1. |
- Henmyr, Viktor, et al.
(författare)
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Characterization of genetic variation in TLR8 in relation to allergic rhinitis
- 2015
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Ingår i: Allergy. European Journal of Allergy and Clinical Immunology. - : Wiley-Blackwell. - 0105-4538 .- 1398-9995.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A previous investigation of all 10 TLR-genes for associations with allergic rhinitis (AR) detected a number of significant SNPs in the TLR8 locus. The associations indicated that an accumulation of rare variants could explain the signal. The present study therefore searches for rare variants in the TLR8 region and also investigates the reproducibility of previous SNP associations.METHODS: The TLR8 gene was re-sequenced in 288 AR patients from Malmö and the data was compared with publically available data. Seven previously AR-associated SNPs from TLR8 were analyzed for AR-associations in 422 AR patients and 859 controls from the BAMSE cohort. The associations detected in present and previous studies were compared.RESULTS: Sequencing detected 13 polymorphisms (3 promotor, 10 coding) among 288 AR patients. Four of the coding polymorphisms were rare (MAF <1%) and three of those were novel. Two coding polymorphisms were benign missense mutations and the rest were synonymous. Comparison with 1000Genomes and Exome Aggregation Consortium data revealed no accumulation of rare variants in the AR cases. The AR-association tests made using the BAMSE cohort yielded 5 P-values < 0.05. Tests of IgE-levels yielded 4 significant SNP associations to birch pollen. Comparing results between different populations revealed opposing risk alleles, different gender effects and response to different allergens in the different populations.CONCLUSIONS: Rare variants in TLR8 are not associated with AR. Comparison of present and previous association studies reveal contradictory results for common variants. Thus, no associations exist between genetic variation in TLR8 and AR. This article is protected by copyright. All rights reserved.
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2. |
- Bach, Andreas, et al.
(författare)
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HAMNEN SOM ENERGINOD : Ett koncept för hamnens roll i omställningen mot ett hållbart transportsystem
- 2022
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Transportsystemet står inför en enorm utmaning då trycket på genomförandet av hållbara operationer aldrig varit större. Enligt IEA står transportsektorn för 16% av det totala koldioxidutsläppet i världen som med nödvändighet måste minska för att vi ska kunna lämna efter oss en planet med resurser för framtida generationer. Utmaningen kräver att alla delar av transportsystemet gör sitt bidrag, oavsett om det handlar om transportoperatörer, transportnoder, myndigheter på såväl lokal, regional som global nivå och tvärs samtliga transportslag. Det slutar dock inte där, det är lika viktigt att de som konstruerar olika typer av lastbärare och fordon för både gods- och persontransporter också beaktar den energi som förväntas vara tillgänglig i rätt kvantitet och till rätt pris. Energiproducenter behöver också tillgodose att efterfrågade energibärare produceras och finns att tillgå vid rätt plats och i tillräcklig kvantitet då den behövs. Detta är i linje med de behov av insatser som Sveriges regering lyfter inom transporteffektivitet, hållbara förnybara drivmedel samt energieffektiva fordon och fartyg, för att reducera Sveriges territoriella CO2 utsläpp i linje med de globala målen. En viktig del av transportsystemet är hamnar som har fönster mot flera olika transportslag och utgör multimodala noder som förväntas ombesörja en så sömlös övergång mellan olika transportslag som möjligt, såsom till/från sjö, järnväg och väg. Svenska hamnar är inget undantag, utan i Sverige med sin längsta europeiska kustremsa behöver Sveriges hamnar också etablera tillräcklig kapabilitet för att hantera såväl inhemska transportbehov som förväntade transporter för import och export på ett hållbart sätt. Hamnar står inför utmaningen att både bedriva sina operationer på ett så hållbart sätt som möjligt genom nyttjande av fossilfri energi, att förse besökare med fossilfria energibärare, och att balansera sitt nyttjande och distribution av hållbar energi med de behov som omgivningen har. Organisationer med lastbilar, tåg, och fartyg som besöker en transportnod, däribland hamnar, förväntar sig att de kan försörjas med viss energi. Transportnoder kan således inte bara betraktas utifrån att vara en effektiv omlastningspunkt, utan behöver också betraktas utifrån den roll som transportnoden har och kan komma att ta i den del av energisystemet som relaterar till transportsystemet. Hamnar som transportnoder behöver således etablera en förmåga som energinod. I föreliggande projekt har trender beaktats för utvecklingen inom olika transportslag, intervjuer genomförts med svenska hamnar samt en enkätundersökning genomförts riktad till en majoritet av Sveriges hamnar. I projektet identifieras att de viktigaste drivkrafterna för hamnarnas hållbarhets- och omställningsarbete är kundkrav, kostnadsbesparingar, hamnens interna målsättning (ofta baserad på ägarnas krav och vision) samt regelverk. Slutsatsen är att Sveriges hamnar har en stark ambition att utveckla sin förmåga som energinod för olika roller. Samtidigt råder en villrådighet om vilka satsningar