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| 2. |
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| 3. |
- Bjurling-Sjöberg, Petronella, 1968-
(författare)
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Clinical Pathway Implementation and Teamwork in Swedish Intensive Care : Challenges in Evidence-Based Practice and Interprofessional Collaboration
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Suboptimal quality of care is an evident issue in current healthcare services. Clinical pathways (CPs) have the potential to facilitate evidence-based practice and interprofessional teamwork, and thereby improve patient safety and quality of care.The overall aim of the thesis was to develop comprehensive empirical knowledge and understanding of CP implementation and teamwork in Swedish intensive care units (ICUs). Four studies were included (I-IV).Study I was a survey including all Swedish ICUs (N84) and a document analysis of CP examples (n12). In total, 17 (20%) ICUs used CPs and many had implementation plans. The quality, extent and content of the CPs (n56) varied greatly, with sometimes insufficient interprofessionalism, evidence base and renewal.Study II was a mixed method including ICUs using CPs. The implementation processes were retrospectively explored through questionnaire data (n15) and qualitative content analysis of interviews with key informants (n10). The CP implementation was revealed as a process directed at realizing the usefulness and creating new habits, which requires enthusiasm, support and time.Studies III and IV were grounded theory studies in an action research project in an ICU. Study III explored everyday teamwork through focus group interviews with registered nurses, assistant nurses and anesthesiologists, as well as an individual interview with a physiotherapist (n38). Teamwork was revealed as an act of ‘balancing intertwined responsibilities.’ The type of teamwork fluctuated as the team processes were affected by circumstantial factors and involved individuals. Study IV prospectively explored the implementation process of a CP during a five-year period through repeated focus groups and individual interviews, questionnaires and logbooks/field notes, including the interprofessional project group, staff and managers (n71), and retrospective screening of health records (n136). ‘Struggling for a feasible tool’ was revealed as a central phenomenon. The implementation process included contextual and processual circumstances that enforced negotiations to achieve progress, which made the process tentative and prolonged and had consequences on the process output.In conclusion, CP implementation processes are affected by multiple interplaying factors. Although progress has been achieved in evidence-based practice and interprofessional collaboration there is still potential for substantial improvements, emphasizing a need for further facilitation.
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| 4. |
- Carlson, Michael, 1963-, et al.
(författare)
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Bridging the Gap Between Theory and Practice : Experiences from Statistics Sweden in Applying SDC Methodology
- 2006
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Statistics Sweden has identified a need to increase the level of knowl-edge in the SDC field among methodologists and also to develop a unified view and strategy on application of SDC methodology. A project was thus initiated with the goal to spread knowledge but also to collate current practices and ex-periences within the agency. The project resulted in a course on SDC given at Statistics Sweden and this paper provides a brief first report on the work so far, reviewing the background and describing the course and possible future activities. Furthermore, several practical examples were discussed during the course, two of which are briefly described here; the Industrial production index and Structure of wages and earnings in the private sector.
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| 7. |
- Danielsson, Martin, 1982-
(författare)
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Digitala distinktioner : Klass och kontinuitet i unga mäns vardagliga mediepraktiker
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation explores how social class matters in young men’s everyday relationship to digital media. The aim is to contribute to the existing knowledge about how young people incorporate digital media in their everyday lives by focusing on the structural premises of this process. It also presents an empirically grounded critique of popular ideas about young people as a “digital generation”, about the internet as a socially transformative force, and about class as an increasingly redundant category.The empirical material consists of qualitative interviews with 34 young men (16-19 years) from different class backgrounds, upper secondary schools and study programmes. Drawing on the conceptual tools of Pierre Bourdieu, three classes are constructed: the “cultural capital rich”, the “upwardly mobile”, and the “cultural capital poor”.The analysis shows that class, through the workings of habitus, structures the young men’s relationship to school and future aspirations. This also engenders class-distinctive ways of conceiving leisure and digital media use. Through their class habitus and taste, the young men tend to orient themselves and navigate in different ways in what they perceive as a space of digital goods and practices, endowed with different symbolic value in school and society. The “cultural capital rich” are drawn to-wards practices capable of yielding symbolic profit in the field of education and beyond, whereas the other classes gravitate towards the “illegitimate” digital culture but deal with this different ways.These findings indicate that there are social and cultural continuities at play within recent technological changes. They also expose the structural differences hidden by sweeping statements about young people as a “digital generation”. Finally, they show that class, contrary to popular beliefs about “the death of class”, still represents a pertinent analytical category.
