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Key features: 

• The Northern Sweden Health and Disease Study (NSHDS) was initiated in the mid-1980s. The NSHDS is a population-based prospective longitudinal cohort comprising >140 000 participants in the two northernmost regions in Sweden, Norrbotten and Västerbotten, with >240 000 blood samples and 1.5 million person-years of follow-up.
• The NSHDS includes three sub-cohorts: the Västerbotten Intervention Programme (VIP), the expanded Northern Sweden Monitoring of Trends and Determinants of Cardiovascular Disease (MONICA) Study, and the Mammography Screening Project (MSP). The VIP is both a community-based cardiometabolic intervention programme encouraging healthy lifestyle (targeting individuals 40, 50, and 60 years of age), and a corresponding research cohort. The MONICA is an observational study focusing on cardiovascular disease and its associated risk factors, recruiting individuals aged 25–74 years. The MSP recruited women attending mammography during 1995–2006. The NSHDS median participation age is 50 years (53% women).
• Most participants contribute data on health, lifestyle, anthropometric measures, blood pressure, blood lipids, and glucose tolerance, along with research blood samples that are fractionated, frozen within an hour of collection, and stored at –80°C. Linkage to registries, clinical cohorts, and biological tissue archives facilitates studies of well-characterized participants (often combined with intervention studies).
• Collaborations are encouraged. Additional information can be found at: info.brs@umu.se; https://www.umu.se/en/biobank

Aims: Diet is a determinant of cardiovascular diseases (CVD) with coronary disease as predominant cause of pre-mature death. To analyse how diet was associated with coronary atherosclerosis, including plaque features.

Methods and results: The cross-sectional population-based study using data from the Swedish CArdioPulmonary BioImage Study (SCAPIS) included 24 079 adults aged 50-64 years, recruited in 2013 to 2018 who were free of clinical cardiovascular disease. The recruitment and comprehensive examinations were conducted at six locations in Sweden. A dietary index (DI) based on a previously published anti-inflammatory DI including high proportion of plant-based foods, and low in red or processed meat and sugar-sweetened beverages was constructed. The reference group was within lowest DI tertile. Coronary atherosclerosis assessed by coronary computed tomography angiography, including any-, significant-, and adverse or high-risk coronary plaque, which is non-calcified with a significant stenosis ≥50%. Lowest, compared to highest DI tertile was associated with younger age, more often men (62.2% vs. 32.9%), higher high-sensitive C-reactive protein, more cardiometabolic risk and smokers, higher alcohol-, and higher energy-intake. In the highest and lowest tertile, coronary plaques were present in 36.3% and 44.3%, respectively, stenosis ≥ 50% in 3.7% and 6.0%. Non-calcified coronary plaques with stenosis ≥50% were present in 0.9% and 1.5% in highest and lowest tertiles. In multivariable analyses, the lowest tertile of DI was associated with high-risk plaque features after adjusting for age, sex, smoking, with waist circumference, triglycerides (TGs), and hypertension as possible mediators.

Conclusion: A low-fibre diet with high red meat content was associated with high-risk plaques features, increased coronary calcification and significant stenosis. Waist circumference, TGs, and hypertension emerged as potential mediators of these associations, underscoring the role of metabolic and hemodynamic factors in the dietary impact on coronary atherosclerosis. Our findings strengthen the importance of cardioprotective dietary recommendations.

Aims: To investigate the association between dietary patterns at Ages 40, 50, and 60 and subclinical carotid atherosclerosis at Age 60.

Methods and results: Participants who were 60 years of age at the Swedish VIPVIZA (VisualiZation of asymptomatic Atherosclerotic disease) trial baseline (2013-16) with retrospective VIP (Västerbotten Intervention Programme) dietary data at Ages 40, 50, and 60 (n = 1034) were included. Dietary patterns were assessed using the Mediterranean diet score (MDS) and healthy diet score, while carotid ultrasound was used to measure carotid artery intima-media thickness (CIMT) and carotid plaque (CP). Multivariable regressions and mediation analysis investigated associations, sex differences and potential mediating factors. High [odds ratio (OR): 0.72, 95% confidence interval (CI): 0.52-0.98] or midrange (OR: 0.74, 95% CI: 0.55-0.99) cumulative MDS for Ages 40, 50, and 60, as compared with low, was associated with lower CP presence at Age 60. Initial sex-stratified analysis yielded similar, though non-significant, point estimates. Further analysis revealed that the relationship between plaque and MDS seem driven more by women (OR: 0.41, 95% CI: 0.237-0.703) while a significant association between CIMT and MDS was only present in men (P < 0.05). Healthy diet score during midlife did not show any significant associations with CP or CIMT at Age 60.