som skulle ge störst effekter för hamnens verksamhet. Viktigt att notera är också att olika hamnar har olika förutsättningar och roller i transportsystemet, beroende på dess geografiska placering, storlek och typ av gods / passagerare som hanteras. Samtidigt görs stora investeringar i Sveriges hamnsystem, för att proaktivt utveckla en kapabilitet att möta dagens och morgondagens transportbehov, särskilt i ljuset av den omflyttning som sker från vägbundna transporter till järnväg och sjö. Det är vanligt att hamnar etablerar inlandsterminalskapabilitet, d v s skapar förmåga för omlastning mellan tåg och väg där inte någon sjötransport behöver vara inblandad. Många av Sveriges järnvägsoperatörer ser hamnar som strategiska noder i järnvägssystemet. Dessutom det är tydligt från intervjuerna, vilket även styrks av enkätsvar, att respondenterna anser att otillräckliga finansiella medel, höga kostnader och skatt, omogen teknik, infrastruktur, effekt, standardisering, kompetens, och politisk otydlighet är de största utmaningar som påverkar svenska hamnars roll i hållbarhets- och omställningsarbete. Baserat på genomförd trend- och nulägesanalys föreslås en mognadsmodell som rådgivande för hamnens proaktiva utveckling av sin energinodskapacitet. Denna modell tar utgångspunkt i att hamnen etablerar en energistrategi som tar höjd för nödvändiga samarbeten och investeringar som de både blir tvingade till genom regelverk, påverkade av genom beslut och själva har rådighet över. Hamnarna är tydliga med att huvudverksamheten är att utgöra en transportnod, men att de, för att möjliggöra en omställning mot ett hållbart transportsystem, också behöver ge utrymme för andra aktörer, såsom energiproducenter och energidistributörer att bedriva sin verksamhet relaterat till hamnens geografiska område. Således behöver det kluster av aktörer som ingår i hamnen som nod expanderas till att också innefatta producenter och distributörer av energi. Hamnens energistrategi är rådgivande för att hamnen skall kunna etablera en förmåga som säkerställer att de krav som hamnens operationer, hamnens besökare och hamnens roll med sin geografiska placering, möts. Föreslagen mognadsmodell riktar uppmärksamhet just till dessa nivåer av förmåga och skapar grunder för formuleringen av en proaktiv strategi för den enskilda hamnens roll i transportsystemets energiomställning. En viktig grund blir då att simulera framtida energibehov, såsom inom elförsörjnings- och eldistributionsområdet, men även för andra energibärare, varför detta projekt föreslår ett fortsättningsprojekt där förväntade energibehov kan simuleras och bli rådgivande för strategi, samverkan och investering för Sveriges hamnar. En sådan simuleringsmodell bygger på hamnens digitala förmåga att fånga och använda data från operationer för att säkerställa att hamnen bidrar till transporteffektivitet, användning av hållbara förnybara drivmedel samt energieffektiva fordon och fartyg. Samspelet mellan hamnen som energinod och transportbärares kapabilitet att drivas på hållbar energi samt energiproducenters/energidistributörers förmåga att tillhandahålla fossilfri energi, utgör grunden till fossilfria transporter. Fossilfria väg-, järnvägs- och sjötransporter kan således inte etableras utan att ta hänsyn till alla ingående komponenter. I denna nödvändiga transformation har hamnar och andra transportnoder en nyckelroll.
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3. |
- Englund, Hanna, et al.
(författare)
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Radiation exposure in patients with inflammatory bowel disease and irritable bowel syndrome in the years 2001-2011
- 2017
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 52:3, s. 300-305
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To compare cumulative ionizing radiation in patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) for the years 2001-2011. To study how radiation exposure change over time in patients with newly diagnosed IBD and factors associated with radiation exposure.MATERIAL AND METHODS: All radiological investigations performed between 1 January 2001 and 31 December 2011 were retrospectively recorded in patients with Crohn's disease (CD) (n = 103), ulcerative colitis (UC) (n = 304) and IBS (n = 149). Analyses were done with Mann-Whitney and Chi-Square test.RESULTS: The median total cumulative radiation exposure in mSv for CD (20.0, inter quartile range (IQR) 34.8), UC (7.01, IQR 23.8), IBS (2.71, IQR 9.15) and the proportion of patients who had been exposed for more than 50 mSv during the study period (CD 19%, UC 11%, IBS 3%) were significantly higher in the patients with CD compared to patients with UC (p < .001) and IBS (p < .001), respectively. In turn, patients with UC had significantly higher doses than patients with IBS (p = .005). Risk factors for radiation exposure were female gender (CD), early onset (UC), ileocolonic location (CD), previous surgery (CD and UC), depression (IBS) and widespread pain (IBS). In newly diagnosed CD, there was a significant decline in median cumulative radiation dose in mSv (17.2 vs. 12.0; p = .048) during the study period.CONCLUSIONS: Patients with CD are at greatest risk for high cumulative radiation exposure, but there is a decline in exposure during the late 2000s. Non-colectomized patients with UC and patients with IBS have a relatively low risk of cumulative radiation exposure.
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4. |
- Jakobsson, Mattias, et al.