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| 8. |
- Del Gobbo, Liana C., et al.
(författare)
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omega-3 Polyunsaturated Fatty Acid Biomarkers and Coronary Heart Disease Pooling Project of 19 Cohort Studies
- 2016
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Ingår i: JAMA Internal Medicine. - : American Medical Association (AMA). - 2168-6106 .- 2168-6114. ; 176:8, s. 1155-1166
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE The role of omega-3 polyunsaturated fatty acids for primary prevention of coronary heart disease (CHD) remains controversial. Most prior longitudinal studies evaluated self-reported consumption rather than biomarkers. OBJECTIVE To evaluate biomarkers of seafood-derived eicosapentaenoic acid (EPA; 20: 5 omega-3), docosapentaenoic acid (DPA; 22: 5 omega-3), and docosahexaenoic acid (DHA; 22: 6 omega-3) and plant-derived alpha-linolenic acid (ALA; 18: 3 omega-3) for incident CHD. DATA SOURCES A global consortium of 19 studies identified by November 2014. STUDY SELECTION Available prospective (cohort, nested case-control) or retrospective studies with circulating or tissue omega-3 biomarkers and ascertained CHD. DATA EXTRACTION AND SYNTHESIS Each study conducted standardized, individual-level analysis using harmonized models, exposures, outcomes, and covariates. Findings were centrally pooled using random-effects meta-analysis. Heterogeneity was examined by age, sex, race, diabetes, statins, aspirin, omega-6 levels, and FADS desaturase genes. MAIN OUTCOMES AND MEASURES Incident total CHD, fatal CHD, and nonfatal myocardial infarction (MI). RESULTS The 19 studies comprised 16 countries, 45 637 unique individuals, and 7973 total CHD, 2781 fatal CHD, and 7157 nonfatal MI events, with omega-3 measures in total plasma, phospholipids, cholesterol esters, and adipose tissue. Median age at baseline was 59 years (range, 18-97 years), and 28 660 (62.8%) were male. In continuous (per 1-SD increase) multivariable-adjusted analyses, the omega-3 biomarkers ALA, DPA, and DHA were associated with a lower risk of fatal CHD, with relative risks (RRs) of 0.91 (95% CI, 0.84-0.98) for ALA, 0.90 (95% CI, 0.85-0.96) for DPA, and 0.90 (95% CI, 0.84-0.96) for DHA. Although DPA was associated with a lower risk of total CHD (RR, 0.94; 95% CI, 0.90-0.99), ALA (RR, 1.00; 95% CI, 0.95-1.05), EPA (RR, 0.94; 95% CI, 0.87-1.02), and DHA (RR, 0.95; 95% CI, 0.91-1.00) were not. Significant associations with nonfatal MI were not evident. Associations appeared generally stronger in phospholipids and total plasma. Restricted cubic splines did not identify evidence of nonlinearity in dose responses. CONCLUSIONS AND RELEVANCE On the basis of available studies of free-living populations globally, biomarker concentrations of seafood and plant-derived omega-3 fatty acids are associated with a modestly lower incidence of fatal CHD.
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| 9. |
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| 10. |
- Hallmans, Göran, et al.
(författare)
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Cardiovascular disease and diabetes in the Northern Sweden Health and Disease Study Cohort : evaluation of risk factors and their interactions.
- 2003
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Ingår i: Scandinavian Journal of Public Health. Supplement Links. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 61, s. 18-24
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is, first, to describe the organization, sampling procedures, availability of samples/database, ethical considerations, and quality control program of the Northern Sweden Health and Disease Study Cohort. Secondly, some examples are given of studies on cardiovascular disease and diabetes with a focus on the biomarker programme. The cohort has been positioned as a national and international resource for scientific research.
