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  • 1. Bianchi, Marta
    et al.
    Strid, Anna
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lindroos, Anna-Karin
    Sonesson, Ulf
    Hallstrom, Elinor
    Systematic Evaluation of Nutrition Indicators for Use within Food LCA Studies2020In: Sustainability, E-ISSN 2071-1050, Vol. 12, no 21, article id 8992Article in journal (Refereed)
    Abstract [en]

    Expressing the environmental impact of foods in relation to the nutritional quality is a promising approach in the search for methods integrating interdisciplinary sustainability perspectives. However, the lack of standardized methods regarding how to include nutrient metrics can lead to unharmonized results difficult to interpret. We evaluated nutrient density indexes by systematically assessing the role of methodological variables with the purpose of identifying the index able to rank foods with the highest coherence with the Swedish dietary guidelines. Among 45 variants of the nutrient density index NRF (Nutrient Rich Food), a Sweden-tailored NRF11.3 index, including 11 desirable nutrients and 3 undesirable nutrients, calculated per portion size or 100 kcal with the application of weighting, ranked foods most coherently with the guidelines. This index is suggested to be suitable as complementary functional unit (FU) in comparative life cycle assessment (LCA) studies across food categories. The results clarify implications of methodological choices when calculating nutrient density of foods and offer guidance to LCA researchers on which nutrition metric to use when integrating nutritional aspects in food LCA.

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  • 2.
    Bodén, Stina
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Zheng, Rui
    Hanhineva, Kati
    Landberg, Rikard
    Harlid, Sophia
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Vidman, Linda
    Gunter, Marc
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Biobank Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    Brunius, Carl
    Data-driven dietary patterns and their association with colorectal cancer risk and untargeted plasma metabolite profilesManuscript (preprint) (Other academic)
  • 3.
    Bodén, Stina
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Zheng, Rui
    Department of Surgical Sciences, The EpiHub, Uppsala University, Uppsala, Sweden.
    Ribbenstedt, Anton
    Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden.
    Landberg, Rikard
    Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden.
    Harlid, Sophia
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Vidman, Linda
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Gunter, Marc J.
    International Agency for Research On Cancer, Nutrition and Metabolism Section, Lyon Cedex 08, France; Cancer Epidemiology and Prevention Research Unit, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM). Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Brunius, Carl
    Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden.
    Dietary patterns, untargeted metabolite profiles and their association with colorectal cancer risk2024In: Scientific Reports, E-ISSN 2045-2322, Vol. 14, no 1, article id 2244Article in journal (Refereed)
    Abstract [en]

    We investigated data-driven and hypothesis-driven dietary patterns and their association to plasma metabolite profiles and subsequent colorectal cancer (CRC) risk in 680 CRC cases and individually matched controls. Dietary patterns were identified from combined exploratory/confirmatory factor analysis. We assessed association to LC–MS metabolic profiles by random forest regression and to CRC risk by multivariable conditional logistic regression. Principal component analysis was used on metabolite features selected to reflect dietary exposures. Component scores were associated to CRC risk and dietary exposures using partial Spearman correlation. We identified 12 data-driven dietary patterns, of which a breakfast food pattern showed an inverse association with CRC risk (OR per standard deviation increase 0.89, 95% CI 0.80–1.00, p = 0.04). This pattern was also inversely associated with risk of distal colon cancer (0.75, 0.61–0.96, p = 0.01) and was more pronounced in women (0.69, 0.49–0.96, p = 0.03). Associations between meat, fast-food, fruit soup/rice patterns and CRC risk were modified by tumor location in women. Alcohol as well as fruit and vegetables associated with metabolite profiles (Q2 0.22 and 0.26, respectively). One metabolite reflecting alcohol intake associated with increased CRC risk, whereas three metabolites reflecting fiber, wholegrain, and fruit and vegetables associated with decreased CRC risk.

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  • 4.
    Dahlgren, Lars
    et al.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Emmelin, Maria
    Lund University.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing. University West.
    Sahlén, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Winkvist, Anna
    Department of Clinical Nutrition, Sahlgrenska Academy.
    Qualitative methodology for international public health2019 (ed. 3)Book (Other academic)
  • 5.
    Grenville, Zoe S.
    et al.
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
    Noor, Urwah
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
    His, Mathilde
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France.
    Viallon, Vivian
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France.
    Rinaldi, Sabina
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France.
    Aglago, Elom K.
    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
    Amiano, Pilar
    Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain; Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, 20014 San Sebastián, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
    Brunkwall, Louise
    Department of Clinical Sciences, Lund University, 221 84 Malmö, Sweden.
    Chirlaque, María Dolores
    CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain.
    Drake, Isabel
    Department of Clinical Sciences, Lund University, 221 84 Malmö, Sweden; , Skåne University Hospital, 214 28 Malmö, Sweden.
    Eichelmann, Fabian
    Department of Molecular Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany.
    Freisling, Heinz
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France.
    Grioni, Sara
    Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
    Heath, Alicia K.
    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
    Kaaks, Rudolf
    Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Katzke, Verena
    Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Mayén-Chacon, Ana-Lucia
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France.
    Milani, Lorenzo
    Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
    Moreno-Iribas, Conchi
    CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Navarra Public Health Institute, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
    Pala, Valeria
    Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
    Olsen, Anja
    Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, Aarhus University, Denmark.
    Sánchez, Maria-Jose
    Escuela Andaluza de Salud Pública (EASP), Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
    Schulze, Matthias B.
    Department of Molecular Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany.
    Tjønneland, Anne
    Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Tsilidis, Konstantinos K.
    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece.
    Weiderpass, Elisabete
    International Agency for Research on Cancer, World Health Organization, Lyon, France.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Zamora-Ros, Raul
    Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
    Key, Timothy J.
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
    Smith-Byrne, Karl
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
    Travis, Ruth C.
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
    Schmidt, Julie A.
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Department of Clinical Epidemiology, Department of Clinical Medicine, University Hospital, Aarhus University and Aarhus, DK-8200 Aarhus N, Denmark.
    Diet and BMI Correlate with Metabolite Patterns Associated with Aggressive Prostate Cancer2022In: Nutrients, E-ISSN 2072-6643, Vol. 14, no 16, article id 3306Article in journal (Refereed)
    Abstract [en]

    Three metabolite patterns have previously shown prospective inverse associations with the risk of aggressive prostate cancer within the European Prospective Investigation into Cancer and Nutrition (EPIC). Here, we investigated dietary and lifestyle correlates of these three prostate cancer-related metabolite patterns, which included: 64 phosphatidylcholines and three hydroxysphingomyelins (Pattern 1), acylcarnitines C18:1 and C18:2, glutamate, ornithine, and taurine (Pattern 2), and 8 lysophosphatidylcholines (Pattern 3). In a two-stage cross-sectional discovery (n = 2524) and validation (n = 518) design containing 3042 men free of cancer in EPIC, we estimated the associations of 24 dietary and lifestyle variables with each pattern and the contributing individual metabolites. Associations statistically significant after both correction for multiple testing (False Discovery Rate = 0.05) in the discovery set and at p < 0.05 in the validation set were considered robust. Intakes of alcohol, total fish products, and its subsets total fish and lean fish were positively associated with Pattern 1. Body mass index (BMI) was positively associated with Pattern 2, which appeared to be driven by a strong positive BMI-glutamate association. Finally, both BMI and fatty fish were inversely associated with Pattern 3. In conclusion, these results indicate associations of fish and its subtypes, alcohol, and BMI with metabolite patterns that are inversely associated with risk of aggressive prostate cancer.