(författare)
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Evolution of chloroplast mononucleotide microsatellites in Arabidopsis thaliana
- 2007
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Ingår i: Theoretical and Applied Genetics. - : Springer. - 0040-5752 .- 1432-2242. - 0040-5752 ; 114:2, s. 223-235
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Tidskriftsartikel (refereegranskat)abstract
- The level of variation and the mutation rate were investigated in an empirical study of 244 chloroplast microsatellites in 15 accessions of Arabidopsis thaliana. In contrast to SNP variation, microsatellite variation in the chloroplast was found to be common, although less common than microsatellite variation in the nucleus. No microsatellite variation was found in coding regions of the chloroplast. To evaluate different models of microsatellite evolution as possible explanations for the observed pattern of variation, the length distribution of microsatellites in the published DNA sequence of the A. thaliana chloroplast was subsequently used. By combining information from these two analyses we found that the mode of evolution of the chloroplast mononucleotide microsatellites was best described by a linear relation between repeat length and mutation rate, when the repeat lengths exceeded about 7 bp. This model can readily predict the variation observed in non-coding chloroplast DNA. It was found that the number of uninterrupted repeat units had a large impact on the level of chloroplast microsatellite variation. No other factors investigated-such as the position of a locus within the chromosome, or imperfect repeats-appeared to affect the variability of chloroplast microsatellites. By fitting the slippage models to the Genbank sequence of chromosome 1, we show that the difference between microsatellite variation in the nucleus and the chloroplast is largely due to differences in slippage rate.
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5. |
- Säll, T., et al.
(författare)
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Chloroplast DNA indicates a single origin of the allotetraploid Arabidopsis suecica
- 2003
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Ingår i: Journal of Evolutionary Biology. - : John Wiley & Sons Inc.. - 1010-061X .- 1420-9101. ; 16:5, s. 1019-1029
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Tidskriftsartikel (refereegranskat)abstract
- DNA sequencing was performed on up to 12 chloroplast DNA regions [giving a total of 4288 base pairs (bp) in length] from the allopolyploid Arabidopsis suecica (48 accessions) and its two parental species, A. thaliana (25 accessions) and A. arenosa (seven accessions). Arabidopsis suecica was identical to A. thaliana at all 93 sites where A. thaliana and A. arenosa differed, thus showing that A. thaliana is the maternal parent of A. suecica. Under the assumption that A. thaliana and A. arenosa separated 5 million years ago, we estimated a substitution rate of 2.9 x 10(-9) per site per year in noncoding single copy sequence. Within A. thaliana we found 12 substitution (single bp) and eight insertion/deletion (indel) polymorphisms, separating the 25 accessions into 15 haplotypes. Eight of the A. thaliana accessions from central Sweden formed one cluster, which was separated from a cluster consisting of central European and extreme southern Swedish accessions. This latter cluster also included the A. suecica accessions, which were all identical except for one 5 bp indel. We interpret this low level of variation as a strong indication that A. suecica effectively has a single origin, which we dated at 20 000 years ago or more.
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8. |
- Andersson-Sköld, Yvonne, 1957-, et al.
(författare)
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Coal tar-containing asphalt : Resource or hazardous waste?
- 2007
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Ingår i: Journal of Industrial Ecology. - : Wiley-Blackwell. - 1088-1980 .- 1530-9290. ; 11:4, s. 99-116
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Tidskriftsartikel (refereegranskat)abstract
- Coal tar was used in Sweden for the production of asphalt and for the drenching of stabilization gravel until 1973. The tar has high concentrations of polycyclic aromatic hydrocarbons (PAH), some of which may be strongly carcinogenic. Approximately 20 million tonnes of tar-containing asphalt is present in the public roads in Sweden. Used asphalt from rebuilding can be classified as hazardous waste according to the Swedish Waste Act. The cost of treating the material removed as hazardous waste can be very high due to the large amount that has to be treated, and the total environmental benefit is unclear. The transport of used asphalt to landfill or combustion will affect other environmental targets. The present project, based on three case studies of road projects in Sweden, evaluates the consequences of four scenarios for handling the material: reuse, landfill, biological treatment, and incineration. The results show that reuse of the coal tar-containing materials in new road construction is the most favorable alternative in terms of cost, material use, land use, energy consumption, and air emissions.
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9. |
- Annuk, Margus, et al.
(författare)
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Erythropoietin impairs endothelial vasodilatory function in patients with renal anemia and in healthy subjects
- 2006
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Ingår i: Nephron. Clinical practice. - : S. Karger AG. - 1660-8151 .- 2235-3186 .- 1660-2110. ; 102:1, s. c30-c34
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim: The mechanisms underlying the aggravation or development of hypertension frequently seen during treatment of renal anemia with epoetins are not fully elucidated. The aim of the present study was to investigate the effects of epoetin alfa on endothelial vasodilatory function in patients with renal anemia and in healthy subjects. Methods: Eighteen preuremic patients with anemia (GFR 23.4 ± 11 SD ml/min, Hb 101 ± 8 g/l) and 10 healthy subjects underwent evaluation of endothelium-dependent vasodilation (EDV) and endothelium-independent vasodilation (EIDV) by means of forearm blood flow (FBF) measurements with venous occlusion plethysmography during local intra-arterial infusions of methacholine (MCh, evaluating EDV) and sodium nitroprusside (SNP, evaluating EIDV). These investigations were performed before and 30 min after an intravenous injection of epoetin alfa (10,000 IU). Ten healthy subjects underwent the same procedure with the exception that saline were given instead of epoetin. The patients were treated with epoetin alfa subcutaneously for 12-19 weeks and revaluated when Hb exceeded 120 g/l. Results: EDV was attenuated after the epoetin injection in both renal patients and healthy subjects. This impairment persisted after anemia had been treated. EDIV and blood pressure remained constant. Saline had no effect on the variables measured. Conclusion: Our results indicate that epoetin alfa impairs endothelial function in renal patients and healthy subjects which may have an impact on vascular complications.
