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  • Sundström, Björn, 1968-, et al. (författare)
  • Cardiovascular risk factors among patients with ankylosing spondylitis in comparison to the general population
  • 2012
  • Ingår i: Annals of the Rheumatic diseases : supplement 3. ; s. 648
  • Konferensbidrag (refereegranskat)abstract
    • Background:An increased risk of cardiovascular diseases (CVD) has been reported among patients with Ankylosing Spondylitis (AS). As of today, little is known what causes this increase.Objectives: The aim of this study was to evaluate whether traditional CVD risk factors, such as smoking, diet, physical activity and atherogenic blood lipids, differ among AS patients in comparison to the general population.Methods: Eighty-nine patients diagnosed with AS by fulfilling the modified New York criteria were identified in the databases of a community intervention programme, the Västerbotten Intervention Programme (VIP). The patients were compared with 356 controls matched for age, sex and study period. As part of the VIP, participants have completed questionnaires regarding diet, physical activity and smoking. Additionally, the VIP included measurement of blood pressure, height and weight, and blood samples analysed for cholesterol, serum triglycerides and blood glucose.Results: Levels of serum triglycerides (p<0.01) and cholesterol (p<0.01) were significantly lower in the patient group. Among the patients, the level of triglycerides was inversely correlated to the intake of total fat (rs = -0.25, p<0.05), monounsaturated fats (rs = -0.29, p<0.05) and positively correlated to the intake of carbohydrates (rs =0.26, p<0.05). These correlations were not seen among the controls. No significant differences were found between patients and controls regarding diet, physical activity, exercise frequency or smoking habits nor in measurements of body mass index (BMI), weight or blood pressure.Conclusions: The patients exhibited significantly lower levels of cholesterol and triglycerides compared with controls. There were correlations between diet and atherogenic blood lipids among the patients which were not found in the control group. The results suggest that there may be differences in fat metabolism among patients with AS in comparison with the general population.
  • Sundström, Björn, et al. (författare)
  • Kost och andra kardiovaskulära riskfaktorer hos patienter med ankyloserande spondylit
  • 2011
  • Ingår i: Abstrakt Medicinska riksstämman Stockholm 2011.
  • Konferensbidrag (refereegranskat)abstract
    • BakgrundHos patienter med ankyloserande spondylit (AS) har man sett en ökad förekomst av kardiovaskulära sjukdomar och det är inte klarlagt vad som orsakar denna ökning. Syftet med studien var därför att utvärdera om kost och andra kardiovaskulära riskfaktorer hos patienter med AS skiljer sig åt i jämförelse med normalbefolkningen. Metod Åttionio patienter med AS, diagnosticerade enligt de modifierade New York kriterierna, identifierades i databaserna till ett hälsoundersökningsprojekt, det så kallade Västerbotten Intervention Project (VIP). Patienterna jämfördes med 356 kontroller matchade för ålder, kön och undersökningsperiod. Inom VIP har deltagarna fyllt i enkäter om kost, fysisk aktivitet och rökning. Blodtryck, längd och vikt, har mätts och blodprover har analyserats för kolesterol, triglycerider och blodsockernivåer. Resultat Vi fann inga signifikanta skillnader mellan patienter och kontroller avseende kost, fysisk aktivitet, träningsvanor, rökvanor, BMI, vikt eller blodtryck. Däremot hade patienterna signifikant lägre nivåer av serumtriglycerider (p <0,001) och -kolesterol (p <0,01). Hos patienterna var triglyceridvärdet omvänt korrelerat till totala intaget av fett (rs = -0,25, p <0,05) liksom intaget av enkelomättade fetter (rs = -0,29, p <0,05) och positivt korrelerat till intaget av kolhydrater (rs = 0,26, p <0,05). Kolesterolvärdet visade också en positiv korrelation till intag av kolhydrater (rs = 0,26, p <0,05) och negativ korrelation till intaget av enkelomättade fetter (rs = -0,28, p <0,05). Dessa samband sågs inte hos kontrollerna. Sammanfattning Patienterna uppvisade signifikant lägre nivåer av kolesterol och triglycerider jämfört med kontrollgruppen. Det fanns samband mellan kost och aterogena blodfetter hos patienter som inte fanns i kontrollgruppen. Resultaten antyder att det kan finnas skillnader i fettmetabolismen hos patienter med AS i jämförelse med normalbefolkningen.
