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  • 1. Agudo, Antonio
    et al.
    Cayssials, Valerie
    Bonet, Catalina
    Tjønneland, Anne
    Overvad, Kim
    Boutron-Ruault, Marie-Christine
    Affret, Aurélie
    Fagherazzi, Guy
    Katzke, Verena
    Schübel, Ruth
    Trichopoulou, Antonia
    Karakatsani, Anna
    La Vecchia, Carlo
    Palli, Domenico
    Grioni, Sara
    Tumino, Rosario
    Ricceri, Fulvio
    Panico, Salvatore
    Bueno-de-Mesquita, Bas
    Peeters, Petra H.
    Weiderpass, Elisabete
    Skeie, Guri
    Nøst, Theresa H.
    Lasheras, Cristina
    Rodríguez-Barranco, Miguel
    Amiano, Pilar
    Chirlaque, María-Dolores
    Ardanaz, Eva
    Ohlsson, Bodil
    Dias, Joana A.
    Nilsson, Lena M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Myte, Robin
    Khaw, Kay-Tee
    Perez-Cornago, Aurora
    Gunter, Marc
    Huybrechts, Inge
    Cross, Amanda J.
    Tsilidis, Kostas
    Riboli, Elio
    Jakszyn, Paula
    Inflammatory potential of the diet and risk of gastric cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) study2018In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 107, no 4, p. 607-616Article in journal (Refereed)
    Abstract [en]

    Chronic inflammation plays a critical role in the pathogenesis of the 2 major types of gastric cancer. Several foods, nutrients, and nonnutrient food components seem to be involved in the regulation of chronic inflammation. We assessed the association between the inflammatory potential of the diet and the risk of gastric carcinoma, overall and for the 2 major subsites: cardia cancers and noncardia cancers. A total of 476,160 subjects (30% men, 70% women) from the European Investigation into Cancer and Nutrition (EPIC) study were followed for 14 y, during which 913 incident cases of gastric carcinoma were identified, including 236 located in the cardia, 341 in the distal part of the stomach (noncardia), and 336 with overlapping or unknown tumor site. The dietary inflammatory potential was assessed by means of an inflammatory score of the diet (ISD), calculated with the use of 28 dietary components and their corresponding inflammatory scores. The association between the ISD and gastric cancer risk was estimated by HRs and 95% CIs calculated by multivariate Cox regression models adjusted for confounders. The inflammatory potential of the diet was associated with an increased risk of gastric cancer. The HR (95% CI) for each increase in 1 SD of the ISD were 1.25 (1.12, 1.39) for all gastric cancers, 1.30 (1.06, 1.59) for cardia cancers, and 1.07 (0.89, 1.28) for noncardia cancers. The corresponding values for the highest compared with the lowest quartiles of the ISD were 1.66 (1.26, 2.20), 1.94 (1.14, 3.30), and 1.07 (0.70, 1.70), respectively. Our results suggest that low-grade chronic inflammation induced by the diet may be associated with gastric cancer risk. This pattern seems to be more consistent for gastric carcinomas located in the cardia than for those located in the distal stomach. This study is listed on the ISRCTN registry as ISRCTN12136108.

  • 2. Aleksandrova, Krasimira
    et al.
    Bamia, Christina
    Drogan, Dagmar
    Lagiou, Pagona
    Trichopoulou, Antonia
    Jenab, Mazda
    Fedirko, Veronika
    Romieu, Isabelle
    Bueno-de-Mesquita, H. Bas
    Pischon, Tobias
    Tsilidis, Kostas
    Overvad, Kim
    Tjønneland, Anne
    Bouton-Ruault, Marie-Christine
    Dossus, Laure
    Racine, Antoine
    Kaaks, Rudolf
    Kuehn, Tilman
    Tsironis, Christos
    Papatesta, Eleni-Maria
    Saitakis, George
    Palli, Domenico
    Panico, Salvatore
    Grioni, Sara
    Tumino, Rosario
    Vineis, Paolo
    Peeters, Petra H.
    Weiderpass, Elisabete
    Lukic, Marko
    Braaten, Tonje
    Ramon Quiros, J.
    Lujan-Barroso, Leila
    Sanchez, Mara-Jose
    Chilarque, Maria-Dolores
    Ardanas, Eva
    Dorronsoro, Miren
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Wallström, Peter
    Ohlsson, Bodil
    Bradbury, Kathryn E.
    Khaw, Kay-Tee
    Wareham, Nick
    Stepien, Magdalena
    Duarte-Salles, Talita
    Assi, Nada
    Murphy, Neil
    Gunter, Marc J.
    Riboli, Elio
    Boeing, Heiner
    Trichopoulos, Dimitrios
    The association of coffee intake with liver cancer risk is mediated by biomarkers of inflammation and hepatocellular injury: data from the European Prospective Investigation into Cancer and Nutrition2015In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 102, no 6, p. 1498-1508Article in journal (Refereed)
    Abstract [en]

    Background: Higher coffee intake has been purportedly related to a lower risk of liver cancer. However, it remains unclear whether this association may be accounted for by specific biological mechanisms. Objective: We aimed to evaluate the potential mediating roles of inflammatory, metabolic, liver injury, and iron metabolism biomarkers on the association between coffee intake and the primary form of liver cancer-hepatocellular carcinoma (HCC). Design: We conducted a prospective nested case-control study within the European Prospective Investigation into Cancer and Nutrition among 125 incident HCC cases matched to 250 controls using an incidence-density sampling procedure. The association of coffee intake with HCC risk was evaluated by using multivariable-adjusted conditional logistic regression that accounted for smoking, alcohol consumption, hepatitis infection, and other established liver cancer risk factors. The mediating effects of 21 biomarkers were evaluated on the basis of percentage changes and associated 95% CIs in the estimated regression coefficients of models with and without adjustment for biomarkers individually and in combination. Results: The multivariable-adjusted RR of having >= 4 cups (600mL) coffee/d compared with <2 cups (300 mL)/d was 0.25 (95% CI: 0.11, 0.62; P-trend = 0.006). A statistically significant attenuation of the association between coffee intake and HCC risk and thereby suspected mediation was confirmed for the inflammatory biomarker IL-6 and for the biomarkers of hepatocellular injury glutamate dehydrogenase, alanine aminotransferase, aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), and total bilirubin, which-in combination-attenuated the regression coefficients by 72% (95% CI: 7%, 239%). Of the investigated biomarkers, IL-6, AST, and GGT produced the highest change in the regression coefficients: 40%, 56%, and 60%, respectively. Conclusion: These data suggest that the inverse association of coffee intake with HCC risk was partly accounted for by biomarkers of inflammation and hepatocellular injury.

  • 3. Allard, Christina
    et al.
    Axelsson, Per
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Brännlund, Isabelle
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Cocq, Coppélie
    Umeå University, Faculty of Arts, Department of language studies.
    Hjortfors, Lis-Mari
    Umeå University, Faculty of Arts, Department of language studies. Umeå University, Faculty of Arts, Centre for Sami Research.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Ledman, Anna-Lill
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Löf, Annette
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Johansson Lönn, Eva
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Moen, Jon
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    Nordin, Gabriella
    Umeå University, Arctic Research Centre at Umeå University.
    Nordlund, Christer
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Norlin, Björn
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Outakoski, Hanna
    Umeå University, Faculty of Arts, Department of language studies.
    Reimerson, Elsa
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Sandström, Camilla
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Sandström, Moa
    Umeå University, Faculty of Arts, Centre for Sami Research. Umeå University, Faculty of Arts, Department of language studies.
    Sehlin MacNeil, Kristina
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Sköld, Peter
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Stoor, Krister
    Umeå University, Faculty of Arts, Department of language studies.
    Storm Mienna, Christina
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Svonni, Charlotta
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Vinka, Mikael
    Össbo, Åsa
    Umeå University, Faculty of Arts, Department of language studies.
    Rasbiologiskt språkbruk i statens rättsprocess mot sameby2015In: Dagens Nyheter, ISSN 1101-2447Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Statens hantering av forskningsresultat i rättsprocessen med Girjas sameby utgör ett hot mot Sverige som rättsstat och kunskapsnation. Åratal av svensk och internationell forskning underkänns och man använder ett språkbruk som skulle kunna vara hämtat från rasbiologins tid. Nu måste staten ta sitt ansvar och börja agera som en demokratisk rättsstat, skriver 59 forskare.

  • 4. Asli, Lene A.
    et al.
    Braaten, Tonje
    Olsen, Anja
    Tjonneland, Anne
    Overvad, Kim
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Renstrom, Frida
    Umeå University, Faculty of Medicine, Department of Biobank Research. Department of Clinical Sciences, Lund University, Sweden.
    Lund, Eiliv
    Skeie, Guri
    Potato consumption and risk of pancreatic cancer in the HELGA cohort2018In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 119, no 12, p. 1408-1415Article, review/survey (Refereed)
    Abstract [en]

    Potatoes have been a staple food in many countries throughout the years. Potatoes have a high glycaemic index (GI) score, and high GI has been associated with several chronic diseases and cancers. Still, the research on potatoes and health is scarce and contradictive, and we identified no prospective studies that had investigated the association between potatoes as a single food and the risk of pancreatic cancer. The aim of this study was to prospectively investigate the association between potato consumption and pancreatic cancer among 114 240 men and women in the prospective HELGA cohort, using Cox proportional hazard models. Information on diet (validated FFQ's), lifestyle and health was collected by means of a questionnaire, and 221 pancreatic cancer cases were identified through cancer registries. The mean follow-up time was 11.4 (95 % CI 0.3, 169) years. High consumption of potatoes showed a non-significantly higher risk of pancreatic cancer in the adjusted model (hazard ratio (HR) 1.44; 95 % CI 0.93, 2.22, P-for trend 0.030) when comparing the highest v. the lowest quartile of potato consumption. In the sex-specific analyses, significant associations were found for females (HR 2.00; 95 % CI 1.07, 3.72, P-for trend 0.020), but not for males (HR 1.01; 95 % CI 0.56, 1.84, P-for trend 0.34). In addition, we explored the associations by spline regression, and the absence of dose-response effects was confirmed. In this study, high potato consumption was not consistently associated with a higher risk of pancreatic cancer. Further studies with larger populations are needed to explore the possible sex difference.

  • 5. Bamia, C.
    et al.
    Lagiou, P.
    Jenab, M.
    Aleksandrova, K.
    Fedirko, V.
    Trichopoulos, D.
    Overvad, K.
    Tjonneland, A.
    Olsen, A.
    Clavel-Chapelon, F.
    Boutron-Ruault, M-C
    Kvaskoff, M.
    Katzke, V. A.
    Kuehn, T.
    Boeing, H.
    Noethlings, U.
    Palli, D.
    Sieri, S.
    Panico, S.
    Tumino, R.
    Naccarati, A.
    Bueno-de-Mesquita, H. B(As)
    Peeters, P. H. M.
    Weiderpass, E.
    Skeie, G.
    Quiros, J. R.
    Agudo, A.
    Chirlaque, M-D
    Sanchez, M-J
    Ardanaz, E.
    Dorronsoro, M.
    Ericson, U.
    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.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Khaw, K-T
    Wareham, N.
    Key, T. J.
    Travis, R. C.
    Ferrari, P.
    Stepien, M.
    Duarte-Salles, T.
    Norat, T.
    Murphy, N.
    Riboli, E.
    Trichopoulou, A.
    Fruit and vegetable consumption in relation to hepatocellular carcinoma in a multi-centre, European cohort study2015In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 112, no 7, p. 1273-1282Article in journal (Refereed)
    Abstract [en]

    Background:Vegetable and/or fruit intakes in association with hepatocellular carcinoma (HCC) risk have been investigated in case-control studies conducted in specific European countries and cohort studies conducted in Asia, with inconclusive results. No multi-centre European cohort has investigated the indicated associations. Methods: In 486 799 men/women from the European Prospective Investigation into Cancer and nutrition, we identified 201 HCC cases after 11 years median follow-up. We calculated adjusted hazard ratios (HRs) for HCC incidence for sex-specific quintiles and per 100 g d(-1) increments of vegetable/fruit intakes. Results: Higher vegetable intake was associated with a statistically significant, monotonic reduction of HCC risk: HR (100 g d(-1) increment): 0.83; 95% CI: 0.71-0.98. This association was consistent in sensitivity analyses with no apparent heterogeneity across strata of HCC risk factors. Fruit intake was not associated with HCC incidence: HR (100 g d(-1) increment): 1.01; 95% CI: 0.92-1.11. Conclusions: Vegetable, but not fruit, intake is associated with lower HCC risk with no evidence for heterogeneity of this association in strata of important HCC risk factors. Mechanistic studies should clarify pathways underlying this association. Given that HCC prognosis is poor and that vegetables are practically universally accessible, our results may be important, especially for those at high risk for the disease.

