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  • 201.
    Shungin, Dmitry
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Skåne University Hospital, Lund University.
    Cornelis, Marilyn C.
    Divaris, Kimon
    Holtfreter, Birte
    Shaffer, John R.
    Yu, Yau-Hua
    Barros, Silvana P.
    Beck, James D.
    Biffar, Reiner
    Boerwinkle, Eric A.
    Crout, Richard J.
    Ganna, Andrea
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Biobank Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Hindy, George
    Hu, Frank B.
    Kraft, Peter
    McNeil, Daniel W.
    Melander, Olle
    Moss, Kevin L.
    North, Kari E.
    Orho-Melander, Marju
    Pedersen, Nancy L.
    Ridker, Paul M.
    Rimm, Eric B.
    Rose, Lynda M.
    Rukh, Gull
    Teumer, Alexander
    Weyant, Robert J.
    Chasman, Daniel I.
    Joshipura, Kaumudi
    Kocher, Thomas
    Magnusson, Patrik K. E.
    Marazita, Mary L.
    Nilsson, Peter
    Offenbacher, Steve
    Smith, George Davey
    Lundberg, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Palmer, Tom M.
    Timpson, Nicholas J.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Franks, Paul W.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Skåne University Hospital, Lund University; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
    Using genetics to test the causal relationship of total adiposity and periodontitis: Mendelian randomization analyses in the Gene-Lifestyle Interactions and Dental Endpoints (GLIDE) Consortium2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, no 2, p. 638-650Article in journal (Refereed)
    Abstract [en]

    Background: The observational relationship between obesity and periodontitis is widely known, yet causal evidence is lacking. Our objective was to investigate causal associations between periodontitis and body mass index (BMI). Methods: We performed Mendelian randomization analyses with BMI-associated loci combined in a genetic risk score (GRS) as the instrument for BMI. All analyses were conducted within the Gene-Lifestyle Interactions and Dental Endpoints (GLIDE) Consortium in 13 studies from Europe and the USA, including 49 066 participants with clinically assessed (seven studies, 42.1% of participants) and self-reported (six studies, 57.9% of participants) periodontitis and genotype data (17 672/31 394 with/without periodontitis); 68 761 participants with BMI and genotype data; and 57 871 participants (18 881/38 990 with/without periodontitis) with data on BMI and periodontitis. Results: In the observational meta-analysis of all participants, the pooled crude observational odds ratio (OR) for periodontitis was 1.13 [95% confidence interval (CI): 1.03, 1.24] per standard deviation increase of BMI. Controlling for potential confounders attenuated this estimate (OR = 1.08; 95% CI: 1.03, 1.12). For clinically assessed periodontitis, corresponding ORs were 1.25 (95% CI: 1.10, 1.42) and 1.13 (95% CI: 1.10, 1.17), respectively. In the genetic association meta-analysis, the OR for periodontitis was 1.01 (95% CI: 0.99, 1.03) per GRS unit (per one effect allele) in all participants and 1.00 (95% CI: 0.97, 1.03) in participants with clinically assessed periodontitis. The instrumental variable meta-analysis of all participants yielded an OR of 1.05 (95% CI: 0.80, 1.38) per BMI standard deviation, and 0.90 (95% CI: 0.56, 1.46) in participants with clinical data. Conclusions: Our study does not support total adiposity as a causal risk factor for periodontitis, as the point estimate is very close to the null in the causal inference analysis, with wide confidence intervals.

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

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

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

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

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

  • 203. Slimani, N
    et al.
    Kaaks, R
    Ferrari, P
    Casagrande, C
    Clavel-Chapelon, F
    Lotze, G
    Kroke, A
    Trichopoulos, D
    Trichopoulou, A
    Lauria, C
    Bellegotti, M
    Ocké, MC
    Peeters, PH
    Engeset, D
    Lund, E
    Agudo, A
    Larranaga, N
    Mattisson, I
    Andren, C
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Odontology, Cariology.
    Davey, G
    Welch, AA
    Overvad, K
    Tjonneland, A
    Van Staveren, WA
    Saracci, R
    Riboli, E
    European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics.2002In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 5, no 6B, p. 1125-1145Article in journal (Refereed)
    Abstract [en]

    The European Prospective Investigation into Cancer and Nutrition (EPIC), which covers a large cohort of half a million men and women from 23 European centres in 10 Western European countries, was designed to study the relationship between diet and the risk of chronic diseases, particularly cancer. Information on usual individual dietary intake was assessed using different validated dietary assessment methods across participating countries. In order to adjust for possible systematic over- or underestimation in dietary intake measurements and correct for attenuation bias in relative risk estimates, a calibration approach was developed. This approach involved an additional dietary assessment common across study populations to re-express individual dietary intakes according to the same reference scale. A single 24-hour diet recall was therefore collected, as the EPIC reference calibration method, from a stratified random sample of 36 900 subjects from the entire EPIC cohort, using a software program (EPIC-SOFT) specifically designed to standardise the dietary measurements across study populations. This paper describes the design and populations of the calibration sub-studies set up in the EPIC centres. In addition, to assess whether the calibration sub-samples were representative of the entire group of EPIC cohorts, a series of subjects' characteristics known possibly to influence dietary intakes was compared in both population groups. This was the first time that calibration sub-studies had been set up in a large multi-centre European study. These studies showed that, despite certain inherent methodological and logistic constraints, a study design such as this one works relatively well in practice. The average response in the calibration study was 78.3% and ranged from 46.5% to 92.5%. The calibration population differed slightly from the overall cohort but the differences were small for most characteristics and centres. The overall results suggest that, after adjustment for age, dietary intakes estimated from calibration samples can reasonably be interpreted as representative of the main cohorts in most of the EPIC centres.

  • 204. Steffen, Annika
    et al.
    Bergmann, Manuela M
    Sanchez, Maria-Jose
    Chirlaque, Maria-Dolores
    Jakszyn, Paula
    Amiano, Pilar
    Ramon Quiros, J
    Barricarte Gurrea, Aurelio
    Ferrari, Pietro
    Romieu, Isabelle
    Fedirko, Veronika
    Bueno-de-Mesquita, HB
    Siersema, Peter D
    Peeters, Petra HM
    Khaw, Kay-Tee
    Wareham, Nick
    Allen, Naomi E
    Crowe, Francesca L
    Skeie, Guri
    Hallmanns, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Borgquist, Signe
    Ericson, Ulrika
    Egeberg, Rikke
    Tjonneland, Anne
    Overvad, Kim
    Grote, Verena
    Li, Kuanrong
    Trichopoulou, Antonia
    Oikonomidou, Despoina
    Pantzalis, Menelaos
    Tumino, Rosario
    Panico, Salvatore
    Palli, Domenico
    Krogh, Vittorio
    Naccarati, Alessio
    Mouw, Traci
    Vergnaud, Anne-Claire
    Norat, Teresa
    Boeing, Heiner
    Meat and heme iron intake and risk of squamous cell carcinoma of the upper aero-digestive tract in the European Prospective Investigation into Cancer and Nutrition (EPIC)2012In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 21, no 12, p. 2138-2148Article in journal (Refereed)
    Abstract [en]

    Background: Evidence from prospective studies on intake of meat and fish and risk of squamous cell carcinoma (SCC) of the upper aero-digestive tract (UADT) is scarce. We prospectively investigated the association of meat and fish intake with risk of SCC of the UADT and the possible mechanism via heme iron in the large multicenter European Prospective Investigation into Cancer and Nutrition (EPIC) study.

