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  • 51.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Ruuth, Anders
    Department of Obstetrics and Gynaecology, Sunderby Hospital, Luleå, Sweden.
    Andersson, Liselott
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Department of Obstetrics and Gynaecology, Sunderby Hospital, Luleå, Sweden.
    Bergdahl, Ingvar A.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Mercury concentrations in pregnant women in circumpolar Sweden (Kiruna)2018Rapport (Övrigt vetenskapligt)
    Abstract [en]

    High exposure to mercury have been found in populations living in circumpolar areas, due to high consumption of sea food and accumulation of mercury closer to the north pole. The developing fetus is especially sensitive to effects of mercury. Exposure to mercury has previously been examined in pregnant women in Sweden, but not in pregnant women residing in Sweden north of the polar circle.

    In the years 2015-2016, mercury was measured in whole blood from 51 pregnant women living in the city of Kiruna in circumpolar Sweden, taking part in an international comparison between eight circumpolar countries. This report presents the Swedish results on mercury concentrations and associations with some exposure determinants. Also, compliance to dietary advice on fish consumption, appointed to fertile women, was examined.

    The median concentration of total-Hg in whole blood was 0.40 μg/L (min, max; <0.40, 1.88) among the 51 pregnant women in Kiruna. This is similar or lower compared to concentrations of mercury in pregnant women in other parts of Sweden. None of the women in the study had concentrations of mercury that are considered as dangerous.

    Mercury concentrations were associated with total fish consumption but not to consumption of predatory fish, known to be higher in mercury. All of the women in the study had knowledge about dietary advice on fish consumption. One woman exceeded the recommended consumption of predatory fish, limited due to risk of high mercury content, but this woman did not have high concentrations of mercury. While the vast majority of women thus followed the recommendations of not eating too much polluted fish, only 15 % of the women reported sufficient fish consumption to comply with the dietary advice (2-3 times/week).

    In conclusion, pregnant women in circumpolar Sweden have low exposure to mercury, and do not deviant from pregnant women in other parts of Sweden. Knowledge about dietary advice on fish consumption appointed to fertile women is very good. The public health concern though, is that pregnant women in circumpolar Sweden do not eat enough fish.

  • 52. Wennberg, Maria
    et al.
    Stromberg, Ulf
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Kauhanen, Jussi
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Salonen, Jukka
    Skerfving, Staffan
    Tuomainen, Tomi-Pekka
    Vessby, Bengt
    Virtanen, Jyrki
    Myocardial infarction in relation to mercury and fatty acids from fish2012Ingår i: Toxicology Letters, ISSN 0378-4274, E-ISSN 1879-3169, Vol. 211, s. S125-S125Artikel i tidskrift (Refereegranskat)
  • 53.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Strömberg, Ulf
    Bergdahl, Ingvar A
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Kauhanen, Jussi
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Salonen, Jukka T
    Skerfving, Staffan
    Tuomainen, Tomi-Pekka
    Vessby, Bengt
    Virtanen, Jyrki K
    Myocardial infarction in relation to mercury and fatty acids from fish: a risk-benefit analysis based on pooled Finnish and Swedish data in men2012Ingår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 96, nr 4, s. 706-713Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Exposure to methylmercury from fish has been associated with increased risk of myocardial infarction (MI) in some studies. At the same time, marine n-3 (omega-3) PUFAs are an inherent constituent of fish and are regarded as beneficial. To our knowledge, no risk-benefit model on the basis of data on methylmercury, PUFA, and MI risk has yet been presented.

    Objective: The objective of this study was to describe how exposure to both marine n-3 PUFAs and methylmercury relates to MI risk by using data from Finland and Sweden.

    Design: We used matched case-control sets from Sweden and Finland that were nested in population-based, prospective cohort studies. We included 361 men with MI from Sweden and 211 men with MI from Finland. MI risk was estimated in a logistic regression model with the amount of mercury in hair (hair-Hg) and concentrations of n-3 PUFAs (EPA and DHA) in serum (S-PUFA) as independent variables.

    Results: The median hair-Hg was 0.57 mu g/g in Swedish and 1.32 mu g/g in Finnish control subjects, whereas the percentage of S-PUFA was 4.21% and 3.83%, respectively. In combined analysis, hair-Hg was associated with higher (P = 0.005) and S-PUFA with lower (P = 0.011) MI risk. Our model indicated that even a small change in fish consumption (ie, by increasing S-PUFA by 1%) would prevent 7% of MIs, despite a small increase in mercury exposure. However, at a high hair-Hg, the modeled beneficial effect of PUFA on MI risk was counteracted by methylmercury.

    Conclusions: Exposure to methylmercury was associated with increased risk of MI, and higher S-PUFA concentrations were associated with decreased risk of MI. Thus, MI risk may be reduced by the consumption of fish high in PUFAs and low in methylmercury.