  • 6. Bamia, Christina
    et al.
    Lagiou, Pagona
    Jenab, Mazda
    Trichopoulou, Antonia
    Fedirko, Veronika
    Aleksandrova, Krasimira
    Pischon, Tobias
    Overvad, Kim
    Olsen, Anja
    Tjønneland, Anne
    Boutron-Ruault, Marie-Christine
    Fagherazzi, Guy
    Racine, Antoine
    Kuhn, Tilman
    Boeing, Heiner
    Floegel, Anna
    Benetou, Vasiliki
    Palli, Domenico
    Grioni, Sara
    Panico, Salvatore
    Tumino, Rosario
    Vineis, Paolo
    Bueno-de-Mesquita, H B As
    Dik, Vincent K
    Bhoo-Pathy, Nirmala
    Uiterwaal, Cuno S P M
    Weiderpass, Elisabete
    Lund, Eiliv
    Quirós, J Ramón
    Zamora-Ros, Raul
    Molina-Montes, Esther
    Chirlaque, Maria-Dolores
    Ardanaz, Eva
    Dorronsoro, Miren
    Lindkvist, Björn
    Wallström, Peter
    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.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Khaw, Kay-Tee
    Wareham, Nick
    Bradbury, Kathryn E
    Travis, Ruth C
    Ferrari, Pietro
    Duarte-Salles, Talita
    Stepien, Magdalena
    Gunter, Marc
    Murphy, Neil
    Riboli, Elio
    Trichopoulos, Dimitrios
    Coffee, tea and decaffeinated coffee in relation to hepatocellular carcinoma in a European population: multicentre, prospective cohort study2015In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 136, no 8, p. 1899-1908Article in journal (Refereed)
    Abstract [en]

    Inverse associations of coffee and/or tea in relation to hepatocellular carcinoma (HCC) risk have been consistently identified in studies conducted mostly in Asia where consumption patterns of such beverages differ from Europe. In the European Prospective Investigation into Cancer and nutrition (EPIC), we identified 201 HCC cases among 486,799 men/women, after a median follow-up of 11 years. We calculated adjusted hazard ratios (HRs) for HCC incidence in relation to quintiles/categories of coffee/tea intakes. We found that increased coffee and tea intakes were consistently associated with lower HCC risk. The inverse associations were substantial, monotonic and statistically significant. Coffee consumers in the highest compared to the lowest quintile had lower HCC risk by 72% [HR: 0.28; 95% confidence intervals (CIs): 0.16-0.50, p-trend < 0.001]. The corresponding association of tea with HCC risk was 0.41 (95% CI: 0.22-0.78, p-trend = 0.003). There was no compelling evidence of heterogeneity of these associations across strata of important HCC risk factors, including hepatitis B or hepatitis C status (available in a nested case-control study). The inverse, monotonic associations of coffee intake with HCC were apparent for caffeinated (p-trend = 0.009), but not decaffeinated (p-trend = 0.45) coffee for which, however, data were available for a fraction of subjects. Results from this multicentre, European cohort study strengthen the existing evidence regarding the inverse association between coffee/tea and HCC risk. Given the apparent lack of heterogeneity of these associations by HCC risk factors and that coffee/tea are universal exposures, our results could have important implications for high HCC risk subjects.

  • 7. Berendsen, Agnes A M
    et al.
    Kang, Jae H
    van de Rest, Ondine
    Jankovic, Nicole
    Kampman, Ellen
    Kiefte-de Jong, Jessica C
    Franco, Oscar H
    Ikram, M Arfan
    Pikhart, Hynek
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Brenner, Hermann
    Boffetta, Paolo
    Rafnsson, Snorri Bjorn
    Gustafson, Deborah
    Kyrozis, Andreas
    Trichopoulou, Antonia
    Feskens, Edith J M
    Grodstein, Francine
    de Groot, Lisette C P G M
    Association of Adherence to a Healthy Diet with Cognitive Decline in European and American Older Adults: A Meta-Analysis within the CHANCES Consortium2017In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 43, no 3-4, p. 215-227Article in journal (Refereed)
    Abstract [en]

    AIM: To examine the association between a healthy diet, assessed by the Healthy Diet Indicator (HDI), and cognitive decline in older adults. METHODS: Data from 21,837 participants aged ≥55 years from 3 cohorts (Survey in Europe on Nutrition and the Elderly, a Concerted Action [SENECA], Rotterdam Study [RS], Nurses' Health Study [NHS]) were analyzed. HDI scores were based on intakes of saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, fruits and vegetables, and fiber. The Telephone Interview for Cognitive Status in NHS and Mini-Mental State Examination in RS and SENECA were used to assess cognitive function from multiple repeated measures. Using multivariable-adjusted, mixed linear regression, mean differences in annual rates of cognitive decline by HDI quintiles were estimated. RESULTS: Multivariable-adjusted differences in rates in the highest versus the lowest HDI quintile were 0.01 (95% CI -0.01, 0.02) in NHS, 0.00 (95% CI -0.02, 0.01) in RS, and 0.00 (95% CI -0.05, 0.05) in SENECA with a pooled estimate of 0.00 (95% CI -0.01, 0.01), I2 = 0%. CONCLUSIONS: A higher HDI score was not related to reduced rates of cognitive decline in European and American older adults.

  • 8. Bhoo-Pathy, Nirmala
    et al.
    Peeters, Petra H. M.
    Uiterwaal, Cuno S. P. M.
    Bueno-de-Mesquita, H. Bas
    Bulgiba, Awang M.
    Bech, Bodil Hammer
    Overvad, Kim
    Tjønneland, Anne
    Olsen, Anja
    Clavel-Chapelon, Francoise
    Fagherazzi, Guy
    Perquier, Florence
    Teucher, Birgit
    Kaaks, Rudolf
    Schuetze, Madlen
    Boeing, Heiner
    Lagiou, Pagona
    Orfanos, Philippos
    Trichopoulou, Antonia
    Agnoli, Claudia
    Mattiello, Amalia
    Palli, Domenico
    Tumino, Rosario
    Sacerdote, Carlotta
    van Duijnhoven, Franzel J. B.
    Braaten, Tonje
    Lund, Eiliv
    Skeie, Guri
    Redondo, Maria-Luisa
    Buckland, Genevieve
    Sanchez Perez, Maria Jose
    Chirlaque, Maria-Dolores
    Ardanaz, Eva
    Amiano, Pilar
    Wirfalt, Elisabet
    Wallstrom, Peter
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Khaw, Kay-Tee
    Wareham, Nick
    Allen, Naomi E.
    Key, Timothy J.
    Rinaldi, Sabina
    Romieu, Isabelle
    Gallo, Valentina
    Riboli, Elio
    van Gils, Carla H.
    Coffee and tea consumption and risk of pre- and postmenopausal breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study2015In: Breast Cancer Research, ISSN 1465-5411, E-ISSN 1465-542X, Vol. 17, article id 15Article in journal (Refereed)
    Abstract [en]

    Introduction: Specific coffee subtypes and tea may impact risk of pre- and post-menopausal breast cancer differently. We investigated the association between coffee (total, caffeinated, decaffeinated) and tea intake and risk of breast cancer. Methods: A total of 335,060 women participating in the European Prospective Investigation into Nutrition and Cancer (EPIC) Study, completed a dietary questionnaire from 1992 to 2000, and were followed-up until 2010 for incidence of breast cancer. Hazard ratios (HR) of breast cancer by country-specific, as well as cohort-wide categories of beverage intake were estimated. Results: During an average follow-up of 11 years, 1064 premenopausal, and 9134 postmenopausal breast cancers were diagnosed. Caffeinated coffee intake was associated with lower risk of postmenopausal breast cancer: adjusted HR = 0.90, 95% confidence interval (CI): 0.82 to 0.98, for high versus low consumption; P-trend = 0.029. While there was no significant effect modification by hormone receptor status (P = 0.711), linear trend for lower risk of breast cancer with increasing caffeinated coffee intake was clearest for estrogen and progesterone receptor negative (ER-PR-), postmenopausal breast cancer (P = 0.008). For every 100 ml increase in caffeinated coffee intake, the risk of ER-PR- breast cancer was lower by 4% (adjusted HR: 0.96, 95% CI: 0.93 to 1.00). Non-consumers of decaffeinated coffee had lower risk of postmenopausal breast cancer (adjusted HR = 0.89; 95% CI: 0.80 to 0.99) compared to low consumers, without evidence of dose-response relationship (P-trend = 0.128). Exclusive decaffeinated coffee consumption was not related to postmenopausal breast cancer risk, compared to any decaffeinated-low caffeinated intake (adjusted HR = 0.97; 95% CI: 0.82 to 1.14), or to no intake of any coffee (HR: 0.96; 95%: 0.82 to 1.14). Caffeinated and decaffeinated coffee were not associated with premenopausal breast cancer. Tea intake was neither associated with pre- nor post-menopausal breast cancer. Conclusions: Higher caffeinated coffee intake may be associated with lower risk of postmenopausal breast cancer. Decaffeinated coffee intake does not seem to be associated with breast cancer.

  • 9.
    Bodén, Stina
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Andersson, Jonas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Shivappa, Nitin
    Hebert, James R
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Dietary inflammatory index and risk of first myocardial infarction: a prospective population-based study2017In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 16, article id 21Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chronic, low-grade inflammation is an established risk factor for cardiovascular disease. The inflammatory impact of diet can be reflected by concentrations of inflammatory markers in the bloodstream and the inflammatory potential of diet can be estimated by the dietary inflammatory index (DII(TM)), which has been associated with cardiovascular disease risk in some previous studies. We aimed to examine the association between the DII and the risk of first myocardial infarction (MI) in a population-based study with long follow-up.

    METHOD: We conducted a prospective case-control study of 1389 verified cases of first MI and 5555 matched controls nested within the population-based cohorts of the Northern Sweden Health and Disease Study (NSHDS), of which the largest is the ongoing Västerbotten Intervention Programme (VIP) with nearly 100 000 participants during the study period. Median follow-up from recruitment to MI diagnosis was 6.4 years (6.2 for men and 7.2 for women). DII scores were derived from a validated food frequency questionnaire (FFQ) administered in 1986-2006. Multivariable conditional logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI), using quartile 1 (most anti-inflammatory diet) as the reference category. For validation, general linear models were used to estimate the association between the DII scores and two inflammatory markers, high-sensitivity C-reactive protein (hsCRP) and interleukin 6 (IL-6) in a subset (n = 605) of the study population.

    RESULTS: Male participants with the most pro-inflammatory DII scores had an increased risk of MI [ORQ4vsQ1 = 1.57 (95% CI 1.21-2.02) P trend = 0.02], which was essentially unchanged after adjustment for potential confounders, including cardiovascular risk factors [ORQ4vsQ1 = 1.50 (95% CI 1.14-1.99), P trend = 0.10]. No association was found between DII and MI in women. An increase of one DII score unit was associated with 9% higher hsCRP (95% CI 0.03-0.14) and 6% higher IL-6 (95% CI 0.02-0.11) in 605 controls with biomarker data available.

    CONCLUSION: A pro-inflammatory diet was associated with an elevated risk of first myocardial infarction in men; whereas for women the relationship was null. Consideration of the inflammatory impact of diet could improve prevention of cardiovascular disease.

  • 10. Buckland, G
    et al.
    Ros, M M
    Roswall, N
    Bueno-de-Mesquita, H B
    Travier, N
    Tjonneland, A
    Kiemeney, L A
    Sacerdote, C
    Tumino, R
    Ljungberg, Börje
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Gram, I T
    Weiderpass, E
    Skeie, G
    Malm, J
    Ehrnström, R
    Chang-Claude, J
    Mattiello, A
    Agnoli, C
    Peeters, P H
    Boutron-Ruault, M C
    Fagherazzi, G
    Clavel-Chapelon, F
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Amiano, P
    Trichopoulou, A
    Oikonomou, E
    Tsiotas, K
    Sánchez, M J
    Overvad, K
    Quirós, J R
    Chirlaque, M D
    Barricarte, A
    Key, T J
    Allen, N E
    Khaw, K T
    Wareham, N
    Riboli, E
    Kaaks, R
    Boeing, H
    Palli, D
    Romieu, I
    Romaguera, D
    Gonzalez, C A
    Adherence to the Mediterranean diet and risk of bladder cancer in the EPIC cohort study2014In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 134, no 10, p. 2504-2511Article in journal (Refereed)
    Abstract [en]

    There is growing evidence of the protective role of the Mediterranean diet (MD) on cancer. However, to date no epidemiological study has investigated the influence of the MD on bladder cancer. We evaluated the association between adherence to the MD and risk of urothelial cell bladder cancer (UCC), according to tumor aggressiveness, in the European Prospective Investigation into Cancer and Nutrition (EPIC). The analysis included 477,312 participants, recruited from ten European countries between 1991 and 2000. Information from validated dietary questionnaires was used to develop a relative Mediterranean diet score (rMED), including nine dietary components. Cox regression models were used to assess the effect of the rMED on UCC risk, while adjusting for dietary energy and tobacco smoking of any kind. Stratified analyses were performed by sex, BMI, smoking status, European region and age at diagnosis. During an average follow-up of 11 years, 1,425 participants (70.9% male) were diagnosed with a first primary UCC. There was a negative but non-significant association between a high versus low rMED score and risk of UCC overall (HR: 0.84 [95% CI 0.69, 1.03]) and risk of aggressive (HR: 0.88 [95% CI 0.61, 1.28]) and non-aggressive tumors (HR: 0.78 [95% CI 0.54, 1.14]). Although there was no effect modification in the stratified analyses, there was a significant 34% (p = 0.043) decreased risk of UCC in current smokers with a high rMED score. In EPIC, the MD was not significantly associated with risk of UCC, although we cannot exclude that a MD may reduce risk in current smokers.