    Methods: Multivariable proportional hazards models were used to estimate relative risks (RR) of SCC of the UADT in relation to intake of total meat, as well as subtypes of meat, fish, and heme iron among 348,738 individuals from 7 European countries.

    Results: During an average follow-up of 11.8 years, a total of 682 incident cases of UADT SCC were accrued. Intake of processed meat was positively associated with risk of SCC of the UADT in the total cohort (highest vs. lowest quintile: RR = 1.41; 95% confidence interval (CI) = 1.03-1.941, however, in stratified analyses, this association was confined to the group of current smokers (highest vs. lowest quintile: RR = 1.89; 95% CI = 1.22-2.93). Red meat, poultry, fish, and heme iron were not consistently related to UADT SCC.

    Conclusion: Higher intake of processed meat was positively associated with KC of the UADT among smokers. Although this finding was stable in various sensitivity analyses, we cannot rule out residual confounding by smoking. Confirmation in future studies and identification of biologic mechanisms is warranted.

    Impact: Smokers may further increase their risk for SCC of the UADT if they additionally consume large amounts of processed meat.

    Cancer Epidemiol Biomarkers Prev; 21(12); 2738-48. (C)2012 AACR.

  • 205. Stenudd, C
    et al.
    Nordlund, Åke
    Umeå University, Faculty of Medicine, Odontology, Cariology.
    Ryberg, M
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Odontology, Cariology.
    Källestål, Carina
    Strömberg, Nicklas
    Umeå University, Faculty of Medicine, Odontology, Cariology.
    The association of bacterial adhesion with dental caries.2001In: Journal of Dental Research, Vol. 80, no 11, p. 2005-10Article in journal (Refereed)
    Abstract [en]

    Saliva adhesion of bacteria is a key event in oral biofilm formation. Here, we used partial least-squares (PLS) analysis to correlate adhesion of cariogenic (Streptococcus mutans Ingbritt) and commensal (Actinomyces naeslundii LY7) model bacteria, and their agglutinin and acidic proline-rich protein ligands, respectively, with high and low caries experiences in 38 children reflecting today's skewed caries distribution. Adhesion of S. mutans was among the factors correlating strongest with high caries experience when PLS modeled together with traditional factors (e.g., sugar intake, lactobacilli counts). Saliva phenotypes with high agglutinin levels and Db-s (an acidic PRP variant) coincided with both high caries experience and S. mutans adhesion. A. naeslundii adhesion correlated with low caries experience. Non-Db phenotypes (i.e., acidic PRP-1 and PRP-2 variants) coincided with both low caries experience and S. mutans, but high A. naeslundii, adhesion. Thus, bacterial adhesion may modulate susceptibility and resistance to dental caries.

  • 206.
    Strömberg, Nicklas
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Ahlfors, S
    Borén, Thomas
    Bratt, P
    Hallberg, K
    Hammarström, KJ
    Holm, C
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Järvholm, M
    Kihlberg, J
    Li, T
    Ryberg, M
    Zand, G
    Anti-adhesion and diagnostic strategies for oro-intestinal bacterial pathogens.1996In: Advances in Experimental Medicine and Biology, ISSN 0065-2598, E-ISSN 2214-8019, Vol. 408, p. 9-24Article in journal (Refereed)
  • 207.
    Sundström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Bengtsson, Camilla
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Klareskog, Lars
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm.
    High sodium intake among smokers is a risk factor for acpa positivity in RA2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, no Supplement 2, p. S136-S136Article in journal (Other academic)
  • 208.
    Sundström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Johansson, Gunnar
    Högskolan i Halmstad, Sektionen för hälsa och samhälle .
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Wållberg Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Cardiovascular risk factors among patients with ankylosing spondylitis in comparison to the general population2012In: Annals of the Rheumatic diseases: supplement 3, 2012, Vol. 71, p. 648-Conference paper (Refereed)
  • 209.
    Sundström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Johansson, Gunnar
    Högskolan i Halmstad, Sektionen för hälsa och samhälle.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Wållberg Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Kost och andra kardiovaskulära riskfaktorer hos patienter med ankyloserande spondylit2011In: Abstrakt Medicinska riksstämman Stockholm 2011, 2011Conference paper (Refereed)
  • 210.
    Sundström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology. University Hospital, Umeå.
    Johansson, Gunnar
    Högskolan i Halmstad, Sektionen för hälsa och samhälle .
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Wållberg Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Modifiable cardiovascular risk factors in patients with ankylosing spondylitis2014In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 33, no 1, p. 111-117Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate whether modifiable cardiovascular disease (CVD) risk factors, e.g. atherogenic blood lipids, hypertension and lifestyle-related factors such as smoking, diet and physical inactivity, differ among patients with ankylosing spondylitis (AS) in comparison to the general population. Eighty-eight patients diagnosed with AS were identified by analysis of the databases of a previous community intervention programme, the Västerbotten intervention programme. The patients were compared with 351 controls matched for age, sex and study period. These databases include the results of blood samples analysed for cholesterol, triglycerides and plasma glucose, as well as data on hypertension, height, weight, smoking and dietary habits and physical activity. No significant differences were found between patients and controls regarding hypertension, body mass index, physical activity, diet or smoking. Levels of serum triglycerides (p < 0.01) and cholesterol (p < 0.01) were significantly lower in the patient group. Among the patients, the level of triglycerides correlated inversely with the intake of total fat (r s = −0.25, p < 0.05), monounsaturated fats (r s = −0.29, p < 0.05) and positively correlated to the intake of carbohydrates (r s = 0.26, p < 0.05). These associations were not apparent among the controls. In the cohort of AS patients studied, no differences were found regarding the modifiable risk factors for CVD compared with the general population. Hence, the increased presence of CVD in patients with AS may be caused by other factors such as differences in metabolism and medication such as NSAID or the chronic low-grade inflammation present in the disease.

  • 211.
    Sundström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Johansson, Gunnar
    School of social and health sciences, Halmstad university, Halmstad, Sweden.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Wållberg-Jonsson, Solveig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Diet and cardiovascular risk factors among patients with ankylosing spondylitis in comparison with the general populationManuscript (preprint) (Other academic)
    Abstract [en]

    Background: An increased risk of cardiovascular diseases (CVD) has been reported among patients with Ankylosing Spondylitis (AS).  As of today, little is known what causes this increase.  The aim of this study was to evaluate whether diet and traditional CVD risk factors differ among AS patients in comparison to the general population.