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10. |
- Annuk, Margus, et al.
(författare)
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Impaired endothelium-dependent vasodilatation in renal failure in humans
- 2001
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 16:2, s. 302-306
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The main causes of death in patients with chronic renal failure (CRF) are cardiovascular complications. The aim of the present study was to compare endothelium-dependent vasodilatation (EDV) in patients with chronic renal failure with a control population controlling for hypertension, diabetes mellitus and hypercholesterolaemia. METHODS: Fifty-six patients with moderate CRF (mean creatinine clearance 29.4 ml/min/1.73 m(2)) underwent evaluation of EDV and endothelium-independent vasodilatation (EIDV) by means of forearm blood flow (FBF) measurements with venous occlusion plethysmography during local intra-arterial infusions of methacholine (Mch, 2 and 4 microg/min evaluating EDV) and sodium nitroprusside (SNP, 5 and 10 microg/min evaluating EIDV). Fifty-six control subjects without renal impairment underwent the same investigation. RESULTS: Infusion of Mch increased FBF significantly less in patients with renal failure than in controls (198 vs 374%, P<0.001), whereas no significant difference was seen regarding the vasodilatation induced by SNP (278 vs 269%). The differences in EDV between the groups were still significant after controlling for hypertension, blood glucose, and serum cholesterol in multiple regression analysis (P<0.001). EDV was related to serum creatinine (r=-0.37, P<0.01), creatinine clearance (r=0.45, P<0.005) and to serum triglyceride levels (r=-0.29, P<0.005) in the CRF group. CONCLUSIONS: Patients with moderate CRF have an impaired EDV even after correction for traditional cardiovascular risk factors and this impairment is related to the degree of renal failure.
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11. |
- Annuk, Margus, et al.
(författare)
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Oxidative stress and endothelial function in chronic renal failure
- 2001
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Ingår i: Journal of the American Society of Nephrology. - 1046-6673 .- 1533-3450. ; 12:12, s. 2747-2752
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- This study aimed to investigate the relationship between oxidative stress and endothelium-dependent vasodilation in patients with chronic renal failure (CRF). Thirty-seven patients with CRF underwent evaluation of endothelium-dependent vasodilation and endothelium-independent vasodilation by means of forearm blood flow measurements with venous occlusion plethysmography during local intra-arterial infusions of methacholine (evaluating endothelium-dependent vasodilation) and sodium nitroprusside (evaluating endothelium-independent vasodilation). Lag phase of lipoprotein fraction to oxidation, total antioxidative activity, diene conjugates, thiobarbituric acid reactive substances, lipid hydroperoxide, reduced glutathione (GSH), oxidized GSH (GSSG), and the GSH redox ratio (GSSG/GSH) were all measured as markers of oxidative stress. Two groups of healthy subjects (61 and 37 subjects, respectively) were used as controls. In one group, oxidative stress markers were measured, whereas endothelium-dependent vasodilation and endothelium-independent vasodilation were assessed in the other group. Compared with controls, the patients with renal insufficiency had an impaired endothelium-dependent vasodilation, a shorter lag phase of lipoprotein fraction, and higher levels of diene conjugates, lipid hydroperoxide, and GSSG levels. The GSSG/GSH ratio was lower in patients with CRF. Endothelium-dependent vasodilation was positively correlated with total antioxidative activity (r = 0.41, P = 0.016), GSH (r = 0.44, P < 0.0098), and lag phase of LDL (r = 0.35, P = 0.036) and negatively correlated with GSSG (r = -0.40, P < 0.018), GSSG/GSH (r = -0.47, P = 0.0057), and diene conjugates (r = -0.53 P < 0.0015) in patients with CRF. These results show that an impaired endothelium vasodilation function and oxidative stress are related to each other in patients with CRF.