  • 11. Caini, Saverio
    et al.
    Masala, Giovanna
    Saieva, Calogero
    Kvaskoff, Marina
    Sacerdote, Carlotta
    Savoye, Isabelle
    Hemmingsson, Oskar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Bech, Bodil Hammer
    Overvad, Kim
    Tjonneland, Anne
    Petersen, Kristina E. N.
    Mancini, Francesca Romana
    Boutron-Ruault, Marie-Christine
    Cervenka, Iris
    Kaaks, Rudolf
    Kuehn, Tilman
    Boeing, Heiner
    Floegel, Anna
    Trichopoulou, Antonia
    Valanou, Elisavet
    Kritikou, Maria
    Tagliabue, Giovanna
    Panico, Salvatore
    Tumino, Rosario
    Bueno-de-Mesquita, H. B(as)
    Peeters, Petra H.
    Veierod, Marit B.
    Ghiasvand, Reza
    Lukic, Marko
    Ramon Quiros, Jose
    Chirlaque, Maria-Dolores
    Ardanaz, Eva
    Salamanca Fernandez, Elena
    Larranaga, Nerea
    Zamora-Ros, Raul
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Ljuslinder, Ingrid
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Jirstrom, Karin
    Sonestedt, Emily
    Key, Timothy J.
    Wareham, Nick
    Khaw, Kay-Tee
    Gunter, Marc
    Huybrechts, Inge
    Murphy, Neil
    Tsilidis, Konstantinos K.
    Weiderpass, Elisabete
    Palli, Domenico
    Coffee, tea and melanoma risk: findings from the European Prospective Investigation into Cancer and Nutrition2017In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 140, no 10, p. 2246-2255Article in journal (Refereed)
    Abstract [en]

    What's new? Laboratory studies suggest that coffee and tea protect against melanoma, but epidemiological findings are inconsistent. Here the authors studied more than 400,000 participants within the European Prospective Investigation into Cancer and Nutrition (EPIC) and confirmed an inverse association between caffeinated coffee consumption and melanoma risk. No association was found with decaffeinated coffee or tea. Interestingly, drinking coffee only protected men, but not women, from developing the often fatal skin cancer, raising interesting questions about gender-specific hormones or coffee habits influencing this association. In vitro and animal studies suggest that bioactive constituents of coffee and tea may have anticarcinogenic effects against cutaneous melanoma; however, epidemiological evidence is limited to date. We examined the relationships between coffee (total, caffeinated or decaffeinated) and tea consumption and risk of melanoma in the European Prospective Investigation into Cancer and Nutrition (EPIC). EPIC is a multicentre prospective study that enrolled over 500,000 participants aged 25-70 years from ten European countries in 1992-2000. Information on coffee and tea drinking was collected at baseline using validated country-specific dietary questionnaires. We used adjusted Cox proportional hazards regression models to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for the associations between coffee and tea consumption and melanoma risk. Overall, 2,712 melanoma cases were identified during a median follow-up of 14.9 years among 476,160 study participants. Consumption of caffeinated coffee was inversely associated with melanoma risk among men (HR for highest quartile of consumption vs. non-consumers 0.31, 95% CI 0.14-0.69) but not among women (HR 0.96, 95% CI 0.62-1.47). There were no statistically significant associations between consumption of decaffeinated coffee or tea and the risk of melanoma among both men and women. The consumption of caffeinated coffee was inversely associated with melanoma risk among men in this large cohort study. Further investigations are warranted to confirm our findings and clarify the possible role of caffeine and other coffee compounds in reducing the risk of melanoma.

  • 12.
    Carson, Dean B
    et al.
    Umeå University, Arctic Research Centre at Umeå University.
    Sköld, Peter
    Umeå University, Arctic Research Centre at Umeå University.
    Carson, Doris A.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    The local demography of resource economies: long term implications of natural resource industries for demographic development in sparsely populated areas2016In: Settlements at the edge: remote human settlements in developed nations / [ed] Andrew Taylor, Dean B. Carson, Prescott C. Ensign, Lee Huskey, Rasmus Ole Rasmussen, Gertrude Saxinger, Cheltenham, UK: Edward Elgar Publishing, 2016, p. 357-378Chapter in book (Other academic)
    Abstract [en]

    Settlements at the Edge examines the evolution, characteristics, functions and shifting economic basis of settlements in sparsely populated areas of developed nations. With a focus on demographic change, the book features theoretical and applied cases which explore the interface between demography, economy, well-being and the environment. This book offers a comprehensive and insightful knowledge base for understanding the role of population in shaping the development and histories of northern sparsely populated areas of developed nations including Alaska (USA), Australia, Canada, Greenland, Norway, Russia, Sweden, Finland and other nations with territories within the Arctic Circle.

  • 13. Dik, Vincent K
    et al.
    Bueno-de-Mesquita, H Bas
    Van Oijen, Martijn GH
    Siersema, Peter D
    Uiterwaal, Cuno SPM
    Van Gils, Carla H
    Van Duijnhoven, Fränzel JB
    Cauchi, Stéphane
    Yengo, Loic
    Froguel, Philippe
    Overvad, Kim
    Bech, Bodil H
    Tjønneland, Anne
    Olsen, Anja
    Boutron-Ruault, Marie-Christine
    Racine, Antoine
    Fagherazzi, Guy
    Kühn, Tilman
    Campa, Daniele
    Boeing, Heiner
    Aleksandrova, Krasimira
    Trichopoulou, Antonia
    Peppa, Eleni
    Oikonomou, Eleni
    Palli, Domenico
    Grioni, Sara
    Vineis, Paolo
    Tumino, Rosaria
    Panico, Salvatore
    Peeters, Petra HM
    Weiderpass, Elisabete
    Engeset, Dagrun
    Braaten, Tonje
    Dorronsoro, Miren
    Chirlaque, María-Dolores
    Sánchez, María-José
    Barricarte, Aurelio
    Zamora-Ros, Raul
    Argüelles, Marcial
    Jirström, Karin
    Wallström, Peter
    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.
    Ljuslinder, Ingrid
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Arctic Research Centre at Umeå University.
    Travis, Ruth C
    Khaw, Kay-Tee
    Wareham, Nick
    Freisling, Heinz
    Licaj, Idlir
    Jenab, Mazda
    Gunter, Marc J
    Murphy, Neil
    Romaguera-Bosch, Dora
    Riboli, Elio
    Coffee and tea consumption, genotype based CYP1A2 and NAT2 activity, and colorectal cancer risk: results from the EPIC cohort study2014In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 135, no 2, p. 401-412Article in journal (Refereed)
    Abstract [en]

    Coffee and tea contain numerous antimutagenic and antioxidant components and high levels of caffeine that may protect against colorectal cancer (CRC). We investigated the association between coffee and tea consumption and CRC risk and studied potential effect modification by CYP1A2 and NAT2 genotypes, enzymes involved in the metabolization of caffeine. Data from 477,071 participants (70.2% female) of the European Investigation into Cancer and Nutrition (EPIC) cohort study were analyzed. At baseline (1992-2000) habitual (total, caffeinated and decaffeinated) coffee and tea consumption was assessed with dietary questionnaires. Cox proportional hazards models were used to estimate adjusted hazard ratio's (HR) and 95%-confidence intervals (95%-CI). Potential effect modification by genotype-based CYP1A2 and NAT2 activity was studied in a nested case-control set of 1,252 cases and 2,175 controls. After a median follow-up of 11.6 years, 4,234 participants developed CRC (mean age 64.7±8.3 years). Total coffee consumption (high vs. non/low) was not associated with CRC risk (HR 1.06, 95%-CI 0.95-1.18) or subsite cancers, and no significant associations were found for caffeinated (HR 1.10, 95%-CI 0.97-1.26) and decaffeinated coffee (HR 0.96, 95%-CI 0.84-1.11) and tea (HR 0.97, 95%-CI 0.86-1.09). High coffee and tea consuming subjects with slow CYP1A2 or NAT2 activity had a similar CRC risk compared to non/low coffee and tea consuming subjects with a fast CYP1A2 or NAT2 activity, which suggest that caffeine metabolism does not affect the link between coffee and tea consumption and CRC risk. This study shows that coffee and tea consumption is not likely to be associated with overall CRC.

  • 14. Dik, Vincent K
    et al.
    Murphy, Neil
    Siersema, Peter D
    Fedirko, Veronika
    Jenab, Mazda
    Kong, So Y
    Hansen, Camilla P
    Overvad, Kim
    Tjønneland, Anne
    Olsen, Anja
    Dossus, Laure
    Racine, Antoine
    Bastide, Nadia
    Li, Kuanrong
    Kühn, Tilman
    Boeing, Heiner
    Aleksandrova, Krasimira
    Trichopoulou, Antonia
    Trichopoulos, Dimitrios
    Barbitsioti, Antonia
    Palli, Domenico
    Contiero, Paolo
    Vineis, Paolo
    Tumino, Rosaria
    Panico, Salvatore
    Peeters, Petra H M
    Weiderpass, Elisabete
    Skeie, Guri
    Hjartåker, Anette
    Amiano, Pilar
    Sánchez, María-José
    Fonseca-Nunes, Ana
    Barricarte, Aurelio
    Chirlaque, María-Dolores
    Redondo, Maria-Luisa
    Jirström, Karin
    Manjer, Jonas
    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.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Bradbury, Kathryn E
    Khaw, Kay-Tee
    Wareham, Nicholas
    Cross, Amanda J
    Riboli, Elio
    Bueno-de-Mesquita, H Bas
    Prediagnostic intake of dairy products and dietary calcium and colorectal cancer survival-results from the EPIC Cohort Study2014In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 23, no 9, p. 1813-1823Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We investigated whether prediagnostic reported intake of dairy products and dietary calcium is associated with colorectal cancer survival.

    METHODS: Data from 3,859 subjects with colorectal cancer (42.1% male; mean age at diagnosis, 64.2 ± 8.1 years) in the European Investigation into Cancer and Nutrition cohort were analyzed. Intake of dairy products and dietary calcium was assessed at baseline (1992-2000) using validated, country-specific dietary questionnaires. Multivariable Cox regression models were used to calculate HR and corresponding 95% confidence intervals (CI) for colorectal cancer-specific death (n = 1,028) and all-cause death (n = 1,525) for different quartiles of intake.

    RESULTS: The consumption of total dairy products was not statistically significantly associated with risk of colorectal cancer-specific death (adjusted HR Q4 vs. Q1, 1.17; 95% CI, 0.97-1.43) nor that of all-cause death (Q4 vs. Q1, 1.16; 95% CI, 0.98-1.36). Multivariable-adjusted HRs for colorectal cancer-specific death (Q4 vs. Q1) were 1.21 (95% CI, 0.99-1.48) for milk, 1.09 (95% CI, 0.88-1.34) for yoghurt, and 0.93 (95% CI, 0.76-1.14) for cheese. The intake of dietary calcium was not associated with the risk of colorectal cancer-specific death (adjusted HR Q4 vs. Q1, 1.01; 95% CI, 0.81-1.26) nor that of all-cause death (Q4 vs. Q1, 1.01; 95% CI, 0.84-1.21).

    CONCLUSIONS: The prediagnostic reported intake of dairy products and dietary calcium is not associated with disease-specific or all-cause risk of death in patients diagnosed with colorectal cancer.

    IMPACT: The impact of diet on cancer survival is largely unknown. This study shows that despite its inverse association with colorectal cancer risk, the prediagnostic intake of dairy and dietary calcium does not affect colorectal cancer survival.