    Material and method: Eighty-nine patients diagnosed with AS by fulfilling the modified New York criteria were identified in the databases of a community intervention programme, the Västerbotten Intervention Programme (VIP).  The patients were compared with 356 controls matched for age, sex and study period.  As part of the VIP, participants have completed questionnaires regarding diet, physical activity and smoking.  Additionally, the VIP included measurement of blood pressure, height and weight, and blood samples analysed for cholesterol, serum triglycerides and blood glucose.

    Results: No significant differences were found between patients and controls regarding diet, physical activity, exercise frequency or smoking habits; nor in measurements of body mass index (BMI), weight or blood pressure.  However, levels of serum triglycerides (p<0.01) and cholesterol (p<0.01) were significantly lower in the patient group.  Among the patients, the level of triglycerides was inversely correlated to the intake of total fat (rs = -0.25, p<0.05), monounsaturated fats (rs = -0.29, p<0.05) and positively correlated to the intake of carbohydrates (rs = 0.26, p<0.05).  These correlations were not seen among the controls.

    Conclusions: The patients exhibited significantly lower levels of cholesterol and triglycerides compared with controls.  There were correlations between diet and atherogenic blood lipids among the patients which were not found in the control group.  The results suggest that there may be differences in fat metabolism among patients with AS in comparison to the general population.

  • 212.
    Sundström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Dahlqvist, Solbritt Rantapää
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Diet and Other Lifestyle Related Factors and the Risk of Developing Rheumatoid Arthritis2012In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 64, no 10, p. S1141-S1141Article in journal (Other academic)
  • 213.
    Sundström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Rantapää Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Dietary sodium increases the risk for rheumatoid arthritis among smokers2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, p. 329-329Article in journal (Refereed)
  • 214.
    Sundström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology. University Hospital, Umeå.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Rantapää Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Interaction between dietary sodium and smoking increases the risk for rheumatoid arthritis: results from a nested case-control study2015In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 54, no 3, p. 487-493Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Recent studies in animal models and on human cells have shown an effect of sodium chloride (NaCl) on Th17 cells promoting inflammation. The aim of this study was to evaluate the impact of NaCl intake on the risk of development of RA.

    METHODS: A nested case-control study was performed using population-based prospective data from the Västerbotten Intervention Programme. The study included 386 individuals who had stated their dietary habits as part of a community intervention programme a median of 7.7 years before the onset of symptoms of RA. For comparison, 1886 matched controls were identified from the same database and co-analysed.

    RESULTS: No significant association was found between sodium intake and the development of RA when all of the individuals were included. In analyses stratified for smoking status at the time of the examination, sodium intake more than doubled the risk for RA among smokers [odds ratio (OR) 2.26 (95% CI 1.06, 4.81)]. This was not observed among non-smokers. Additive interaction analysis of smoking and cases with the highest tertile of sodium intake revealed that 54% of the increased risk of developing RA from these exposures was due to interaction between them [attributable proportion 0.54 (95% CI 0.26, 0.82)]. The risk was further increased for the development of anti-CCP-positive and/or HLA shared epitope-positive RA.

    CONCLUSION: Although we were unable to confirm our stated hypothesis, our results that high sodium consumption among smokers was associated with the risk of RA may provide new insights into the impact of smoking in RA development.

  • 215.
    Sundström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Rantapää Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Interaktion mellan salt och rökning ökar risken för reumatoid artrit2014In: ReumaBulletinen, ISSN 2000-2246, Vol. 96, no 2, p. 22-Article in journal (Refereed)
  • 216.
    Sundström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Rantapää Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Kost och livsstil som riskfaktorer för att utveckla reumatoid artrit2012In: Abstrakt Medicinska riksstämman Stockholm 2012, 2012Conference paper (Refereed)
  • 217.
    Sundström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Diet and alcohol as risk factors for rheumatoid arthritis: a nested case-control study2015In: Rheumatology International, ISSN 0172-8172, E-ISSN 1437-160X, Vol. 35, no 3, p. 533-539Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate whether alcohol and diet, assessed as both macronutrients and dietary patterns, increased the risk of development of rheumatoid arthritis (RA) through a nested case-control design in the Vasterbotten Intervention Program (VIP) cohort. Individuals in the VIP who had developed RA after the dietary survey were identified from medical records at the department of rheumatology at the University Hospital, UmeAyen (n = 386), and matched to 1,886 controls from the same database. Diet was assessed as food groups, as macronutrients and as scores of dietary patterns, namely the carbohydrate-restricted diet score, the Mediterranean diet score and the healthy diet indicator score. When analysing the dietary patterns, consumption of food groups and different macronutrients, a significant association was found in the highest tertile of carbohydrate-restricted diet among the cases with a subsequent anti-CCP-positive disease 1.40 (1.02-1.92), as well as in the highest tertile of protein consumption among smokers (OR = 1.80, 95 % CI 1.09-2.95). However, after additional adjustment for sodium intake, these associations were no longer statistically significant. No association was observed between alcohol consumption and the risk of RA. To summarize, there were no significant associations between diet, or alcohol consumption, and the risk of development of RA within this cohort. The lack of any significant associations of alcohol consumption may be explained by a low consumption in the studied population overall or alternatively by methodological issues raised recently.

  • 218.
    Sundström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Dietary patterns, macronutrients and alcohol as risk factors for rheumatoid arthritis2014In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, p. 1144-1145Article in journal (Other academic)
  • 219.
    Sundström, Björn
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Reumatology.
    Dietary Sodium Increases The Risk For Rheumatoid Arthritis Among Smokers – Results From a Nested Case-Control Study.2013In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 65, no Special Issue, Supplement 10, p. S966-S966, Meeting Abstract: 2271Article in journal (Other academic)
  • 220. Sundström, Johan
    et al.
    Björkelund, Cecilia
    Giedraitis, Vilmantas
    Hansson, Per-Olof
    Högman, Marieann
    Janson, Christer
    Koupil, Ilona
    Kristenson, Margareta
    Lagerros, Ylva Trolle
    Leppert, Jerzy
    Lind, Lars
    Lissner, Lauren
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Ludvigsso, Jonas F.
    Nilsson, Peter M.
    Olsson, Håkan
    Pedersen, Nancy L.
    Rosenblad, Andreas
    Rosengren, Annika
    Sandin, Sven
    Snackerstrom, Tomas
    Stenbeck, Magnus
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Heart Center, Umeå University, Umeå.
    Weiderpass, Elisabete
    Wanhainen, Ers
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Fortier, Isabel
    Heller, Susanne
    Storgards, Maria
    Svennblad, Bodil
    Rationale for a Swedish cohort consortium2019In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 1, p. 21-28Article in journal (Refereed)
    Abstract [en]

    We herein outline the rationale for a Swedish cohort consortium, aiming to facilitate greater use of Swedish cohorts for world-class research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on rare exposures and outcomes, leading to better utilization of study participants' data, better return of funders' investments, and higher benefit to patients and populations. We motivate the proposed infrastructure partly by lessons learned from a pilot study encompassing data from 21 cohorts. We envisage a standing Swedish cohort consortium that would drive development of epidemiological research methods and strengthen the Swedish as well as international epidemiological competence, community, and competitiveness.