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| 11. |
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| 12. |
- Jansson, Ingegerd, et al.
(författare)
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The Process of Practicing Statistical Disclosure Control in Tabular Data at Statistics Sweden
- 2010
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Ingår i: Q2010 European Conference on Quality in Official Statistics, Helsinki, Finland, 3-6 May 2010.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- It follows from Swedish legislation that Statistics Sweden, when publishing statistical data, must first assess the risk of disclosing confidential information, and then assess the risk that disclosure will result in any harm or damage. In case of considerable risk of the latter, data should be properly protected. We are attempting to handle this by a simple process describing how disclosure control should be applied within Statistics Sweden. Following the general process orientation of statistics production within Statistics Sweden, the process of statistical disclosure control (SDC) in tables must fit within the general production process, and the recommended methods and tools used should as much as possible be shared by all statistical products. We will describe the process for SDC in tables, the contents of a handbook where the process and appropriate methods are described, and the ongoing work with IT-solutions. Presently, work is concentrated on making it possible to run τ-Argus from SAS. Plans for implementation and training will also be briefly described.
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| 13. |
- Johansson, Anders, et al.
(författare)
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Prevalence of systemic immunoreactivity to Aggregatibacter actinomycetemcomitans leukotoxin in relation to the incidence of myocardial infarction
- 2011
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Ingår i: BMC Infectious Diseases. - : BioMed Central. - 1471-2334. ; 11:1, s. 55-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic infections and associated inflammatory markers are suggested risk factors for cardiovascular disease (CVD). The proinflammatory cytokine, interleukin (IL)-1, is suggested to play a role in the regulation of local inflammatory responses in both CVD and periodontitis. The leukotoxin from the periodontal pathogen Aggregatibacter actinomycetemcomitans has recently been shown to cause abundant secretion of IL-1 from macrophages. The aim of the present study was to compare the prevalence of systemic immunoreactivity to A. actinomycetemcomitans leukotoxin in myocardial infarction (MI) cases (n=532) and matched controls (n=1000) in a population-based case and referents study in northern Sweden. Methods: Capacity to neutralize A. actinomycetemcomitans leukotoxin was analyzed in a bioassay with leukocytes, purified leukotoxin, and plasma. Plasma samples that inhibited lactate-dehydrogenase release from leukotoxin-lysed cells by 50 % were classified as positive. Results: Neutralizing capacity against A. actinomycetemcomitans leukotoxin was detected in 53.3% of the plasma samples. The ability to neutralize leukotoxin correlated to increasing age in men (n=1082) but not in women (n=450). There was no correlation between presence of systemic leukotoxin neutralization capacity and the incidence of MI, except for women (n=146). Women with a low neutralizing capacity had a significantly higher incidence of MI than those who had a high neutralizing capacity. Conclusions: Systemic immunoreactivity against A. actinomycetemcomitans leukotoxin was found at a high prevalence in the analyzed population of adults from northern Sweden. The results from the present study do not support the hypothesis that systemic leukotoxin-neutralizing capacity can decrease the risk for MI.
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| 14. |
- Johansson, Ingegerd, et al.