  • 15. Dossus, Laure
    et al.
    Franceschi, Silvia
    Biessy, Carine
    Navionis, Anne-Sophie
    Travis, Ruth C
    Weiderpass, Elisabete
    Scalbert, Augustin
    Romieu, Isabelle
    Tjønneland, Anne
    Olsen, Anja
    Overvad, Kim
    Boutron-Ruault, Marie-Christine
    Bonnet, Fabrice
    Fournier, Agnès
    Fortner, Renee T
    Kaaks, Rudolf
    Aleksandrova, Krasimira
    Trichopoulou, Antonia
    La Vecchia, Carlo
    Peppa, Eleni
    Tumino, Rosario
    Panico, Salvatore
    Palli, Domenico
    Agnoli, Claudia
    Vineis, Paolo
    Bueno-de-Mesquita, H B As
    Peeters, Petra H
    Skeie, Guri
    Zamora-Ros, Raul
    Chirlaque, María-Dolores
    Ardanaz, Eva
    Sánchez, Maria-Jose
    Ramón Quirós, Jose
    Dorronsoro, Miren
    Sandström, Maria
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Schmidt, Julie A
    Khaw, Kay-Tee
    Tsilidis, Konstantinos K
    Aune, Dagfinn
    Riboli, Elio
    Rinaldi, Sabina
    Adipokines and inflammation markers and risk of differentiated thyroid carcinoma: The EPIC study2018In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 142, no 7, p. 1332-1342Article in journal (Refereed)
    Abstract [en]

    Other than the influence of ionizing radiation and benign thyroid disease, little is known about the risk factors for differentiated thyroid cancer (TC) which is an increasing common cancer worldwide. Consistent evidence shows that body mass is positively associated with TC risk. As excess weight is a state of chronic inflammation, we investigated the relationship between concentrations of leptin, adiponectin, C-reactive protein, interleukin (IL)-6, IL-10 and tumor necrosis factor (TNF)-α and the risk of TC. A case-control study was nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) study and included 475 first primary incident TC cases (399 women and 76 men) and 1,016 matched cancer-free cohort participants. Biomarkers were measured in serum samples using validated and highly sensitive commercially available immunoassays. Odds ratios (ORs) of TC by levels of each biomarker were estimated using conditional logistic regression models, adjusting for BMI and alcohol consumption. Adiponectin was inversely associated with TC risk among women (ORT3vs.T1  = 0.69, 95% CI: 0.49-0.98, Ptrend  = 0.04) but not among men (ORT3vs.T1  = 1.36, 95% CI: 0.67-2.76, Ptrend  = 0.37). Increasing levels of IL-10 were positively associated with TC risk in both genders and significantly so in women (ORT3vs.T1  = 1.59, 95% CI: 1.13-2.25, Ptrend  = 0.01) but not in men (ORT3vs.T1  = 1.78, 95% CI: 0.80-3.98, Ptrend  = 0.17). Leptin, CRP, IL-6 and TNF-α were not associated with TC risk in either gender. These results indicate a positive association of TC risk with IL-10 and a negative association with adiponectin that is probably restricted to women. Inflammation may play a role in TC in combination with or independently of excess weight.

  • 16.
    Dudarev, Alexey A
    et al.
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Alloyarov, Pavel R
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Chupakhin, Valery S
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Dushkina, Eugenia V
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Sladkova, Yuliya N
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Dorofeyev, Vitaliy M
    Dubna City Hospital, Moscow oblast, Russia.
    Kolesnikova, Tatijana A
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Fridman, Kirill B
    Northwest Public Health Research Center, St. Petersburg, Russia.
    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.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Arctic Research Centre at Umeå University.
    Food and water security issues in Russia I: Food security in the general population of the Russian Arctic, Siberia and the Far East2013In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 72, p. 1-10, article id 21848Article in journal (Refereed)
    Abstract [en]

    Background. Problems related to food security in Russian Arctic (dietary imbalance, predominance ofcarbohydrates, shortage of milk products, vegetables and fruits, deficit of vitamins and microelements,chemical, infectious and parasitic food contamination) have been defined in the literature. But no standardprotocol of food security assessment has been used in the majority of studies.

    Objectives. Our aim was to obtain food security indicators, identified within an Arctic collaboration,for selected regions of the Russian Arctic, Siberia and the Far East, and to compare food safety in theseterritories.

    Study design and methods. In 18 regions of the Russian Arctic, Siberia and the Far East, the followingindicators of food security were analyzed: food costs, food consumption, and chemical and biological foodcontamination for the period 2000-2011.

    Results. Food costs in the regions are high, comprising 2343% of household income. Only 4 out of 10 foodgroups (fish products, cereals, sugar, plant oil) are consumed in sufficient amounts. The consumption of milkproducts, eggs, vegetables, potatoes, fruits (and berries) is severely low in a majority of the selected regions.There are high levels of biological contamination of food in many regions. The biological and chemicalcontamination situation is alarming, especially in Chukotka. Only 7 food pollutants are under regularcontrol; among pesticides, only DDT. Evenki AO and Magadan Oblast have reached peak values in foodcontaminants compared with other regions. Mercury in local fish has not been analyzed in the majority of theregions. In 3 regions, no monitoring of DDToccurs. Aflatoxins have not been analyzed in 5 regions. Nitrateshad the highest percentage in excess of the hygienic threshold in all regions. Excesses of other pollutants indifferent regions were episodic and as a rule not high.

    Conclusion. Improvement of the food supply and food accessibility in the regions of the Russian Arctic,Siberia and the Far East is of utmost importance. Both quantitative and qualitative control of chemical andbiological contaminants in food is insufficient and demands radical enhancement aimed at improving foodsecurity.

  • 17. Dudarev, Alexey
    et al.
    Dorofeyey, Vitaliy
    Dushkina, Eugenia
    Alloyarov, Pavel
    Chupakhin, Valery
    Sladkova, Yuliya
    Kolesnikova, Tatjana
    Fridman, Kirill
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Evengård, Birgitta
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Food and water security issues in Russia III: food- and waterborne diseases in the Russian Arctic, Siberia and the Far East, 2000-20112013In: International Journal of Circumpolar Health, ISSN 2242-3982, E-ISSN 2242-3982, Vol. 72, p. 21856-Article in journal (Refereed)
    Abstract [en]

    Background. The food- and waterborne disease situation in Russia requires special attention. Poor quality of centralized water supplies and sewage systems, biological and chemical contamination of drinking water, as well as contamination of food products, promote widespread infectious diseases, significantly exceeding nationwide rates in the population living in the two-thirds of Russian northern territories.Objectives. The general aim was to assess the levels of food- and waterborne diseases in selected regions of Russian Arctic, Siberia and the Far East (for the period 2000ᅵ2011), and to compare disease levels among regions and with national levels in Russia.Study design and methods. This study is the first comparative assessment of the morbidity in these fields of the population of 18 selected regions of Russian Arctic, Siberia and the Far East, using official statistical sources. The incidences of infectious and parasitic food- and waterborne diseases among the general population (including indigenous peoples) have been analyzed in selected regions (per 100,000 of population, averaged for 2000ᅵ2011).Results. Among compulsory registered infectious and parasitic diseases, there were high rates and widespread incidences in selected regions of shigellosis, yersiniosis, hepatitis A, tularaemia, giardiasis, enterobiasis, ascariasis, diphyllobothriasis, opistorchiasis, echinococcosis and trichinellosis.Conclusion. Incidences of infectious and parasitic food- and waterborne diseases in the general population of selected regions of the Russian Arctic, Siberia and the Far East (2000ᅵ2011) are alarmingly high. Parallel solutions must be on the agenda, including improvement of sanitary conditions of cities and settlements in the regions, modernization of the water supply and of the sewage system. Provision and monitoring of the quality of the drinking water, a reform of the general healthcare system and the epidemiological surveillance (including gender-divided statistics), enhancement of laboratory diagnostics and the introduction of preventive actions are urgently needed.

  • 18. Dudarev, Alexey
    et al.
    Dushkina, Eugenia
    Sladkova, Yuliya
    Alloyarov, Pavel
    Chupakhin, Valeriy
    Dorofeyey, Vitaliy
    Kolesnikova, Tatijana
    Fridman, Kirill
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Arctic Research Centre at Umeå University.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Food and water security issues in Russia II: Water security in general population of Russian Arctic, Siberia and Far East, 2000-20112013In: International Journal of Circumpolar Health, ISSN 2242-3982, E-ISSN 2242-3982, Vol. 72, p. 22646-Article in journal (Refereed)
    Abstract [en]

    Background. Poor state of water supply systems, shortage of water purification facilities and disinfection systems, low quality of drinking water generally in Russia and particularly in the regions of the Russian Arctic, Siberia and Far East have been defined in the literature. However, no standard protocol of water security assessment has been used in the majority of studies.Study design and methods. Uniform water security indicators collected from Russian official statistical sources for the period 2000ᅵ2011 were used for comparison for 18 selected regions in the Russian Arctic, Siberia and Far East. The following indicators of water security were analyzed: water consumption, chemical and biological contamination of water reservoirs of Categories I and II of water sources (centralized ᅵ underground and surface, and non-centralized) and of drinking water.Results. Water consumption in selected regions fluctuated from 125 to 340 L/person/day. Centralized water sources (both underground and surface sources) are highly contaminated by chemicals (up to 40ᅵ80%) and biological agents (up to 55% in some regions), mainly due to surface water sources. Underground water sources show relatively low levels of biological contamination, while chemical contamination is high due to additional water contamination during water treatment and transportation in pipelines. Non-centralized water sources are highly contaminated (both chemically and biologically) in 32ᅵ90% of samples analyzed. Very high levels of chemical contamination of drinking water (up to 51%) were detected in many regions, mainly in the north-western part of the Russian Arctic. Biological contamination of drinking water was generally much lower (2.5ᅵ12%) everywhere except Evenki AO (27%), and general and thermotolerant coliform bacteria predominated in drinking water samples from all regions (up to 17.5 and 12.5%, correspondingly). The presence of other agents was much lower: Coliphages ᅵ 0.2ᅵ2.7%, Clostridia spores, Giardia cysts, pathogenic bacteria, Rotavirus ᅵ up to 0.8%. Of a total of 56 chemical pollutants analyzed in water samples from centralized water supply systems, 32 pollutants were found to be in excess of hygienic limits, with the predominant pollutants being Fe (up to 55%), Cl (up to 57%), Al (up to 43%) and Mn (up to 45%).Conclusion. In 18 selected regions of the Russian Arctic, Siberia and Far East Category I and II water reservoirs, water sources (centralized ᅵ underground, surface; non-centralized) and drinking water are highly contaminated by chemical and biological agents. Full-scale reform of the Russian water industry and water security system is urgently needed, especially in selected regions.

  • 19. Ek, Weronica E.
    et al.
    Tobi, Elmar W.
    Ahsan, Muhammad
    Lampa, Erik
    Ponzi, Erica
    Kyrtopoulos, Soterios A.
    Georgiadis, Panagiotis
    Lumey, L. H.
    Heijmans, Bastiaan T.
    Botsivali, Maria
    Bergdahl, Ingvar A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Karlsson, Torgny
    Rask-Andersen, Mathias
    Palli, Domenico
    Ingelsson, Erik
    Hedman, Åsa K.
    Nilsson, Lena M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Vineis, Paolo
    Lind, Lars
    Flanagan, James M.
    Johansson, Åsa
    Tea and coffee consumption in relation to DNA methylation in four European cohorts2017In: Human Molecular Genetics, ISSN 0964-6906, E-ISSN 1460-2083, Vol. 26, no 16, p. 3221-3231Article in journal (Refereed)
    Abstract [en]

    Lifestyle factors, such as food choices and exposure to chemicals, can alter DNA methylation and lead to changes in gene activity. Two such exposures with pharmacologically active components are coffee and tea consumption. Both coffee and tea has been suggested to play an important role in modulating disease-risk in humans by suppressing tumour progression, decreasing inflammation and influencing estrogen metabolism. These mechanisms may be mediated by changes in DNA methylation.To investigate if DNA methylation in blood is associated with coffee and tea consumption we performed a genome-wide DNA methylation study for coffee and tea consumption in four European cohorts (N = 3,096). DNA methylation was measured from whole blood at 421,695 CpG sites distributed throughout the genome and analysed in men and women both separately and together in each cohort. Meta-analyses of the results and additional regional-level analyses were performed.After adjusting for multiple testing, the meta-analysis revealed that two individual CpG-sites, mapping to DNAJC16 and TTC17, were differentially methylated in relation to tea consumption in women. No individual sites were associated in men or in the sex-combined analysis for tea or coffee. The regional analysis revealed that 28 regions were differentially methylated in relation to tea consumption in women. These regions contained genes known to interact with estradiol metabolism and cancer. No significant regions were found in the sex-combined and male-only analysis for either tea or coffee consumption.

  • 20. Engeset, D.
    et al.
    Skeie, G.
    Olsen, A.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Dietary patterns and whole grain in Scandinavia. The HELGA project2013In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 63, no Supplement 1, p. 341-341Article in journal (Other academic)
    Abstract [en]

    Background and objectives: In the recent years a trendwithin nutrition epidemiology has been to assess overall dietaryquality, often by identifying dietary patterns. The HELGAstudy population is based on samples of existing cohorts fromthe three Scandinavian countries. All three cohorts are part ofthe EPIC study. The aim of this study is to find a typical wholegrain pattern in Scandinavia and see if the pattern is similar inthe three countries.Methods: The associations among the variables were investigatedby factor analysis.Results: Both Norway and Sweden had two breakfast patternsand one dinner pattern. Both the countries had a healthybreakfast pattern including food items commonly consideredhealthy, such as fruit, yoghurt and breakfast cereals. However,coarse bread was the main item in a more traditional pattern for Norway, while it was a part of the healthy pattern inSweden. The second breakfast pattern in Sweden included unhealthyitems like white bread, cakes, sweets, soft drinks andalcohol. The dinner pattern was almost equal in Sweden andNorway. Denmark differed from the other Scandinavian countriesconcerning dietary patterns. Only one breakfast patternwas found. This pattern had some similarities with the traditionalNorwegian pattern, but scored high on all whole grainitems while in Norway only wheat had a high score. Two dinnerpatterns are seen for Denmark, the healthier one includesfruit and vegetables, fish and poultry, the second includes meatand meat products, ice cream and alcohol.Conclusions: When comparing dietary patterns from thethree Scandinavian countries, we find both differences andsimilarities. The main whole grain item used in Norway andSweden seems to be wheat, while rye is more dominant in Denmark.