  • Sundström, Björn, et al. (författare)
  • Modifiable cardiovascular risk factors in patients with ankylosing spondylitis
  • 2014
  • Ingår i: Clinical Rheumatology. - Springer London. - 0770-3198. ; 33:1, s. 111-117
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to evaluate whether modifiable cardiovascular disease (CVD) risk factors, e.g. atherogenic blood lipids, hypertension and lifestyle-related factors such as smoking, diet and physical inactivity, differ among patients with ankylosing spondylitis (AS) in comparison to the general population. Eighty-eight patients diagnosed with AS were identified by analysis of the databases of a previous community intervention programme, the Västerbotten intervention programme. The patients were compared with 351 controls matched for age, sex and study period. These databases include the results of blood samples analysed for cholesterol, triglycerides and plasma glucose, as well as data on hypertension, height, weight, smoking and dietary habits and physical activity. No significant differences were found between patients and controls regarding hypertension, body mass index, physical activity, diet or smoking. Levels of serum triglycerides (p?<?0.01) and cholesterol (p?<?0.01) were significantly lower in the patient group. Among the patients, the level of triglycerides correlated inversely with the intake of total fat (r s?=??0.25, p?<?0.05), monounsaturated fats (r s?=??0.29, p?<?0.05) and positively correlated to the intake of carbohydrates (r s?=?0.26, p?<?0.05). These associations were not apparent among the controls. In the cohort of AS patients studied, no differences were found regarding the modifiable risk factors for CVD compared with the general population. Hence, the increased presence of CVD in patients with AS may be caused by other factors such as differences in metabolism and medication such as NSAID or the chronic low-grade inflammation present in the disease.
  • Agogo, George O., et al. (författare)
  • Use of Two-Part Regression Calibration Model to Correct for Measurement Error in Episodically Consumed Foods in a Single-Replicate Study Design EPIC Case Study
  • 2014
  • Ingår i: PLoS ONE. - 1932-6203. ; 9:11, s. e113160
  • Tidskriftsartikel (refereegranskat)abstract
    • In epidemiologic studies, measurement error in dietary variables often attenuates association between dietary intake and disease occurrence. To adjust for the attenuation caused by error in dietary intake, regression calibration is commonly used. To apply regression calibration, unbiased reference measurements are required. Short-term reference measurements for foods that are not consumed daily contain excess zeroes that pose challenges in the calibration model. We adapted twopart regression calibration model, initially developed for multiple replicates of reference measurements per individual to a single-replicate setting. We showed how to handle excess zero reference measurements by two-step modeling approach, how to explore heteroscedasticity in the consumed amount with variance-mean graph, how to explore nonlinearity with the generalized additive modeling (GAM) and the empirical logit approaches, and how to select covariates in the calibration model. The performance of two-part calibration model was compared with the one-part counterpart. We used vegetable intake and mortality data from European Prospective Investigation on Cancer and Nutrition (EPIC) study. In the EPIC, reference measurements were taken with 24-hour recalls. For each of the three vegetable subgroups assessed separately, correcting for error with an appropriately specified two-part calibration model resulted in about three fold increase in the strength of association with all-cause mortality, as measured by the log hazard ratio. Further found is that the standard way of including covariates in the calibration model can lead to over fitting the two-part calibration model. Moreover, the extent of adjusting for error is influenced by the number and forms of covariates in the calibration model. For episodically consumed foods, we advise researchers to pay special attention to response distribution, nonlinearity, and covariate inclusion in specifying the calibration model.
  • Agudo, Antonio, et al. (författare)
  • Impact of Cigarette Smoking on Cancer Risk in the European Prospective Investigation into Cancer and Nutrition Study.