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13. |
- Berhan, Yonas, 1970-
(författare)
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Epidemiological studies of childhood diabetes and important health complications to the disease
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims: The overall aim of this thesis was to increase knowledge regarding the occurrence of childhood onset T1D and T2D in Sweden and in relation to that describe and elucidate important aspects on two grave complications to diabetes; end-stage renal disease (ESRD) and mortality. The two first studies included in this thesis aimed to describe and analyze the cumulative incidence of childhood onset T1D in Sweden and to assess the occurrence of undetected T2D in Swedish children. The aim with the third study was to describe the cumulative incidence of ESRD, and to analyze how ESRD risk differs with age at-onset and sex. The aim of the fourth study was to show how parental socioeconomic status (SES) affects all cause mortality in Swedish patients with childhood onset T1D.Study populations: The foundation for the studies on T1D was data from the Swedish Childhood Diabetes Registry (SCDR). When studying ESRD we also included adult onset T1D cases from the Diabetes Incidence Study in Sweden (DISS). The study on T2D was a population-based screening study where BMI was measured in 5528 school-children and hemoglobin A1c was measured in children with overweight according to international age and sex specific BMI cut-offs. To study ESRD and mortality, we linked the SCDR to various nationwide registers containing individual information on SES, mortality and ESRD.Results: The incidence rates of childhood onset T1D has continued to increase in Sweden 1977–2007. Age- and sex-specific incidence rates varied from 21.6 (95% CI 19.4–23.9) during 1978–1980 to 43.9 (95% CI 40.7– 47.3) during 2005–2007. Cumulative incidence by birth-cohorts has shifted to a younger age at-onset over the first 22 years of incidence registration. From the year 2000 there was a significant reverse in this trend (p<0.01). In contrast to the increase of T1D, we found no evidence of undetected T2D among Swedish school children. Despite a relatively high incidence in T1D in Sweden there is low cumulative incidence of ESRD, 3.3% at maximum 30 years of duration. We found difference between the sexes regarding long-term risk of developing ESRD that was dependent on the age at onset of T1D. When analyzing how socioeconomic status affects mortality in different age at death groups, we found that having parents that received income support increased mortality up to three times in those who died after 18 years of age.Conclusion: The incidence of childhood onset T1D continued to increase in Sweden 1978-2007. Between the years 1978-1999 there was a shift to a younger age at-onset, but from the year 2000 there is a change in this shift indicating a possible trend break. The prevalence of T2D among Swedish children up to 12 years of age is probably very low. There is still a low cumulative incidence of T1D associated ESRD in Sweden. The risk of developing ESRD depends on age at-onset of T1D, and there is a clear difference in risk between men and woman. Excess mortality among subjects with childhood onset T1D still exists, and low parental socioeconomic status additionally increased mortality in this group.
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15. |
- Cashman, Kevin D., et al.
(författare)
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Individual participant data (IPD)-level meta-analysis of randomised controlled trials to estimate the vitamin D dietary requirements in dark-skinned individuals resident at high latitude
- 2022
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Ingår i: European Journal of Nutrition. - : Springer. - 1436-6207 .- 1436-6215. ; 61, s. 1015-1034
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Tidskriftsartikel (refereegranskat)abstract
- Context and purpose: There is an urgent need to develop vitamin D dietary recommendations for dark-skinned populations resident at high latitude. Using data from randomised controlled trials (RCTs) with vitamin D3-supplements/fortified foods, we undertook an individual participant data-level meta-regression (IPD) analysis of the response of wintertime serum 25-hydroxyvitamin (25(OH)D) to total vitamin D intake among dark-skinned children and adults residing at ≥ 40° N and derived dietary requirement values for vitamin D.Methods: IPD analysis using data from 677 dark-skinned participants (of Black or South Asian descent; ages 5–86 years) in 10 RCTs with vitamin D supplements/fortified foods identified via a systematic review and predefined eligibility criteria. Outcome measures were vitamin D intake estimates across a range of 25(OH)D thresholds.Results: To maintain serum 25(OH)D concentrations ≥ 25 and 30 nmol/L in 97.5% of individuals, 23.9 and 27.3 µg/day of vitamin D, respectively, were required among South Asian and 24.1 and 33.2 µg/day, respectively, among Black participants. Overall, our age-stratified intake estimates did not exceed age-specific Tolerable Upper Intake Levels for vitamin D. The vitamin D intake required by dark-skinned individuals to maintain 97.5% of winter 25(OH)D concentrations ≥ 50 nmol/L was 66.8 µg/day. This intake predicted that the upper 2.5% of individuals could potentially achieve serum 25(OH)D concentrations ≥ 158 nmol/L, which has been linked to potential adverse effects in older adults in supplementation studies.Conclusions: Our IPD-derived vitamin D intakes required to maintain 97.5% of winter 25(OH)D concentrations ≥ 25, 30 and 50 nmol/L are substantially higher than the equivalent estimates for White individuals. These requirement estimates are also higher than those currently recommended internationally by several agencies, which are based predominantly on data from Whites and derived from standard meta-regression based on aggregate data. Much more work is needed in dark-skinned populations both in the dose–response relationship and risk characterisation for health outcomes.
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16. |
- Domellöf, Magnus, et al.
(författare)
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Effects of mode of oral iron administration on serum ferritin and haemoglobin in infants
- 2008
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 97:8, s. 1055-1060
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate effects of iron-fortified foods (FFs) and medicinal iron drops (MD) on iron status in infants. Methods: Data from one MD and one FF study were compared. Infants were divided into groups depending on the predominant source and amount of dietary iron during 6–9 months of age: MD: Medicinal iron drops (1 mg/kg/day). FF: iron intake >1.3 mg/kg/day, predominantly from FF and no iron supplements. Low iron (LI) group: iron intake <1.3 mg/kg/day and no iron supplements. Results: Mean iron intake did not differ between MD (n = 30) and FF (n = 35) groups but was lower in the LI (n = 232) group. The FF group had significantly higher mean Hb at 9 months compared to the MD and LI groups (120 vs. 115 g/L and 120 vs. 116 g/L, respectively, p ≤ 0.005). The MD group had significantly higher mean SF at 9 months compared to the FF and the LI groups (46 vs. 23 μg/L and 46 vs. 26 μg/L, respectively, p < 0.001). Conclusions: Our results suggest that, in healthy, term, nonanaemic 6–9-month-old infants, iron given as medicinal iron drops is primarily deposited into iron stores while iron given as iron-fortified foods is primarily utilized for Hb synthesis.