  • 21. Engeset, Dagrun
    et al.
    Hofoss, Dag
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Olsen, Anja
    Tjønneland, Anne
    Skeie, Guri
    Dietary patterns and whole grain cereals in the Scandinavian countries: differences and similarities. The HELGA project2015In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, no 5, p. 905-915Article in journal (Refereed)
    Abstract [en]

    Objective: To identify dietary patterns with whole grains as a main focus to see if there is a similar whole grain pattern in the three Scandinavian countries; Denmark, Sweden and Norway. Another objective is to see if items suggested for a Nordic Food Index will form a typical Nordic pattern when using factor analysis. Setting: The HELGA study population is based on samples of existing cohorts: the Norwegian Women and Cancer Study, the Swedish Vasterbotten cohort and the Danish Diet, Cancer and Health study. The HELGA study aims to generate knowledge about the health effects of whole grain foods. Subjects: The study included a total of 119 913 participants. Design: The associations among food variables from FFQ were investigated by principal component analysis. Only food groups common for all three cohorts were included. High factor loading of a food item shows high correlation of the item to the specific diet pattern. Results: The main whole grain for Denmark and Sweden was rye, while Norway had highest consumption of wheat. Three similar patterns were found: a cereal pattern, a meat pattern and a bread pattern. However, even if the patterns look similar, the food items belonging to the patterns differ between countries. Conclusions: High loadings on breakfast cereals and whole grain oat were common in the cereal patterns for all three countries. Thus, the cereal pattern may be considered a common Scandinavian whole grain pattern. Food items belonging to a Nordic Food Index were distributed between different patterns.

  • 22.
    Evengård, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Arctic Research Centre at Umeå University.
    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.
    Destouni, Gia
    Stockholms universitet.
    Säker tillgång till mat och vatten prioriterad fråga för Arktis2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 05, p. CCF7-Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Arktis befinner sig i förändring. Dessa förändringar beror på mänskliga aktiviteter i regionen och på den globala klimatförändringen, som märks först och mest i norr till exempel där den sibiriska tundran övergår i gräsbevuxen terräng. Djur och människor som bor i den här delen av världen är redan påverkade av förändringarna och kommer att förbli så under lång tid framöver. Ursprungsbefolkningar runt om i Arktis samlar sig i protester, nu senast i Kanada. De många ursprungsbefolkningarna i Arktis lever ofta nära naturen och är därför mer sårbara än andra, men även samhällen med god infrastruktur påverkas av miljöförändringar. I Sverige märkte vi nyligen detta, när närmare 100 000 personer i Östersund och Skellefteå med omgivningar vintern 2010–2011 fick koka sitt vatten under månader på grund av att en parasit (Cryptosporidium) kom in i vattnet. Olika slags system behöver kontrolleras regelbundet, så att säkra datatolkningar kan ges till beslutsfattare, för att vidta åtgärder i tid för ökad säkerhet.

  • 23. Gunter, Marc J.
    et al.
    Murphy, Neil
    Cross, Amanda J..
    Dossus, Laure
    Dartois, Laureen
    Fagherazzi, Guy
    Kaaks, Rudolf
    Kühn, Tilman
    Boeing, Heiner
    Aleksandrova, Krasimira
    Tjønneland, Anne
    Olsen, Anja
    Overvad, Kim
    Larsen, Sofus Christian
    Redondo Cornejo, Maria Luisa
    Agudo, Antonio
    Sánchez Pérez, María José
    Altzibar, Jone M.
    Navarro, Carmen
    Ardanaz, Eva
    Khaw, Kay-Tee
    Butterworth, Adam
    Bradbury, Kathryn E.
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Palli, Domenico
    Grioni, Sara
    Vineis, Paolo
    Panico, Salvatore
    Tumino, Rosario
    Bueno-de-Mesquita, Bas
    Siersema, Peter
    Leenders, Max
    Beulens, Joline W. J.
    Uiterwaal, Cuno U.
    Wallström, Peter
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Landberg, Rikard
    Weiderpass, Elisabete
    Skeie, Guri
    Braaten, Tonje
    Brennan, Paul
    Licaj, Idlir
    Muller, David C.
    Sinha, Rashmi
    Wareham, Nick
    Riboli, Elio
    Coffee Drinking and Mortality in 10 European Countries: A Multinational Cohort Study2017In: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 167, no 4, p. 236-247Article in journal (Refereed)
    Abstract [en]

    Background: The relationship between coffee consumption and mortality in diverse European populations with variable coffee preparation methods is unclear.

    Objective: To examine whether coffee consumption is associated with all-cause and cause-specific mortality.

    Design: Prospective cohort study.

    Setting: 10 European countries.

    Participants: 521 330 persons enrolled in EPIC (European Prospective Investigation into Cancer and Nutrition).

    Measurements: Hazard ratios (HRs) and 95% CIs estimated using multivariable Cox proportional hazards models. The association of coffee consumption with serum biomarkers of liver function, inflammation, and metabolic health was evaluated in the EPIC Biomarkers subcohort (n = 14 800).

    Results: During a mean follow-up of 16.4 years, 41 693 deaths occurred. Compared with nonconsumers, participants in the highest quartile of coffee consumption had statistically significantly lower all-cause mortality (men: HR, 0.88 [95% CI, 0.82 to 0.95]; P for trend < 0.001; women: HR, 0.93 [CI, 0.87 to 0.98]; P for trend = 0.009). Inverse associations were also observed for digestive disease mortality for men (HR, 0.41 [CI, 0.32 to 0.54]; P for trend < 0.001) and women (HR, 0.60 [CI, 0.46 to 0.78]; P for trend < 0.001). Among women, there was a statistically significant inverse association of coffee drinking with circulatory disease mortality (HR, 0.78 [CI, 0.68 to 0.90]; P for trend < 0.001) and cerebrovascular disease mortality (HR, 0.70 [CI, 0.55 to 0.90]; P for trend = 0.002) and a positive association with ovarian cancer mortality (HR, 1.31 [CI, 1.07 to 1.61]; P for trend = 0.015). In the EPIC Biomarkers subcohort, higher coffee consumption was associated with lower serum alkaline phosphatase; alanine aminotransferase; aspartate aminotransferase; γ-glutamyltransferase; and, in women, C-reactive protein, lipoprotein(a), and glycated hemoglobin levels.

    Limitations: Reverse causality may have biased the findings; however, results did not differ after exclusion of participants who died within 8 years of baseline. Coffee-drinking habits were assessed only once.

    Conclusion: Coffee drinking was associated with reduced risk for death from various causes. This relationship did not vary by country.

    Primary Funding Source: European Commission Directorate-General for Health and Consumers and International Agency for Research on Cancer.

  • 24.
    Johansson, Ingegerd
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Stegmayr, Birgitta
    The National Board of Welfare, Stockholm, Sweden .
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Medicine, Skellefteå County Hospital, Skellefteå, Sweden.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Winkvist, Anna
    Associations among 25-year trends in diet, cholesterol and BMI from 140,000 observations in men and women in Northern Sweden2012In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 11, article id 40Article in journal (Refereed)
    Abstract [en]

    Background: In the 1970s, men in northern Sweden had among the highest prevalences of cardiovascular diseases (CVD) worldwide. An intervention program combining population- and individual-oriented activities was initiated in 1985. Concurrently, collection of information on medical risk factors, lifestyle and anthropometry started. Today, these data make up one of the largest databases in the world on diet intake in a population- based sample, both in terms of sample size and follow-up period. The study examines trends in food and nutrient intake, serum cholesterol and body mass index (BMI) from 1986 to 2010 in northern Sweden.

    Methods: Cross-sectional information on self-reported food and nutrient intake and measured body weight, height, and serum cholesterol were compiled for over 140,000 observations. Trends and trend breaks over the 25-year period were evaluated for energy-providing nutrients, foods contributing to fat intake, serum cholesterol and BMI.

    Results: Reported intake of fat exhibited two significant trend breaks in both sexes: a decrease between 1986 and 1992 and an increase from 2002 (women) or 2004 (men). A reverse trend was noted for carbohydrates, whereas protein intake remained unchanged during the 25-year period. Significant trend breaks in intake of foods contributing to total fat intake were seen. Reported intake of wine increased sharply for both sexes (more so for women) and export beer increased for men. BMI increased continuously for both sexes, whereas serum cholesterol levels decreased during 1986 - 2004, remained unchanged until 2007 and then began to rise. The increase in serum cholesterol coincided with the increase in fat intake, especially with intake of saturated fat and fats for spreading on bread and cooking.

    Conclusions: Men and women in northern Sweden decreased their reported fat intake in the first 7 years (19861992) of an intervention program. After 2004 fat intake increased sharply for both genders, which coincided with introduction of a positive media support for low carbohydrate-high-fat (LCHF) diet. The decrease and following increase in cholesterol levels occurred simultaneously with the time trends in food selection, whereas a constant increase in BMI remained unaltered. These changes in risk factors may have important effects on primary and secondary prevention of cardiovascular disease (CVD).

  • 25. Johnsen, Nina F.
    et al.
    Frederiksen, Kirsten
    Christensen, Jane
    Skeie, Guri
    Lund, Eiliv
    Landberg, Rikard
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Nilsson, Lena M.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Halkjaer, Jytte
    Olsen, Anja
    Overvad, Kim
    Tjonneland, Anne
    Whole-grain products and whole-grain types are associated with lower all-cause and cause-specific mortality in the Scandinavian HELGA cohort2015In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 114, no 4, p. 608-623Article in journal (Refereed)
    Abstract [en]

    No study has yet investigated the intake of different types of whole grain (WG) in relation to all-cause and cause-specific mortality in a healthy population. The aim of the present study was to investigate the intake of WG products and WG types in relation to all-cause and cause-specific mortality in a large Scandinavian HELGA cohort that, in 1992-8, included 120 010 cohort members aged 30-64 years from the Norwegian Women and Cancer Study, the Northern Sweden Health and Disease Study, and the Danish Diet Cancer and Health Study. Participants filled in a FFQ from which data on the intake of WG products were extracted. The estimation of daily intake of WG cereal types was based on country-specific products and recipes. Mortality rate ratios (MRR) and 95% CI were estimated using the Cox proportional hazards model. A total of 3658 women and 4181 men died during the follow-up (end of follow-up was 15 April 2008 in the Danish sub-cohort, 15 December 2009 in the Norwegian sub-cohort and 15 February 2009 in the Swedish sub-cohort). In the analyses of continuous WG variables, we found lower all-cause mortality with higher intake of total WG products (women: MRR 0.89 (95% CI 0.86, 0.91); men: MRR 0.89 (95% CI 0.86, 0.91) for a doubling of intake). In particular, intake of breakfast cereals and non-white bread was associated with lower mortality. We also found lower all-cause mortality with total intake of different WG types (women: MRR 0.88 (95% CI 0.86, 0.92); men: MRR 0.88 (95% CI 0.86, 0.91) for a doubling of intake). In particular, WG oat, rye and wheat were associated with lower mortality. The associations were found in both women and men and for different causes of deaths. In the analyses of quartiles of WG intake in relation to all-cause mortality, we found lower mortality in the highest quartile compared with the lowest for breakfast cereals, non-white bread, total WG products, oat, rye (only men), wheat and total WG types. The MRR for highest v. lowest quartile of intake of total WG products was 0.68 (95% CI 0.62, 0.75, P-trend over quartiles, 0.0001) for women and 0.75 (95% CI 0.68, 0.81, P-trend over quartiles, 0.0001) for men. The MRR for highest v. lowest quartile of intake of total WG types was 0.74 (95% CI 0.67, 0.81, P-trend over quartiles, 0.0001) for women and 0.75 (95% CI 0.68, 0.82, P-trend (over quartiles), 0.0001) for men. Despite lower statistical power, the analyses of cause-specific mortality according to quartiles of WG intake supported these results. In conclusion, higher intake of WG products and WG types was associated with lower mortality among participants in the HELGA cohort. The study indicates that intake of WG is an important aspect of diet in preventing early death in Scandinavia.