  • 2012
  • Ingår i: Journal of Clinical Oncology. - 0732-183X .- 1527-7755. ; :Nov.,19
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSEOur aim was to assess the impact of cigarette smoking on the risk of the tumors classified by the International Agency for Research on Cancer as causally associated with smoking, referred to as tobacco-related cancers (TRC). METHODSThe study population included 441,211 participants (133,018 men and 308,193 women) from the European Prospective Investigation Into Cancer and Nutrition. We investigated 14,563 participants who developed a TRC during an average follow-up of 11 years. The impact of smoking cigarettes on cancer risk was assessed by the population attributable fraction (AF(p)), calculated using the adjusted hazard ratios and 95% CI for current and former smokers, plus either the prevalence of smoking among cancer cases or estimates from surveys in representative samples of the population in each country.ResultsThe proportion of all TRC attributable to cigarette smoking was 34.9% (95% CI, 32.5 to 37.4) using the smoking prevalence among cases and 36.2% (95% CI, 33.7 to 38.6) using the smoking prevalence from the population. The AF(p) were above 80% for cancers of the lung and larynx, between 20% and 50% for most respiratory and digestive cancers and tumors from the lower urinary tract, and below 20% for the remaining TRC. CONCLUSIONUsing data on cancer incidence for 2008 and our AF(p) estimates, about 270,000 new cancer diagnoses per year can be considered attributable to cigarette smoking in the eight European countries with available data for both men and women (Italy, Spain, United Kingdom, the Netherlands, Greece, Germany, Sweden, Denmark).
  • Al-Delaimy, WK, et al. (författare)
  • Plasma levels of six carotenoids in nine European countries: report from the European Prospective Investigation into Cancer and Nutrition (EPIC)
  • 2004
  • Ingår i: Public Health Nutrition. - C A B I Publishing. - 1368-9800. ; 7:6, s. 713-722
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: In addition to their possible direct biological effects, plasma carotenoids can be used as biochemical markers of fruit and vegetable consumption for identifying diet-disease associations in epidemiological studies. Few studies have compared levels of these carotenoids between countries in Europe. Objective: Our aim was to assess the variability of plasma carotenoid levels within the cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Methods: Plasma levels of six carotenoids-alpha-carotene, beta-carotene, beta-cryptoxanthin, lycopene, lutein and zeaxanthin-were measured cross-sectionally in 3043 study subjects from 16 regions in nine European countries. We investigated the relative influence of gender, season, age, body mass index (BMI), alcohol intake and smoking status on plasma levels of the carotenoids. Results: Mean plasma level of the sum of the six carotenoids varied twofold between regions (1.35 mumol l(-1) for men in Malmo, Sweden vs. 2.79 mumol l(-1) for men in Ragusa/Naples, Italy; 1.61 mumol l(-1) for women in The Netherlands vs. 3.52 mumol l(-1) in Ragusa/Naples, Italy). Mean levels of individual carotenoids varied up to fourfold (alpha-carotene: 0.06 mumol l(-1) for men in Murcia, Spain vs. 0.25 mumol l(-1) for vegetarian men living in the UK). In multivariate regression analyses, region was the most important predictor of total plasma carotenoid level (partial R-2=27.3%), followed by BMI (partial R-2=5.2%), gender (partial R-2=2.7%) and smoking status (partial R-2=2.8%). Females had higher total carotenoid levels than males across Europe. Conclusions: Plasma levels of carotenoids vary substantially between 16 different regions in Italy, Greece, Spain, France, Germany, the UK, Sweden, Denmark and The Netherlands. Compared with region of residence, the other demographic and lifestyle factors and laboratory measurements have limited predictive value for plasma carotenoid levels in Europe.
  • Aleksandrova, Krasimira, et al. (författare)
  • Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study
  • 2014
  • Ingår i: BMC Medicine. - BioMed Central. - 1741-7015. ; 12, s. 168
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors are individually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of this study was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factors healthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore the association of this index with CRC incidence using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Methods: In the EPIC cohort, a total of 347,237 men and women, 25- to 70-years old, provided dietary and lifestyle information at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC cases were identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazards regression models and population attributable risks (PARs) have been calculated. Results: After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors, the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70 to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors; P-trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; P for trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend <0.0001) for rectal cancer, respectively (P-difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) were attributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index. Conclusions: Combined lifestyle factors are associated with a lower incidence of CRC in European populations characterized by western lifestyles. Prevention strategies considering complex targeting of multiple lifestyle factors may provide practical means for improved CRC prevention.
  • Bamia, Christina, et al. (författare)
  • Dietary patterns and survival of older Europeans : the EPIC-Elderly Study (European Prospective Investigation into Cancer and Nutrition).
