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  • 1.
    Hagfors, Linda
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    A Mediterranean dietary intervention study of patients with rheumatoid arthritis2005Ingår i: Scandinavian Journal of Nutrition/Næringsforskning, ISSN 1102-6480, E-ISSN 1651-2359, Vol. 49, nr 1, s. 42-Artikel i tidskrift (Övrigt vetenskapligt)
  • 2.
    Hagfors, Linda
    Umeå universitet, Samhällsvetenskaplig fakultet, Kostvetenskap.
    A Mediterranean dietary intervention study of patients with rheumatoid arthritis2003Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Case control studies have shown that a high consumption of fish, olive oil, and cooked vegetables is associated with a decreased risk of developing rheumatoid arthritis (RA). These foods have a central position in the traditional Cretan Mediterranean diet, and it has been suggested that dietary factors contribute to the low prevalence of RA in Mediterranean countries. The overall aim of this thesis was to examine whether a modified Cretan Mediterranean diet can reduce signs and symptoms of RA. This was investigated in a three-month dietary intervention trial in which 51 patients with well controlled, although active RA of at least two years duration took part. A further aim was to study the compliance with the experimental and control diets used in the study, and to validate the diet history interview method used to assess the dietary intake. The validation was carried out by means of biological markers of dietary intake.

    From baseline to the end of the study the group that had adopted the Cretan Mediterranean diet (MD group; n=26) obtained a reduction in disease activity, improved physical function, and improved vitality, while no changes was seen in the control diet group (CD group; n=25).

    According to the dietary assessments, the intake frequencies of antioxidant-rich food items increased in the MD group. This group also had a significantly higher intake of vitamin E, vitamin C and selenium compared to the CD group. Despite the reported increase in the consumption frequencies of antioxidant-rich foods, the plasma levels of carotenoids, vitamin C, lipid adjusted tocopherols, uric acid and urine malondialdehyde, a marker of oxidative stress, were unchanged at the end of the study. The plasma levels of retinol, vitamin C and uric acid were, however, correlated to indices of disease activity. Changes in the reported consumption of food groups with relevance to the fat intake were also observed in the MD group, including an increased intake of fish, shellfish and poultry, and a decreased intake of meat and high fat dairy products. As a result, the total fat intake was lower in the MD group compared to the CD group. Furthermore, in the MD group a slightly higher percentage of the energy intake was derived from polyunsaturated fatty acids and a lower percentage from saturated fatty acids. This group also had a lower ratio of n-6:n-3 fatty acids. A corresponding change in the relation between n-6 and n-3 fatty acids was also observed in s-phospholipids.

    The validation of the diet history interview method showed that the diet history interview could capture the dietary intake fairly well. The validity of the reported dietary intake did not differ between the MD and the CD group, which indicates that the dietary assessment was not biased by the dietary intervention.

  • 3.
    Hagfors, Linda
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Johansson, Gunnar
    Umeå universitet, Humanistiska fakulteten, Konstvetenskap.
    Sköldstam, Lars
    Kretensisk medelhavskost vid reumatoid artrit2004Ingår i: Tidskriften Medikament, Vol. 9, nr 2, s. 56-61Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 4.
    Hagfors, Linda
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Leanderson, P.
    Sköldstam, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Johansson, Gunnar
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Andersson, J.
    Antioxidant intake, plasma antioxidants and oxidative stress in a randomized, controlled, parallel, Mediterranean dietary intervention study on patients with rheumatoid arthritis2003Ingår i: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 2, nr 5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Previously we have reported that patients with rheumatoid arthritis (RA) obtained a significant reduction in disease activity by adopting a Mediterranean-type diet. The present study was carried out to investigate the antioxidant intake, the plasma levels of antioxidants and a marker of oxidative stress (malondialdehyde) during the study presented earlier.