    Am J Clin Nutr 2012;96:706-13.

  • 54.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. The Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. The Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
    Uusitalo, U
    Tuomilehto, J
    Shaw, J E
    Zimmet, P Z
    Kowlessur, S
    Pauvaday, V
    Magliano, D J
    High consumption of pulses is associated with lower risk of abnormal glucose metabolism in women in Mauritius2015Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 32, nr 4, s. 513-520Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: To investigate if consumption of pulses was associated with a reduced risk of developing abnormal glucose metabolism, increases in body weight and increases in waist circumference in a multi-ethnic cohort in Mauritius.

    METHODS: Population-based surveys were performed in Mauritius in 1992 and in 1998. Pulse consumption was estimated from a food frequency questionnaire in 1992 and outcomes were measured in 1998. At both time points, anthropometry was undertaken and an oral glucose tolerance test was performed.

    RESULTS: Mauritian women with the highest consumption of pulses (highest tertile) had a reduced risk of developing abnormal glucose metabolism [odds ratio 0.52; 95% CI 0.27, 0.99) compared with those with the lowest consumption, and also after multivariable adjustments. In women, a high consumption of pulses was associated with a smaller increase in BMI.

    CONCLUSIONS: High consumption of pulses was associated with a reduced risk of abnormal glucose metabolism and a smaller increase in BMI in Mauritian women. Promotion of pulse consumption could be an important dietary intervention for the prevention of Type 2 diabetes and obesity in Mauritius and should be examined in other populations and in clinical trials.

  • 55.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Tornevi, Andreas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Kariologi.
    Hörnell, Agneta
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Bergdahl, Ingvar A
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Diet and lifestyle factors associated with fish consumption in men and women: a study of whether gender differences can result in gender-specific confounding2012Ingår i: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 11, s. 101-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Fish consumption and intake of omega-3 fatty acids from fish are associated with a lower risk of cardiovascular disease. However, a prospective study from northern Sweden showed that high consumption of fish is associated with an increased risk of stroke in men, but not in women. The current study aimed to determine if fish consumption is differently related to lifestyle in men compared with women in northern Sweden.

    METHODS: Lifestyle information on 32,782 men and 34,866 women (aged 30--60 years) was collected between 1992 and 2006 within the Vasterbotten Intervention Programme (a health intervention in northern Sweden). Spearman correlation coefficients (Rs) were calculated for associations between self-reported consumption of fish and other food items or lifestyle variables.

    RESULTS: Fish consumption was positively associated with other foods considered healthy (e.g., root vegetables, lettuce/cabbage/spinach/broccoli, chicken, and berries; Rs = 0.21-0.30), as well as with other healthy lifestyle factors (e.g., exercise and not smoking) and a higher educational level, in both men and women. The only gender difference found, concerned the association between fish consumption and alcohol consumption. Men who were high consumers of fish had a higher intake of all types of alcohol compared with low to moderate fish consumers. For women, this was true only for wine.

    CONCLUSIONS: Except for alcohol, the association between fish consumption and healthy lifestyle did not differ between men and women in northern Sweden. It is important to adjust for other lifestyle variables and socioeconomic variables in studies concerning the effect of fish consumption on disease outcome.

  • 56.
    Wennberg, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Vessby, Bengt
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Evaluation of relative intake of fatty acids according to the Northern Sweden FFQ with fatty acid levels in erythrocyte membranes as biomarkers2009Ingår i: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, s. 1-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To evaluate the validity of the Northern Sweden eighty-four-item FFQ to estimate intake of fatty acids relative to 24 h diet recalls (24-HDR) and fatty acids in erythrocyte membranes.

    DESIGN: Participants, randomly recruited from the population-based Västerbotten Intervention Project, answered the eighty-four-item FFQ. During the following year each participant carried out ten 24-HDR. Intake of fatty acids measured by the FFQ was compared with intake by the 24-HDR and fatty acid levels in erythrocytes.

    SETTING: The county of Västerbotten in northern Sweden.

    SUBJECTS: Ninety-six men and ninety-nine women.

    RESULTS: Spearman correlation coefficients (rs) between intakes of the fatty acids 14 : 0, 15 : 0, 16 : 0, 17 : 0, 18 : 2n-6, 18 : 3n-3, 20 : 5n-3 and 22 : 6n-3 estimated by the FFQ and the 24-HDR were all significant and ranged from 0.29 (22 : 6n-3 in men and women) to 0.60 (16 : 0 in men), whereas significant correlations between FFQ-estimated intake and erythrocyte membrane content were only seen for milk fatty acids 14 : 0, 15 : 0 and 17 : 0 (rs = 0.23-0.34) and fish fatty acids 20 : 5n-3 and 22 : 6n-3 (rs = 0.42-0.51).