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17. |
- Ebenhard, Torbjörn, et al.
(författare)
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Environmental effects of brushwood harvesting for bioenergy
- 2017
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Ingår i: Forest Ecology and Management. - : Elsevier BV. - 0378-1127 .- 1872-7042. ; 383, s. 85-98
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Tidskriftsartikel (refereegranskat)abstract
- Sweden aims to increase the proportion of renewable energy sources, ultimately to be able to phase out fossil fuels. To achieve this, new energy sources need to be explored. In this multi-disciplinary article, we examine the technical, economical, ecological and legal possibilities to commercially and sustainably harvest brushwood for bioenergy, while simultaneously gaining positive environmental effects, both for biological diversity, the cultural heritage, and the climate. The Swedish open landscape is becoming covered with secondary brushwood regrowth through natural succession, except where it is kept open. Brushwood is spreading along roads, railway lines, edge zones, in power line corridors, abandoned semi-natural grasslands, nature reserves, and in marginal land in urban areas. Such brushwood consists of saplings, bushes and young trees of a range of deciduous plant species, e.g. birch, aspen, alder and goat willow, sometimes mixed with conifers, often forming dense thickets. Such secondary brushwood regrowth could be systematically utilised as a new source of renewable bioenergy. Commercial brushwood harvesting in Sweden may contribute 26 PJ of energy annually, which may be a small but significant contribution, considering the favourable energy ratio (E-r = 28), indicating that large emission reductions can be achieved, if fossil fuels are replaced. Growing brushwood does not require fertilizers or pesticides, soil tillage or crop management, and it does not compete with any other potential land use. Many brushwood habitats are already being managed to clear brushwood, for other purposes, minimizing the added harvesting cost. Apart from providing bioenergy, it has also been suggested that brushwood harvesting would benefit biological diversity. A large number of nationally redlisted species are dependent on the active management of open habitats, including semi-natural grasslands, and man-made habitats such as road verges and power line corridors. Our literature review shows that brushwood harvesting could benefit both biological diversity and the cultural heritage, and contribute to the management of the open cultural landscape. There are however certain limitations. Brushwood harvesting would favour a certain set of species, including many redlisted, but it may also threaten another set of species, especially species associated with early successional stages of forest regeneration, as well as forest edge species, depending on how and where it is applied. Harvesting may be affected by legislation imposing limitations regarding habitats of particular importance for biodiversity. The environmental and legal constraints would probably reduce the profitability of brushwood harvesting in certain areas, as well as the annual production of bioenergy.
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18. |
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19. |
- Fredriksson, Marie, et al.
(författare)
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Risk of cancer in young and middle-aged adults with childhood-onset type 1 diabetes in Sweden - A prospective cohort study
- 2022
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Ingår i: Diabetic Medicine. - : John Wiley & Sons. - 0742-3071 .- 1464-5491.
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis: In persons with type 1 diabetes, the risk of cancer remains controversial. We wanted to examine the excess risk of cancer in a large population-based cohort diagnosed with type 1 diabetes before 15 years of age.Study population and methods: From 1 July 1977 to 31 December 2013, we prospectively and on a national scale included 18,724 persons (53% men) with childhood-onset type 1 diabetes. For each person with type 1 diabetes, we selected four referents, matched for the date at birth and municipality of living at the time when the case developed diabetes. Cases and referents were linked to national registers of cancer and of the cause of death.Results: A total of 125 persons (61% women) with diabetes had 135 different cancers, all diagnosed after the diabetes diagnosis. The median duration from diabetes diagnosis to first cancer diagnosis was 19 years (interquartile range 10-26). The median age at cancer diagnosis in the diabetes group was 28 years (interquartile range 20-35). The overall standardized incidence ratio (95%), using the Swedish general population as referents for women with diabetes was 1.28 (1.02, 1.58) and when comparing women with diabetes with matched referents, we found a hazard ratio of 1.42 (1.10, 1.85). No elevated risk was seen for men. Cancers of the breast and testis were the most common types in women and men respectively.Conclusions: Women with childhood-onset type 1 diabetes had a small but significantly elevated risk of cancer. No such tendency was seen for men. The reason behind this is unclear.
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20. |
- Fureman, Anna-Lena, et al.
