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Background/objectives: Metabolic alterations, physical activity, and dietary pattern together can explain why smoking cessation (SC) often results in weight gain. We studied changes in weight and changes in cardiovascular (CVD) risk factors after an intervention that included an exercise program, dietary advice, and stress management.

Subjects/methods: The patient population (n = 1,782) attended the Vindeln Patient Education Centre (VPE-center) for a 4-week comprehensive lifestyle intervention program, which included the option of smoking cessation. The data were collected before and after, at either the 6- or 12-month follow-up on 247 smokers, 95 former smokers, and 1,440 non-smokers.

Results: A high CVD-risk population lost weight and had decreased serum triglyceride (S-TG) and increased serum phosphate (S-P) at the 6- or 12-month follow-up. At baseline, smokers and former smokers had higher S-TG and lower systolic blood pressure (SBP) than non-smokers. Smokers had higher S-P at baseline and higher S-TG at follow-up than non-smokers. A daily energy intake of around 6,300 kJ (1,500 kcal) and a schedule of physical activity resulted in weight loss, but to a significantly lesser extent in patients who quit smoking compared to patients who continued to smoke or stayed as non-smokers. With SC, a decrease in S-P was associated with weight gain, whereas an increase in S-P was associated with weight loss.

Conclusion: An interaction between smoking habits, body mass index (BMI), and S-P may express a metabolic change that contributes to the degree of weight loss. Differences in changed metabolic response according to smoking habits express effects from smoking cessation, besides differences in the amount of weight change.

Background: Parkinson´s disease (PD) is a neurodegenerative disorder with high risk of cognitive impairment and dementia, where a known risk factor pattern includes low body weight and low blood lipids.

Objectives: This cohort study investigates prospective associations between changes in body mass index (BMI), plasma triglycerides (P-TG) and plasma cholesterol with mild cognitive impairment (MCI) at time of PD diagnosis.

Methods: Patients with PD were identified prospectively in a community-based study of idiopathic Parkinsonism (n = 151) where the patient database was crosslinked to the Northern Sweden Health and Disease Study. The present prospective cohort study (n = 96) considers the timepoint for the healthcare visit the baseline and time for diagnosis as follow-up. At diagnosis of PD, 42 patients (43.8%) were diagnosed with MCI. Associations between prodromal body weight changes and blood lipids with risk of MCI at PD diagnosis were assessed with logistic regression [odd ratio (OR) and 95% confidence intervals (CIs)] adjusted for age and sex.

Results: High P-TG at time of diagnosis were protective for MCI whereas a high age increased risk in patients with PD (OR: 0.31; 95% CI: 0.11, 0.87 and OR: 1.11; 95% CI: 1.02, 1.22, respectively). BMI was not predictive for MCI, neither at diagnosis nor for change over time (adjusted OR 0.99; 95% CI: 0.88, 1.13 and OR 1.12; 95% CI: 0.94, 1.33, respectively). An increase in P-TG was protective for MCI (OR: 0.34; 95% CI: 0.13, 0.88) whereas an interaction between change in BMI and P-TG (OR: 2.21; 95% CI: 1.02, 4.77) increased risk.

Conclusions: High risk of MCI in patients with PD at the time of diagnosis was associated with low levels of P-TG and an interaction between change in BMI and P-TG before diagnosis, suggesting that nutritional factors have complex influence on cognitive function in the prodromal stage of PD.

Objectives. To investigate how age, malnutrition, and the level of plasma cortisol and phosphate in patients with Parkinson's disease (PD) at time of diagnosis are associated with body composition and handgrip strength in males and females compared to controls. Materials & Methods. This cross-sectional study includes baseline data from a cohort of newly diagnosed patients with Parkinson's disease (N = 75; M/F = 41/34) in the New Parkinsonism in Umeå study (NYPUM). Body Impedance (BIS), handgrip strength (HGS) assessments, and evaluation of risk for malnutrition (Mini Nutritional Assessment (MNA) score) and cognitive performance (Mini-Mental State Examination (MMSE)) were performed at time of PD diagnosis. Results. Low fat-free mass index (FFMI), MNA score, and a high Unified Parkinson's Disease Rating Scale (UPDRS-total and UPDRS-III) were associated with high daytime levels of P-cortisol in total PD population but not in controls. Partial correlations reveal that high fat mass percent (FM (%)) and low FFMI were associated with older age in males with PD but not females with PD. Risk of malnutrition was associated with P-cortisol in males but not in females with PD (r =-0.511, P=0.001, and n = 41 and r =-0.055, P=0.759, and n = 34, respectively). Multiple linear regressions show that an interaction between P-cortisol and P-phosphate, older age, and high UPDRS-III score were associated with HGS in total patient population and males but not females. Conclusions. Age-and disease-associated risk factors that decrease muscle mass and HGS and increase FM (%) in patients with PD differ between males and females by an association with levels of cortisol and phosphate.

Background: Life-style interventions, including smoking cessation and weight control are of importance for managing future escalating prevalence of obesity. Smoking habits and obesity have jointly great impact on mortality, however mechanisms behind the effect and variables involved in the obesity paradox is still unknown.

Objectives: This study examines risk factors for all-cause, cardiovascular, and cancer mortality in males and females with high cardiovascular risk, mediated by smoking habits, body mass index (BMI, kg/m2), and serum phosphate (S-P) levels.

Methods: Patients were admitted to the Vindeln Patient Education Center in groups of 30 for a four-week residential comprehensive program (114 hours) focusing on smoking cessation, stress reduction, food preferences and selections, and physical exercise. The follow-up, in years from 1984 to 2014 corresponds to 30 years. This study included 2,504 patients (1,408 females and 1,096 males). Cox regression analysis was used to assess mortality risk associated with smoking habits, low and high BMI, and low and high S-P levels.

Results: High BMI (>34,2 kg/m2), current smoking, type 2 diabetes mellitus (T2DM), high serum calcium (S-Ca), mmol/L and high systolic blood pressure (SBP, mmHg) were associated with all-cause mortality irrespective of sex. Former and current smoking females had a high all-cause mortality (adjusted hazard ratio [HR] 1.581; 95% CI 1.108–2.256, adjusted hazard ratio [HR] 1.935; 95% CI 1.461–2.562, respectively) while current smoking and high BMI increased risk for cardiovascular mortality (adjusted hazard ratio [HR] 3.505; 95% CI 2.140–5.740 and [HR] 1.536; 95% CI 1.058–2.231, respectively). Neither low nor high levels of S-P predicted all-cause, cardiovascular disease (CVD) and cancer mortality in males or females while low levels of S-P predicted all-cause mortality in smokers (adjusted hazard ratio [HR] 1.713; 95% CI 1.211–2.424). In non-smokers, low BMI (<27.6 kg/m2) was protecting and high BMI a risk for all-cause mortality. In males, ischemic heart disease (IHD), and low serum albumin (S-Alb) were associated with all-cause mortality. In females, an interaction between high BMI and smoking (HbmiSM) decreased the cardiovascular mortality (adjusted hazard ratio [HR] 0.410; 95% CI 0.179–0.937, respectively).

Conclusions: High BMI and current smoking were associated with all-cause mortality in both males and females in the present high cardiovascular-risk cohort. In current smokers and non-smokers, T2DM and high S-Ca were associated with an increase in all-cause mortality, while low S-P was associated with all-cause mortality in smokers. Interaction between high BMI and smoking contribute to the obesity paradox by being protective for cardiovascular mortality in females.