     Methods: RA patients randomized to either a Mediterranean type diet (MD group; n = 26) or a control diet (CD group; n = 25) were compared during a three month dietary intervention study. Their antioxidant intake was assessed by means of diet history interviews and their intake of antioxidant-rich foods by a self-administered questionnaire. The plasma levels of retinol, antioxidants (α- and γ-tocopherol, β-carotene, lycopene, vitamin C and uric acid) and urinary malondialdehyde (MDA), a marker for oxidative stress, were determined using high performance liquid chromatography. The Student's t-test for independent samples and paired samples were used to test differences between and within groups. For variables with skewed distributions Mann-Whitney U-test and Wilcoxon signed ranks test were performed. To evaluate associations between dietary intake of antioxidants, as well as between disease activity, MDA and antioxidants we used Pearson's product moment correlation or Spearman's rank correlation.

    Results: The MD group had significantly higher intake frequencies of antioxidant-rich foods, and also higher intakes of vitamin C (p = 0.014), vitamin E (p = 0.007) and selenium (p = 0.004), and a lower intake of retinol (p = 0.049), compared to the CD group. However, the difference between the groups regarding vitamin C intake was not significant when under- and over-repoters were excluded (p = 0.066). There were no changes in urine MDA or in the plasma levels of antioxidants (after p-lipid adjustments of the tocopherol results), from baseline to the end of the study. The levels of retinol, vitamin C and uric acid were negatively correlated to disease activity variables. No correlation was found between antioxidant intake and the plasma levels of antioxidants.

    Conclusions: Despite an increase in reported consumption of antioxidant-rich foods during the Mediterranean diet intervention, the levels of plasma antioxidants and urine MDA did not change. However, the plasma levels of vitamin C, retinol and uric acid were inversely correlated to variables related to RA disease activity.

  • 5.
    Hagfors, Linda
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Nilsson, I.
    Sköldstam, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Johansson, Gunnar
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Fat intake and composition of fatty acids in serum phospholipids in a randomized, controlled, parallel, Mediterranean dietary intervention study on patients with rheumatoid arthritis2005Ingår i: Nutrition and MetabolismArtikel i tidskrift (Refereegranskat)
  • 6.
    Hagfors, Linda
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Westerterp, K
    Sköldstam, L
    Johansson, Gunnar
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Validity of reported energy expenditure and reported intake of energy, protein, sodium and potassium in rheumatoid arthritis patients in a dietary intervention study2005Ingår i: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 59, nr 2, s. 238-245Artikel i tidskrift (Refereegranskat)
    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.

  • 7.
    Hagfors, Linda
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Westerterp, K.
    Sköldstam, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Johansson, Gunnar
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Validity of reported energy expenditure and reported intake of energy, protein, sodium and potassium in rheumatoid arthritis patients on a Cretan Mediterranean diet2005Ingår i: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 59, s. 238-45Artikel i tidskrift (Refereegranskat)
  • 8.
    Hagfors, Linda
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Westerterp, K
    Sköldstam, Lars
    Johansson, Gunnar
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Validity of the reported energy expenditure and the reported dietary intake of rheumatoid arthritis patients in a dietary intervention study2006Ingår i: Paper presented at Sixth International Conference on Dietary Assessment Methods, Köpenhamn, Danmark 27-29 april 2006, Köpenhamn, Danmark, 2006Konferensbidrag (Refereegranskat)
  • 9.
    Kautto, Ethel
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Rydén, Petra
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Högberg, Lotta
    Carlsson, Annelie
    Hagfors, Linda
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    What happens to food choices when a gluten-free diet is required?: A prospective longitudinal population-based study among Swedish adolescent with coeliac disease and their peers2014Ingår i: Journal of Nutritional Science, ISSN 2048-6790, E-ISSN 2048-6790, Vol. 3, nr e2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A dietary survey was performed during a large screening study in Sweden among 13-year-old adolescents. The aim was to study how the intake of food groups was affected by a screening-detected diagnosis of celiac disease (CD) and its gluten-free (GF) treatment. Food intake, was reported using a food frequency questionnaires (FFQ) and intake reported by the adolescents who was screened to CD was compared with the intake of two same-aged referent groups: i) adolescents diagnosed to CD prior screening and ii) adolescents without CD.. The food intake groups were measured at baseline before the screening-detected cases were aware of their CD, and 12-18 months later.