(författare)
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Comparing Continuous Subcutaneous Insulin Infusion and Multiple Daily Injections in children with type 1 diabetes in Sweden from 2011 to 2016 : a longitudinal study from the Swedish National Quality Register (SWEDIABKIDS)
- 2021
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Ingår i: Pediatric Diabetes. - : Blackwell Publishing. - 1399-543X .- 1399-5448. ; 22:5, s. 766-775
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study aimed to compare metabolic control measured as hemoglobin A1c (HbA1c), the risk of severe hypoglycemia, and body composition measured as BMI-SDS in a nationwide sample of children and adolescents with type 1 diabetes with continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI), respectively.METHODS: Longitudinal data from 2011-2016 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with both cross-sectional (6 years) and longitudinal (4 years) comparisons. Main end points were changes in HbA1c, BMI-SDS, and incidence of severe hypoglycemia.RESULTS: <0.001) and the use of CSII increased in both sexes and all age groups. Mean HbA1c was 0.1% (0.7-1.5 mmol/mol) lower in the CSII treated group. Teenagers, especially girls, using CSII tended to have higher BMI-SDS. There was no difference in the number of hypoglycemias between CSII and MDI over the years 2011-2016.CONCLUSION: There was a small decrease in HbA1c with CSII treatment but of little clinical relevance. Overall, mean HbA1c decreased in both sexes and all age groups without increasing the episodes of severe hypoglycemia, indicating that other factors than insulin method contributed to a better metabolic control.
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21. |
- Fureman, Anna-Lena, et al.
(författare)
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Partial clinical remission of Type 1 diabetes in Swedish children : A longitudinal study from the Swedish National Quality Register (SWEDIABKIDS) and the Better Diabetes Diagnosis (BDD) study
- 2024
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Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert. - 1520-9156 .- 1557-8593.
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Tidskriftsartikel (refereegranskat)abstract
- AIMS/HYPOTHESIS: To investigate the frequency and characteristics of partial remission in Swedish children with type 1 diabetes and whether insulin delivery method, i.e., continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) affect incidence and duration of this period 2007-2011. Factors that increase the proportion of subjects that enter partial remission and extend this period can improve long-term metabolic control and reduce the risk of severe hypoglycemia, improve quality of life and in the long run reduce late complications.METHODS: Longitudinal data from 2007-2020 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with all reported newly diagnosed children. Data on C-peptide from the participants in the Better Diabetes Diagnosis study (BDD) from 2007-2010 were used. The definition of partial remission was Insulin Dose Adjusted HbA1c (IDAA1c): HbA1c (%)+(4 x total daily insulin dose (U/kg/day)) ≤9.RESULTS: Of the 3,887 patients, 56% were boys. More boys than girls were in partial remission throughout the follow-up period until 24 months after diabetes onset. Fewer children 0-6 years old had partial remission at 3 and 12 months but not at 24 months compared to older age groups. A larger proportion of patients using CSII at 12 and 24 months remained in partial remission compared to those with MDI (37% vs 33%, p=0.02 and 31% vs 27%, p<0.01 respectively). The level of C-peptide was higher in the group with partial remission and mean HbA1c was lower, both p<0.001. Partial remission at 12 months after diabetes onset was associated with CSII (OR:1.39 CI:1.13, 1.71), shorter diabetes duration (OR:0.80 CI:0.76, 0.84) and male sex (OR:1.23 CI:1.04, 1.46)Conclusions/interpretation: Insulin through MDI, longer duration of diabetes, and female sex were associated with lower frequency of partial remission. Use of CSII seem to contribute to longer partial remission among Swedish children with type 1 diabetes.
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22. |
- Halldén, Christer, et al.
(författare)
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Origin of Swedish hemophilia A mutations
- 2012
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Ingår i: Journal of Thrombosis and Haemostasis. - : Elsevier BV. - 1538-7933 .- 1538-7836. ; 10:12, s. 2503-2511
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Tidskriftsartikel (refereegranskat)abstract
- Background: Hemophilia A (HA) has a high level of variation within the disease class, with more than 1000 mutations being listed in the HAMSTeRS database. At the same time a number of F8 mutations are present in specific populations at high frequencies. Objectives: The simultaneous presence of large numbers of rare mutations and a small number of high-frequency mutations raises questions about the origins of HA mutations. The present study was aimed at describing the origins of HA mutations in the complete Swedish population. The primary issue was to determine what proportion of identical mutations are identical by descent (IBD) and what proportion are attributable to recurrent mutation events. The age of IBD mutations was also determined. Patients/Methods: In Sweden, the care of HA is centralized, and the Swedish HA population consists of 750 patients from > 300 families (35% severe, 15% moderate, and 50% mild). Identical haplotypes were defined by single-nucleotide polymorphism and microsatellite haplotyping, and the ages of the mutations were estimated with estiage. Results: Among 212 presumably unrelated patients with substitution mutations, 97 (46%) had mutations in common with other patients. Haplotyping of the 97 patients showed that 47 had IBD mutations (22%) with estimated ages of between two and 35 generations. The frequency of mild disease increased with an increasing number of patients sharing the mutations. Conclusions: A majority of the IBD mutations are mild and have age estimates of a few hundred years, but some could date back to the Middle Ages.
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23. |
- Halldén, Christer, et al.