  • 221. Suzuki, Reiko
    et al.
    Allen, Naomi E
    Key, Timothy J
    Appleby, Paul N
    Tjønneland, Anne
    Johnsen, Nina Føns
    Jensen, Majken K
    Overvad, Kim
    Boeing, Heiner
    Pischon, Tobias
    Kaaks, Rudolf
    Rohrmann, Sabine
    Trichopoulou, Antonia
    Misirli, Gesthimani
    Trichopoulos, Dimitrios
    Bueno-de-Mesquita, H Bas
    van Duijnhoven, Fränzel
    Sacerdote, Carlotta
    Pala, Valeria
    Palli, Domenico
    Tumino, Rosario
    Ardanaz, Eva
    Quirós, José Ramón
    Larrañaga, Nerea
    Sánchez, Maria-José
    Tormo, María-José
    Jakszyn, Paula
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Odontology.
    Stattin, Pär
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Urology and Andrology.
    Berglund, Göran
    Manjer, Jonas
    Bingham, Sheila
    Khaw, Kay-Tee
    Egevad, Lars
    Ferrari, Pietro
    Jenab, Mazda
    Riboli, Elio
    A prospective analysis of the association between dietary fiber intake and prostate cancer risk in EPIC.2009In: International journal of cancer. Journal international du cancer, ISSN 1097-0215, Vol. 124, no 1, p. 245-9Article in journal (Refereed)
    Abstract [en]

    Few studies have examined the association between dietary fiber intake and prostate cancer risk. We evaluated the association between dietary fiber intake and the risk of prostate cancer among 142,590 men in the European Prospective Investigation into Cancer and Nutrition (EPIC). Consumption of dietary fiber (total, cereal, fruit and vegetable fiber) was estimated by validated dietary questionnaires and calibrated using 24-hr dietary recalls. Incidence rate ratios were estimated using Cox regression and adjusted for potential confounding factors. During an average of 8.7 years follow-up, prostate cancer was diagnosed in 2,747 men. Overall, there was no association between dietary fiber intake (total, cereal, fruit or vegetable fiber) and prostate cancer risk, although calibrated intakes of total fiber and fruit fiber were associated with nonstatistically significant reductions in risk. There was no association between fiber derived from cereals or vegetables and risk and no evidence for heterogeneity in any of the risk estimates by stage or grade of disease. Our results suggest that dietary fiber intake is not associated with prostate cancer risk.

  • 222.
    Söderström, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Schneede, Jörn
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Palmqvist, Richard
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Homocysteine and cotinine levels in smokers and snus users2015In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 241, no 1, p. E129-E129Article in journal (Other academic)
  • 223. Söderström, Ulf
    et al.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Sunnegårdh-Grönberg, Karin
    Umeå University, Faculty of Medicine, Department of Odontology.
    A retrospective analysis of caries treatment and development in relation to assessed caries risk in an adult population in Sweden.2014In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 14, no 1, p. 126-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Public Dental Service of Västerbotten County (Sweden) recommends using population-based prevention strategies combined with an individual strategy for high-risk patients to manage caries. To facilitate this management strategy, all patients are evaluated for their risk of developing caries in the coming year using defined criteria. Using caries risk scoring over a seven-year period, the present study evaluates prophylactic measures, caries development, and non-operative treatments in adult patients.

    METHODS: From all adult patients (25-65 years; n = 76 320) scored with a high caries risk in 2005 (baseline) and with a dental visit in 2011, 200 subjects were randomly selected. In addition, an equally sized control group with a no/low caries risk was selected. Information concerning dental status, counselling, treatments, visits, and costs were retrieved from dental records.

    RESULTS: Over the seven-year study period, subjects with high caries risk had significantly higher caries incidence in spite of shorter recall intervals, more dental appointments, and higher costs for dental care than subjects with no/low caries risk. Non-operative measures, such as additional fluoride and individual counselling on diet at baseline (2005), was higher in the high caries risk group, whereas information about basic prophylaxis and counselling on oral hygiene showed only small differences. The frequency of non-operative measures given during the seven-year study period to patients in the high caries risk group is considered to be remarkably low and improvement, determined as reclassification from high to no/low caries risk from 2005 to 2011, was seen in only 13% of the participants.

    CONCLUSIONS: This study formulated two major conclusions. First, adult patients with high or no/low caries represent different populations, that each contain distinct subpopulations, those who improve/impair or maintained their caries risk and disease progression. These groups need different strategies in disease treatment. Second, preventive measures and non-operative treatments were associated with improvements in caries risk and maintenance, but the extent to which such treatments were given to high caries risk subjects was unacceptably low. Improved adherence to the guidelines for caries treatment may reduce caries risk, visits to dental clinics, and costs for the patients.

  • 224. Tanaka, Toshiko
    et al.
    Ngwa, Julius S.
    van Rooij, Frank J. A.
    Zillikens, M. Carola
    Wojczynski, Mary K.
    Frazier-Wood, Alexis C.
    Houston, Denise K.
    Kanoni, Stavroula
    Lemaitre, Rozenn N.
    Luan, Jian'an
    Mikkila, Vera
    Renstrom, Frida
    Sonestedt, Emily
    Zhao, Jing Hua
    Chu, Audrey Y.
    Qi, Lu
    Chasman, Daniel I.
    Otto, Marcia C. de Oliveira
    Dhurandhar, Emily J.
    Feitosa, Mary F.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Khaw, Kay-Tee
    Lohman, Kurt K.
    Manichaikul, Ani
    McKeown, Nicola M.
    Mozaffarian, Dariush
    Singleton, Andrew
    Stirrups, Kathleen
    Viikari, Jorma
    Ye, Zheng
    Bandinelli, Stefania
    Barroso, Ines
    Deloukas, Panos
    Forouhi, Nita G.
    Hofman, Albert
    Liu, Yongmei
    Lyytikainen, Leo-Pekka
    North, Kari E.
    Dimitriou, Maria
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Kahonen, Mika
    Langenberg, Claudia
    Ordovas, Jose M.
    Uitterlinden, Andre G.
    Hu, Frank B.
    Kalafati, Ioanna-Panagiota
    Raitakari, Olli
    Franco, Oscar H.
    Johnson, Andrew
    Emilsson, Valur
    Schrack, Jennifer A.
    Semba, Richard D.
    Siscovick, David S.
    Arnett, Donna K.
    Borecki, Ingrid B.
    Franks, Paul
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Kritchevsky, Stephen B.
    Lehtimaki, Terho
    Loos, Ruth J. F.
    Orho-Melander, Marju
    Rotter, Jerome I.
    Wareham, Nicholas J.
    Witteman, Jacqueline C. M.
    Ferrucci, Luigi
    Dedoussis, George
    Cupples, L. Adrienne
    Nettleton, Jennifer A.
    Genome-wide meta-analysis of observational studies shows common genetic variants associated with macronutrient intake2013In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 97, no 6, p. 1395-1402Article in journal (Refereed)
    Abstract [en]

    Background: Macronutrient intake varies substantially between individuals, and there is evidence that this variation is partly accounted for by genetic variants.