  • 26.
    Knudsen, Markus Dines
    et al.
    Danish Cancer Society, Research Center, Copenhagen, Denmark.
    Kyrø, Cecilie
    Danish Cancer Society, Research Center, Copenhagen, Denmark.
    Olsen, Anja
    Danish Cancer Society, Research Center, Copenhagen, Denmark.
    Dragsted, Lars O
    Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
    Skeie, Guri
    Department of Community Medicine, University of Tromsø, Tromsø, Norway.
    Lund, Eiliv
    Department ofCommunity Medicine, University of Tromsø, Tromsø, Norway.
    Åman, Per
    Department of food Science, Swedish University of Agriculture Science, Uppsala, Sweden.
    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.
    Bueno-de-Mesquita, H. B.
    National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
    Tjønneland, Anne
    Danish Cancer Society, Research Center, Copenhagen, Denmark.
    Landberg, Rikard
    Department of Food Science, Swedish University of Agriculture Science, Uppsala, Sweden and Nutritional Epidemiology Unit, Institute for Environmental Medicine, Karolinska Institute, Stockholm.
    Self-Reported Whole-Grain Intake and Plasma Alkylresorcinol Concentrations in Combination in Relation to the Incidence of Colorectal Cancer2014In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 179, no 10, p. 1188-1196Article in journal (Refereed)
    Abstract [en]

    Self-reported food frequency questionnaires (FFQs) have occasionally been used to investigate the association between whole-grain intake and the incidence of colorectal cancer, but the results from those studies have been inconsistent. We investigated this association using intakes of whole grains and whole-grain products measured via FFQs and plasma alkylresorcinol concentrations, a biomarker of whole-grain wheat and rye intake, both separately and in combination (Howe's score with ranks). We conducted a nested case-control study in a cohort from a research project on Nordic health and whole-grain consumption (HELGA, 1992-1998). Incidence rate ratios and 95% confidence intervals were calculated using conditional logistic regression. Plasma alkylresorcinol concentrations alone and Howe's score with ranks were inversely associated with the incidence of distal colon cancer when the highest quartile was compared with the lowest (for alkylresorcinol concentrations, incidence rate ratio = 0.34, 95% confidence interval: 0.13, 0.92; for Howe's score with ranks, incidence rate ratio = 0.35, 95% confidence interval: 0.15, 0.86). No association was observed between whole-grain intake and any colorectal cancer (colon, proximal, distal or rectum cancer) when using an FFQ as the measure/exposure variable for whole-grain intake. The results suggest that assessing whole-grain intake using a combination of FFQs and biomarkers slightly increases the precision in estimating the risk of colon or rectal cancer by reducing the impact of misclassification, thereby increasing the statistical power of the study.

  • 27. Kyro, Cecilie
    et al.
    Skeie, Guri
    Loft, Steffen
    Landberg, Rikard
    Christensen, Jane
    Lund, Eiliv
    Nilsson, Lena M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Palmqvist, Richard
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Tjonneland, Anne
    Olsen, Anja
    Intake of whole grains from different cereal and food sources and incidence of colorectal cancer in the Scandinavian HELGA cohort2013In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 24, no 7, p. 1363-1374Article in journal (Refereed)
    Abstract [en]

    A high intake of whole grains has been associated with a lower incidence of colorectal cancer, but few studies are available on the association with whole grains from different cereals, for example, wheat, rye and oats, and none has addressed these separately. The objective of this study was to investigate the association between whole-grain intake and colorectal cancer. We used data from the large population-based Scandinavian cohort HELGA consisting of 108,000 Danish, Swedish, and Norwegian persons, of whom 1,123 developed colorectal cancer during a median of 11 years of follow-up. Detailed information on daily intake of whole-grain products, including whole-grain bread, crispbread, and breakfast cereals, was available, and intakes of total whole grains and specific whole-grain species (wheat, rye, and oats) were estimated. Associations between these whole-grain variables and the incidence of colorectal cancer were investigated using Cox proportional hazards models. Intake of whole-grain products was associated with a lower incidence of colorectal cancer per 50-g increment (incidence rate ratio [IRR], 0.94; 95 % confidence interval [CI], 0.89, 0.99), and the same tendency was found for total whole-grain intake (IRR pr. 25-g increment, 0.94; 95 % CI, 0.88, 1.01). Intake of whole-grain wheat was associated with a lower incidence of colorectal cancer (IRR for highest versus lowest quartile of intake, 0.66; 95 % CI, 0.51, 0.85), but no statistical significant linear trend was observed (p for trend: 0.18). No significant association was found for whole-grain rye or oats. Whole-grain intake was associated with a lower incidence of colorectal cancer.

  • 28. Landais, Edwige
    et al.
    Moskal, Aurelie
    Mullee, Amy
    Nicolas, Genevieve
    Gunter, Marc J.
    Huybrechts, Inge
    Overvad, Kim
    Roswall, Nina
    Affret, Aurelie
    Fagherazzi, Guy
    Mahamat-Saleh, Yahya
    Katzke, Verena
    Kuehn, Tilman
    La Vecchia, Carlo
    Trichopoulou, Antonia
    Valanou, Elissavet
    Saieva, Calogero
    de Magistris, Maria Santucci
    Sieri, Sabina
    Braaten, Tonje
    Skeie, Guri
    Weiderpass, Elisabete
    Ardanaz, Eva
    Chirlaque, Maria-Dolores
    Garcia, Jose Ramon
    Jakszyn, Paula
    Rodriguez-Barranco, Miguel
    Brunkwall, Louise
    Huseinovic, Ena
    Nilsson, Lena
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wallström, Peter
    Bueno-de-Mesquita, Bas
    Peeters, Petra H.
    Aune, Dagfinn
    Key, Tim
    Lentjes, Marleen
    Riboli, Elio
    Slimani, Nadia
    Freisling, Heinz
    Coffee and Tea Consumption and the Contribution of Their Added Ingredients to Total Energy and Nutrient Intakes in 10 European Countries: Benchmark Data from the Late 1990s2018In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 10, no 6, article id 725Article in journal (Refereed)
    Abstract [en]

    Background: Coffee and tea are among the most commonly consumed nonalcoholic beverages worldwide, but methodological differences in assessing intake often hamper comparisons across populations. We aimed to (i) describe coffee and tea intakes and (ii) assess their contribution to intakes of selected nutrients in adults across 10 European countries.

    Method: Between 1995 and 2000, a standardized 24-h dietary recall was conducted among 36,018 men and women from 27 European Prospective Investigation into Cancer and Nutrition (EPIC) study centres. Adjusted arithmetic means of intakes were estimated in grams (=volume) per day by sex and centre. Means of intake across centres were compared by sociodemographic characteristics and lifestyle factors.

    Results: In women, the mean daily intake of coffee ranged from 94 g/day (similar to 0.6 cups) in Greece to 781 g/day (similar to 4.4 cups) in Aarhus (Denmark), and tea from 14 g/day (similar to 0.1 cups) in Navarra (Spain) to 788 g/day (similar to 4.3 cups) in the UK general population. Similar geographical patterns for mean daily intakes of both coffee and tea were observed in men. Current smokers as compared with those who reported never smoking tended to drink on average up to 500 g/day more coffee and tea combined, but with substantial variation across centres. Other individuals' characteristics such as educational attainment or age were less predictive. In all centres, coffee and tea contributed to less than 10% of the energy intake. The greatest contribution to total sugar intakes was observed in Southern European centres (up to similar to 20%).

    Conclusion: Coffee and tea intake and their contribution to energy and sugar intake differed greatly among European adults. Variation in consumption was mostly driven by geographical region.

  • 29. Lassale, Camille
    et al.
    Gunter, Marc J.
    Romaguera, Dora
    Peelen, Linda M.
    Van der Schouw, Yvonne T.
    Beulens, Joline W. J.
    Freisling, Heinz
    Muller, David C.
    Ferrari, Pietro
    Huybrechts, Inge
    Fagherazzi, Guy
    Boutron-Ruault, Marie-Christine
    Affret, Aurelie
    Overvad, Kim
    Dahm, Christina C.
    Olsen, Anja
    Roswall, Nina
    Tsilidis, Konstantinos K.
    Katzke, Verena A.
    Kuehn, Tilman
    Buijsse, Brian
    Quiros, Jose-Ramon
    Sanchez-Cantalejo, Emilio
    Etxezarreta, Nerea
    Maria Huerta, Jose
    Barricarte, Aurelio
    Bonet, Catalina
    Khaw, Kay-Tee
    Key, Timothy J.
    Trichopoulou, Antonia
    Bamia, Christina
    Lagiou, Pagona
    Palli, Domenico
    Agnoli, Claudia
    Tumino, Rosario
    Fasanelli, Francesca
    Panico, Salvatore
    Bueno-de-Mesquita, H. Bas
    Boer, Jolanda M. A.
    Sonestedt, Emily
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Renström, Frida
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Weiderpass, Elisabete
    Skeie, Guri
    Lund, Eiliv
    Moons, Karel G. M.
    Riboli, Elio
    Tzoulaki, Ioanna
    Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 7, article id e0159025Article in journal (Refereed)
    Abstract [en]

    Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72-0.79) to 0.88 (0.84-0.92) for all-cause, 0.76 (0.69-0.83) to 0.84 (0.76-0.92) for CVD and 0.78 (0.73-0.83) to 0.91 (0.85-0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors.

  • 30. Leenders, Max
    et al.
    Sluijs, Ivonne
    Ros, Martine M
    Boshuizen, Hendriek C
    Siersema, Peter D
    Ferrari, Pietro
    Weikert, Cornelia
    Tjonneland, Anne
    Olsen, Anja
    Boutron-Ruault, Marie-Christine
    Clavel-Chapelon, Franoise
    Nailler, Laura
    Teucher, Birgit
    Li, Kuanrong
    Boeing, Heiner
    Bergmann, Manuela M
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Palli, Domenico
    Pala, Valeria
    Panico, Salvatore
    Tumino, Rosario
    Sacerdote, Carlotta
    Peeters, Petra HM
    van Gils, Carla H
    Lund, Eiliv
    Engeset, Dagrun
    Redondo, Maria Luisa
    Agudo, Antonio
    Sanchez, Maria Jose
    Navarro, Carmen
    Ardanaz, Eva
    Sonestedt, Emily
    Ericson, Ulrika
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Khaw, Kay-Tee
    Warcham, Nicholas J
    Key, Timothy J
    Crowe, Francesca L
    Romieu, Isabelle
    Gunter, Marc J
    Gallo, Valentina
    Overvad, Kim
    Riboli, Elio
    Bueno-de-Mesquita, H Bas
    Fruit and vegetable consumption and mortality European Prospective Investigation Into Cancer and Nutrition2013In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 178, no 4, p. 590-602Article in journal (Refereed)
  • 31. Lukic, Marko
    et al.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Skeie, Guri
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Braaten, Tonje
    Coffee consumption and risk of rare cancers in Scandinavian countries2018In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 33, no 3, p. 287-302Article in journal (Refereed)
    Abstract [en]

    Studies on the association between heavy coffee consumption and risk of less frequently diagnosed cancers are scarce. We aimed to quantify the association between filtered, boiled, and total coffee consumption and the risk of bladder, esophageal, kidney, pancreatic, and stomach cancers. We used data from the Norwegian Women and Cancer Study and the Northern Sweden Health and Disease Study. Information on coffee consumption was available for 193,439 participants. We used multivariable Cox proportional hazards models to calculate hazard ratios (HR) with 95% confidence intervals (CI) for the investigated cancer sites by category of total, filtered, and boiled coffee consumption. Heavy filtered coffee consumers (C 4 cups/day) had a multivariable adjusted HR of 0.74 of being diagnosed with pancreatic cancer (95% CI 0.57-0.95) when compared with light filtered coffee consumers (<= 1 cup/day). We did not observe significant associations between total or boiled coffee consumption and any of the investigated cancer sites, neither in the entire study sample nor in analyses stratified by sex. We found an increased risk of bladder cancer among never smokers who were heavy filtered or total coffee consumers, and an increased risk of stomach cancer in never smokers who were heavy boiled coffee consumers. Our data suggest that increased filtered coffee consumption might reduce the risk of pancreatic cancer. We did not find evidence of an association between coffee consumption and the risk of esophageal or kidney cancer. The increased risk of bladder and stomach cancer was confined to never smokers.

