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- Arvidsson-Lenner, R, et al.
(författare)
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Glycaemic index
- 2004
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Ingår i: Scandinavian Journal of Food and Nutrition. - : Informa UK Limited. - 1748-2976. ; 48:2, s. 84-94
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Tidskriftsartikel (refereegranskat)abstract
- The glycaemic index (GI) concept is based on the difference in blood glucose response after ingestion of the same amount of carbohydrates from different foods, and possible implications of these differences for health, performance and well-being. GI is defined as the incremental blood glucose area (0-2 h) following ingestion of 50 g of available carbohydrates in the test product as a percentage of the corresponding area following an equivalent amount of carbohydrate from a reference product. A high GI is generally accompanied by a high insulin response. The glycaemic load (GL) is the GI×the amount (g) of carbohydrate in the food/100. Many factors affect the GI of foods, and GI values in published tables are indicative only, and cannot be applied directly to individual foods. Properly determined GI values for individual foods have been used successfully to predict the glycaemic response of a meal, while table values have not. An internationally recognised method for GI determination is available, and work is in progress to improve inter- and intra-laboratory performance. Some epidemiological studies and intervention studies indicate that low GI diets may favourably influence the risk of chronic diseases such as diabetes and coronary heart disease, although further well-controlled studies are needed for more definite conclusions. Low GI diets have been demonstrated to improve the blood glucose control, LDL-cholesterol and a risk factor for thrombosis in intervention studies with diabetes patients, but the effect in free-living conditions remains to be shown. The impact of GI in weight reduction and maintenance as well as exercise performance also needs further investigation. The GI concept should be applied only to foods providing at least 15 g and preferably 20 g of available carbohydrates per normal serving, and comparisons should be kept within the same food group. For healthy people, the significance of GI is still unclear and general labelling is therefore not recommended. If introduced, labelling should be product-specific and considered on a case-by-case basis.
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- Björk-Eriksson, Thomas, 1960, et al.
(författare)
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Mortality Among Pediatric Patients With Acute Lymphoblastic Leukemia in Sweden From 1988 to 2017
- 2022
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Ingår i: JAMA network open. - : American Medical Association (AMA). - 2574-3805. ; 5:11
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Acute lymphoblastic leukemia (ALL) constitutes 20% to 30% of all pediatric cancers. The 5-year overall survival among pediatric patients with ALL in high-income countries such as Sweden is currently more than 90%, but long-term unselected nationwide mortality data and mortality data in relation to the general population are lacking. Objective: To compare mortality between pediatric patients with ALL and the general population during a 30-year period in Sweden and to assess the incidence of ALL in Sweden. Design, Setting, and Participants: This cohort study included pediatric patients (aged <18 years) with a morphologically verified ALL diagnosis in the Swedish Cancer Register and/or at least 2 ALL diagnoses in the Swedish National Patient Register between January 1, 1988, and December 31, 2017. Data were cross-linked to the Swedish Cause of Death Register. Data were analyzed from May 2019 to January 2022. Main Outcomes and Measures: The main outcomes were mortality among patients with ALL compared with that in the general population and mortality in different subgroups within the cohort. Standardized mortality ratios (SMRs) were calculated using the general Swedish population as a reference. Within-cohort survival analyses were performed. Results: A total of 2397 patients (1354 [56%] male; mean [SD] age at diagnosis, 6.1 [4.7] years) were included in the study. The mean (SD) incidence of pediatric ALL during the study period was 4.11 (0.60) cases per 100 000 persons per year (females, 3.68 [0.65] cases per 100 000 persons per year; males, 4.52 [0.81] cases per 100 000 persons per year; P<.001). The observed number of deaths among pediatric patients with ALL was 409 vs the 9.5 deaths expected in the general population, resulting in an overall SMR of 43.1 (95% CI, 39.0-47.5); females had a higher SMR than males (57.8 [95% CI, 49.5-67.2] vs 34.5 [95% CI, 32.0-41.4]; P<.001). Analysis within the cohort showed a continued decrease in survival throughout the 30-year follow-up. The association between calendar year of ALL diagnosis, corresponding with different ALL treatment protocols, and mortality showed the lowest survival for the 1988-1991 group and the highest for the 2008-2017 group (χ2=20.3; P<.001). Conclusions and Relevance: In this cohort study, a consistently high SMR was seen among pediatric patients with ALL. Within the ALL cohort, survival evolved to a similar extent as in the young general population of Sweden. Furthermore, survival among patients with ALL decreased throughout the whole follow-up period without any trend difference after the 5-year follow-up time point. The changes in ALL treatment protocols were associated with overall improved absolute survival over time.
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- Olsson, Daniel S, 1983, et al.