(författare)
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Dairy intake revisited - associations between dairy intake and lifestyle related cardio-metabolic risk factors in a high milk consuming population
- 2018
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Ingår i: Nutrition Journal. - : Springer Science and Business Media LLC. - 1475-2891. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe association between milk and dairy intake and the incidence of cardiometabolic diseases, cancer and mortality has been evaluated in many studies, but these studies have had conflicting results with no clear conclusion on causal or confounding associations. The present study aims to further address this association by cross-sectional and longitudinal evaluation of the associations between exposure to various types of dairy products and metabolic risk markers among inhabitants in northern Sweden while taking other lifestyle factors into account.MethodsRespondents in the Vasterbotten Intervention Programme with complete and plausible diet data between 1991 and 2016 were included, yielding 124,934 observations from 90,512 unique subjects. For longitudinal analysis, 27,682 participants with a visit 8-12years after the first visit were identified. All participants completed a validated Food Frequency Questionnaire. Metabolic risk markers, including body mass index (BMI), blood pressure, serum (S) cholesterol and triglycerides, and blood glucose, were measured. Participants were categorized into quintiles by intake of dairy products, and risk (odds ratios, OR) of undesirable levels of metabolic risk markers was assessed in multivariable logistic regression analyses. In longitudinal analyses, intake quintiles were related to desirable levels of metabolic risk markers at both visits or deterioration at follow-up using Cox regression analyses.ResultsThe OR of being classified with an undesirable BMI decreased with increasing quintiles of total dairy, cheese and butter intake but increased with increasing non-fermented milk intake. The OR of being classified with an undesirable S-cholesterol level increased with increasing intake of total dairy, butter and high fat (3%) non-fermented milk, whereas an undesirable S-triglyceride level was inversely associated with cheese and butter intake in women. In longitudinal analyses, increasing butter intake was associated with deterioration of S-cholesterol and blood glucose levels, whereas increasing cheese intake was associated with a lower risk of deterioration of S-triglycerides.ConclusionsConfounding factors likely contribute to the demonstrated association between dairy intake and mortality, and other medical conditions and analyses should be stratified by dairy type.
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| 15. |
- Johansson, Ingegerd, et al.
(författare)
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Dairy Product Intake and Cardiometabolic Diseases in Northern Sweden: A 33-Year Prospective Cohort Study
- 2019
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 11:2
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Tidskriftsartikel (refereegranskat)abstract
- Dairy products are important constituents of most diets, and their association with adverse health outcomes remains a focus. We characterized dairy food intake and examined associations with the incidence of type 2 diabetes (T2D), myocardial infarction (MI) or stroke among 108,065 Swedish men and women. Hazard ratios (HRs) and 95% CIs were estimated using the multivariable Cox proportional hazards models in a population characterized by high milk tolerance. During a mean follow-up of 14.2 years, 11,641 first-time events occurred. Non-fermented milk intake decreased, whereas butter intake increased over the period. For high intake of non-fermented milk, the HR (95% CI) for developing T2D and MI was 1.17 (1.03, 1.34) and 1.23 (1.10, 1.37), respectively, in men. A greater intake of butter, fermented milk, and cheese tended to be associated with a reduced risk of T2D and/or MI. Non-consumers and those who chose low-fat variants of the targeted dairy products had increased risk for T2D, MI, or stroke compared to those in the non-case group. Generally, effect-sizes were small. This prospective study found that non-fermented milk was associated with an increased risk for developing T2D and MI and that subjects abstaining from dairy products or choosing low-fat variants were at greater risk. However, the overall cardiometabolic risk of non-fermented milk intake was judged as low, since the effect sizes were small.
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| 16. |
- Jouper, John, 1960-, et al.
(författare)
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Mindful Rehabilitering : ett utvecklingsarbete inom Kronobergsläns landsting
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Patienterna vid Smärtrehab, Kronobergsläns landsting, har haft långvarig smärta i minst sex månader och har remitterats till ett fem månaders multimodalt program. Programmet börjar med en sju veckors rehabiliteringskurs. Utvecklingsarbetet syftar till att pröva om stress och energikurvorna (Mindfulnesschemat; notering av tankar, känslor, kroppsförnimmelser i förhållande till upplevd stress och energi) leder till en ökad medvetenhet om sin situation, samt om stress och energikurvorna kan användas som ett diskussionsunderlag vid återgången till förvärvsarbete. Utvecklingsarbetet har pågått under tre år. Det första året kännetecknades av information och utbildning av personalen, samt utveckling av stress och energikurvorna. Under det andra och tredje året erbjöds patienterna vid smärtrehabiliteringen att arbeta med stress och energikurvorna under rehabiliteringskursen. Stress och energikurvorna kan ge en konkret nuläges bild om hur livet ter sig, om det är stressigt eller energifyllt, om hur tankar, känslor och kroppsbesvär förändrar sig i och med att nivåerna av stress och energi förändrar sig. Den här konkreta bilden, den ökade medvetenheten, kan den enskilde patienten använda sig av i sin egen utveckling, men också i samtal med rehabiliteringscoach och i samband med återgången till förvärvsarbete. Nyttan av och förmågan att ta till sig den "nya medvetenheten om livet" varierar förmodligen med graden av acceptans för sin situation. Att självskatta stress och energikurvor kan vara ett redskap vid rehabiliteringen av smärtpatienter.