  • 32.
    Löf, Annette
    et al.
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Andersson, Tore
    Institutionen för ekonomi, teknik och samhälle, Luleå tekniska universitet.
    Horstkotte, Tim
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Ledman, Anna-Lill
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Sehlin Macneil, Kristina
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Össbo, Åsa
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Okunskap om samisk kultur grogrund för strukturell diskriminering2013In: Västerbottens-Kuriren, ISSN 1104-0246Article in journal (Other (popular science, discussion, etc.))
  • 33. Merritt, Melissa A.
    et al.
    Tzoulaki, Ioanna
    Tworoger, Shelley S.
    De Vivo, Immaculata
    Hankinson, Susan E.
    Fernandes, Judy
    Tsilidis, Konstantinos K.
    Weiderpass, Elisabete
    Tjonneland, Anne
    Petersen, Kristina E. N.
    Dahm, Christina C.
    Overvad, Kim
    Dossus, Laure
    Boutron-Ruault, Marie-Christine
    Fagherazzi, Guy
    Fortner, Renee T.
    Kaaks, Rudolf
    Aleksandrova, Krasimira
    Boeing, Heiner
    Trichopoulou, Antonia
    Bamia, Christina
    Trichopoulos, Dimitrios
    Palli, Domenico
    Grioni, Sara
    Tumino, Rosario
    Sacerdote, Carlotta
    Mattiello, Amalia
    Bueno-de-Mesquita, H. B. (as)
    Onland-Moret, N. Charlotte
    Peeters, Petra H.
    Gram, Inger T.
    Skeie, Guri
    Ramon Quiros, J.
    Duell, Eric J.
    Sanchez, Maria-Jose
    Salmeron, D.
    Barricarte, Aurelio
    Chamosa, Saioa
    Ericson, Ulrica
    Sonestedt, Emily
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Idahl, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Khaw, Kay-Tee
    Wareham, Nicholas
    Travis, Ruth C.
    Rinaldi, Sabina
    Romieu, Isabelle
    Patel, Chirag J.
    Riboli, Elio
    Gunter, Marc J.
    Investigation of Dietary Factors and Endometrial Cancer Risk Using a Nutrient-wide Association Study Approach in the EPIC and Nurses' Health Study (NHS) and NHSII2015In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 24, no 2, p. 466-471Article in journal (Refereed)
    Abstract [en]

    Data on the role of dietary factors in endometrial cancer development are limited and inconsistent. We applied a "nutrient-wide association study" approach to systematically evaluate dietary risk associations for endometrial cancer while controlling for multiple hypothesis tests using the false discovery rate (FDR) and validating the results in an independent cohort. We evaluated endometrial cancer risk associations for dietary intake of 84 foods and nutrients based on dietary questionnaires in three prospective studies, the European Prospective Investigation into Cancer and Nutrition (EPIC; N = 1,303 cases) followed by validation of nine foods/nutrients (FDR <= 0.10) in the Nurses' Health Studies (NHS/NHSII; N = 1,531 cases). Cox regression models were used to estimate HRs and 95% confidence intervals (CI). In multivariate adjusted comparisons of the extreme categories of intake at baseline, coffee was inversely associated with endometrial cancer risk (EPIC, median intake 750 g/day vs. 8.6; HR, 0.81; 95% CI, 0.68-0.97, P-trend = 0.09; NHS/NHSII, median intake 1067 g/day vs. none; HR, 0.82; 95% CI, 0.70-0.96, P-trend = 0.04). Eight other dietary factors that were associated with endometrial cancer risk in the EPIC study (total fat, monounsaturated fat, carbohydrates, phosphorus, butter, yogurt, cheese, and potatoes) were not confirmed in the NHS/NHSII. Our findings suggest that coffee intake may be inversely associated with endometrial cancer risk. Further data are needed to confirm these findings and to examine the mechanisms linking coffee intake to endometrial cancer risk to develop improved prevention strategies. (C)2015 AACR.

  • 34. Michaud, Dominique S
    et al.
    Gallo, Valentina
    Schlehofer, Brigitte
    Tjønneland, Anne
    Olsen, Anja
    Overvad, Kim
    Dahm, Christina C
    Teucher, Birgit
    Lukanova, Annekatrin
    Boeing, Heiner
    Schütze, Madlen
    Trichopoulou, Antonia
    Lagiou, Pagona
    Kyrozis, Andreas
    Sacerdote, Carlotta
    Krogh, Vittorio
    Masala, Giovanna
    Tumino, Rosario
    Mattiello, Amalia
    Bueno-de-Mesquita, H Bas
    Ros, Martine M
    Peeters, Petra HM
    van Gils, Carla H
    Skeie, Guri
    Engeset, Dagrun
    Parr, Christine L
    Ardanaz, Eva
    Chirlaque, Maria-Dolores
    Dorronsoro, Miren
    Sánchez, Maria José
    Argüelles, Marcial
    Jakszyn, Paula
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Melin, Beatrice
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Manjer, Jonas
    Wirfält, Elisabet
    Khaw, Kay-Tee
    Wareham, Nick
    Allen, Naomi E
    Key, Timothy J
    Romieu, Isabelle
    Vineis, Paolo
    Riboli, Elio
    Coffee and tea intake and risk of brain tumors in the European prospective investigation into cancer and nutrition (EPIC) cohort study2010In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 92, no 5, p. 1145-1150Article in journal (Refereed)
    Abstract [en]

    Background: In a recent US cohort study, total coffee and tea consumption was inversely associated with risk of glioma, and experimental studies showed that caffeine can slow the invasive growth of glioblastoma.

    Objective: The objective was to examine the relation between coffee and tea intake and the risk of glioma and meningioma in a large European cohort study, the European Prospective Investigation into Cancer and Nutrition (EPIC).

    Design: Data on coffee and tea intake were collected from men and women recruited into the EPIC cohort study. Over an average of 8.5 y of follow-up, 343 cases of glioma and 245 cases of meningioma were newly diagnosed in 9 countries. We used Cox proportional hazards models to examine the relation between coffee and tea and brain tumors.

    Results: We observed no associations between coffee, tea, or combined coffee and tea consumption and risk of either type of brain tumor when using quantiles based on country-specific distributions of intake. However, a significant inverse association was observed for glioma risk among those consuming ≥100 mL coffee and tea per day compared with those consuming <100 mL/d (hazard ratio: 0.66; 95% CI: 0.44, 0.97; P = 0.03). The association was slightly stronger in men (hazard ratio: 0.59; 95% CI: 0.34, 1.01) than in women (hazard ratio: 0.74; 95% CI: 0.42, 1.31), although neither was statistically significant.

    Conclusions: In this large cohort study, we observed an inverse association between total coffee and tea consumption and risk of glioma that was consistent with the findings of a recent study. These findings, if further replicated in other studies, may provide new avenues of research on gliomas.

  • 35. Moskal, Aurelie
    et al.
    Pisa, Pedro T.
    Ferrari, Pietro
    Byrnes, Graham
    Freisling, Heinz
    Boutron-Ruault, Marie-Christine
    Cadeau, Claire
    Nailler, Laura
    Wendt, Andrea
    Kuehn, Tilman
    Boeing, Heiner
    Buijsse, Brian
    Tjonneland, Anne
    Halkjaer, Jytte
    Dahm, Christina C.
    Chiuve, Stephanie E.
    Quiros, Jose R.
    Buckland, Genevieve
    Molina-Montes, Esther
    Amiano, Pilar
    Huerta Castano, Jose M.
    Barricarte Gurrea, Aurelio
    Khaw, Kay-Tee
    Lentjes, Marleen A.
    Key, Timothy J.
    Romaguera, Dora
    Vergnaud, Anne-Claire
    Trichopoulou, Antonia
    Bamia, Christina
    Orfanos, Philippos
    Palli, Domenico
    Pala, Valeria
    Tumino, Rosario
    Sacerdote, Carlotta
    de Magistris, Maria Santucci
    Bueno-de-Mesquita, H. Bas
    Ocke, Marga C.
    Beulens, Joline W. J.
    Ericson, Ulrika
    Drake, Isabel
    Nilsson, Lena M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Weiderpass, Elisabete
    Hjartaker, Anette
    Riboli, Elio
    Slimani, Nadia
    Nutrient Patterns and Their Food Sources in an International Study Setting: Report from the EPIC Study2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 6, p. e98647-Article in journal (Refereed)
    Abstract [en]

    Background: Compared to food patterns, nutrient patterns have been rarely used particularly at international level. We studied, in the context of a multi-center study with heterogeneous data, the methodological challenges regarding pattern analyses. Methodology/Principal Findings: We identified nutrient patterns from food frequency questionnaires (FFQ) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study and used 24-hour dietary recall (24-HDR) data to validate and describe the nutrient patterns and their related food sources. Associations between lifestyle factors and the nutrient patterns were also examined. Principal component analysis (PCA) was applied on 23 nutrients derived from country-specific FFQ combining data from all EPIC centers (N = 477,312). Harmonized 24-HDRs available for a representative sample of the EPIC populations (N = 34,436) provided accurate mean group estimates of nutrients and foods by quintiles of pattern scores, presented graphically. An overall PCA combining all data captured a good proportion of the variance explained in each EPIC center. Four nutrient patterns were identified explaining 67% of the total variance: Principle component (PC) 1 was characterized by a high contribution of nutrients from plant food sources and a low contribution of nutrients from animal food sources; PC2 by a high contribution of micro-nutrients and proteins; PC3 was characterized by polyunsaturated fatty acids and vitamin D; PC4 was characterized by calcium, proteins, riboflavin, and phosphorus. The nutrients with high loadings on a particular pattern as derived from country-specific FFQ also showed high deviations in their mean EPIC intakes by quintiles of pattern scores when estimated from 24-HDR. Center and energy intake explained most of the variability in pattern scores. Conclusion/Significance: The use of 24-HDR enabled internal validation and facilitated the interpretation of the nutrient patterns derived from FFQs in term of food sources. These outcomes open research opportunities and perspectives of using nutrient patterns in future studies particularly at international level.

  • 36. Murphy, Neil
    et al.
    Norat, Teresa
    Ferrari, Pietro
    Jenab, Mazda
    Bueno-de-Mesquita, Bas
    Skeie, Guri
    Dahm, Christina C.
    Overvad, Kim
    Olsen, Anja
    Tjonneland, Anne
    Clavel-Chapelon, Francoise
    Boutron-Ruault, Marie Christine
    Racine, Antoine
    Kaaks, Rudolf
    Teucher, Birgit
    Boeing, Heiner
    Bergmann, Manuela M.
    Trichopoulou, Antonia
    Trichopoulos, Dimitrios
    Lagiou, Pagona
    Palli, Domenico
    Pala, Valeria
    Panico, Salvatore
    Tumino, Rosario
    Vineis, Paolo
    Siersema, Peter
    van Duijnhoven, Franzel
    Peeters, Petra H. M.
    Hjartaker, Anette
    Engeset, Dagrun
    Gonzalez, Carlos A.
    Sanchez, Maria-Jose
    Dorronsoro, Miren
    Navarro, Carmen
    Ardanaz, Eva
    Quiros, Jose R.
    Sonestedt, Emily
    Ericson, Ulrika
    Nilsson, Lena
    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.
    Khaw, Kay-Tee
    Wareham, Nick
    Key, Timothy J.
    Crowe, Francesca L.
    Fedirko, Veronika
    Wark, Petra A.
    Chuang, Shu-Chun
    Riboli, Elio
    Dietary fibre intake and risks of Cancers of the Colon and Rectum in the European prospective investigation into Cancer and Nutrition (EPIC)2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 6, p. e39361-Article in journal (Refereed)
    Abstract [en]

    Background: Earlier analyses within the EPIC study showed that dietary fibre intake was inversely associated with colorectal cancer risk, but results from some large cohort studies do not support this finding. We explored whether the association remained after longer follow-up with a near threefold increase in colorectal cancer cases, and if the association varied by gender and tumour location.

    Methodology/Principal Findings: After a mean follow-up of 11.0 years, 4,517 incident cases of colorectal cancer were documented. Total, cereal, fruit, and vegetable fibre intakes were estimated from dietary questionnaires at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models stratified by age, sex, and centre, and adjusted for total energy intake, body mass index, physical activity, smoking, education, menopausal status, hormone replacement therapy, oral contraceptive use, and intakes of alcohol, folate, red and processed meats, and calcium. After multivariable adjustments, total dietary fibre was inversely associated with colorectal cancer (HR per 10 g/day increase in fibre 0.87, 95% CI: 0.79-0.96). Similar linear associations were observed for colon and rectal cancers. The association between total dietary fibre and risk of colorectal cancer risk did not differ by age, sex, or anthropometric, lifestyle, and dietary variables. Fibre from cereals and fibre from fruit and vegetables were similarly associated with colon cancer; but for rectal cancer, the inverse association was only evident for fibre from cereals.

    Conclusions/Significance: Our results strengthen the evidence for the role of high dietary fibre intake in colorectal cancer prevention.

  • 37.
    Naska, Androniki
    et al.
    Athens, Greece.
    Katsoulis, Michail
    Athens, Greece.
    Orfanos, Philippos
    Athens, Greece.
    Lachat, Carl
    Gent, Belgium.
    Gedrich, Kurt
    Freising, Germany.
    Rodrigues, Sara S P
    Porto, Portugal.
    Freisling, Heinz
    Lyon, France.
    Kolsteren, Patrick
    Antwerp, Belgium.
    Engeset, Dagrun
    Tromsø, Norway.
    Lopes, Carla
    Porto, Portugal.
    Elmadfa, Ibrahim
    Vienna, Austria .
    Wendt, Andrea
    Heidelberg, Germany.
    Knüppel, Sven
    Nuthetal, Germany.
    Turrini, Aida
    Rome, Italy .
    Tumino, Rosario
    Ragusa, Italy.
    Ocké, Marga C
    Bilthoven, The Netherlands.
    Sekula, Wlodzimierz
    Warsaw, Poland.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Key, Tim
    Oxford OX3 7LF, UK.
    Trichopoulou, Antonia
    Athens, Greece.
    Eating out is different from eating at home among individuals who occasionally eat out: A cross-sectional study among middle-aged adults from eleven European countries2015In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 113, no 12, p. 1951-1964Article in journal (Refereed)
    Abstract [en]

    Eating out has been linked to the current obesity epidemic, but the evaluation of the extent to which out of home (OH) dietary intakes are different from those at home (AH) is limited. Data collected among 8849 men and 14 277 women aged 35-64 years from the general population of eleven European countries through 24-h dietary recalls or food diaries were analysed to: (1) compare food consumption OH to those AH; (2) describe the characteristics of substantial OH eaters, defined as those who consumed 25 % or more of their total daily energy intake at OH locations. Logistic regression models were fit to identify personal characteristics associated with eating out. In both sexes, beverages, sugar, desserts, sweet and savoury bakery products were consumed more OH than AH. In some countries, men reported higher intakes of fish OH than AH. Overall, substantial OH eating was more common among men, the younger and the more educated participants, but was weakly associated with total energy intake. The substantial OH eaters reported similar dietary intakes OH and AH. Individuals who were not identified as substantial OH eaters reported consuming proportionally higher quantities of sweet and savoury bakery products, soft drinks, juices and other non-alcoholic beverages OH than AH. The OH intakes were different from the AH ones, only among individuals who reported a relatively small contribution of OH eating to their daily intakes and this may partly explain the inconsistent findings relating eating out to the current obesity epidemic.