    Objective: The objective of the study was to identify common genetic variants that are associated with macronutrient intake.

    Design: We performed 2-stage genome-wide association (GWA) meta-analysis of macronutrient intake in populations of European descent. Macronutrients were assessed by using food-frequency questionnaires and analyzed as percentages of total energy consumption from total fat, protein, and carbohydrate. From the discovery GWA (n = 38,360), 35 independent loci associated with macronutrient intake at P < 5 x 10(-6) were identified and taken forward to replication in 3 additional cohorts (n = 33,533) from the DietGen Consortium. For one locus, fat mass obesity-associated protein (FTO), cohorts with Illumina MetaboChip genotype data (n 7724) provided additional replication data.

    Results: A variant in the chromosome 19 locus (rs838145) was associated with higher carbohydrate (beta +/- SE: 0.25 +/- 0.04%; P = 1.68 x 10(-8)) and lower fat (beta = SE: -0.21 +/- 0.04%; P = 1.57 x 10(-9)) consumption. A candidate gene in this region, fibroblast growth factor 21 (FGF21), encodes a fibroblast growth factor involved in glucose and lipid metabolism. The variants in this locus were associated with circulating FGF21 protein concentrations (P < 0.05) but not mRNA concentrations in blood or brain. The body mass index (BMI) increasing allele of the FTO variant (rs1421085) was associated with higher protein intake (beta +/- SE: 0.10 +/- 0.02%; P = 9.96 x 10(-10)), independent of BMI (after adjustment for BMI, beta +/- SE: 0.08 +/- 0.02%; P = 3.15 x 10(-7)).

    Conclusion: Our results indicate that variants in genes involved in nutrient metabolism and obesity are associated with macronutrient consumption in humans. Trials related to this study were registered at clinicaltrials.gov as NCT00005131 (Atherosclerosis Risk in Communities), NCT00005133 (Cardiovascular Health Study), NCT00005136 (Family Heart Study), NCT00005121 (Framingham Heart Study), NCT00083369 (Genetic and Environmental Determinants of Triglycerides), NCT01331512 (InCHIANTI Study), and NCT00005487 (Multi-Ethnic Study of Atherosclerosis).

  • 225. Tanner, A. C. R.
    et al.
    Sonis, A. L.
    Holgerson, Pernilla Lif
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Starr, J. R.
    Nunez, Y.
    Kressirer, C. A.
    Paster, B. J.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    White-spot Lesions and Gingivitis Microbiotas in Orthodontic Patients2012In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 91, no 9, p. 853-858Article in journal (Refereed)
    Abstract [en]

    White-spot lesions (WSL) associated with orthodontic appliances are a cosmetic problem and increase risk for cavities. We characterized the microbiota of WSL, accounting for confounding due to gingivitis. Participants were 60 children with fixed appliances, aged between 10 and 19 yrs, half with WSL. Plaque samples were assayed by a 16S rRNA-based microarray (HOMIM) and by PCR. Mean gingival index was positively associated with WSL (p = 0.018). Taxa associated with WSL by microarray included Granulicatella elegans (p = 0.01), Veillonellaceae sp. HOT 155 (p < 0.01), and Bifidobacterium Cluster 1 (p = 0.11), and by qPCR, Streptococcus mutans (p = 0.008) and Scardovia wiggsiae (p = 0.04) Taxa associated with gingivitis by microarray included: Gemella sanguinis (p = 0.002), Actinomyces sp. HOT 448 (p = 0.003), Prevotella cluster IV (p = 0.021), and Streptococcus sp. HOT 071/070 (p = 0.023); and levels of S. mutans (p = 0.02) and Bifidobacteriaceae (p = 0.012) by qPCR. Species' associations with WSL were minimally changed with adjustment for gingivitis level. Partial least-squares discriminant analysis yielded good discrimination between children with and those without WSL. Granulicatella, Veillonellaceae and Bifidobacteriaceae, in addition to S. mutans and S. wiggsiae, were associated with the presence of WSL in adolescents undergoing orthodontic treatment. Many taxa showed a stronger association with gingivitis than with WSL.

  • 226. Tanner, ACR
    et al.
    Kent, RL Jr
    Holgersson, Pernilla Lif
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Hughes, CV
    Loo, CY
    Kanasi, E
    Chalmers, NI
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Microbiota of severe early childhood caries before and after therapy2011In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 90, no 11, p. 1298-1305Article in journal (Refereed)
    Abstract [en]

    Severe early childhood caries (ECC) is difficult to treat successfully. This study aimed to characterize the microbiota of severe ECC and evaluate whether baseline or follow-up microbiotas are associated with new lesions post-treatment. Plaque samples from 2- to 6-year-old children were analyzed by a 16S rRNA-based microarray and by PCR for selected taxa. Severe-ECC children were monitored for 12 months post-therapy. By microarray, species associated with severe-ECC (n = 53) compared with caries-free (n = 32) children included Slackia exigua (p = 0.002), Streptococcus parasanguinis (p = 0.013), and Prevotella species (p < 0.02). By PCR, severe-ECC-associated taxa included Bifidobacteriaceae (p < 0.001), Scardovia wiggsiae (p = 0.003), Streptococcus mutans with bifidobacteria (p < 0.001), and S. mutans with S. wiggsiae (p = 0.001). In follow-up, children without new lesions (n = 36) showed lower detection of taxa including S. mutans, changes not observed in children with follow-up lesions (n = 17). Partial least-squares modeling separated the children into caries-free and two severe-ECC groups with either a stronger bacterial or a stronger dietary component. We conclude that several species, including S. wiggsiae and S. exigua, are associated with the ecology of advanced caries, that successful treatment is accompanied by a change in the microbiota, and that severe ECC is diverse, with influences from selected bacteria or from diet.

  • 227.
    Timby, Niklas
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lif Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    West, Christina E.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lonnerdal, Bo
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Oral Microbiota in Infants Fed a Formula Supplemented with Bovine Milk Fat Globule Membranes: A Randomized Controlled Trial2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 1, article id e0169831Article in journal (Refereed)
    Abstract [en]

    Background In a recent study, supplementation of infant formula with milk fat globule membranes (MFGM) decreased the incidence of otitis media in infants <6 months of age. Objectives The aim of the present study was to characterize the oral microbiota in infants fed MFGM-supplemented formula and compare it to that of infants fed standard formula or breast milk.

    Methods In a prospective double-blinded randomized controlled trial, exclusively formula-fed infants <2 months of age were randomized to be fed experimental formula (EF, n = 80) with reduced energy and protein and supplemented with a bovine MFGM concentrate, or standard formula (SF, n = 80) until 6 months of age. A breast-fed reference (BFR, n = 80) group was also recruited. The oral microbiota was analyzed at 4 (n = 124) and 12 (n = 166) months of age using Illumina MiSeq multiplex sequencing and taxonomic resolution against the HOMD 16S rDNA database of oral bacteria.