    CONCLUSION: The Northern Sweden eighty-four-item FFQ gives a satisfactory estimate of the intake of fish fatty acids (20 : 5n-3 and 22 : 6n-3) and milk fatty acids (15 : 0 and 17 : 0), whereas its validity for fatty acids 18 : 2n-6 and 18 : 3n-3, derived mainly from vegetable oils, cannot be shown.

  • 57.
    Wennberg, Patrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Gustafsson, Per E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Dunstan, David W
    Wennberg, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Television viewing and low leisure-time physical activity in adolescence independently predict the metabolic syndrome in mid-adulthood2013Ingår i: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 36, nr 7, s. 2090-2097Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE We investigated whether television (TV) viewing and low leisure-time physical activity in adolescence predict the metabolic syndrome in mid-adulthood.

    RESEARCH DESIGN AND METHODS TV viewing habits and participation in leisure-time physical activity at age 16 years were assessed by self-administered questionnaires in a population-based cohort in Northern Sweden. The presence of the metabolic syndrome at age 43 years was ascertained in 888 participants (82% of the baseline sample) using the International Diabetes Federation criteria. Odds ratios (ORs) and CIs were calculated using logistic regression.

    RESULTS The overall prevalence of the metabolic syndrome at age 43 years was 26.9%. Adjusted OR for the metabolic syndrome at age 43 years was 2.14 (95% CI 1.24-3.71) for those who reported "watching several shows a day" versus "one show/week" or less and 2.31 (1.13-4.69) for leisure-time physical activity "several times/month" or less compared with "daily" leisure-time physical activity at age 16 years. TV viewing at age 16 years was associated with central obesity, low HDL cholesterol, and hypertension at age 43 years, whereas low leisure-time physical activity at age 16 years was associated with central obesity and triglycerides at age 43 years.

    CONCLUSIONS Both TV viewing and low leisure-time physical activity in adolescence independently predicted the metabolic syndrome and several of the metabolic syndrome components in mid-adulthood. These findings suggest that reduced TV viewing in adolescence, in addition to regular physical activity, may contribute to cardiometabolic health later in life.

  • 58.
    Wennberg, Patrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Gustafsson, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Howard, Bethany
    Wennberg, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Television viewing over the life course and the metabolic syndrome in mid-adulthood: a longitudinal population-based study2014Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 68, nr 10, s. 928-933Artikel i tidskrift (Refereegranskat)
  • 59.
    Winkvist, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Department of Internal Medicine and Clinical Nutrition, Sahlgenska Academy, University of Gothenburg, Box 459SE-405 30 Gothenburg, Sweden.
    Klingberg, Sofia
    Nilsson, Lena Maria
    Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Wennberg, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Renström, Frida
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Department of Clinical Sciences, Genetic & Molecular Epidemiology Unit, Lund University, Malmö, Sweden.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Longitudinal 10-year changes in dietary intake and associations with cardio-metabolic risk factors in the Northern Sweden Health and Disease Study2017Ingår i: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 16, artikel-id 20Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Dietary risks today constitute the largest proportion of disability-adjusted life years (DALYs) globally and in Sweden. An increasing number of people today consume highly processed foods high in saturated fat, refined sugar and salt and low in dietary fiber, vitamins and minerals. It is important that dietary trends over time are monitored to predict changes in disease risk.

    Methods: In total, 15,995 individuals with two visits 10 (±1) years apart in the population-based Västerbotten Intervention Programme 1996–2014 were included. Dietary intake was captured with a 64-item food frequency questionnaire. Percent changes in intake of dietary components, Healthy Diet Score and Dietary Inflammatory Index were calculated and related to body mass index (BMI), serum cholesterol and triglyceride levels and blood pressure at the second visit in multivariable regression analyses.

    Results: For both sexes, on group level, proportion of energy intake (E%) from carbohydrates and sucrose decreased (largest carbohydrate decrease among 40 year-olds) and E% protein and total fat as well as saturated and poly-unsaturated fatty acids (PUFA) increased (highest protein increase among 30 year-olds and highest fat increase among 60 year-olds) over the 10-year period. Also, E% trans-fatty acids decreased. On individual basis, for both sexes decreases in intake of cholesterol and trans-fatty acids were associated with lower BMI and serum cholesterol at second visit (all P < 0.05). For men, increases in intake of whole grain and Healthy Diet Score were associated with lower BMI and serum cholesterol at second visit (all P < 0.05). Also for men, decreases in intake of trans-fatty acids and increases in Healthy Diet Score were associated with lower systolic blood pressure at second visit (P = 0.002 and P < 0.000). For women, increases in intake of PUFA and Healthy Diet Score were associated with lower BMI at second visit (P = 0.01 and P < 0.05). Surprisingly, increases in intake of sucrose among women were associated with lower BMI at second visit (P = 0.02).