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  • 6. Heath, Alicia K
    et al.
    Muller, David C.
    van den Brandt, Piet A.
    Papadimitriou, Nikos
    Critselis, Elena
    Gunter, Marc
    Vineis, Paolo
    Weiderpass, Elisabete
    Fagherazzi, Guy
    Boeing, Heiner
    Ferrari, Pietro
    Olsen, Anja
    Tjønneland, Anne
    Arveux, Patrick
    Boutron-Ruault, Marie-Christine
    Mancini, Francesca Romana
    Kühn, Tilman
    Turzanski-Fortner, Renée
    Schulze, Matthias B.
    Karakatsani, Anna
    Thriskos, Paschalis
    Trichopoulou, Antonia
    Masala, Giovanna
    Contiero, Paolo
    Ricceri, Fulvio
    Panico, Salvatore
    Bueno-de-Mesquita, Bas
    Bakker, Marije F.
    van Gils, Carla H.
    Standahl Olsen, Karina Standahl
    Skeie, Guri
    Lasheras, Cristina
    Agudo, Antonio
    Rodríguez-Barranco, Miguel
    Sánchez, Maria-José
    Amiano, Pilar
    Chirlaque, María-Dolores
    Barricarte, Aurelio
    Drake, Isabel
    Ericson, Ulrika
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden..
    Key, Tim
    Freisling, Heinz
    His, Mathilde
    Huybrechts, Inge
    Christakoudi, Sofia
    Ellingjord-Dale, Merete
    Riboli, Elio
    Tsilidis, Konstantinos K.
    Tzoulaki, Ioanna
    Nutrient-wide association study of 92 foods and nutrients and breast cancer risk2020In: Breast Cancer Research, ISSN 1465-5411, E-ISSN 1465-542X, Vol. 22, no 1, article id 5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several dietary factors have been reported to be associated with risk of breast cancer, but to date, unequivocal evidence only exists for alcohol consumption. We sought to systematically assess the association between intake of 92 foods and nutrients and breast cancer risk using a nutrient-wide association study.

    METHODS: Using data from 272,098 women participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, we assessed dietary intake of 92 foods and nutrients estimated by dietary questionnaires. Cox regression was used to quantify the association between each food/nutrient and risk of breast cancer. A false discovery rate (FDR) of 0.05 was used to select the set of foods and nutrients to be replicated in the independent Netherlands Cohort Study (NLCS).

    RESULTS: Six foods and nutrients were identified as associated with risk of breast cancer in the EPIC study (10,979 cases). Higher intake of alcohol overall was associated with a higher risk of breast cancer (hazard ratio (HR) for a 1 SD increment in intake = 1.05, 95% CI 1.03-1.07), as was beer/cider intake and wine intake (HRs per 1 SD increment = 1.05, 95% CI 1.03-1.06 and 1.04, 95% CI 1.02-1.06, respectively), whereas higher intakes of fibre, apple/pear, and carbohydrates were associated with a lower risk of breast cancer (HRs per 1 SD increment = 0.96, 95% CI 0.94-0.98; 0.96, 95% CI 0.94-0.99; and 0.96, 95% CI 0.95-0.98, respectively). When evaluated in the NLCS (2368 cases), estimates for each of these foods and nutrients were similar in magnitude and direction, with the exception of beer/cider intake, which was not associated with risk in the NLCS.

    CONCLUSIONS: Our findings confirm a positive association of alcohol consumption and suggest an inverse association of dietary fibre and possibly fruit intake with breast cancer risk.

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  • 7.
    Hesselink, André
    et al.
    Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Ueland, Per M.
    Department of Clinical Science, University of Bergen, Bergen, Norway; Bevital AS, Bergen, Norway.
    Schneede, Jørn
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Karlsson, Therese
    Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden; Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden.
    Healthy Nordic diet and associations with plasma concentrations of metabolites in the choline oxidation pathway: a cross-sectional study from Northern Sweden2023In: Nutrition Journal, E-ISSN 1475-2891, Vol. 22, no 1, article id 26Article in journal (Refereed)
    Abstract [en]

    Background: The choline oxidation pathway and metabolites involved have been linked to diseases including cardiovascular disease, type 2 diabetes and cancer. A healthy Nordic diet is a recently defined dietary pattern associated with decreased risk for these diseases. Our aim was to explore associations between adherence to a healthy Nordic diet and plasma concentrations of metabolites of the choline oxidation pathway.

    Methods: The Healthy Nordic Food Index (HNFI) and Baltic Sea Diet Score (BSDS) were applied to cross-sectional data (n = 969) from the Västerbotten Intervention Programme in Northern Sweden to score adherence to a healthy Nordic diet. Data included responses to a dietary questionnaire and blood sample analyses (1991–2008). Associations of diet scores with plasma concentrations of metabolites of the choline oxidation pathway and total homocysteine (tHcy), seven metabolites in total, were evaluated with linear regression, adjusting for age, BMI, education and physical activity.

    Results: HNFI scores showed linear relationships with plasma choline (β = 0.11), betaine (β = 0.46), serine (β = 0.98) and tHcy (β = − 0.38), and BSDS scores with betaine (β = 0.13) and tHcy (β = − 0.13); unstandardized beta coefficients, all significant at P < 0.05. The regression models predicted changes in plasma metabolite concentrations (± 1 SD changes in diet score) in the range of 1–5% for choline, betaine, serine and tHcy. No other statistically significant associations were observed.

    Conclusions: A healthy Nordic diet was associated with plasma concentrations of several metabolites of the choline oxidation pathway. Although relationships were statistically significant, effect sizes were moderate. Further research is warranted to explore the underlying mechanisms and associations with health outcomes.

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  • 8.
    His, Mathilde
    et al.
    International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, 150 cours Albert Thomas, Lyon CEDEX 08, France.
    Viallon, Vivian
    International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, 150 cours Albert Thomas, Lyon CEDEX 08, France.
    Dossus, Laure
    International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, 150 cours Albert Thomas, Lyon CEDEX 08, France.
    Schmidt, Julie A.
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
    Travis, Ruth C.
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
    Gunter, Marc J.
    International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, 150 cours Albert Thomas, Lyon CEDEX 08, France.
    Overvad, Kim
    Department of Public Health, Aarhus University, Aarhus, Denmark.
    Kyrø, Cecilie
    Danish Cancer Society Research Center, Copenhagen, Denmark.
    Tjønneland, Anne
    Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, Section of Environmental Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Lécuyer, Lucie
    Université Paris-Saclay, UVSQ, Inserm, CESP U1018, “Exposome and Heredity” team, Gustave Roussy, Villejuif, France.
    Rothwell, Joseph A.
    Université Paris-Saclay, UVSQ, Inserm, CESP U1018, “Exposome and Heredity” team, Gustave Roussy, Villejuif, France.
    Severi, Gianluca
    Université Paris-Saclay, UVSQ, Inserm, CESP U1018, “Exposome and Heredity” team, Gustave Roussy, Villejuif, France; Department of Statistics, Computer Science, Applications “G. Parenti”, University of Florence, Florence, Italy.
    Johnson, Theron
    Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Katzke, Verena
    Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Schulze, Matthias B.
    Department of Molecular Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, Potsdam, Germany.
    Masala, Giovanna
    Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
    Sieri, Sabina
    Epidemiology and Prevention Unit, Fondazione IRCCS Instituto Nazionale dei Tumori di Milano, Milan, Italy.
    Panico, Salvatore
    Dipartimento Di Medicina Clinica E Chirurgia, Federico Ii University, Naples, Italy.
    Tumino, Rosario
    Cancer Registry and Histopathology Department, Provincial Health Authority (ASP 7) Ragusa, Ragusa, Italy.
    Macciotta, Alessandra
    Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
    Boer, Jolanda M. A.
    Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment (RIVM), BA, Bilthoven, Netherlands.
    Monninkhof, Evelyn M.
    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
    Olsen, Karina Standahl
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Nøst, Therese H.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Sandanger, Torkjel M.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Agudo, Antonio
    Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, L’Hospitalet de Llobregat, Spain; Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program; Bellvitge Biomedical Research Institute - IDIBELL, L’Hospitalet de Llobregat, Spain.
    Sánchez, Maria-Jose
    Escuela Andaluza de Salud Pública (EASP), Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
    Amiano, Pilar
    Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, San Sebastián, Spain; Biodonostia Health Research Institute, Group of Epidemiology of Chronic and Communicable Diseases, San Sebastián, Spain; CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
    Colorado-Yohar, Sandra M.
    CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain; Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia.
    Ardanaz, Eva
    CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
    Vidman, Linda
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Heath, Alicia K.
    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
    Weiderpass, Elisabete
    International Agency for Research on Cancer (IARC/WHO), Office of the Director, Lyon, France.
    Huybrechts, Inge
    International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, 150 cours Albert Thomas, Lyon CEDEX 08, France.
    Rinaldi, Sabina
    International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, 150 cours Albert Thomas, Lyon CEDEX 08, France.
    Lifestyle correlates of eight breast cancer-related metabolites: a cross-sectional study within the EPIC cohort2021In: BMC Medicine, E-ISSN 1741-7015, Vol. 19, no 1, article id 312Article in journal (Refereed)
    Abstract [en]

    Background: Metabolomics is a promising molecular tool for identifying novel etiological pathways leading to cancer. In an earlier prospective study among pre- and postmenopausal women not using exogenous hormones, we observed a higher risk of breast cancer associated with higher blood concentrations of one metabolite (acetylcarnitine) and a lower risk associated with higher blood concentrations of seven others (arginine, asparagine, phosphatidylcholines (PCs) aa C36:3, ae C34:2, ae C36:2, ae C36:3, and ae C38:2).