    The result showed that the food intakes are affected by a screen detected CD and its dietary treatment. Many flour-based foods were reduced such as pizza, fish fingers, and pastries. The result also indicated that the bread intake was lower before the screened diagnosis compared to the other studied groups, but increased afterwards. Specially manufactured GF-products (e.g. pasta and bread) were frequently used in the screened CDgroup after changing to a GF-diet. Our results suggest that changing to a GF-diet reduces the intake of some popular foods, and the ingredients on the plate are altered, but this do not necessarily include a change of food groups. The availability of manufactured GF-replacement products makes it possible for adolescents to keep many of their old food habits when diagnosed with CD in Sweden.

  • 10.
    Ryden, Petra
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Mattsson Sydner, Ylva
    Inst f Hushållsvetenskap, Uppsala Universitet.
    Hagfors, Linda
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Counting the cost of healthy eating: a Swedish comparison of Mediterranean-style and ordinary diets2008Ingår i: International Journal of Consumer Studies, ISSN 1470-6423, E-ISSN 1470-6431, Vol. 32, nr 2, s. 138-146Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this research was to examine the cost of a diet generally regarded as healthy, a Swedish version of the Mediterranean diet, and to compare it with the cost of an ordinary Swedish diet. A total of 30 individuals provided detailed dietary data collected in a randomized intervention study, examining the effect of dietary change to a Mediterranean-style diet in patients with rheumatoid arthritis (Mediterranean group, n = 16, control group, n = 14). The data, covering 1-month dietary intake, were examined with three different diet quality indicators to see whether the Mediterranean group consumed a healthier diet than the control group. All diet quality indicators showed that the Mediterranean group consumed a healthier diet than the control group. Consumer food prices were used to analyse the cost of the different diets. In immediate consumer cost terms, eating a healthier diet was more expensive when differences in energy intake were discounted. However, non-energy adjusted costs showed no significant difference between the groups. Hence, if one of the reasons for choosing a healthier diet is to achieve weight loss – by consuming less energy – it is possible that healthier eating is not more expensive.

  • 11.
    Rydén, Petra
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hagfors, Linda
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Diet cost, diet quality and socio-economic position: how are they related and what contributes to differences in diet costs?2011Ingår i: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 14, nr 9, s. 1680-1692Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To examine diet costs in relation to dietary quality and socio-economic position, and to investigate underlying reasons for differences in diet costs.

    Design: Dietary intake was assessed by a 4 d food diary and evaluated using the 2005 Healthy Eating Index (HEI). National consumer food prices collected by Statistics Sweden and from two online stores/supermarkets were used to estimate diet costs.

    Setting: Sweden.

    Subjects: A nationally representative sample of 2160 children aged 4, 8 or 11 years.

    Results: Higher scores on the HEI resulted in higher diet costs and, conversely, higher diet costs were linked to increased total HEI scores. Children who consumed the most healthy and/or expensive diets ate a more energy-dilute and varied diet compared with those who ate the least healthy and/or least expensive diets. They also consumed more fish, ready meals and fruit. Regression analysis also linked increased food costs to these food groups. There was a positive, but weak, relationship between HEI score and diet cost, parental education and parental occupation respectively.

    Conclusions: Healthy eating is associated with higher diet cost in Swedish children, in part because of price differences between healthy and less-healthy foods. The cheapest and most unhealthy diets were found among those children whose parents were the least educated and had manual, low-skill occupations. Our results pose several challenges for public health policy makers, as well as for nutrition professionals, when forming dietary strategies and providing advice for macro- and microlevels in society.

  • 12.
    Rydén, Petra
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Kautto, Ethel
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Olsson, Cecilia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Högberg, L
    Department of Clinical and Molecular Medicine, Linköping University.
    Carlsson, A
    Department of Pediatrics, Lund University.
    Hagfors, Linda
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    What happens with the healthiness of the diet among Swedish adolescent  boys and girls when a gluten-free diet is required?Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Objectives To explore how diagnosis of celiac disease (CD) in early adolescence affects overall food intake and healthiness of the diet in comparison with age- and sex matched controls and children with CD diagnosed in early childhood.