    Conclusions: In this large population-based sample, dietary changes over 10 years towards less carbohydrates and more protein and fat were noted. Individual changes towards the Nordic dietary recommendations were associated with healthier cardio-metabolic risk factor profile at second visit.

  • 60. Wood, Angela M.
    et al.
    Kaptoge, Stephen
    Butterworth, Adam S.
    Willeit, Peter
    Warnakula, Samantha
    Bolton, Thomas
    Paige, Ellie
    Paul, Dirk S.
    Sweeting, Michael
    Burgess, Stephen
    Bell, Steven
    Astle, William
    Stevens, David
    Koulman, Albert
    Selmer, Randi M.
    Verschuren, W. M. Monique
    Sato, Shinichi
    Njolstad, Inger
    Woodward, Mark
    Salomaa, Veikko
    Nordestgaard, Borge G.
    Yeap, Bu B.
    Fletcher, Astrid
    Melander, Olle
    Kuller, Lewis H.
    Balkau, Beverley
    Marmot, Michael
    Koenig, Wolfgang
    Casiglia, Edoardo
    Cooper, Cyrus
    Arndt, Volker
    Franco, Oscar H.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Gallacher, John
    de la Camara, Agustin Gomez
    Volzke, Henry
    Dahm, Christina C.
    Dale, Caroline E.
    Bergmann, Manuela M.
    Crespo, Carlos J.
    van der Schouw, Yvonne T.
    Kaaks, Rudolf
    Simons, Leon A.
    Lagiou, Pagona
    Schoufour, Josje D.
    Boer, Jolanda M. A.
    Key, Timothy J.
    Rodriguez, Beatriz
    Moreno-Iribas, Conchi
    Davidson, Karina W.
    Taylor, James O.
    Sacerdote, Carlotta
    Wallace, Robert B.
    Quiros, J. Ramon
    Tumino, Rosario
    Blazer, Dan G., II
    Linneberg, Allan
    Daimon, Makoto
    Panico, Salvatore
    Howard, Barbara
    Skeie, Guri
    Strandberg, Timo
    Weiderpass, Elisabete
    Nietert, Paul J.
    Psaty, Bruce M.
    Kromhout, Daan
    Salamanca-Fernandez, Elena
    Kiechl, Stefan
    Krumholz, Harlan M.
    Grioni, Sara
    Palli, Domenico
    Huerta, Jose M.
    Price, Jackie
    Sundstrom, Johan
    Arriola, Larraitz
    Arima, Hisatomi
    Travis, Ruth C.
    Panagiotakos, Demosthenes B.
    Karakatsani, Anna
    Trichopoulou, Antonia
    Kuhn, Tilman
    Grobbee, Diederick E.
    Barrett-Connor, Elizabeth
    van Schoor, Natasja
    Boeing, Heiner
    Overvad, Kim
    Kauhanen, Jussi
    Wareham, Nick
    Langenberg, Claudia
    Forouhi, Nita
    Wennberg, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Despres, Jean-Pierre
    Cushman, Mary
    Cooper, Jackie A.
    Rodriguez, Carlos J.
    Sakurai, Masaru
    Shaw, Jonathan E.
    Knuiman, Matthew
    Voortman, Trudy
    Meisinger, Christa
    Tjonneland, Anne
    Brenner, Hermann
    Palmieri, Luigi
    Dallongeville, Jean
    Brunner, Eric J.
    Assmann, Gerd
    Trevisan, Maurizio
    Gillum, Richard F.
    Ford, Ian
    Sattar, Naveed
    Lazo, Mariana
    Thompson, Simon G.
    Ferrari, Pietro
    Leon, David A.
    Smith, George Davey
    Peto, Richard
    Jackson, Rod
    Banks, Emily
    Di Angelantonio, Emanuele
    Danesh, John
    Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies2018Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 391, nr 10129, s. 1513-1523Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease.

    Methods: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12.5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5.6 years [5th-95th percentile 1.04-13.5]) from 71 011 participants from 37 studies.

    Findings: In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5.4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1.14, 95% CI, 1.10-1.17), coronary disease excluding myocardial infarction (1.06, 1.00-1.11), heart failure (1.09, 1.03-1.15), fatal hypertensive disease (1.24, 1.15-1.33); and fatal aortic aneurysm (1.15, 1.03-1.28). By contrast, increased alcohol consumption was loglinearly associated with a lower risk of myocardial infarction (HR 0.94, 0.91-0.97). In comparison to those who reported drinking >0-<= 100 g per week, those who reported drinking >100-<= 200 g per week, >200-<= 350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively.

    Interpretation: In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.

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