    Methods: To identify determinants of these breast cancer-related metabolites, we conducted a cross-sectional analysis to identify their lifestyle and anthropometric correlates in 2358 women, who were previously included as controls in case-control studies nested within the European Prospective Investigation into Cancer and Nutrition cohort and not using exogenous hormones at blood collection. Associations of each metabolite concentration with 42 variables were assessed using linear regression models in a discovery set of 1572 participants. Significant associations were evaluated in a validation set (n = 786).

    Results: For the metabolites previously associated with a lower risk of breast cancer, concentrations of PCs ae C34:2, C36:2, C36:3, and C38:2 were negatively associated with adiposity and positively associated with total and saturated fat intakes. PC ae C36:2 was also negatively associated with alcohol consumption and positively associated with two scores reflecting adherence to a healthy lifestyle. Asparagine concentration was negatively associated with adiposity. Arginine and PC aa C36:3 concentrations were not associated to any of the factors examined. For the metabolite previously associated with a higher risk of breast cancer, acetylcarnitine, a positive association with age was observed.

    Conclusions: These associations may indicate possible mechanisms underlying associations between lifestyle and anthropometric factors, and risk of breast cancer. Further research is needed to identify potential non-lifestyle correlates of the metabolites investigated.

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  • 9.
    Hjorth, Therese
    et al.
    Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden..
    Huseinovic, Ena
    Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden..
    Hallström, Elinor
    Department of Agrifood and Bioscience, RISE- Research Institutes of Sweden, Gothenburg, Sweden..
    Strid, Anna
    Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden..
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Sonesson, Ulf
    Department of Agrifood and Bioscience, RISE- Research Institutes of Sweden, Gothenburg, Sweden..
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden..
    Changes in dietary carbon footprint over ten years relative to individual characteristics and food intake in the Västerbotten Intervention Programme2020In: Scientific Reports, E-ISSN 2045-2322, Vol. 10, no 1, article id 20Article in journal (Refereed)
    Abstract [en]

    The objective was to examine 10-year changes in dietary carbon footprint relative to individual characteristics and food intake in the unique longitudinal Västerbotten Intervention Programme, Sweden. Here, 14 591 women and 13 347 men had been followed over time. Food intake was assessed via multiple two study visits 1996-2016, using a 64-item food frequency questionnaire. Greenhouse gas emissions (GHGE) related to food intake, expressed as kg carbon dioxide equivalents/1000 kcal and day, were estimated. Participants were classified into GHGE quintiles within sex and 10-year age group strata at both visits. Women and men changing from lowest to highest GHGE quintile exhibited highest body mass index within their quintiles at first visit, and the largest increase in intake of meat, minced meat, chicken, fish and butter and the largest decrease in intake of potatoes, rice and pasta. Women and men changing from highest to lowest GHGE quintile exhibited basically lowest rates of university degree and marriage and highest rates of smoking within their quintiles at first visit. Among these, both sexes reported the largest decrease in intake of meat, minced meat and milk, and the largest increase in intake of snacks and, for women, sweets. More research is needed on how to motivate dietary modifications to reduce climate impact and support public health.

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  • 10.
    Huybrechts, Inge
    et al.
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France.
    Rauber, Fernanda
    Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil; Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil.
    Nicolas, Geneviève
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France.
    Casagrande, Corinne
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France.
    Kliemann, Nathalie
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France.
    Wedekind, Roland
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France.
    Biessy, Carine
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France.
    Scalbert, Augustin
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France.
    Touvier, Mathilde
    Sorbonne Paris Nord University, INSERM U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University Paris Cité (CRESS), Paris, France.
    Aleksandrova, Krasimira
    Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology (BIPS), Bremen, Germany; Human and Health Sciences, University of Bremen, Bremen, Germany.
    Jakszyn, Paula
    Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain; Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain.
    Skeie, Guri
    Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
    Bajracharya, Rashmita
    German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Boer, Jolanda M. A.
    Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
    Borné, Yan
    Department of Clinical Sciences Malmö, Faculty of Medicine, Nutritional Epidemiology, Lund University, Lund, Sweden.
    Chajes, Veronique
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France.
    Dahm, Christina C.
    Department of Public Health, Aarhus University, Aarhus, Denmark.
    Dansero, Lucia
    Department of Clinical and Biological Sciences, Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH), University of Turin, Turin, Italy.
    Guevara, Marcela
    Instituto de Salud Pública de Navarra, Pamplona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
    Heath, Alicia K.
    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
    Ibsen, Daniel B.
    Department of Public Health, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus, Denmark; MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.
    Papier, Keren
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
    Katzke, Verena
    German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Kyrø, Cecilie
    Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.
    Masala, Giovanna
    Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
    Molina-Montes, Esther
    Department of Nutrition and Food Science, University of Granada, Campus of Cartuja, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Biomedical Research Centre, Institute of Nutrition and Food Technology (INYTA) “José Mataix”, University of Granada, Granada, Spain.
    Robinson, Oliver J. K.
    MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
    Santiuste de Pablos, Carmen
    CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
    Schulze, Matthias B.
    Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, Potsdam, Germany.
    Simeon, Vittorio
    Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Vanvitelli University, Naples, Italy.
    Sonestedt, Emily
    Department of Clinical Sciences Malmö, Faculty of Medicine, Nutritional Epidemiology, Lund University, Lund, Sweden.
    Tjønneland, Anne
    Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.
    Tumino, Rosario
    Hyblean Association for Epidemiological Research, AIRE ONLUS, Ragusa, Italy.
    van der Schouw, Yvonne T.
    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
    Verschuren, W. M. Monique
    Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
    Vozar, Beatrice
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Gunter, Marc J.
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France.
    Monteiro, Carlos A.
    Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil; Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
    Millett, Christopher
    Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil; Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom.
    Levy, Renata Bertazzi
    Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil; Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil.
    Characterization of the degree of food processing in the European prospective investigation into cancer and nutrition: application of the nova classification and validation using selected biomarkers of food processing2022In: Frontiers in Nutrition, E-ISSN 2296-861X, Vol. 9, article id 1035580Article in journal (Refereed)
    Abstract [en]

    Background: Epidemiological studies have demonstrated an association between the degree of food processing in our diet and the risk of various chronic diseases. Much of this evidence is based on the international Nova classification system, which classifies food into four groups based on the type of processing: (1) Unprocessed and minimally processed foods, (2) Processed culinary ingredients, (3) Processed foods, and (4) “Ultra-processed” foods (UPF). The ability of the Nova classification to accurately characterise the degree of food processing across consumption patterns in various European populations has not been investigated so far. Therefore, we applied the Nova coding to data from the European Prospective Investigation into Cancer and Nutrition (EPIC) in order to characterize the degree of food processing in our diet across European populations with diverse cultural and socio-economic backgrounds and to validate this Nova classification through comparison with objective biomarker measurements.

