fridays and weekends.

    METHODS: Dietary intake (g, kJ, energy %) was assessed using a computerized 24-h recall method in a sample of 2- to 9-year-old children from Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden who were participating in the IDEFICS baseline study (2007-2008). Analyses were performed in 9497 children by selecting one 24-h recall per child (for comparison of weekdays vs weekends, and Fridays vs weekdays and weekends). Selected stratified analyses were performed by country and age group.

    RESULTS: Intake of total sugars exceeded 20 energy % in all countries but one. In the non-stratified analyses, the intakes of total sugars and foods and drinks rich in added sugar were found to be higher on weekends compared with weekdays (both P < 0.001), and intakes on Fridays were a mix between intakes on weekdays and weekends. Energy intake did not differ between weekdays and weekends. Results were somewhat heterogeneous, both across countries and age groups.

    CONCLUSIONS: High intake of sugar remains an important nutritional problem in children of many European countries. Interventions aiming to prevent this diet pattern may optimize their impact by targeting dietary habits on Fridays and weekends. Furthermore, when conducting dietary assessment in children, data from weekends and Fridays in combination with a selection of Mondays to Thursdays are needed to capture habitual sugar intake. Age and dietary cultures should also be considered in dietary intervention and assessment as effect modifications were seen for both age and country.

  • 44. Uijterschout, L
    et al.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Abbink, M
    Berglund, Staffan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    van Veen, I
    Vos, P
    Rövekamp, L
    Boersma, B
    Hudig, C
    Vos, R
    van Goudoever, J B
    Brus, F
    Iron deficiency in the first 6 months of age in infants born between 32 and 37 weeks of gestational age2015In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 69, no 5, p. 598-602Article in journal (Refereed)
    Abstract [en]

    Background/objectives: Preterm infants are at risk of iron deficiency (ID). In the Netherlands, preterm infants born after 32 weeks of gestational age (GA) do not receive iron supplementation on a routine basis. We hypothesized that dietary iron intake in these infants might not be sufficient to meet the high iron requirements during the first 6 months of life.

    Subjects/methods: In a prospective cohort study, we analyzed the prevalence and risk factors of ID in 143 infants born between 32+0 and 36+6 weeks GA who did not receive iron supplementation.Results:ID at the age of 4 and 6 months was present in 27 (18.9%) and 7 (4.9%) infants. Results of a multivariable logistic regression analysis showed that ID was associated with lower birth weight, a shorter duration of formula feeding, more weight gain in the first 6 months of life and lower ferritin concentrations at the age of 1 week.

    Conclusions: Preterm infants born after 32 weeks GA have an increased risk of ID compared with those born at term, supporting the need of iron supplementation. Our results suggests that measurement of ferritin at the age of 1 week might be useful to identify those infants at particular risk and could be used in populations without general supplementation programs. However, the efficacy and safety of individualized iron supplementation, based on ferritin concentrations at the age of 1 week, together with other predictors of ID, needs to be further investigated, preferably in a randomized controlled trial.

  • 45.
    Uijterschout, L.
    et al.
    The Hague, The Netherlands.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Vloemans, J.
    The Hague, The Netherlands.
    Vos, R.
    The Hague, The Netherlands.
    Hudig, C.
    The Hague, The Netherlands.
    Bubbers, S.
    The Hague, The Netherlands.
    Verbruggen, S.
    rotterdam, The Netherlands.
    Veldhorst, M.
    The Netherlands.
    de Leeuw, T.
    Rotterdam, The Netherlands.
    Teunisse, P. P.
    rotterdam, The Netherlands.
    van Goudoever, J. B.
    Amsterdam, The Netherlands.
    Brus, F.
    The Hague, The Netherlands.
    The value of Ret-Hb and sTfR in the diagnosis of iron depletion in healthy, young children2014In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 68, no 8, p. 882-886Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Reticulocyte hemoglobin (Ret-Hb) content and soluble transferrin receptor (sTfR) are described as promising biomarkers in the analysis of iron status. However, the value of Ret-Hb and sTfR in the early detection of iron depletion, as frequently observed in children in high-income countries, is unclear. We hypothesized that young children to iron depletion, using the WHO cutoff of ferritin < 12 mu g/l, would have lower Ret-Hb and higher sTfR concentrations compared to children with a ferritin >= level 12 mu g/l.

    SUBJECTS/METHODS: In this cross-sectional study, we analyzed mean concentrations of Ret-Hb and sTfR in 351 healthy children aged 0.5-3 years in a high-income country. The Student's t-test was used to compare Ret-Hb and sTfR concentrations between groups.

    RESULTS: We showed that concentrations of Ret-Hb and sTfR are similar in children with and without iron depletion. A decrease in Ret-Hb concentration was present only when ferritin concentrations were < 8 mu g/l. sTfR concentrations were similar in children with ferritin concentrations < 6 mu g/l and >= 12 mu g/l.