Conclusion: Findings underscore associations of midlife Mediterranean-style diet and lower presence of subclinical carotid atherosclerosis at Age 60 and confirm the significance of dietary interventions as potential means for cardiovascular disease prevention. The study enhances understanding of long-term dietary patterns and their link to subclinical atherosclerosis, supporting future interventions and further research.Keywords: Carotid intima media thickness; Carotid plaque; Dietary patterns; Healthy diet score; Mediterranean diet score; Subclinical atherosclerosis.

The 2021 Arctic Monitoring Assessment Program (AMAP)’s Human Health Assessment report presents a summary of the presence of contaminants in human populations across the circumpolar Arctic and provides an update to the previous assessment released in 2015. The primary objective of this paper is to summarise some of these findings by describing the current levels of metals across the Arctic, including key regional and temporal trends based on available national data and literature, and highlight knowledge gaps. Many Arctic populations continue to have elevated levels of these contaminants, and the highest levels of mercury (Hg) were observed in populations from Greenland, Faroe Islands, and Nunavik (Canada). Still, concentrations of several metals are declining in Arctic populations in regions where time trends data exist, although the declines are not consistent across all regions. The 2021 AMAP human health assessment report and this paper provide an extensive summary of levels of metals and trace elements in adults, pregnant women, and children across the Arctic.

The Arctic Monitoring Assessment Program (AMAP) is tasked with monitoring and assessing the status of environmental contaminants in the Arctic, documenting levels and trends, and producing science-based assessments. The objectives of this paper are to present the current levels of persistent organic pollutants (POPs) across the Arctic, and to identify trends and knowledge gaps as detailed in the most recent AMAP Human Health Assessment Report. Many Arctic populations continue to have elevated levels of these contaminants, and the highest levels of POPs were observed in populations from Greenland, Faroe Islands, and Nunavik (Canada), as well as populations in the coastal Chukotka district (Russia) for legacy POPs only. Concentrations of most POPs are declining in Arctic populations in regions where time trends data exist, although the declines are not consistent across all regions. The exceptions are per- and polyfluoroalkyl substances, with concentrations of some long-chain PFAS such as perfluorononanoic acid increasing in populations in Nunavik, Greenland and Sweden. This paper provides a more extensive summary of levels of contaminants in adults, pregnant women, and children across the Arctic than previous AMAP human health assessments, particularly for levels of long-chain PFAS, which are currently under consideration for inclusion in the Stockholm Convention.

Frequent sauna bathing has been associated with a reduced risk of cardiovascular disease and proposed as a mediator for improved health. Therefore, the aim was to describe and compare sauna bathers with non-sauna bathers in northern Sweden based on their demographics, health and life attitudes, and to describe sauna bathers’ sauna habits. Questions on sauna bathing habits were included in the questionnaire for the participants in the Northern Sweden MONICA (multinational monitoring of trends and determinants in cardiovascular disease) study, conducted during spring of 2022, inviting adults 25–74 years living in the two northernmost counties of Sweden (Norr- and Västerbotten), randomly selected from the population register. Of the 1180 participants in MONICA 2022, 971 (82%) answered the question about sauna bathing. Of these, 641 (66%) were defined as sauna bathers. Sauna bathers reported less hypertension diagnosis and self-reported pain. They also reported higher levels of happiness and energy, more satisfying sleep patterns, as well as better general and mental health. Sauna bathers were younger, more often men and found to have a healthier life-profile compared to non-sauna bathers. Additionally, the results suggest that the positive effects associated with sauna bathing plateaued from 1–4 times per month.

Objectives: To examine the 36-year trends in tobacco use in northern Sweden.

Design and outcome measure: Cross-sectional analysis of the eight population-based surveys that constitute the northern Sweden MONICA study (1986, 1990, 1994, 1999, 2004, 2009, 2014 and 2022). Cigarette smoking and snus use were self-reported via questionnaires, and age-adjusted percentages of cigarette smoking (including occasional use) and snus use were calculated via logit models.

Setting: General population of Norrbotten and Västerbotten (the two northernmost counties of Sweden).

Participants: 6678 women and 6320 men, aged 25 to 74 years, were included for analysis. A total of 191 participants were excluded due to missing data on either cigarette smoking or snus use.

Results: Cigarette smoking decreased on a survey-to-survey basis, reaching a minimum in 2022 of 4.9% among men and 9.7% among women, corresponding to a percentage point change of 26.3 and 20.8, respectively, compared with 1986 (p_within-group<0.01). With respect to snus, the use increased steeply up until 1999 among men, after which it persisted around 25% to 30% (26.2% in 2022), with percentage point changes between 6.6 and 13.4 compared with 1986 (p_within-group<0.01). The percentage of female snus users was extremely low in the first surveys but increased continuously over time, reaching a maximum of 13.0% in 2022 and a percentage point change of 12.5 since 1986 (p_within-group<0.01). Cigarette smoking—but not snus use—was more common in Norrbotten than in Västerbotten in 2022 (p_{between-group}<0.01).