  • 2007
  • Ingår i: Public Health Nutrition. - 1368-9800. ; 10:6, s. 590-8
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To investigate the association of a posteriori dietary patterns with overall survival of older Europeans. Design and setting: This is a multi-centre cohort study. Cox regression analysis was used to investigate the association of the prevailing, a posteriori-derived, plant-based dietary pattern with all-cause mortality in a population of subjects who were 60 years or older at recruitment to the European Prospective Investigation into Cancer and Nutrition (EPIC-Elderly cohort). Analyses controlled for all known potential risk factors. Subjects: in total, 74 607 men and women, 60 years or older at enrolment and without previous coronary heart disease, stroke or cancer, with complete information about dietary intakes and potentially confounding variables, and with known survival status as of December 2003, were included in the analysis. Results: An increase in the score which measures the adherence to the plant-based diet was associated with a lower overall mortality, a one standard deviation increment corresponding to a statistically significant reduction of 14% (95% confidence interval 5-23%). In country-specific analyses the apparent association was stronger in Greece, Spain, Denmark and The Netherlands, and absent in the UK and Germany. Conclusions: Greater adherence to the plant-based diet that was defined a posteriori in this population of European elders is associated with lower all-cause mortality. This dietary score is moderately positively correlated with the Modified Mediterranean Diet Score that has been constructed a priori and was also shown to be beneficial for the Survival of the same EPIC-Elderly cohort.
  • Benetou, V, et al. (författare)
  • Diet and hip fractures among elderly Europeans in the EPIC cohort
  • 2011
  • Ingår i: European Journal of Clinical Nutrition. - 0954-3007. ; 65:1, s. 132-139
  • Tidskriftsartikel (refereegranskat)abstract
    • In a prospective study of the elderly, diet, including consumption of dairy products, alcohol and vitamin D, did not appear to play a major role in hip fracture incidence. There is however, weak and statistically non-significant evidence that vegetable and fish consumption and intake of polyunsaturated lipids may have a beneficial, whereas saturated lipid intake a detrimental effect.
  • Benetou, V, et al. (författare)
  • Mediterranean diet and incidence of hip fractures in a European cohort.
  • 2012
  • Ingår i: Osteoporosis International. - 0937-941X. ; 24:5, s. 1587-1598
  • Tidskriftsartikel (refereegranskat)abstract
    • Prevention of hip fractures is of critical public health importance. In a cohort of adults from eight European countries, evidence was found that increased adherence to Mediterranean diet, measured by a 10-unit dietary score, is associated with reduced hip fracture incidence, particularly among men. INTRODUCTION: Evidence on the role of dietary patterns on hip fracture incidence is scarce. We explored the association of adherence to Mediterranean diet (MD) with hip fracture incidence in a cohort from eight European countries. METHODS: A total of 188,795 eligible participants (48,814 men and 139,981 women) in the European Prospective Investigation into Cancer and nutrition study with mean age 48.6 years (±10.8) were followed for a median of 9 years, and 802 incident hip fractures were recorded. Diet was assessed at baseline through validated dietary instruments. Adherence to MD was evaluated by a MD score (MDs), on a 10-point scale, in which monounsaturated were substituted with unsaturated lipids. Association with hip fracture incidence was assessed through Cox regression with adjustment for potential confounders. RESULTS: Increased adherence to MD was associated with a 7 % decrease in hip fracture incidence [hazard ratio (HR) per 1-unit increase in the MDs 0.93; 95 % confidence interval (95 % CI)?=?0.89-0.98]. This association was more evident among men and somewhat stronger among older individuals. Using increments close to one standard deviation of daily intake, in the overall sample, high vegetable (HR?=?0.86; 95 % CI?=?0.79-0.94) and high fruit (HR?=?0.89; 95 % CI?=?0.82-0.97) intake was associated with decreased hip fracture incidence, whereas high meat intake (HR?=?1.18; 95 % CI?=?1.06-1.31) with increased incidence. Excessive ethanol consumption (HR high versus moderate?=?1.74; 95 % CI?=?1.32-2.31) was also a risk factor. CONCLUSIONS: In a prospective study of adults, increased adherence to MD appears to protect against hip fracture occurrence, particularly among men.
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