    CONCLUSIONS: Our results showed that the discriminative value of Ret-Hb and sTfR for the detection of iron depletion is limited. Our findings suggest that ferritin is the most useful biomarker in the screening of iron depletion in healthy children in high-income countries. However, ideally, reference ranges of iron status biomarkers should be based on studies showing that children with concentrations outside reference ranges have poor neurodevelopmental outcomes.

  • 46. van Bakel, M M E
    et al.
    Kaaks, R
    Feskens, E J M
    Rohrmann, S
    Welch, A A
    Pala, V
    Avloniti, K
    van der Schouw, Y T
    van der A, D L
    Du, H
    Halkjaer, J
    Tormo, M J
    Cust, A E
    Brighenti, F
    Beulens, J W
    Ferrari, P
    Biessy, C
    Lentjes, M
    Spencer, E A
    Panico, S
    Masala, G
    Bueno-de-Mesquita, H B
    Peeters, P H M
    Trichopoulou, A
    Psaltopoulou, T
    Clavel-Chapelon, F
    Touvier, M
    Skeie, G
    Rinaldi, S
    Sonestedt, E
    Johansson, I
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Schulze, M
    Ardanaz, E
    Buckland, G
    Tjønneland, A
    Overvad, K
    Bingham, S
    Riboli, E
    Slimani, N
    Dietary glycaemic index and glycaemic load in the European Prospective Investigation into Cancer and Nutrition.2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63 Suppl 4, p. S188-205Article in journal (Refereed)
    Abstract [en]

    GI means varied modestly across countries and genders, whereas GL means varied more, but it may possibly act as a surrogate of carbohydrate intake.

  • 47.
    Vikdahl, M.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Backman, L.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Forsgren, Lars
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Håglin, Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Cardiovascular risk factors and the risk of Parkinson's disease2015In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 69, no 6, p. 729-733Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: The objective of this study was to investigate whether serum triglycerides (S-TG), cholesterol, blood pressure and waist/height ratio are risk factors for Parkinson's disease (PD).

    SUBJECTS AND METHODS: A population-based sample within the Northern Sweden Health and Disease Study (NSHDS) was used in this study (n = 101 790 subjects). Cases with PD were identified prospectively in a community-based study of idiopathic Parkinsonism in the period 2004-2009 in the county of Vasterbotten in northern Sweden. The case database obtained was crosslinked to the NSHDS. Eighty-four of 147 patients with PD had visited the primary health care 2-8 years before diagnosis for participation in the NSHDS. For each case, four referents from the NSHDS population were selected, matched for sex, age, year of health survey, subcohort and geographic area.

    RESULTS: Cases had lower mean S-TG levels (P = 0.007). After stratification for sex, the lower S-TG remained significant for men (P = 0.006) but not for women (P = 0.450), and these were confirmed by the conditional logistic regression for all cases, none adjusted (hazard ratio (HR): 0.65; 95% confidence interval (CI): 0.42, 0.99) and after adjusting for age, body mass index (BMI) and physical activity (HR: 0.61; 95% CI: 0.39, 0.96). Systolic blood pressure (SBP) was negatively associated with PD risk after adjustments for age, BMI and physical activity (HR: 0.98; 95% CI: 0.97-0.99). Smoking and former smoking were associated with a reduced risk for PD.

    CONCLUSIONS: We found lower S-TG and SBP 2-8 years before a diagnosis of PD. Smoking was confirmed to be negatively associated with PD, whereas recreational activity indicates a risk for women.

  • 48. Welch, A A
    et al.
    Fransen, H
    Jenab, M
    Boutron-Ruault, M C
    Tumino, R
    Agnoli, C
    Ericson, U
    Johansson, I
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Ferrari, P
    Engeset, D
    Lund, E
    Lentjes, M
    Key, T
    Touvier, M
    Niravong, M
    Larrañaga, N
    Rodríguez, L
    Ocké, M C
    Peeters, P H M
    Tjønneland, A
    Bjerregaard, L
    Vasilopoulou, E
    Dilis, V
    Linseisen, J
    Nöthlings, U
    Riboli, E
    Slimani, N
    Bingham, S
    Variation in intakes of calcium, phosphorus, magnesium, iron and potassium in 10 countries in the European Prospective Investigation into Cancer and Nutrition study.2009In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 63 Suppl 4, p. S101-21Article in journal (Refereed)
    Abstract [en]

    Intakes of minerals vary substantially throughout Europe, with some geographical variability in their food sources.