    Methods This is a longitudinal dietary sub-study of a school-based CD-screening of 12-year-olds (ETICS - Exploring the Iceberg of Coeliacs in Sweden), a part of the PreventCD project. The dietary study was conducted in 2005-2008 and included the following groups resulting from the screening: I) screening-detected CD cases (n=80), II) previously diagnosed CD cases (n=28), and III) two samples of age- and sex matched non-CD children (admission, n=619; follow-up, n=447). All CD cases completed two food-frequency-and-amount-questionnaires (FFQ), covering the previous four weeks; one at admission and one at a follow-up 18-24 months later. The screening-detected CD cases completed the first FFQ before a gluten free diet was initiated. The non-CD children consisted of a cross-sectional sample at each time point, and thus only completed one FFQ each (i.e. either at admission or follow-up). The Goldberg cut-off method was used to validate reported energy intake. The food choices at admission and follow-up were compared among the three groups, and the healthiness of the diet evaluated using two Swedish dietary indexes.

    Results and Conclusion Intakes of most food groups were similar at baseline. The adolescents diagnosed with CD did only minor changes in their overall food choices. Visible changes were reductions within food groups where gluten-free alternatives are not readily available, such as pastries and pizza. In contrast, total intake of bread and pasta did not change. All three groups scored fairly low on the dietary indexes at both time points, and there is an obvious need to improve the healthiness of the adolescent diet, whether CD is present or not.

  • 13. Sköldstam, L
    et al.
    Hagfors, Linda
    Umeå universitet, Samhällsvetenskaplig fakultet, Kostvetenskap.
    Johansson, Gunnar
    Umeå universitet, Samhällsvetenskaplig fakultet, Kostvetenskap.
    Medelhavskost som kompletterande behandling vid reumatoid artrit.2001Ingår i: Annual Meeting of Swedish Society of Medicine, 2001, s. 110:319-320Konferensbidrag (Refereegranskat)
  • 14. Sköldstam, Lars
    et al.
    Brudin, L
    Hagfors, Linda
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Johansson, Gunnar
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Weight reduction is not a major reason for improvement in rheumatoid arthritis from lacto-vegetarian, vegan or Mediterranean diets2005Ingår i: Nutrition Journal, Vol. 4, nr 15Artikel i tidskrift (Refereegranskat)
  • 15. Sköldstam, Lars
    et al.
    Hagfors, Linda
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Johansson, Gunnar
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis2003Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 62, nr 3, s. 208-214Artikel i tidskrift (Refereegranskat)
  • 16. Sköldstam, Lars
    et al.
    Hagfors, Linda
    Umeå universitet, Samhällsvetenskaplig fakultet, Kostvetenskap.
    Johansson, Gunnar
    Umeå universitet, Samhällsvetenskaplig fakultet, Kostvetenskap.
    Reumatoid artrit och kretensisk medelhavskost2002Ingår i: Svensk Rehabilitering, Vol. 2, s. 45-49Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 17.
    Sundström, Björn
    et al.
    Department of Medical Rehabilitation, Gällivare Hospital.
    Stålnacke, K
    Department of Medicine/Rehabilitation, Kiruna Hospital.
    Hagfors, Linda
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Johansson, Gunnar
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Supplementation of Omega-3 fatty acids in patients with ankylosing spondylitis2006Ingår i: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 35, s. 359-362Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To study the effect of supplementation with omega‐3 fatty acids on disease variables and drug consumption in patients with ankylosing spondylitis (AS).

    Methods: Twenty‐four patients were randomized to either a low‐dose (1.95 g omega‐3/day) or a high‐dose (4.55 g omega‐3/day) supplement. Disease activity, functional impairment, erythrocyte sedimentation rate (ESR), and drug consumption were assessed during visits at baseline and at weeks 7, 14, and 21.

    Results: Eighteen patients completed the study, nine patients from each group. The patients in the high‐dose group exhibited a significant decrease in disease activity according to the Bath Ankylosing Disease Activity Index (BASDAI; p = 0.038), which was not seen in the low‐dose group. Significant differences were not found on drug consumption or in functional capacity in either of the groups. No significant differences were found when comparing the results between the high‐ and low‐dose groups.

    Conclusion: Omega‐3 fatty acids in adequate doses may have the capacity to decrease the disease activity of AS. However, larger and better controlled studies are needed before any further conclusions can be made on the extent of this capacity.

    Read More: http://informahealthcare.com/doi/abs/10.1080/03009740600844357

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