    Results Species richness in the oral samples did not differ between the EF and SF groups, but partial least square modeling identified a few taxa that were significantly associated with being in either group, e.g. lower level of Moraxella catarrhalis in the EF group. Infants in the BFR group had significantly lower species richness at 4 months of age and their microbiota pattern differed markedly from the formula-fed groups.

    Conclusions Supplementation of infant formula with MFGM yielded moderate effects on the oral micro biome. Moraxella catarrhalis was less prevalent in infants fed EF than in those fed SF and may be associated with the decrease in otitis media seen in the same group.

  • 228. Tjonneland, A
    et al.
    Christensen, J
    Olsen, A
    Stripp, C
    Thomsen, BL
    Overvad, K
    Peeters, PH
    van Gils, CH
    Bueno-de-Mesquita, HB
    Ocké, MC
    Thiebaut, A
    Fournier, A
    Clavel-Chapelon, F
    Berrino, F
    Palli, D
    Tumino, R
    Panico, S
    Vineis, P
    Agudo, A
    Ardanaz, E
    Martinez-Garcia, C
    Amiano, P
    Navarro, C
    Quirós, JR
    Key, TJ
    Reeves, G
    Khaw, KT
    Bingham, S
    Trichopoulou, A
    Trichopoulos, D
    Naska, A
    Nagel, G
    Chang-Claude, J
    Boeing, H
    Lahmann, PH
    Manjer, J
    Wirfält, E
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Lund, E
    Skele, G
    Hjartåker, A
    Ferrari, P
    Slimani, N
    Kaaks, R
    Riboli, E
    Alcohol intake and breast cancer risk: the European Prospective Investigation into Cancer and Nutrition (EPIC).2007In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 18, no 4, p. 361-371Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Most epidemiologic studies have suggested an increased risk of breast cancer with increasing alcohol intake. Using data from 274,688 women participating in the European Prospective Investigation into Cancer and Nutrition study (EPIC), we investigated the relation between alcohol intake and the risk of breast cancer. METHODS: Incidence rate ratios (IRRs) based on Cox proportional hazard models were calculated using reported intake of alcohol, recent (at baseline) and lifetime exposure. We adjusted for known risk factors and stratified according to study center as well as potentially modifying host factors. RESULTS: During 6.4 years of follow up, 4,285 invasive cases of breast cancer within the age group 35-75 years were identified. For all countries together the IRR per 10 g/day higher recent alcohol intake (continuous) was 1.03 (95% confidence interval (CI): 1.01-1.05). When adjusted, no association was seen between lifetime alcohol intake and risk of breast cancer. No difference in risk was shown between users and non-users of HRT, and there was no significant interaction between alcohol intake and BMI, HRT or dietary folate. CONCLUSION: This large European study supports previous findings that recent alcohol intake increases the risk of breast cancer.

  • 229. Tognon, Gianluca
    et al.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Lissner, Lauren
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Winkvist, Anna
    The Mediterranean Diet Score and Mortality Are Inversely Associated in Adults Living in the Subarctic Region2012In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 142, no 8, p. 1547-1553Article in journal (Refereed)
    Abstract [en]

    The Mediterranean diet has been widely promoted and may be associated with chronic disease prevention and a better overall health status. The aim of this study was to evaluate whether the Mediterranean diet score inversely predicted total or cause-specific mortality in a prospective population study in Northern Sweden (Vasterbotten Intervention Program). The analyses were performed in 77,151 participants (whose diet was measured by means of a validated FFQ) by Cox proportional hazard models adjusted for several potential confounders. The Mediterranean diet score was inversely associated with all-cause mortality in men [HR = 0.96(95% Cl = 0.93, 0.99)] and women [HR = 0.95 (95% Cl = 0.91, 0.99)], although not in obese men. In men, but not in women, the score was inversely associated with total cancer mortality [HR = 0.92 (95% Cl = 0.87, 0.98)], particularly for pancreas cancer [HR = 0.82 (95% Cl = 0.68, 0.99)]. Cardiovascular mortality was inversely associated with diet only in women [HR = 0.90(95% Cl = 0.82, 0.99)]. Except for alcohol [HR = 0.83(95% Cl = 0.76, 0.90)] and fruit intake [HR = 0.90 (95% Cl = 0.83, 0.98)], no food item of the Mediterranean diet score independently predicted mortality. Higher scores were associated with increasing age, education, and physical activity. Moreover, healthful dietary and lifestyle-related factors additively decreased the mortality likelihood. Even in a subarctic region, increasing Mediterranean diet scores were associated with a longer life, although the protective effect of diet was of small magnitude compared with other healthful dietary and lifestyle-related factors examined.

  • 230. Travier, Noemie
    et al.
    Agudo, Antonio
    May, Anne M.
    Gonzalez, Carlos
    Luan, Jian'an
    Wareham, Nick J.
    Bueno-de-Mesquita, H. Bas
    van den Berg, Saskia W.
    Slimani, Nadia
    Rinaldi, Sabina
    Clavel-Chapelon, Francoise
    Boutron-Ruault, Marie-Christine
    Palli, Domenico
    Sieri, Sabina
    Mattiello, Amalia
    Tumino, Rosario
    Vineis, Paolo
    Norat, Teresa
    Romaguera, Dora
    Rodriguez, Laudina
    Sanchez, Maria-Jose
    Dorronsoro, Miren
    Barricarte, Aurelio
    Huerta, Jose M.
    Key, Tim J.
    Orfanos, Philippos
    Naska, Androniki
    Trichopoulou, Antonia
    Rohrmann, Sabina
    Kaaks, Rudolf
    Bergmann, Manuela M.
    Boeing, Heiner
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Manjer, Jonas
    Lindkvist, Bjorn
    Jakobsen, Mariane U.
    Overvad, Kim
    Tjonneland, Anne
    Halkjaer, Jytte
    Lund, Eiliv
    Braaten, Toni
    Odysseos, Andreani
    Riboli, Elio
    Peeters, Petra H.
    Longitudinal changes in weight in relation to smoking cessation in participants of the EPIC-PANACEA study2012In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 54, no 3-4, p. 183-192Article in journal (Refereed)
    Abstract [en]

    Purpose. We assessed the association between smoking cessation and prospective weight change in the European population of the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of smoking. Eating out of home And obesity (EPIC-PANACEA) project. Methods. The study involved more than 300,000 healthy volunteers, recruited between 1992 and 2000 in 9 European countries, who provided data on anthropometry and smoking habits at baseline and after a follow-up of 5 years on average. Adjusted mixed-effects linear regression models were used to obtain sex-specific summary estimates of the association between the change in smoking status and the annual change in weight. Results. Smoking cessation tends to be followed by weight gain; when compared to stable smokers, annual weight gain was higher in men (0.44 kg (95%CI: 0.36; 0.52)) and women (0.46 kg (95%CI: 0.41; 0.52)) who stopped smoking during follow-up. When smokers who stopped smoking at least 1 year before recruitment were compared to never smokers, no major differences in annual weight gain were observed. The excess weight gain following smoking cessation appears to mainly occur in the first years following the cessation. Conclusions. When considering the benefits of smoking cessation, such findings strengthen the need for promoting cessation offering information on weight gain control and support to weight-concerned smokers in order to remove a barrier to quitting. (C) 2011 Elsevier Inc. All rights reserved.