  • 38.
    Nilsson, Annika E
    et al.
    Stockholm Environment Institute.
    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.
    Quinlan, Allyson
    Resilience Alliance.
    Evengård, Birgitta
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Food security in the Arctic: Preliminary reflections from a resilience perspective2013In: Arctic Resilience: Interim Report 2013 / [ed] Annika E Nilsson, Stockholm: Arctic Council , 2013, , p. 117p. 113-117Chapter in book (Other academic)
    Abstract [en]

    Chapter 10 discusses food security, which is emerging as a major cross-cutting issue in a changingArctic. The preliminary reflections presented in the chapter highlight that food security bringstogether concerns over a range of interacting environmental, social, economic, political andcultural changes. These include: food and water-borne diseases; increasing incidence of lifestylediseases; high costs of healthy foods; contamination; changing ecosystems that impede access tofood; high fuel costs; and loss of traditional knowledge. The chapter concludes that food security isintimately interlinked with social relations and cultural well-being.

  • 39.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    A call for improving health strategies regarding HLA-B27 carriers in the Arctic, considering traditional and scientific knowledge2016In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 75, article id 33200Article in journal (Refereed)
  • 40.
    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.
    Aboriginal food security in the Arctic: a Utopia or a matter of attitude?2015In: EurSafe News, Vol. 17, no 3, p. 2-4Article in journal (Other academic)
    Abstract [en]

    In the discussion on food security in the Arctic, food sovereignty is increasingly emphasized. In many cases, the vision of aboriginal food security equals a the vision of a situation of unchanged access subsistence species from time to time. Unfortunately, this is a very unlikely scenario in the Arctic.

  • 41.
    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.
    Boiled Coffee: An Arctic Example of Potential Residual and Unmeasured Confounding in Coffee Epidemiology2014In: Coffee in Health and Disease Prevention / [ed] Victor R. Preedy, London: Elsevier, 2014, p. 265-274Chapter in book (Other academic)
    Abstract [en]

    Coffee culture differs all over the world and affects the chemical composition of coffee, as well as quantities consumed and lifestyle factors associated with coffee drinking. Boiled coffee is a good example of residual or unmeasured confounding in an Arctic population with two heterogeneous coffee cultures. Although filtered coffee is the most common caffeine brew in this area today, for cultural reasons boiled coffee—traditionally prepared on a stove top or overan open fire—still plays an important role in the population. There are chemical differences between boiled coffee and drip-filtered coffee that might have an impact on public health regarding lifestyle-related diseases. There are certain lifestyle factors, such as leisure-time hunting and fishing, first full-term pregnancy at an early age, and low education level, that are positively associated with the consumption of boiled coffee and inversely associated with the consumption of filtered coffee. The Scandinavian Arctic boiled coffee example illustrates that, when interpreting chemical differences between different coffee brews, lifestyle factors related to coffee culture should always betaken into consideration or at least discussed as apparent candidates of residual or unmeasured confounding.

  • 42.
    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.
    Dietary Patterns in a Circumpolar Context: A Cultural Approach to the Interpretation of Three Studies on Mediterranean, Traditional Sami, and Low-Carbohydrate Dietary Pattern Scores in Northernmost Sweden2014In: The Mediterranean Diet: An Evidence-Based Approach / [ed] Victor R. Preedy and Ronald Ross Watson, London: Elsevier, 2014, 1, p. 579-588Chapter in book (Other academic)
    Abstract [en]

    The Sami, the indigenous people of northern Sweden, have a life expectancy equal to the life expectancy of the country’s majority population and a reduced risk of cancer. Dietary score methodology is a way of applying a culturally defined dietary pattern to any population. Studies on Mediterranean and traditional Sami dietary patterns in a circumpolar context confirm evidence-based dietary guidelines, but the low-carbohydrate dietary pattern does not. Knowledge of food culture and nutritional transitions is important when interpreting risk associations connected to culturally defined dietary patterns.

  • 43.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    New governance for sustainable development in the European Arctic: annual report 20142015Collection (editor) (Other academic)
  • 44.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    New governance for sustainable development in the European Arctic: annual report 20152016Collection (editor) (Other academic)
  • 45.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    New governance for sustainable development in the European Arctic: annual report 20162017Collection (editor) (Other academic)
  • 46.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Sami lifestyle and health: epidemiological studies from northern Sweden2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this PhD thesis was to expand the current knowledge of “traditional Sami” diet and lifestyle, and to test aspects of the Sami diet and lifestyle, specifically dietary pattern, macronutrient distribution and coffee consumption, in population-based epidemiological studies of mortality and incident cardiovascular disease and cancer in a general population.

    In Paper I, semi-structured interviews were conducted with 20 elderly Sami concerning their parent’s lifestyle and diet 50-70 years ago. Questionnaire data from 397 Sami and 1842 matched non-Sami were also analyzed, using non-parametric tests and partial least square methodology.  In Papers II-IV, mortality data and incident cancer data for participants in the Västerbotten Intervention Program (VIP) cohort were used for calculations of hazard ratios by Cox regression. In Paper II, a Sami diet score (0-8 points) was constructed by adding one point for each intake above the median for red meat, fatty fish, total fat, berries and boiled coffee, and one point for each intake below the median for vegetables, bread and fibre. In Paper III, deciles of energy-adjusted carbohydrate (descending) and protein (ascending) intake were added to create a Low-Carbohydrate, High-Protein (LCHP) score (2-20 points). In Paper IV, filtered and boiled coffee consumption was studied in relation to incident cancer. In Paper V, a nested case-control study of filtered and boiled coffee consumption and acute myocardial infarction, risk estimates were calculated by conditional logistic regression.

    Surprisingly, fatty fish may have been more important than reindeer meat for the Sami of southern Lapland in the 1930’s to 1950’s, and it is still consumed more frequently by reindeer-herding Sami than other Sami and non-Sami. Other dietary characteristics of the Sami 50-70 years ago and present-day reindeer-herding Sami were high intakes of fat, blood, and boiled coffee, and low intakes of bread, fibre and cultivated vegetables (Paper I). Stronger adherence to a “traditional Sami” diet, i.e. a higher Sami diet score, was associated with a weak increase in all-cause mortality, particulary apparent in men (Paper II). A diet relatively low in carbohydrates and high in protein, i.e. a high LCHP score, did not predict all-cause mortality compared with low LCHP score, after accounting for saturated fat intake and established risk factors (Paper III).  Neither filtered nor boiled coffee consumption was associated with cancer for all cancer sites combined, or for prostate or colorectal cancer. For breast cancer, consumption of boiled coffee ≥4 versus <1 occasions/day was associated with a reduced risk. An increased risk of premenopausal and a reduced risk of postmenopausal breast cancer were found for both total and filtered coffee. Boiled coffee was positively associated with the risk of respiratory tract cancer, a finding limited to men (Paper IV). A positive association was found between consumption of filtered coffee and the risk of acute myocardial infarction in men (Paper V).

    In conclusion, the findings of Paper I, in particular the relative importance of fatty fish compared to reindeer meat in the “traditional Sami” diet of the 1930’s-1950’s, suggest that aspects of cultural importance may not always be of most objective importance. The findings of Papers II-V generally did not support health benefits for the factors studied. The relatively good health status of the Sami population is therefore probably not attributable to the studied aspects of the “traditional Sami” lifestyle, but further investigation of cohorts with more detailed information on dietary and lifestyle items relevant for “traditional Sami” culture is warranted.

  • 47.
    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.
    Samisk kost som hälsofaktor?2016In: Nordisk Nutrition, ISSN 1654-8337, no 2, p. 27-29Article in journal (Other academic)
    Abstract [sv]

    Historiska matvanor används ofta som modeller för hälsosam kost. Mot bakgrund av att samer ofta beskrivs som världens friskaste urfolk, är det intressant att studera samisk kost som en hälsofaktor. Det finns dock många fallgropar som behöver beaktas vid sådan forskning.

  • 48.
    Nilsson, Lena Maria
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Berner, James
    Dudarev, Alexey A.
    Mulvad, Gert
    Odland, Jon Oyvind
    Parkinson, Alan
    Rautio, Arja
    Tikhonov, Constantine
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Arctic Research Centre at Umeå University.
    Indicators of food and water security in an Arctic Health context - results from an international workshop discussion2013In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 72, p. 21530-Article in journal (Refereed)
    Abstract [en]

    In August 2012, a literature search with the aim of describing indicators on food and water security in an Arctic health context was initialized in collaboration between the Arctic Human Health Expert Group, SDWG/AHHEG and the AMAP (Arctic Monitoring and Assessment Programme within the Arctic Council) Human Health Assessment Group, AMAP/HHAG. In December 2012, workshop discussions were performed with representatives from both of these organizations, including 7 Arctic countries. The aim of this article is to describe the workshop discussions and the rational for the 12 indicators selected and the 9 rejected and to discuss the potential feasibility of these. Advantages and disadvantages of candidate indicators were listed. Informative value and costs for collecting were estimated separately on a 3-level scale: low, medium and high. Based on these reviews, the final selection of promoted and rejected indicators was performed and summarized in tables. Among 10 suggested indicators of food security, 6 were promoted: healthy weight, traditional food proportion in diet, monetary food costs, non-monetary food accessibility, food-borne diseases and food-related contaminants. Four were rejected: per-person dietary energy supply, food security modules, self-estimated food safety and healthy eating. Among 10 suggested indicators of water security, 6 were promoted: per-capita renewable water, accessibility of running water, waterborne diseases, drinking-water-related contaminants, authorized water quality assurance and water safety plans. Four were rejected: water consumption, types of water sources, periodic water shortages and household water costs.

  • 49.
    Nilsson, Lena Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Dahlgren, Lars
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Brustad, Magritt
    Sjölander, Per
    Van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Diet and lifestyle of the Sami of southern Lapland in the 1930s - 1950s and today2011In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 70, no 3, p. 301-318Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe the lifestyle of the Sami of southern Lapland 50 to 70 years ago in relation to the present-day Sami and non-Sami populations and, thereby, to provide a basis for future studies of culturally related determinants of health and illness.

    STUDY DESIGN: A qualitative analysis, and a quantitative comparison of Sami and non-Sami groups.

    METHODS: Semi-structured interviews were conducted with 20 elderly Sami concerning their parents' lifestyle and diet 50 to 70 years ago. Questionnaire data from 81 reindeer-herding Sami, 226 non-reindeer-herding Sami and 1,842 sex-, age- and geographically matched non-Sami from the population-based Västerbotten Intervention Project were analysed by non-parametric tests and partial least squares methodology.

    RESULTS: Surprisingly, fatty fish may have been more important than reindeer meat for the Sami of southern Lapland in the 1930s to 1950s, and it is still consumed more frequently by reindeer-herding Sami than nonreindeer-herding Sami and non-Sami. Other dietary characteristics of the historical Sami and present-day reindeer-herding Sami were higher intakes of fat, blood and boiled coffee, and lower intakes of bread, fibre and cultivated vegetables, compared with present-day non-Sami. Physical activity was also a part of the daily life of the Sami to a greater extent in the 1930s to 1950s than today. Sami men often worked far from home, while the women were responsible for fishing, farming, gardening (which was introduced in the 1930-1950 period), as well as housework and childcare.

    CONCLUSIONS: For studies investigating characteristic lifestyle elements of specific ethnic groups, the elements of greatest acknowledged cultural importance today (in this case reindeer meat) may not be of the most objective importance traditionally.

  • 50.
    Nilsson, Lena Maria
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Destouni, Georgia
    Berner, James
    Dudarev, Alexey A
    Mulvad, Gert
    Odland, Jon Oyvind
    Parkinson, Alan
    Tikhonov, Constantine
    Rautio, Arja
    Evengård, Birgitta
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    A call for urgent monitoring of food and water security based on relevant indicators for the Arctic2013In: Ambio, ISSN 0044-7447, E-ISSN 1654-7209, Vol. 42, no 7, p. 816-822Article in journal (Refereed)
    Abstract [en]

    This perspective paper argues for an urgent need to monitor a set of 12 concrete, measurable indicators of food and water security in the Arctic over time. Such a quantitative indicator approach may be viewed as representing a reductionist rather than a holistic perspective, but is nevertheless necessary for actually knowing what reality aspects to monitor in order to accurately understand, quantify, and be able to project critical changes to food and water security of both indigenous and non-indigenous people in the Arctic. More relevant indicators may be developed in the future, taking us further toward reconciliation between reductionist and holistic approaches to change assessment and understanding. However, the potential of such further development to improved holistic change assessment is not an argument not to urgently start to monitor and quantify the changes in food and water security indicators that are immediately available and adequate for the Arctic context.

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