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| 17. |
- Klingberg, Sofia, 1979, et al.
(författare)
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Dietary Intake of Naturally Occurring Plant Sterols Is Related to a Lower Risk of a First Myocardial Infarction in Men but Not in Women in Northern Sweden
- 2013
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Ingår i: Journal of Nutrition. - : Elsevier BV. - 0022-3166 .- 1541-6100. ; 143:10, s. 1630-1635
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Tidskriftsartikel (refereegranskat)abstract
- Dietary intake of naturally occurring plant sterols is inversely related to serum cholesterol concentrations. Elevated serum cholesterol increases the risk of myocardial infarction (MI), but it is unknown if this can be reduced by dietary intake of naturally occurring plant sterols. Our aim was to investigate if a high intake of naturally occurring plant sterols is related to a lower risk of contracting a first MI. The analysis included 1005 prospective cases (219 women, 786 men) and 3148 matched referents (723 women, 2425 men), aged 29-73 y at baseline, from the population-based Northern Sweden Health and Disease Study. A food frequency. questionnaire (FFQ) was completed at baseline. Absolute plant sterol intake was inversely related to the risk of a first MI in men (OR highest vs. lowest quartile = 0.70; 95% CI: 0.53, 0.85; P-trend = 0.006) but not in women. After adjustment for confounders, the estimated risk was somewhat attenuated (OR highest vs. lowest quartile = 0.71; 95% CI: 0.55,0.92; P-trend = 0.067), suggesting that increasing sterol intake from 150 to 340 mg/d reduces the risk of a first MI by 29%. Energy-adjusted plant sterol intake was not related to the risk of a first MI in either men or women. In conclusion, the findings of this observational study show that a high absolute intake of naturally occurring plant sterols is significantly related to a lower risk of a first MI in men in northern Sweden, whereas no significant relation was seen for energy-adjusted plant sterol intake. In women, no significant associations were found. The results from this study show that intake of plant sterols may be important in prevention of MI.
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| 18. |
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| 19. |
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| 20. |
- Nilsson, Lena Maria, 1965-, et al.
(författare)
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A traditional Sami diet score as a determinant of mortality in a general northern Swedish population
- 2012
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Ingår i: International Journal of Circumpolar Health. - : CoAction Publishing. - 1239-9736 .- 2242-3982. ; 71
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To examine the relationship between "traditional Sami" dietary pattern and mortality in a general northern Swedish population.STUDY DESIGN: Population-based cohort study.METHODS: We examined 77,319 subjects from the Västerbotten Intervention Program (VIP) cohort. A traditional Sami diet score was constructed by adding 1 point for intake above the median level of red meat, fatty fish, total fat, berries and boiled coffee, and 1 point for intake below the median of vegetables, bread and fibre. Hazard ratios (HR) for mortality were calculated by Cox regression.RESULTS: Increasing traditional Sami diet scores were associated with slightly elevated all-cause mortality in men [Multivariate HR per 1-point increase in score 1.04 (95% CI 1.01-1.07), p=0.018], but not for women [Multivariate HR 1.03 (95% CI 0.99-1.07), p=0.130]. This increased risk was approximately equally attributable to cardiovascular disease and cancer, though somewhat more apparent for cardiovascular disease mortality in men free from diabetes, hypertension and obesity at baseline [Multivariate HR 1.10 (95% CI 1.01-1.20), p=0.023].CONCLUSIONS: A weak increased all-cause mortality was observed in men with higher traditional Sami diet scores. However, due to the complexity in defining a "traditional Sami" diet, and the limitations of our questionnaire for this purpose, the study should be considered exploratory, a first attempt to relate a "traditional Sami" dietary pattern to health endpoints. Further investigation of cohorts with more detailed information on dietary and lifestyle items relevant for traditional Sami culture is warranted.