    Methods: After grouping foods in the EPIC dataset according to the Nova classification, a total of 476,768 participants in the EPIC cohort (71.5% women; mean age 51 [standard deviation (SD) 9.93]; median age 52 [percentile (p)25–p75: 58–66] years) were included in the cross-sectional analysis that characterised consumption patterns based on the Nova classification. The consumption of food products classified as different Nova categories were compared to relevant circulating biomarkers denoting food processing, measured in various subsamples (N between 417 and 9,460) within the EPIC cohort via (partial) correlation analyses (unadjusted and adjusted by sex, age, BMI and country). These biomarkers included an industrial transfatty acid (ITFA) isomer (elaidic acid; exogenous fatty acid generated during oil hydrogenation and heating) and urinary 4-methyl syringol sulfate (an indicator for the consumption of smoked food and a component of liquid smoke used in UPF).

    Results: Contributions of UPF intake to the overall diet in % grams/day varied across countries from 7% (France) to 23% (Norway) and their contributions to overall % energy intake from 16% (Spain and Italy) to >45% (in the UK and Norway). Differences were also found between sociodemographic groups; participants in the highest fourth of UPF consumption tended to be younger, taller, less educated, current smokers, more physically active, have a higher reported intake of energy and lower reported intake of alcohol. The UPF pattern as defined based on the Nova classification (group 4;% kcal/day) was positively associated with blood levels of industrial elaidic acid (r = 0.54) and 4-methyl syringol sulfate (r = 0.43). Associations for the other 3 Nova groups with these food processing biomarkers were either inverse or non-significant (e.g., for unprocessed and minimally processed foods these correlations were –0.07 and –0.37 for elaidic acid and 4-methyl syringol sulfate, respectively).

    Conclusion: These results, based on a large pan-European cohort, demonstrate sociodemographic and geographical differences in the consumption of UPF. Furthermore, these results suggest that the Nova classification can accurately capture consumption of UPF, reflected by stronger correlations with circulating levels of industrial elaidic acid and a syringol metabolite compared to diets high in minimally processed foods.

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  • 11.
    Karlsson, T.
    et al.
    Department of Internal Medicine and Clinical Nutrition, Institute of medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Biology and Biological Engineering, Division of Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Sweden.
    Augustin, H.
    Department of Internal Medicine and Clinical Nutrition, Institute of medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lindqvist, Maria
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Otten, Julia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Petersson, Kerstin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Storck-Lindholm, E.
    Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, Institute of medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Effect of the New Nordic Diet compared with usual care on glucose control in gestational diabetes mellitus: Study protocol for the randomized controlled trial intervention with new Nordic DIet in women with GestatiOnal diabetes mellitus (iNDIGO)2022In: Contemporary Clinical Trials, ISSN 1551-7144, E-ISSN 1559-2030, Vol. 115, article id 106706Article in journal (Refereed)
    Abstract [en]

    Background: Gestational diabetes mellitus (GDM) is a pregnancy complication associated with short- and long-term health consequences for mother and child. First line treatment is diet and exercise but there is a recognized knowledge gap as to what diet treatment is optimal. A healthy Nordic diet has been associated with improved health but no studies in women with GDM exist. The New Nordic Diet (NND) is an initiative with the purpose to develop a healthy Nordic diet including foods with the potential to grow in Nordic countries; including fruit, berries, vegetables, whole-grain cereal products, nuts, fish, and rapeseed oil. The purpose of the intervention with new Nordic DIet in women with GestatiOnal diabetes mellitus (iNDIGO) is to test if the NND compared with usual care improves glucose control in women with GDM.

    Methods: The iNDIGO study is a randomized parallel controlled trial where 50 women with GDM will be randomized to either an NND or usual care for 14 days (30–32 weeks of gestation). Participants in the NND group will receive menus and food bags containing foods to be consumed. Primary outcome is glycemic control (time in target) measured using continuous glucose monitoring. Compliance to the dietary intervention will be tested using dietary biomarkers and adherence questionnaires.

    Conclusion: Diet treatment represents first line treatment in GDM but it remains unclear what type of diets are effective. iNDIGO is an efficacy study and will provide evidence as to whether a healthy Nordic diet can improve glucose control in women with GDM.

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  • 12.
    Karlsson, Therese
    et al.
    Department of Internal Medicine and Clinical nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 115, Gothenburg, Sweden; Department of Biology and Biological Engineering, Division of Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Sweden.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 115, Gothenburg, Sweden.
    Rådjursöga, Millie
    Department of Internal Medicine and Clinical nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 115, Gothenburg, Sweden.
    Ellegård, Lars
    Clinical Nutrition Unit, Department of Gastroenterology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Pedersen, Anders
    Swedish NMR Centre, University of Gothenburg, Box 465, Gothenburg, Sweden.
    Lindqvist, Helen M.
    Department of Internal Medicine and Clinical nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 115, Gothenburg, Sweden.
    Identification of single and combined serum metabolites associated with food intake2022In: Metabolites, ISSN 2218-1989, E-ISSN 2218-1989, Vol. 12, no 10, article id 908Article in journal (Refereed)
    Abstract [en]

    Assessment of dietary intake is challenging. Traditional methods suffer from both random and systematic errors; thus objective measures are important complements in monitoring dietary exposure. The study presented here aims to identify serum metabolites associated with reported food intake and to explore whether combinations of metabolites may improve predictive models. Fasting blood samples and a 4-day weighed food diary were collected from healthy Swedish subjects (n = 119) self-defined as having habitual vegan, vegetarian, vegetarian + fish, or omnivore diets. Serum was analyzed for metabolites by 1H-nuclear magnetic resonance spectroscopy. Associations between single and combined metabolites and 39 foods and food groups were explored. Area under the curve (AUC) was calculated for prediction models. In total, 24 foods or food groups associated with serum metabolites using the criteria of rho > 0.2, p < 0.01 and AUC ≥ 0.7 were identified. For the consumption of soybeans, citrus fruits and marmalade, nuts and almonds, green tea, red meat, poultry, total fish and shellfish, dairy, fermented dairy, cheese, eggs, and beer the final models included two or more metabolites. Our results indicate that a combination of metabolites improve the possibilities to use metabolites to identify several foods included in the current diet. Combined metabolite models should be confirmed in dose–response intervention studies.

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  • 13.
    Karlsson, Therese
    et al.
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, P. O. Box 459, Gothenburg, Sweden; Department of Life Sciences, Division of Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Sweden.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, P. O. Box 459, Gothenburg, Sweden.
    Strid, Anna
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, P. O. Box 459, Gothenburg, Sweden.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Associations of dietary choline and betaine with all-cause mortality: a prospective study in a large Swedish cohort2024In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 63, p. 785-796Article in journal (Refereed)
    Abstract [en]

    Purpose: Investigate the association between choline and betaine intake and all-cause mortality in a large Swedish cohort.

    Methods: Women (52,246) and men (50,485) attending the Västerbotten Intervention Programme 1990–2016 were included. Cox proportional hazard regression models adjusted for energy intake, age, BMI, smoking, education, and physical activity were used to estimate mortality risk according to betaine, total choline, phosphatidylcholine, glycerophosphocholine, phosphocholine, sphingomyelin, and free choline intakes [continuous (per 50 mg increase) and in quintiles].

    Results: During a median follow-up of 16 years, 3088 and 4214 deaths were registered in women and men, respectively. Total choline intake was not associated with all-cause mortality in women (HR 1.01; 95% CI 0.97, 1.06; P = 0.61) or men (HR 1.01; 95% CI 0.98, 1.04; P = 0.54). Betaine intake was associated with decreased risk of all-cause mortality in women (HR 0.95; 95% CI 0.91, 0.98; P < 0.01) but not in men. Intake of free choline was negatively associated with risk of all-cause mortality in women (HR 0.98; 95% CI 0.96, 1.00; P = 0.01). No other associations were found between intake of the different choline compounds and all-cause mortality. In women aged ≥ 55 years, phosphatidylcholine intake was positively associated with all-cause mortality. In men with higher folate intake, total choline intake was positively associated with all-cause mortality.

    Conclusion: Overall, our results do not support that intake of total choline is associated with all-cause mortality. However, some associations were modified by age and with higher folate intake dependent on sex. Higher intake of betaine was associated with lower risk of all-cause mortality in women.