  • 231. Travier, Noémie
    et al.
    Agudo, Antonio
    May, Anne M
    Gonzalez, Carlos
    Luan, Jian'an
    Besson, Hervé
    Wareham, Nick J
    Slimani, Nadia
    Rinaldi, Sabina
    Clavel-Chapelon, Françoise
    Boutron-Ruault, Marie-Christine
    Palli, Domenico
    Agnoli, Claudia
    Mattiello, Amalia
    Tumino, Rosario
    Vineis, Paolo
    Rodriguez, Laudina
    Sanchez, Maria-José
    Dorronsoro, Miren
    Barricarte, Aurelio
    Tormo, Maria-José
    Norat, Teresa
    Mouw, Traci
    Key, Tim J
    Spencer, Elizabeth A
    Bueno-de-Mesquita, H Bas
    Vrieling, Alina
    Orfanos, Philippos
    Naska, Ada
    Trichopoulou, Antonia
    Rohrmann, Sabina
    Kaaks, Rudolf
    M Bergmann, Manuela
    Boeing, Heiner
    Hallmans, Goran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Manjer, Jonas
    Lindkvist, Björn
    Jakobsen, Mariane Uhre
    Overvad, Kim
    Tjonneland, Anne
    Halkjaer, Jytte
    Lund, Eiliv
    Braaten, Toni
    Odysseos, Andreani
    Riboli, Elio
    Peeters, Petra H
    Smoking and body fatness measurements: a cross-sectional analysis in the EPIC-PANACEA study2009In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 49, no 5, p. 365-373Article in journal (Refereed)
    Abstract [en]

    Objective: The present study investigates the cross-sectional relationship between tobacco smoking and body fatness.

    Methods: This cross-sectional study consisted of 469,543 men and women who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) study between 1992 and 2000 providing anthropometric measurements and information on smoking. Adjusted multilevel mixed-effects linear regression models were used to assess the association between smoking and body fat mass.

    Results: The analyses showed that BMI and WC were positively associated with smoking intensity in current smokers but negatively associated with time since quitting in former smokers. When compared to never smokers, average current smokers (17 and 13 cig/day for men and women, respectively) showed a lower BMI. When average former smokers (men and women who had stopped smoking for 16 and 15 years, respectively) were compared to never smokers, higher BMI and WC were observed in men, whereas no significant associations were observed in women.

    Conclusions: This cross-sectional study suggests that smoking may be associated with body fatness and fat distribution. Although our findings cannot establish cause and effect, they suggest that providing information and support to those who want to stop may help in preventing weight gain and therefore weaken a barrier against stopping smoking.

  • 232. Trichopoulou, A
    et al.
    Orfanos, P
    Norat, T
    Bueno-de-Mesquita, B
    Ocke, MC
    Peeters, PH
    van der Schouw, YT
    Boeing, H
    Hoffmann, K
    Boffetta, P
    Nagel, G
    Masala, G
    Krogh, V
    Panico, S
    Tumino, R
    Vineis, P
    Bamia, C
    Naska, A
    Benetou, V
    Ferrari, P
    Slimani, N
    Pera, G
    Martinez-Garcia, C
    Navarro, C
    Rodriguez-Barranco, M
    Dorronsoro, M
    Spencer, EA
    Key, TJ
    Bingham, S
    Khaw, KT
    Kesse, E
    Clavel-Chapelon, F
    Boutron-Ruault, MC
    Berglund, G
    Wirfalt, E
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Tjonneland, A
    Olsen, A
    Overvad, K
    Hundborg, HH
    Riboli, E
    Trichopoulos, D
    Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study.2005In: British Medical Journal, Vol. 30, no 330, p. 991-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine whether adherence to the modified Mediterranean diet, in which unsaturates were substituted for monounsaturates, is associated with longer life expectancy among elderly Europeans. DESIGN: Multicentre, prospective cohort study. SETTING: Nine European countries (Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, United Kingdom). PARTICIPANTS: 74,607 men and women, aged 60 or more, without coronary heart disease, stroke, or cancer at enrolment and with complete information about dietary intake and potentially confounding variables. MAIN OUTCOME MEASURES: Extent of adherence to a modified Mediterranean diet using a scoring system on a 10 point scale, and death from any cause by time of occurrence, modelled through Cox regression. RESULTS: An increase in the modified Mediterranean diet score was associated with lower overall mortality, a two unit increment corresponding to a statistically significant reduction of 8% (95% confidence interval 3% to 12%). No statistically significant evidence of heterogeneity was found among countries in the association of the score with overall mortality even though the association was stronger in Greece and Spain. When dietary exposures were calibrated across countries, the reduction in mortality was 7% (1% to 12%). CONCLUSION: The Mediterranean diet, modified so as to apply across Europe, was associated with increased survival among older people.

  • 233. Twetman, Svante
    et al.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Odontology, Cariology.
    Birkhed, D
    Nederfors, T
    Caries incidence in young type 1 diabetes mellitus patients in relation to metabolic control and caries-associated risk factors.2002In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 36, no 1, p. 31-5Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the caries incidence in a group of young patients with type 1 diabetes mellitus over a 3-year period from the onset of the disease in relation to metabolic control and to caries-associated risk factors. Sixty-four children and adolescents (8-15 years of age) had their diabetes treated and monitored according to a standard medical protocol and received extensive preventive oral health care based on individual needs. Data on blood glucose and glycosylated haemoglobin (Hb A(Ic)) were collected from the medical records. Whole saliva was collected every 3rd month and secretion rate, buffer capacity, glucose concentration, mutans streptococci and lactobacilli counts were determined. Dental examinations, including radiographs, were carried out once a year. Patients with less good metabolic control (>8.0% Hb A(Ic)) exhibited higher glucose levels in resting saliva (p < 0.05) and a significantly higher caries incidence (p < 0.05) compared to those with good metabolic control. The most influential determinants for high caries development during the 3-year follow-up period were metabolic control (odds ratio, OR = 5.7), poor oral hygiene (OR = 6.5), previous caries experience (OR = 5.3) and high levels of salivary lactobacilli (OR = 5.0). The findings suggest that the level of metabolic control and traditional caries risk markers are important factors for caries development in children and adolescents with type 1 diabetes mellitus. Copyright 2002 S. Karger AG, Basel