Conclusions: A substantial decline in cigarette smoking has occurred over time in northern Sweden, particularly among men and more notably in Västerbotten. In contrast, snus use has become increasingly common in both sexes and in both counties.

Arctic populations are amongst the highest exposed populations to long-range transported contaminants globally, with the main exposure pathway being through the diet. Dietary advice is an important immediate means to address potential exposure and help minimize adverse health effects. The objective of this work is to enable easier access to dietary advice and communication guidance on contaminants with a focus on the Arctic. This manuscript is part of a special issue summarizing the Arctic Monitoring and Assessment Programme’s Assessment 2021: Human Health in the Arctic. The information was derived with internet searches, and by contacting relevant experts directly. Results include risk communication efforts in European Arctic countries, effectiveness evaluation studies for several Arctic countries, experience of social media use, and the advantages and challenges of using social media in risk communication. We found that current risk communication activities in most Arctic countries emphasize the importance of a nutritious diet. Contaminant-related restrictions are mostly based on mercury; a limited amount of dietary advice is based on other contaminants. While more information on effectiveness evaluation was available, specific information, particularly from Arctic countries other than Canada, is still very limited.

Background: Dietary habits strongly influence health, with poor diets contributing to numerous deaths annually. Addressing this requires improved dietary habits and consistent monitoring thereof. In northern Sweden, a validated food frequency questionnaire (FFQ) has been used for decades, but trends show that its ability to accurately measure intake has diminished. With changing eating habits and food supply, updating the FFQ was crucial, leading to the development of FFQ2020. This study assessed FFQ2020’s relative validity using 24-hour recalls and evaluated its reproducibility.

Methods: Participants were recruited from one of the northern-Sweden population-based health screenings and by advertising. Food intake was registered in an electronic food frequency questionnaire (FFQ2020) (test instrument) and reference data were obtained by six repeated electronic 24-hour dietary recalls (24HDR). Intakes of single foods were aggregated into food groups and healthy diet index scores, and daily energy and nutrient intakes were estimated. Results from the two methods were described and tested in univariate analyses and correlation tests, Bland Altman plots, cross-classification validity, and intra-class correlation analyses.

Results: Totally, 628 adults were invited to participate in the study. Of these, 320 joined, and 244 completed at least four 24HDRs. The median intakes in food groups, as well as the mean index scores and estimated nutrient intakes, were largely similar between the FFQ2020 and 24HDR recordings. The correlation coefficients between the two assessments ranged from 0.253 to 0.693 for food groups, 0.520 to 0.614 for diet indices, and 0.340 to 0.629 for energy and nutrients. Intra-class correlation coefficients indicated at least good reproducibility for intakes of food groups, diet index scores, and nutrients. Generally, Bland-Altman plots did not reveal any gross systematic disagreement between the two methods for any of the assessments. However, there were single observations located outside the upper or lower 95% confidence interval (CI) limits for the difference between FFQ2020 and the 24HDR recordings.

Conclusion: In concert, the results suggest that the relative validity and reproducibility of FFQ2020 are acceptable for trend analyses and group comparisons in large-scale studies but also that extended reference periods would improve the precision of less frequently consumed foods.

Background: The dietary habits among snus users are largely unknown and have not been accounted for in observational studies on the health effects of snus use.

Aim: To examine whether snus users eat unhealthier than never tobacco users.

Methods: A total of 3,397 male participants, examined between 1994 and 2014 in the Northern Sweden Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, were included. Snus use and dietary habits were self-reported using questionnaires, from which intakes of different food groups, macronutrients, and a healthy diet score (HDS) were calculated (the latter as a proxy for overall diet quality). The association between snus use and dietary habits was examined by quantile regression models.

Results: In the multivariable-adjusted model, current snus users had a lower HDS (median difference: −0.86 [95% confidence interval: −1.32, −0.40]) than never tobacco users. Snus users also consumed fewer weekly servings of fruits and berries (median difference: −1.03 [−1.65, −0.40]), and their estimated percentage of energy intake con-sisted of less carbohydrates (median difference: −1.43 [−2.12, −0.74]) and of more total fat (median difference: 0.99 [0.30, 1.67]), saturated fat (median difference: 0.67 [0.29, 1.05]), monounsaturated fat (median difference: 0.44 [0.20, 0.68]), trans fat (median difference: 0.03 [0.01, 0.06]), and alcohol (median difference: 0.21 [0.02, 0.40]).

Conclusion: We observed that snus users had an unhealthier diet than never tobacco users. Future studies on the association between snus use and health outcomes should, therefore, consider diet as a potential confounder.