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  • 14.
    Lindroos, Anna Karin
    et al.
    Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden; Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hallström, Elinor
    Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Research Institutes of Sweden (RISE), Department of Food and Agriculture, Lund, Sweden.
    Moraeus, Lotta
    Department of Risk Benefit Assessment, Swedish Food Agency, Uppsala, Sweden.
    Strid, Anna
    Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Dietary greenhouse gas emissions and diet quality in a cross-sectional study of Swedish adolescents2023In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 118, no 5, p. 956-965Article in journal (Refereed)
    Abstract [en]

    Background: Interventions to improve dietary intake and reduce dietary greenhouse gas emissions (dGHGE) are urgently needed. Adolescence presents a unique time in life to promote sustainable diets. Detailed dietary data are needed to inform public health strategies aiming at improving adolescents’ diet quality and reducing dGHGE.

    Objective: This study aimed to describe dGHGE in Swedish adolescents’ diets by socio-demographic characteristics, evaluate how food groups contribute to dGHGE, and examine dGHGE in relation to diet quality.

    Methods: Data come from the national, school-based, cross-sectional dietary survey Riksmaten Adolescents 2016-17 of 3099 females and males attending school grades 5 (11–12 y old), 8 (14–15 y old) and 11 (17–18 y old). Participants completed 2 web-based 24-h recalls and questionnaires on lifestyle factors. dGHGE was estimated based on life cycle assessment data. Diet quality was estimated using NRF11.3 (Nutrient Rich Food Index) and SHEIA15 (Swedish Healthy Eating Index for Adolescents 2015).

    Results: dGHGE were higher in males than females (medians 4.2 versus 3.8 kg CO2e/10 MJ, P < 0.001). In females, dGHGE were highest in grade 5 (4.0 kg CO2e/10MJ), whereas in males, emissions were highest in grade 11 (4.4 kg CO2e/10MJ), P < 0.001 for the sex/grade interaction. Overweight/obesity was positively associated with CO2e/10MJ, but parental education, birthplace, and degree of urbanization were not. In females, the proportion of dGHGE from animal-based foods was lowest in grade 11, whereas the proportions from plant-based foods and sweet foods/beverages were highest. In males, these proportions were similar across grades. NRF11.3 was not associated with CO2e/10MJ, whereas healthier eating, according to SHEIA15, was inversely associated with CO2e/10MJ.

    Conclusions: Food choices and dGHGE per calorie differ by sex in adolescents. Thus, intervention strategies to improve dietary sustainability need to be tailored differently to females and males. Diet quality should also be considered when promoting reduced GHGE diets.

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  • 15.
    Mayén, Ana-Lucia
    et al.
    International Agency for Research On Cancer (IARC), World Health Organization, Lyon, France.
    Viallon, Vivian
    International Agency for Research On Cancer (IARC), World Health Organization, Lyon, France.
    Botteri, Edoardo
    Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway, Department of Research, Cancer Registry of Norway, Oslo, Norway.
    Proust-Lima, Cecile
    Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France.
    Bagnardi, Vincenzo
    Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy.
    Batista, Veronica
    International Agency for Research On Cancer (IARC), World Health Organization, Lyon, France.
    Cross, Amanda J.
    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
    Laouali, Nasser
    Université Paris-Saclay, “Exposome and Heredity” Group, Villejuif, France.
    MacDonald, Conor J.
    Université Paris-Saclay, “Exposome and Heredity” Group, Villejuif, France.
    Severi, Gianluca
    Université Paris-Saclay, “Exposome and Heredity” Group, Villejuif, France; Department of Statistics, Computer Science, Applications “G. Parenti” (DISIA), University of Florence, Florence, Italy.
    Katzke, Verena
    Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Bergmann, Manuela M.
    German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany.
    Schulze, Mattias B.
    Department of Molecular Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
    Tjønneland, Anne
    Danish Cancer Society Research Center, Diet, Genes and Environment, Copenhagen, Denmark.
    Eriksen, Anne Kirstine
    Danish Cancer Society Research Center, Diet, Genes and Environment, Copenhagen, Denmark.
    Dahm, Christina C.
    Department of Public Health, Aarhus University, Aarhus, Denmark.
    Antoniussen, Christian S.
    Department of Public Health, Aarhus University, Aarhus, Denmark.
    Jakszyn, Paula
    Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain; Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain.
    Sánchez, Maria-Jose
    Escuela Andaluza de Salud Pública (EASP), Granada, Spain; Instituto de Investigación Biosanitaria, Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
    Amiano, Pilar
    Centro de Investigación Biomédica en Red de Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain; Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain; Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain; Instituto de Salud Carlos III, Madrid, Spain.
    Colorado-Yohar, Sandra M.
    Centro de Investigación Biomédica en Red de Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain; Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain; Research Group On Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia.
    Ardanaz, Eva
    Centro de Investigación Biomédica en Red de Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain; Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
    Travis, Ruth
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Oxford, United Kingdom.
    Palli, Domenico
    Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
    Sabina, Sieri
    Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
    Tumino, Rosario
    Hyblean Association for Epidemiological Research AIRE-ONLUS Ragusa, Milan, Italy.
    Ricceri, Fulvio
    Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy.
    Panico, Salvatore
    Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy.
    Bueno-de-Mesquita, Bas
    Former Senior Scientist, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
    Derksen, Jeroen W. G.
    Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
    Sonestedt, Emily
    Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Harlid, Sophia
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Braaten, Tonje
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Gram, Inger Torhild
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Lukic, Marko
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Jenab, Mazda
    International Agency for Research On Cancer (IARC), World Health Organization, Lyon, France.
    Riboli, Elio
    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
    Freisling, Heinz
    International Agency for Research On Cancer (IARC), World Health Organization, Lyon, France.
    Weiderpass, Elisabete
    International Agency for Research On Cancer (IARC), World Health Organization, Lyon, France.
    Gunter, Marc J.
    International Agency for Research On Cancer (IARC), World Health Organization, Lyon, France.
    Ferrari, Pietro
    International Agency for Research On Cancer (IARC), World Health Organization, Lyon, France.
    A longitudinal evaluation of alcohol intake throughout adulthood and colorectal cancer risk2022In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 37, no 9, p. 915-929Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol intake is an established risk factor for colorectal cancer (CRC); however, there is limited knowledge on whether changing alcohol drinking habits during adulthood modifies CRC risk.

    Objective: Leveraging longitudinal exposure assessments on alcohol intake at different ages, we examined the relationship between change in alcohol intake and subsequent CRC risk.

    Methods: Within the European Prospective Investigation into Cancer and Nutrition, changes in alcohol intake comparing follow-up with baseline assessments were investigated in relation to CRC risk. The analysis included 191,180, participants and 1530 incident CRC cases, with exclusion of the first three years of follow-up to minimize reverse causation. Trajectory profiles of alcohol intake, assessed at ages 20, 30, 40, 50 years, at baseline and during follow-up, were estimated using latent class mixed models and related to CRC risk, including 407,605 participants and 5,008 incident CRC cases.

    Results: Mean age at baseline was 50.2 years and the follow-up assessment occurred on average 7.1 years later. Compared to stable intake, a 12 g/day increase in alcohol intake during follow-up was positively associated with CRC risk (HR = 1.15, 95%CI 1.04, 1.25), while a 12 g/day reduction was inversely associated with CRC risk (HR = 0.86, 95%CI 0.78, 0.95). Trajectory analysis showed that compared to low alcohol intake, men who increased their alcohol intake from early- to mid- and late-adulthood by up to 30 g/day on average had significantly increased CRC risk (HR = 1.24; 95%CI 1.08, 1.42), while no associations were observed in women. Results were consistent by anatomical subsite.

    Conclusions: Increasing alcohol intake during mid-to-late adulthood raised CRC risk, while reduction lowered risk.