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| 21. |
- Nilsson, Lena Maria, 1965-, et al.
(författare)
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Dairy Products and Cancer Risk in a Northern Sweden Population
- 2020
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Ingår i: Nutrition and Cancer-an International Journal. - : Informa UK Limited. - 0163-5581 .- 1532-7914. ; 72:3
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Tidskriftsartikel (refereegranskat)abstract
- The role of dairy products in cancer is unclear. We assessed consumption of fermented milk, non-fermented milk, cheese, and butter, estimated from semi-quantitative food frequency questionnaires, in relation to prospective risk of breast, prostate, colorectal, smoking-, and obesity-related cancers in 101,235 subjects, including 12,552 cancer cases, in the population-based Northern Sweden Health and Disease Study. Most analyses (n = 20) rendered null results. In men, we observed an increased prostate cancer risk among high-consumers of cheese (hazard ratio (HR) for highest vs. lowest quintile (Q5-Q1), 1.11; 95% CI, 0.97-1.27; P-trend = 0.013). In women, high-consumers of cheese had a decreased risk of overall cancer (HR Q5-Q1, 0.95; 95% CI, 0.88-1.04; P-trend = 0.039), smoking-related (HR Q5-Q1, 0.84; 95% CI, 0.72-0.97; P-trend <= 0.001), and colorectal cancers (HR Q5-Q1, 0.82; 95% CI, 0.63-1.07; P-trend = 0.048). Butter yielded a weak decreased obesity-related cancer risk in women (HR Q5-Q1, 0.91; 95% CI, 0.81-1.02; P-trend = 0.049). Fermented milk yielded HRs below zero in women, but with no clear linear associations. In conclusion, this study does not support any major adverse or beneficial effects of fermented milk, non-fermented milk, cheese, and butter in the diet from a cancer risk perspective.
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| 22. |
- Nilsson, Lena Maria, et al.
(författare)
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Low-carbohydrate, high-protein score and mortality in a northern Swedish population-based cohort.
- 2012
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Ingår i: European Journal of Clinical Nutrition. - : Springer Science and Business Media LLC. - 0954-3007 .- 1476-5640. ; 66:6, s. 694-700
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/OBJECTIVE: Long-term effects of carbohydrate-restricted diets are unclear. We examined a low-carbohydrate, high-protein (LCHP) score in relation to mortality. SUBJECTS/METHODS: This is a population-based cohort study on adults in the northern Swedish county of Va¨sterbotten. In 37 639 men (1460 deaths) and 39 680 women (923 deaths) from the population-based Va¨sterbotten Intervention Program, deciles of energy-adjusted carbohydrate (descending) and protein (ascending) intake were added to create an LCHP score (2 --20 points). Sex-specific hazard ratios (HR) were calculated by Cox regression. RESULTS: Median intakes of carbohydrates, protein and fat in subjects with LCHP scores 2--20 ranged from 61.0% to 38.6%, 11.3% to 19.2% and 26.6% to 41.5% of total energy intake, respectively. High LCHP score (14 --20 points) did not predict all-cause mortality compared with low LCHP score (2 --8 points), after accounting for saturated fat intake and established risk factors (men: HR for high vs low 1.03 (95% confidence interval (CI) 0.88 -- 1.20), P for continuous¼0.721; women: HR for high vs low 1.10 (95% CI 0.91 -- 1.32), P for continuous¼0.229). For cancer and cardiovascular disease, no clear associations were found. Carbohydrate intake was inversely associated with all-cause mortality, though only statistically significant in women (multivariate HR per decile increase 0.95 (95% CI 0.91 -- 0.99), P¼0.010). CONCLUSION: Our results do not support a clear, general association between LCHP score and mortality. Studies encompassing a wider range of macronutrient consumption may be necessary to detect such an association.