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

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

  • 235. van Bakel, Marit M E
    et al.
    Slimani, Nadia
    Feskens, Edith J M
    Du, Huaidong
    Beulens, Joline W J
    van der Schouw, Yvonne T
    Brighenti, Furio
    Halkjaer, Jytte
    Cust, Anne E
    Ferrari, Pietro
    Brand-Miller, Jennie
    Bueno-de-Mesquita, H Bas
    Peeters, Petra
    Ardanaz, Eva
    Dorronsoro, Miren
    Crowe, Francesca L
    Bingham, Sheila
    Rohrmann, Sabine
    Boeing, Heiner
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Manjer, Jonas
    Tjonneland, Anne
    Overvad, Kim
    Lund, Eiliv
    Skeie, Guri
    Mattiello, Amalia
    Salvini, Simonetta
    Clavel-Chapelon, Françoise
    Kaaks, Rudolf
    Methodological challenges in the application of the Glycemic Index in epidemiological studies using data from the European prospective investigation into cancer and nutrition2009In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 139, no 3, p. 568-575Article in journal (Refereed)
    Abstract [en]

    Associations between the glycemic index (GI) or glycemic load (GL) and diseases are heterogeneous in epidemiological studies. Differences in assigning GI values to food items may contribute to this inconsistency. Our objective was to address methodological issues related to the use of current GI and GL values in epidemiological studies. We performed ecological comparison and correlation studies by calculating dietary GI and GL from country-specific dietary questionnaires (DQ) from 422,837 participants from 9 countries participating in the European Prospective Investigation into Cancer and Nutrition study and single standardized 24-h dietary recalls (24-HDR) obtained from a representative sample (n = 33,404) using mainly Foster Powell's international table as a reference source. Further, 2 inter-rater and 1 inter-method comparison were conducted, comparing DQ GI values assigned by independent groups with values linked by us. The ecological correlation between DQ and 24-HDR was good for GL (overall r = 0.76; P < 0.005) and moderate for GI (r = 0.57; P < 0.05). Mean GI/GL differences between DQ and 24-HDR were significant for most centers. GL but not GI from DQ was highly correlated with total carbohydrate (r = 0.98 and 0.15, respectively; P < 0.0001) and this was higher for starch (r = 0.72; P < 0.0001) than for sugars (r = 0.36; P < 0.0001). The inter-rater and inter-method variations were considerable for GI (weighted kappa coefficients of 0.49 and 0.65 for inter-rater and 0.25 for inter-method variation, respectively) but only mild for GL (weighted kappa coefficients > 0.80). A more consistent methodology to attribute GI values to foods and validated DQ is needed to derive meaningful GI/GL estimates for nutritional epidemiology.

  • 236.
    Van Guelpen, Bethany
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Dahlin, Anna M
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Eklöf, Vincy
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Henriksson, Maria L
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Cullman, Inger
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Palmqvist, Richard
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    One-carbon metabolism and CpG island methylator phenotype status in incident colorectal cancer: a nested case-referent study2010In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 21, no 4, p. 557-566Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: We related prediagnostic plasma folate, vitamin B12, and total homocysteine concentrations, and the MTHFR 677C>T and 1298A>C polymorphisms, to the risk of colorectal cancer with and without the CpG island methylator phenotype (CIMP).

    METHODS: This was a nested case-referent study of 190 cases and double, matched referents from the large, population-based Northern Sweden Health and Disease Study. Using archival tumor tissue, promoter methylation in an eight-gene panel was analyzed by MethyLight.

    RESULTS: A reduced risk of CIMP-low/CIMP-high CRC (>/=1 gene methylated) was observed in subjects with very low plasma folate concentrations [multivariate odds ratio 2.96 (95% CI 1.24-7.08) for quintiles two to five versus one (lowest)]. With the exception of a reduced risk in MTHFR 677 TT-homozygotes, none of the other one-carbon variables were associated with the risk of CIMP-low/CIMP-high CRC. For CIMP-negative CRC, only the MTHFR polymorphisms were statistically significantly related to risk, inversely for 677C>T and positively for 1298A>C, but a tendency toward a reduced risk was observed in subjects with an adequate methyl availability, combining the plasma variables [multivariate odds ratio 0.61 (95% CI 0.32-1.15)].

    CONCLUSION: Though limited by low power, these findings suggest the possibility of different roles for one-carbon metabolism in different pathways of colorectal tumorigenesis.

  • 237.
    Van Guelpen, Bethany
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Stenling, Roger
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Riboli, E
    Winkvist, A
    Palmqvist, Richard
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Low folate levels may protect against colorectal cancer2006In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 55, no 10, p. 1461-1466Article in journal (Other academic)
    Abstract [en]

    BACKGROUND AND AIMS: Dietary folate is believed to protect against colorectal cancer (CRC). However, few studies have addressed the role of circulating levels of folate. The aim of this study was to relate prediagnostic plasma folate and homocysteine concentrations and the methylenetetrahydrofolate reductase (MTHFR) 677C>T and 1298A>C polymorphisms to the risk of developing CRC.

    SUBJECTS: Subjects were 226 cases and 437 matched referents from the population based Northern Sweden Health and Disease Cohort.

    RESULTS: We observed a bell-shaped association between plasma folate concentrations and CRC risk; multivariate odds ratio for middle versus lowest quintile 2.00 (95% confidence interval (CI) 1.13-3.56). In subjects with follow up times greater than the median of 4.2 years however, plasma folate concentrations were strongly positively related to CRC risk; multivariate odds ratio for highest versus lowest quintile 3.87 (95% CI 1.52-9.87; p trend = 0.007). Homocysteine was not associated with CRC risk. Multivariate odds ratios for the MTHFR polymorphisms were, for 677 TT versus CC, 0.41 (95% CI 0.19-0.85; p trend = 0.062), and for 1298 CC versus AA, 1.62 (95% CI 0.94-2.81; p trend = 0.028). Interaction analysis suggested that the result for 1298A>C may have been largely due to linkage disequilibrium with 677C>T. The reduced CRC risk in 677 TT homozygotes was independent of plasma folate status.

    CONCLUSIONS: Our findings suggest a decreased CRC risk in subjects with low folate status. This possibility of a detrimental component to the role of folate in carcinogenesis could have implications in the ongoing debate in Europe concerning mandatory folate fortification of foods.

  • 238.
    Van Guelpen, Bethany
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Nilsson, Torbjörn K
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Witthoft, Cornelia
    Palmqvist, Richard
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Winkvist, Anna
    Folate, vitamin B12, and risk of ischemic and hemorrhagic stroke: a prospective, nested case-referent study of plasma concentrations and dietary intake.2005In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 36, no 7, p. 1426-1431Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Folate metabolism has been implicated in stroke. However, the possibility of a role for folate and vitamin B12, independent of their effects on homocysteine status, remains to be explored. The aim of this prospective, nested case-referent study was to relate plasma and dietary intake levels of folate and vitamin B12 to risk of stroke, taking into consideration plasma homocysteine concentrations and methylenetetrahydrofolate reductase polymorphisms. METHODS: Subjects were 334 ischemic and 62 hemorrhagic stroke cases and matched double referents from the population-based Northern Sweden Health and Disease Cohort. RESULTS: Plasma folate was statistically significantly associated with risk of hemorrhagic stroke in an inv