  • 16. Shi, L.
    et al.
    Brunius, C.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Bergdahl, Ingvar
    Umeå University, Faculty of Medicine, Department of Biobank Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. University of Gothenburg, Gothenburg.
    Hanhineva, K.
    Landberg, Rikard
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Department of Biology andBiological Engineering, Chalmers University of Technology, Gothenburg.
    Plasma metabolite biomarkers of boiled and filtered coffee intake and their association with type 2 diabetes risk2020In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 287, no 4, p. 405-421Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Habitual coffee intake has been associated with a lower risk of developing type 2 diabetes (T2D), but few studies used biomarkers to reflect intake and investigated different coffee brews, that is boiled and filtered, separately.

    OBJECTIVES: To identify plasma metabolites associated with boiled or filtered coffee intake and to examine their association with T2D risk in Swedish adults.

    METHODS: In a case-control study nested within the Västerbotten Intervention Programme, baseline plasma samples from 421 case-control pairs and samples from a subset of 149 pairs at a 10-year follow-up were analysed using untargeted LC-MS metabolomics. We identified metabolites associated with food frequency questionnaires (FFQ)-estimated coffee intake and assessed odds ratios of T2D.

    RESULTS: In total, 24 and 32 metabolites were associated with boiled or filtered coffee intake. We determined robust metabolite panels for highly specific prediction of boiled or filtered coffee. We observed an inverse association between the metabolite panel of filtered coffee and T2D risk. No association with T2D was observed for the panel of boiled coffee intake. Similar results were observed for FFQ-estimated coffee intake.

    CONCLUSIONS: We identified plasma metabolites specifically associated with boiled or filtered coffee intake, which might be used as selective biomarkers. Our study supports a protective role of habitual intake of filtered coffee on T2D development. The lack of association for boiled coffee intake might be due to the lack of a protective effect of boiled coffee or due to the limited number of boiled coffee consumers in this population, but it warrants further investigation.

  • 17. Stepien, Magdalena
    et al.
    Keski-Rahkonen, Pekka
    Kiss, Agneta
    Robinot, Nivonirina
    Duarte-Salles, Talita
    Murphy, Neil
    Perlemuter, Gabriel
    Viallon, Vivian
    Tjønneland, Anne
    Rostgaard-Hansen, Agnetha Linn
    Dahm, Christina C.
    Overvad, Kim
    Boutron-Ruault, Marie-Christine
    Mancini, Francesca Romana
    Mahannat-Saleh, Yahya
    Aleksandrova, Krasimira
    Kaaks, Rudolf
    Kühn, Tilman
    Trichopoulou, Antonia
    Karakatsani, Anna
    Panico, Salvatore
    Tumino, Rosario
    Palli, Domenico
    Tagliabue, Giovanna
    Naccarati, Alessio
    Vermeulen, Roel C. H.
    Bueno-de-Mesquita, Hendrik Bastiaan
    Weiderpass, Elisabete
    Skeie, Guri
    Ramón Quirós, Jose
    Ardanaz, Eva
    Mokoroa, Olatz
    Sala, Núria
    Sánchez, Maria-Jose
    María Huerta, José
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Harlid, Sophia
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Ohlsson, Bodil
    Sjöberg, Klas
    Schmidt, Julie A.
    Wareham, Nick
    Khaw, Kay-Tee
    Ferrari, Pietro
    Rothwell, Joseph A.
    Gunter, Marc
    Riboli, Elio
    Scalbert, Augustin
    Jenab, Mazda
    Metabolic perturbations prior to hepatocellular carcinoma diagnosis: findings from a prospective observational cohort study2021In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 148, no 3, p. 609-625Article in journal (Refereed)
    Abstract [en]

    Hepatocellular carcinoma (HCC) development entails changes in liver metabolism. Current knowledge on metabolic perturbations in HCC is derived mostly from case-control designs, with sparse information from prospective cohorts. Our objective was to apply comprehensive metabolite profiling to detect metabolites whose serum concentrations are associated with HCC development, using biological samples from within the prospective European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (>520 000 participants), where we identified 129 HCC cases matched 1:1 to controls. We conducted high-resolution untargeted liquid chromatography-mass spectrometry-based metabolomics on serum samples collected at recruitment prior to cancer diagnosis. Multivariable conditional logistic regression was applied controlling for dietary habits, alcohol consumption, smoking, body size, hepatitis infection and liver dysfunction. Corrections for multiple comparisons were applied. Of 9206 molecular features detected, 220 discriminated HCC cases from controls. Detailed feature annotation revealed 92 metabolites associated with HCC risk, of which 14 were unambiguously identified using pure reference standards. Positive HCC-risk associations were observed forN1-acetylspermidine, isatin,p-hydroxyphenyllactic acid, tyrosine, sphingosine,l,l-cyclo(leucylprolyl), glycochenodeoxycholic acid, glycocholic acid and 7-methylguanine. Inverse risk associations were observed for retinol, dehydroepiandrosterone sulfate, glycerophosphocholine, gamma-carboxyethyl hydroxychroman and creatine. Discernible differences for these metabolites were observed between cases and controls up to 10 years prior to diagnosis. Our observations highlight the diversity of metabolic perturbations involved in HCC development and replicate previous observations (metabolism of bile acids, amino acids and phospholipids) made in Asian and Scandinavian populations. These findings emphasize the role of metabolic pathways associated with steroid metabolism and immunity and specific dietary and environmental exposures in HCC development.

  • 18. Strid, Anna
    et al.
    Hallström, Elinor
    Hjorth, Therese
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Sonesson, Ulf
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Huseinovic, Ena
    Climate impact from diet in relation to background and sociodemographic characteristics in the Västerbotten Intervention Programme2019In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 22, no 17, p. 3288-3297Article in journal (Refereed)
    Abstract [en]

    Objective: The objective of this study was to examine climate impact from diet across background and sociodemographic characteristics in a population-based cohort in northern Sweden.

    Design: A cross-sectional study within the Västerbotten Intervention Programme. Dietary data from a 64-item food frequency questionnaire collected during 1996–2016 were used. Energy-adjusted greenhouse gas emissions (GHGE) for all participants, expressed as kg carbon dioxide equivalents/day and 4184 kJ (1000 kcal), were estimated using data from life cycle analyses. Differences in background and sociodemographic characteristics were examined between participants with low and high GHGE from diet, respectively. The variables evaluated were age, BMI, physical activity, marital status, level of education, smoking, and residence.

    Setting: Västerbotten county in northern Sweden.

    Participants: In total, 46 893 women and 45 766 men aged 29–65 years.

    Results: Differences in GHGE from diet were found across the majority of examined variables. The strongest associations were found between GHGE from diet and age, BMI, education, and residence (all P < 0·001), with the highest GHGE from diet found among women and men who were younger, had a higher BMI, higher educational level, and lived in urban areas.

    Conclusions: This study is one of the first to examine climate impact from diet across background and sociodemographic characteristics. The results show that climate impact from diet is associated with age, BMI, residence and educational level amongst men and women in Västerbotten, Sweden. These results define potential target populations where public health interventions addressing a move towards more climate-friendly food choices and reduced climate impact from diet could be most effective.

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  • 19.
    Strid, Anna
    et al.
    Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hallström, Elinor
    Department of Agriculture and Food, Rise - Research Institutes of Sweden, Lund, Sweden.
    Lindroos, Anna Karin
    Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Adherence to the Swedish dietary guidelines and the impact on mortality and climate in a population-based cohort study2023In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 26, no 11, p. 2333-2342Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the associations between adherence to the Swedish dietary guidelines and all-cause mortality and thus assessing the index' ability to predict health outcomes, as well as levels of dietary greenhouse gas emissions (GHGEs).

    Design: A longitudinal study 1990-2016 within the population-based cohort Västerbotten Intervention Programme. Dietary data were based on food frequency questionnaires. Diet quality was assessed by the Swedish Healthy Eating Index for Adults 2015 (SHEIA15), based on the 2015 Swedish dietary guidelines. Dietary GHGEs were estimated from life cycle assessment data including emissions from farm to industry gate. Hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality were evaluated with Cox proportional hazards regression, and differences in median GHGEs were tested using the Kruskal-Wallis one-way ANOVA test, between quintiles of SHEIA15 score.

    Setting: Northern Sweden.

    Participants: In total, 49,124 women and 47,651 men, aged 35-65 years.