  • 49. Zamora-Ros, R.
    et al.
    Knaze, V.
    Lujan-Barroso, L.
    Kuhnle, G. G. C.
    Mulligan, A. A.
    Touillaud, M.
    Slimani, N.
    Romieu, I.
    Powell, N.
    Tumino, R.
    Peeters, P. H. M.
    de Magistris, M. S.
    Ricceri, F.
    Sonestedt, E.
    Drake, I.
    Hjartaker, A.
    Skie, G.
    Mouw, T.
    Wark, P. A.
    Romaguera, D.
    Bueno-de-Mesquita, H. B.
    Ros, M.
    Molina, E.
    Sieri, S.
    Quiros, J. R.
    Huerta, J. M.
    Tjonneland, A.
    Halkjaer, J.
    Masala, G.
    Teucher, B.
    Kaas, R.
    Travis, R. C.
    Dilis, V.
    Benetou, V.
    Trichopoulou, A.
    Amiano, P.
    Ardanaz, E.
    Boeing, H.
    Foerster, J.
    Clavel-Chapelon, F.
    Fagherazzi, G.
    Perquier, F.
    Johansson, Gerd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Cassidy, A.
    Overvad, K.
    Gonzalez, C. A.
    Dietary intakes and food sources of phytoestrogens in the European Prospective Investigation into Cancer and Nutrition (EPIC) 24-hour dietary recall cohort2012In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 66, no 8, p. 932-941Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Phytoestrogens are estradiol-like natural compounds found in plants that have been associated with protective effects against chronic diseases, including some cancers, cardiovascular diseases and osteoporosis. The purpose of this study was to estimate the dietary intake of phytoestrogens, identify their food sources and their association with lifestyle factors in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. SUBJECTS/METHODS: Single 24-hour dietary recalls were collected from 36 037 individuals from 10 European countries, aged 35-74 years using a standardized computerized interview programe (EPIC-Soft). An ad hoc food composition database on phytoestrogens (isoflavones, lignans, coumestans, enterolignans and equol) was compiled using data from available databases, in order to obtain and describe phytoestrogen intakes and their food sources across 27 redefined EPIC centres. RESULTS: Mean total phytoestrogen intake was the highest in the UK health-conscious group (24.9 mg/day in men and 21.1 mg/day in women) whereas lowest in Greece (1.3 mg/day) in men and Spain-Granada (1.0 mg/day) in women. Northern European countries had higher intakes than southern countries. The main phytoestrogen contributors were isoflavones in both UK centres and lignans in the other EPIC cohorts. Age, body mass index, educational level, smoking status and physical activity were related to increased intakes of lignans, enterolignans and equol, but not to total phytoestrogen, isoflavone or coumestan intakes. In the UK cohorts, the major food sources of phytoestrogens were soy products. In the other EPIC cohorts the dietary sources were more distributed, among fruits, vegetables, soy products, cereal products, non-alcoholic and alcoholic beverages. CONCLUSIONS: There was a high variability in the dietary intake of total and phytoestrogen subclasses and their food sources across European regions.

  • 50. Zamora-Ros, R.
    et al.
    Knaze, V.
    Romieu, I.
    Scalbert, A.
    Slimani, N.
    Clavel-Chapelon, F.
    Touillaud, M.
    Perquier, F.
    Skeie, G.
    Engeset, D.
    Weiderpass, E.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Landberg, R.
    Bueno-de-Mesquita, H. B.
    Sieri, S.
    Masala, G.
    Peeters, P. H. M.
    Grote, V.
    Huerta, J. M.
    Barricarte, A.
    Amiano, P.
    Crowe, F. L.
    Molina-Montes, E.
    Khaw, K-T
    Argueelles, M. V.
    Tjonneland, A.
    Halkjaer, J.
    de Magistris, M. S.
    Ricceri, F.
    Tumino, R.
    Wirfaelt, E.
    Ericson, U.
    Overvad, K.
    Trichopoulou, A.
    Dilis, V.
    Vidalis, P.
    Boeing, H.
    Foerster, J.
    Riboli, E.
    Gonzalez, C. A.
    Impact of thearubigins on the estimation of total dietary flavonoids in the European Prospective Investigation into Cancer and Nutrition (EPIC) study2013In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 67, no 7, p. 779-782Article in journal (Refereed)
    Abstract [en]

    Thearubigins (TR) are polymeric flavanol-derived compounds formed during the fermentation of tea leaves. Comprising similar to 70% of total polyphenols in black tea, TR may contribute majorly to its beneficial effects on health. To date, there is no appropriate food composition data on TR, although several studies have used data from the US Department of Agriculture (USDA) database to estimate TR intakes. We aimed to estimate dietary TR in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort and assess the impact of including TR or not in the calculation of the total dietary flavonoid intake. Dietary data were collected using a single standardized 24-h dietary recall interviewer-administered to 36 037 subjects aged 35-74 years. TR intakes were calculated using the USDA database. TR intakes ranged from 0.9 mg/day in men from Navarra and San Sebastian in Spain to 532.5 mg/day in men from UK general population. TR contributed <5% to the total flavonoid intake in Greece, Spain and Italy, whereas in the UK general population, TR comprised 48% of the total flavonoids. High heterogeneity in TR intake across the EPIC countries was observed. This study shows that total flavonoid intake may be greatly influenced by TR, particularly in high black tea-consuming countries. Further research on identification and quantification of TR is needed to get more accurate dietary TR estimations.

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