(författare)
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Excess Mortality in Women and Young Adults With Nonfunctioning Pituitary Adenoma: A Swedish Nationwide Study
- 2015
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Ingår i: Journal of Clinical Endocrinology & Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 100:7, s. 2651-2658
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Tidskriftsartikel (refereegranskat)abstract
- Context: Patients with hypopituitarism of various etiologies have excess mortality. The mortality in patients with nonfunctioning pituitary adenoma (NFPA), regardless of pituitary function, is less well studied. Objective: Our aim was to investigate mortality in patients with NFPA and to examine whether age at diagnosis, gender, tumor treatments, or hormonal deficiencies influence the outcome. Design: NFPA patients were identified and followed up in nationwide health registries in Sweden, 1987-2011. The criteria for identification were tested and validated in a subpopulation of the patients. Patients: A total of 2795 unique patients with NFPA (1502 men, 1293 women) were identified and included in the study. Mean age at diagnosis was 58 years (men, 60 y; women, 56 y) and mean follow-up time was 7 years (range 0-25 y). Main Outcome Measures: Standardized mortality ratios (SMRs) and annual incidence rates were calculated using the Swedish population as reference and presented with 95% confidence intervals. Results: Annual incidence of NFPA was 20.3 (18.8-21.9) cases per 1 million inhabitants. During the observation period, 473 patients died against an expected 431, resulting in an SMR of 1.10 (1.00-1.20). Patients diagnosed at younger than 40 years of age had an increased SMR of 2.68 (1.23-5.09). The SMR for patients with hypopituitarism (n = 1500) was 1.06 (0.94-1.19), and for patients with diabetes insipidus (n = 145), it was 1.71 (1.07-2.58). The SMR was increased in women with NFPA (1.29; 1.11-1.48) but not in men (1.00; 0.88-1.12). Women, but not men, with a diagnosis of hypopituitarism and/or diabetes insipidus also had an increased mortality ratio. SMRs due to cerebrovascular (1.73; 1.34-2.19) and infectious diseases (2.08; 1.17-3.44) were increased, whereas the SMR for malignant tumors was decreased (0.76; 0.61-0.94). Conclusions: This nationwide study of patients with NFPA showed an overall excess mortality in women and in patients with a young age at diagnosis. Increased mortality was seen for cerebrovascular and infectious diseases.
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| 9. |
- Olsson, Daniel S, 1983, et al.
(författare)
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Higher incidence of morbidity in women than men with non-functioning pituitary adenoma: a Swedish nationwide study
- 2016
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Ingår i: European Journal of Endocrinology. - : Oxford University Press (OUP). - 0804-4643 .- 1479-683X. ; 175:1, s. 55-61
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Increased mortality rates are found in women and young adults with non-functioning pituitary adenomas (NFPAs). This nationwide study aimed to investigate the burden of comorbidities in patients with NFPA and to examine whether gender influences the outcome. Design: NFPA patients were identified and followed-up from National Registries in Sweden. It was a nationwide, population-based study. Method: Standardised incidence ratios (SIRs) for comorbidities with 95% confidence intervals (CI). Comorbidities were analysed in all patients, both patients with and without hypopituitarism. Results: Included in the analysis were 2795 patients (1502 men, 1293 women), diagnosed with NFPA between 1987 and 2011. Hypopituitarism was reported in 1500 patients (54%). Mean patient-years at risk per patient was 7 (range 0-25). Both men (SIR 2.2, 95% CI: 1.8-2.5; P < 0.001) and women (2.9, 2.4-3.6; P < 0.001) had a higher incidence of type 2 diabetes mellitus (T2DM) than the general population, with women having a higher incidence compared with men (P = 0.02). The incidence of myocardial infarction was increased in women (1.7, 1.3-2.1; P < 0.001), but not in men. Both men (1.3, 1.1-1.6; P = 0.006) and women (2.3; 1.9-2.8; P < 0.001) had an increased incidence of cerebral infarction, with women having a higher incidence than men (P < 0.001). The incidence of sepsis was increased for both genders. The incidence of fractures was increased in women (1.8, 1.5-1.8; P < 0.001), but not for men. Conclusions: This nationwide study shows excessive morbidity due to T2DM, cerebral infarction and sepsis in all NFPA patients. Women had higher incidence of T2DM, myocardial infarction, cerebral infarction and fracture in comparison to both the general population and to men.
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| 10. |
- Olsson, Daniel S, 1983, et al.
(författare)
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Incidence of malignant tumours in patients with a non-functioning pituitary adenoma.
- 2017
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Ingår i: Endocrine-Related Cancer. - : BioScientifica Ltd.. - 1351-0088 .- 1479-6821. ; 24:5, s. 227-235
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Tidskriftsartikel (refereegranskat)abstract
- Whether patients with non-functioning pituitary adenoma (NFPA) are at increased risk of developing malignant tumours has been sparsely studied and is a matter of debate. In this study, we have investigated the incidence of malignant tumours in a large and unselected group of patients with NFPA. The study was nationwide and included all patients diagnosed with NFPA between 1987 and 2011 (n = 2795) in Sweden, identified in the National Patient Register. Malignant tumours, occurring after the NFPA diagnosis, were identified in the Swedish Cancer Register between 1987 and 2014. Standardised incidence ratios (SIRs) for malignant tumours with 95% confidence intervals (CI) were calculated using the Swedish population as reference. In total, 448 malignant tumours were detected in 386 patients with NFPA, as compared to 368 expected malignancies in the general population (SIR 1.22 (95% CI 1.11-1.33)). The incidence of neoplasms of the brain was increased (SIR 5.83 (95% CI 4.03-8.14)). When analysing the total incidence of malignancies excluding neoplasms of the brain, the overall SIR was still increased (SIR 1.14 (95% CI 1.03-1.26)). The incidence of malignant neoplasm of skin other than malignant melanoma (SIR 1.99 (95% CI 1.55-2.52)) and malignant melanoma (SIR 1.62 (95% CI 1.04-2.38)) were increased, whereas the incidence of breast cancer (SIR 0.65 (95% CI 0.42-0.97)) was decreased. The incidence of other types of malignancies did not differ significantly from the expected incidence in the general population. In conclusion, patients with NFPA have an increased overall risk of developing malignancies. To what extent these findings are due to more frequent medical surveillance, genetic predisposition or endocrine changes, remains unknown.
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