    Results: Median follow-up times were 16.0 years for women and 14.7 years for men, during which time 3074 women and 4212 men died. A consistent trend of lower all-cause mortality HRs for both sexes with higher SHEIA15 scores was demonstrated. For women, the all-cause mortality HR was 0.81 [(95% CI 0.71-0.92); p=0.001] and for men 0.90 [(95% CI 0.81-0.996); p=0.041] between the quintile with the highest SHEIA15 score compared with the quintile with the lowest SHEIA15 score. A consistent trend of lower estimated dietary GHGEs among both sexes with higher SHEIA15 scores was also found.

    Conclusions: Adherence to Swedish dietary guidelines, estimated by SHEIA15, seems to promote longevity and reduce dietary climate impact.

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  • 20.
    Strid, Anna
    et al.
    Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hallström, Elinor
    Department of Agriculture and Food, RISE Research Institutes of Sweden, Gothenburg, Sweden.
    Sonesson, Ulf
    Department of Agriculture and Food, RISE Research Institutes of Sweden, Gothenburg, Sweden.
    Sjons, Josefin
    Department of Agriculture and Food, RISE Research Institutes of Sweden, Gothenburg, Sweden.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bianchi, Marta
    Department of Agriculture and Food, RISE Research Institutes of Sweden, Gothenburg, Sweden.
    Sustainability indicators for foods benefiting climate and health2021In: Sustainability, E-ISSN 2071-1050, Vol. 13, no 7, article id 3621Article in journal (Refereed)
    Abstract [en]

    New methods for combined evaluation of nutritional and environmental aspects of food products are needed to enable a transformation of dietary guidelines integrating both health and environmental perspectives. We evaluated two sustainability aspects; nutrition and climate im-pact, of foods commonly consumed in Sweden and the implications of using parallel or integrated assessments of these two aspects, also discussing the usability and suitability of these food sustain-ability indicators in relation to Swedish dietary guidelines, industry food product development, and consumer communication. There were large differences in both nutrient density and climate impact among the different foods. The parallel assessment easily visualized synergies and trade-offs between these two sustainability aspects for the different foods. Coherence with dietary guidelines was good, and suitability and usability deemed satisfying. The integrated indicator showed better coherence with dietary guidelines than indicators based solely on nutrient density or climate impact; however, the difficulty to interpret the score limits its usability in product development and consumer communication. With both methods, advantageous as well as less advantageous plant-based and animal-based food alternatives were suggested. The two alternative methods evaluated could serve as useful tools to drive individual and societal development towards more sustainable food production and consumption.

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  • 21.
    Strid, Anna
    et al.
    Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Bianchi, Marta
    Department of Agriculture and Food, RISE Research Institutes of Sweden, Gothenburg, Sweden; Department of Agriculture and Food, RISE Research Institutes of Sweden, Lund, Sweden.
    Sonesson, Ulf
    Department of Agriculture and Food, RISE Research Institutes of Sweden, Gothenburg, Sweden; Department of Agriculture and Food, RISE Research Institutes of Sweden, Lund, Sweden.
    Hallström, Elinor
    Department of Agriculture and Food, RISE Research Institutes of Sweden, Gothenburg, Sweden; Department of Agriculture and Food, RISE Research Institutes of Sweden, Lund, Sweden.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Diets benefiting health and climate relate to longevity in northern Sweden2021In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 114, no 2, p. 515-529Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Diets combining adequate nutritional quality and low climate impact are highly needed for human and planet health.

    OBJECTIVES: We aimed to 1) evaluate nutrient density indexes' ability to predict mortality, and 2) assess the effects of diets varying in nutrient density and climate impact on total mortality.

    METHODS: Dietary data from 49,124 women and 47,651 men aged 35-65 y in the population-based prospective study Västerbotten Intervention Programme (Sweden) were used. Greenhouse gas emissions (GHGEs) were estimated using data from life cycle assessments. Fifteen variants of nutrient density indexes were evaluated and the index that best predicted mortality was used to estimate participants' nutrient density. GHGEs and nutrient density were adjusted for energy intakes. Total mortality risk was estimated by Cox proportional hazards models for 4 groups of women and men, respectively, i.e., higher nutrient density, lower climate impact (HNutr/LClim); higher nutrient density, higher climate impact (HNutr/HClim); lower nutrient density, lower climate impact (LNutr/LClim); and lower nutrient density, higher climate impact (LNutr/HClim-reference group).

    RESULTS: NRF11.3, a Sweden-adapted variant of the Nutrient Rich Foods index, was identified to have the best ability to predict mortality in the study population. Median follow-up times for women and men were 16.0 and 14.7 y, respectively. For women a significantly lower mortality risk was found for HNutr/LClim (HR: 0.87; 95% CI: 0.79, 0.96; P = 0.008) and HNutr/HClim (HR: 0.87; 95% CI: 0.78, 0.97; P = 0.011) than for LNutr/HClim. Among men LNutr/LClim had a significantly higher mortality risk (HR: 1.10; 95% CI: 1.01, 1.21; P = 0.033) than LNutr/HClim.

    CONCLUSIONS: Diets beneficial for both health and climate are feasible and associated with lower mortality risk in women. Further studies are needed to understand how men may transition into diets that are more sustainable from a combined health and climate perspective.

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  • 22.
    Strid, Anna
    et al.
    Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Hallström, Elinor
    Department of Agriculture and Food, RISE - Research Institutes of Sweden, Lund, Sweden.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Toward a more climate-sustainable diet: possible deleterious impacts on health when diet quality is ignored2023In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 153, no 1, p. 242-252Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nutritional quality, and health and climate impacts are important considerations in the design of sustainable diets.

    OBJECTIVES: To investigate the association between diets varying in nutrient density and climate impact and MI and stroke HRs.

    METHODS: Dietary data of 41,194 women and 39,141 men (35-65 y) who participated in a Swedish population-based cohort study were employed. Nutrient density was calculated using the Sweden-adapted Nutrient Rich Foods 11.3 index. Dietary climate impact was calculated with data from life cycle assessments, including greenhouse gas emissions from primary production to industry gate. HRs and 95% CIs for MI and stroke were assessed with multivariable Cox proportional hazards regression, comparing a least-desirable diet scenario reference group (lower nutrient density, higher climate impact) with three diet groups that varied with respect to higher/lower nutrient density and higher/lower climate impact.

    RESULTS: Median follow-up time from the baseline study visit to MI or stroke diagnosis was 15.7 y for women and 12.8 y for men. The MI hazard was significantly higher for the men with diets of lower nutrient density and lower climate impact (HR: 1.19; 95% CI: 1.06, 1.33; P = 0.004), compared with the reference group. No significant association with MI was observed for any of the diet groups of women. No significant association with stroke was observed among any of the diet groups of women or men.

    CONCLUSIONS: The results among men suggest some adverse health effects for men when diet quality is not considered in the pursuit of more climate-sustainable diets. For women, no significant associations were detected. The mechanism underlying this association for men needs further investigation.