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| 23. |
- Tognon, Gianluca, 1976, et al.
(författare)
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Nonfermented milk and other dairy products: associations with all-cause mortality 1,2
- 2017
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Ingår i: American Journal of Clinical Nutrition. - : Elsevier BV. - 0002-9165 .- 1938-3207. ; 105:6, s. 1502-1511
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 24. |
- Van Guelpen, Bethany, et al.
(författare)
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Plasma folate and total homocysteine levels are associated with the risk of myocardial infarction, independently of each other and of renal function.
- 2009
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Ingår i: Journal of internal medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 266:2, s. 182-95
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate the relationship between plasma folate, vitamin B12 and total homocysteine concentrations, dietary intake of folate and vitamins B12, B6 and B2, and the risk of first acute myocardial infarction (MI). DESIGN: Nested case-referent study with up to 13 years of follow-up. SETTING: The population-based Northern Sweden Health and Disease Study, with 73 879 participants at the time of case ascertainment. SUBJECTS: A total of 571 MI cases (406 men) and 1569 matched referents. Of the cases, 530 had plasma samples available, and 247 had dietary B-vitamin intake data. RESULTS: Plasma concentrations of folate were inversely associated, and total homocysteine positively associated, with the risk of MI, independently of each other and of a number of established and novel cardiovascular risk factors, including renal function [multivariate odds ratio for highest vs. lowest quintile of folate 0.52 (95% CI 0.31-0.84), P for trend = 0.036, and homocysteine 1.92 (95% CI 1.20-3.09), P for trend = 0.006]. For plasma vitamin B12 concentrations, and vitamin B12, B6 and B2 intake, no clear risk relationship was apparent. Though not statistically significant, the results for folate intake were consistent with those for plasma concentrations. CONCLUSIONS: In this large prospective study of a population without mandatory folic acid fortification, both folate and homocysteine were strongly associated with the risk of myocardial infarction, independently of each other and of renal function. Although randomized trials of folic acid supplementation are needed to determine causality, our findings highlight the potential importance of folate, or sources of folate, in incident cardiovascular disease.
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| 25. |
- Warensjö, Eva, et al.
(författare)
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Biomarkers of milk fat and the risk of myocardial infarction in men and women : a prospective, matched case-control study
- 2010
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Ingår i: American Journal of Clinical Nutrition. - : Elsevier BV. - 0002-9165 .- 1938-3207. ; 92:1, s. 194-202
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Tidskriftsartikel (refereegranskat)abstract
- Background: High intakes of saturated fat have been associated with cardiovascular disease, and milk fat is rich in saturated fat. Objective: The objective of this study was to investigate the association between the serum milk fat biomarkers pentadecanoic acid (15:0), heptadecanoic acid (17:0), and their sum (15:0+17:0) and a first myocardial infarction (MI). Design: The study design was a prospective case-control study nested within a large population- based cohort in Sweden. Included in the study were 444 cases (307 men) and 556 controls (308 men) matched on sex, age, date of examination, and geographic region. Clinical, anthropometric, biomarker fatty acid, physical activity, and dietary data were collected. The odds of a first MI were investigated by using conditional logistic regression. Results: In women, proportions of milk fat biomarkers in plasma phospholipids were significantly higher (P < 0.05) in controls than in cases and were, in general, negatively, albeit weakly, correlated with risk factors for metabolic syndrome. The crude standardized odds ratios of becoming an MI case were 0.74 (95% CI: 0.58, 0.94) in women and 0.91 (95% CI: 0.77, 1.1) in men. After multivariable adjustment for confounders, the inverse association remained in both sexes and was significant in women. In agreement with biomarker data, quartiles of reported intake of cheese (men and women) and fermented milk products (men) were inversely related to a first MI (P for trend < 0.05 for all). Conclusions: Milk fat biomarkers were associated with a lower risk of developing a first MI, especially in women. This was partly confirmed in analysis of fermented milk and cheese intake. Components of metabolic syndrome were observed as potential intermediates for the risk relations. Am J Clin Nutr 2010; 92:194-202.
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