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  • 23. Tognon, Gianluca
    et al.
    Nilsson, Lena M.
    Umeå University, Arctic Research Centre at Umeå University.
    Shungin, Dmitry
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Odontology.
    Lissner, Lauren
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Renstrom, Frida
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Nonfermented milk and other dairy products: associations with all-cause mortality 1,22017In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 105, no 6, p. 1502-1511Article in journal (Refereed)
    Abstract [en]

    Background: A positive association between nonfermented milk intake and increased all-cause mortality was recently reported, but overall, the association between dairy intake and mortality is inconclusive. Objective: We studied associations between intake of dairy products and all-cause mortality with an emphasis on nonfermented milk and fat content. Design: A total of 103,256 adult participants (women: 51.0%) from Northern Sweden were included (7121 deaths; mean follow-up: 13.7 y). Associations between all-cause mortality and reported intakes of nonfermented milk (total or by fat content), fermented milk, cheese, and butter were tested with the use of Cox proportional hazards models that were adjusted for age, sex, body mass index, smoking status, education, energy intake, examination year, and physical activity. To circumvent confounding, Mendelian randomization was applied in a subsample via the lactase LCT-13910 C/T single nucleotide polymorphism that is associated with lactose tolerance and milk intake. Results: High consumers of nonfermented milk (>= 2.5 times/d) had a 32% increased hazard (HR: 1.32; 95% CI: 1.18, 1.48) for all-cause mortality compared with that of subjects who consumed milk <= 1 time/wk. The corresponding value for butter was 11% (HR: 1.11; 95% CI: 1.07, 1.21). All nonfermented milk-fat types were independently associated with increased HRs, but compared with full-fat milk, HRs were lower in consumers of medium-and low-fat milk. Fermented milk intake (HR: 0.90; 95% CI: 0.86, 0.94) and cheese intake (HR: 0.93; 95% CI: 0.91, 0.96) were negatively associated with mortality. Results were slightly attenuated by lifestyle adjustments but were robust in sensitivity analyses. Mortality was not significantly associated with the LCT-13910 C/T genotype in the smaller subsample. The amount and type of milk intake was associated with lifestyle variables. Conclusions: In the present Swedish cohort study, intakes of nonfermented milk and butter are associated with higher all-cause mortality, and fermented milk and cheese intakes are associated with lower all-cause mortality. Residual confounding by lifestyle cannot be excluded, and Mendelian randomization needs to be examined in a larger sample.

  • 24.
    Wedekind, Roland
    et al.
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, France.
    Rothwell, Joseph A.
    (CESP), Faculté de Medicine, Université Paris-Saclay, Inserm, Villejuif, France; Institut Gustave Roussy, Villejuif, France.
    Viallon, Vivian
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, France.
    Keski-Rahkonen, Pekka
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, France.
    Schmidt, Julie A.
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK, United Kingdom.
    Chajes, Veronique
    International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, France.
    Katzke, Vna
    Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Johnson, Theron
    Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Santucci de Magistris, Maria
    A.O.U. Federico II, Naples, Italy.
    Krogh, Vittorio
    Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Milan, Italy.
    Amiano, Pilar
    Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain; Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
    Sacerdote, Carlotta
    Unit of Cancer Epidemiology, Città Della Salute e Della Scienza University-Hospital, Via Santena 7, Turin, Italy.
    Redondo-Sánchez, Daniel
    Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Escuela Andaluza de Salud Pública (EASP), Granada, Spain; Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain.
    Huerta, José María
    Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
    Tjønneland, Anne
    Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Pokharel, Pratik
    Danish Cancer Society Research Center, Copenhagen, Denmark; Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, WA, Joondalup, Australia.
    Jakszyn, Paula
    Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain; Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain.
    Tumino, Rosario
    Hyblean Association for Epidemiological Research AIRE – ONLUS, Ragusa, Italy.
    Ardanaz, Eva
    Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
    Sandanger, Torkjel M.
    Department of Community Medicine, UiT - the Arctic University of Norway, Langnes, Tromsø, Norway.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Schulze, Matthias B.
    Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; University of Potsdam, Institute of Nutritional Science, Potsdam, Germany.
    Weiderpass, Elisabete
    International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, France.
    Gunter, Marc J.
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, France.
    Huybrechts, Inge
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, France.
    Scalbert, Augustin
    Nutrition and Metabolism Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, France.
    Determinants of blood acylcarnitine concentrations in healthy individuals of the European Prospective Investigation into Cancer and Nutrition2022In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 41, no 8, p. 1735-1745Article in journal (Refereed)
    Abstract [en]

    Background & aims: Circulating levels of acylcarnitines (ACs) have been associated with the risk of various diseases such as cancer and type 2 diabetes. Diet and lifestyle factors have been shown to influence AC concentrations but a better understanding of their biological, lifestyle and metabolic determinants is needed.

    Methods: Circulating ACs were measured in blood by targeted (15 ACs) and untargeted metabolomics (50 ACs) in 7770 and 395 healthy participants of the European Prospective Investigation into Cancer and Nutrition (EPIC), respectively. Associations with biological and lifestyle characteristics, dietary patterns, self-reported intake of individual foods, estimated intake of carnitine and fatty acids, and fatty acids in plasma phospholipid fraction and amino acids in blood were assessed.

    Results: Age, sex and fasting status were associated with the largest proportion of AC variability (partial-r up to 0.19, 0.18 and 0.16, respectively). Some AC species of medium or long-chain fatty acid moiety were associated with the corresponding fatty acids in plasma (partial-r = 0.24) or with intake of specific foods such as dairy foods containing the same fatty acid. ACs of short-chain fatty acid moiety (propionylcarnitine and valerylcarnitine) were moderately associated with concentrations of branched-chain amino acids (partial-r = 0.5). Intake of most other foods and of carnitine showed little association with AC levels.

    Conclusions: Our results show that determinants of ACs in blood vary according to their fatty acid moiety, and that their concentrations are related to age, sex, diet, and fasting status. Knowledge on their potential determinants may help interpret associations of ACs with disease risk and inform on potential dietary and lifestyle factors that might be modified for disease prevention.

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  • 25.
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Water spirits, medicine-men and witches: avenues to successful reproduction among the Abelam, Papua New Guinea1996In: The anthropology of pregnancy loss: comparative studies in miscarriage, stillbirth and neonatal death / [ed] Roseanne Cecil, Taylor and Francis , 1996, p. 59-74Chapter in book (Refereed)
    Abstract [en]

    This chapter describes how the Abelam, in the East Sepik Province of Papua New Guinea, attempt to gain control over their reproductive health. The ethnographic study reported was carried out in conjunction with a nutrition study of pregnancy, childbirth and infant growth in the same area, in collaboration with the Papua New Guinea Institute of Medical Research in Madang. The Abelam comprise an ethnolinguistic group occupying the area between the southern foothills of the Torricelli Range and the Sepik River in the East Sepik Province, Papua New Guinea. However, the people are unevenly distributed, and in the Wosera the density is as high as 400 per square mile, making it the most densely populated area of mainland Papua New Guinea. The nianmi ensures that adolescent girls become fertile by providing a special mixture and can later be consulted for infertility, while water spirits called wala are needed for conception to take place.

  • 26.
    Winkvist, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ellegård, Lars
    Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Clinical Nutrition Unit, Department of Gastroenterology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Lindqvist, Helen M
    Department of Internal Medicine and Clinical Nutrition, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Towards objective measurements of habitual dietary intake patterns: comparing NMR metabolomics and food frequency questionnaire data in a population-based cohort2024In: Nutrition Journal, E-ISSN 1475-2891, Vol. 23, no 1, article id 29Article in journal (Refereed)
    Abstract [en]

    Background: Low-quality, non-diverse diet is a main risk factor for premature death. Accurate measurement of habitual diet is challenging and there is a need for validated objective methods. Blood metabolite patterns reflect direct or enzymatically diet-induced metabolites. Here, we aimed to evaluate associations between blood metabolite patterns and a priori and data-driven food intake patterns.

    Methods: 1, 895 participants in the Northern Sweden Health and Disease Study, a population-based prospective cohort study, were included. Fasting plasma samples were analyzed with 1H Nuclear Magnetic Resonance. Food intake data from a 64-item validated food frequency questionnaire were summarized into a priori Healthy Diet Score (HDS), relative Mediterranean Diet Score (rMDS) and a set of plant-based diet indices (PDI) as well as data driven clusters from latent class analyses (LCA). Orthogonal projections to latent structures (OPLS) were used to explore clustering patterns of metabolites and their relation to reported dietary intake patterns.

    Results: Age, sex, body mass index, education and year of study participation had significant influence on OPLS metabolite models. OPLS models for healthful PDI and LCA-clusters were not significant, whereas for HDS, rMDS, PDI and unhealthful PDI significant models were obtained (CV-ANOVA p < 0.001). Still, model statistics were weak and the ability of the models to correctly classify participants into highest and lowest quartiles of rMDS, PDI and unhealthful PDI was poor (50%/78%, 42%/75% and 59%/70%, respectively).

    Conclusion: Associations between blood metabolite patterns and a priori as well as data-driven food intake patterns were poor. NMR metabolomics may not be sufficiently sensitive to small metabolites that distinguish between complex dietary intake patterns, like lipids.

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