(författare)
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Origin of Swedish hemophilia B mutations
- 2013
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Ingår i: Journal of Thrombosis and Haemostasis. - : Elsevier BV. - 1538-7933 .- 1538-7836. ; 11:11, s. 2001-2008
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Tidskriftsartikel (refereegranskat)abstract
- Background More than 1100 mutations that cause hemophilia B (HB) have been identified. At the same time, specific F9 mutations are present at high frequencies in certain populations, which raise questions about the origin of HB mutations. ObjectivesTo describe the mutation spectrum of all HB families in Sweden and investigate if mutations appearing in several families are due to independent recurrent mutations (RMs) or to a common mutation event (i.e. are identical by descent (IBD)). Patients/MethodsThe registered Swedish HB population consists of patients from 86 families. Mutations were identified by resequencing and identical haplotypes were defined using 74 markers and a control population of 285 individuals. The ages of IBD mutations were estimated using ESTIAGE. ResultsOut of 77 presumably unrelated patients with substitution mutations, 47 patients (61%) had mutations in common with other patients. Haplotyping of the 47 patients showed that 24 patients had IBD mutations (51%) with estimated ages of between two and 23 generations. A majority of these patients had mild disease. Eight of the 15 mutations observed in more than one family were C>T transitions in CpG sites and all eight were RMs. ConclusionsThe association of IBD mutations with a mild phenotype is similar to what has been previously observed in hemophilia A. Noteworthy features of the mutations that are common to more than one family are the equal proportions of patients with RM and IBD mutations and the correlation between the occurrence of RMs and C>T transitions at CpG sites.
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24. |
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25. |
- Hansson, Lena, et al.
(författare)
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Dietary intake in infants with complex congenital heart disease : a case-control study on macro- and micronutrient intake, meal frequency and growth
- 2016
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Ingår i: Journal of human nutrition and dietetics (Print). - : Wiley. - 0952-3871 .- 1365-277X. ; 29:1, s. 67-74
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Children with severe congenital heart disease (CHD) need considerable nutritional support to reach normal growth. The actual intake of macro- and micronutrients in outpatient CHD infants over a 6-month period in infancy is not described in the literature. The present study aimed to prospectively investigate the distribution between macro- and micronutrient intake, meal frequency and growth in children with CHD.METHODS: At 6, 9 and 12 months of age, a 3-day food diary and anthropometric data were collected in 11 infants with severe CHD and 22 healthy age- and feeding-matched controls. Macro- and micronutrient intake, meal frequency and growth were calculated.RESULTS: Compared to the healthy controls, CHD infants had a statistically significantly higher intake of fat at 9 months of age (4.8 versus 3.6 g kg(-1) day(-1) ), a higher percentage energy (E%) from fat, (40.6% versus 34.5%) and a lower E% from carbohydrates (46.1% versus 39.6%) at 12 months of age, and a lower intake of iron (7.22 versus 9.28 mg day(-1) ) at 6 months of age. Meal frequency was significantly higher at 6 and 9 months of age (P < 0.01). Mean Z-score weight for height, weight for age and body mass index for age were significant lower (P < 0.01) at all time points.CONCLUSIONS: Despite a higher intake of energy from fat and a higher meal frequency, the intake does not meet the needs for growth, and the results may indicate a low intake of micronutrients in CHD infants.
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26. |
- Hansson, Lena, et al.
(författare)
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Fluid restriction negatively affects energy intake and growth in very low birthweight infants with haemodynamically significant patent ductus arteriosus
- 2019
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 108:11, s. 1985-1992
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Tidskriftsartikel (refereegranskat)abstract
- Aim: We explored if fluid restriction in very low birthweight (VLBW) infants with a haemodynamically significant patent ductus arteriosus (PDA) affected energy and protein intakes and growth.Methods: Retrospectively, we identified 90 VLBW infants that were admitted to Umea University Hospital, Sweden, between 2009 and 2012: 42 with and 48 without haemodynamically significant PDA (hsPDA). Anthropometric, fluid, energy and protein intake data during the first 28 days of life were expressed as z‐scores.Results: In the 42 infants diagnosed with hsPDA, fluid intake was restricted after diagnosis, resulting in a decrease in energy and protein intake. No decrease was observed in the other 48 infants in the cohort. Multivariate analysis showed that the z‐score of weight change depended on both ductus arteriosus status and energy intake; thus, infants with hsPDA did not grow as expected with the energy provided to them.Conclusion: Energy and protein intake was diminished in prematurely born infants with hsPDA when fluid was restricted after diagnosis. The initial reduction in intakes may have contributed to the lower postnatal growth observed in these infants.
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27. |
- Hansson, Lena, 1967-, et al.
(författare)
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Vitamin D, liver-related biomarkers, and distribution of fat and lean mass in young patients with Fontan circulation
- 2022
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Ingår i: Cardiology in the Young. - : Cambridge University Press. - 1047-9511 .- 1467-1107. ; 32:6, s. 861-868
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Tidskriftsartikel (refereegranskat)abstract
- Introduction/aim: Young patients with Fontan circulation may have low serum 25-hydroxyvitamin D levels, an affected liver, and unhealthy body compositions. This study aimed to explore the association between vitamin D intake/levels, liver biomarkers, and body composition in young Fontan patients.Method: We collected prospective data in 2017 to 2018, obtained with food-frequency questionnaires, biochemical analyses of liver biomarkers, and dual-energy X-ray absorptiometry scans in 44 children with Fontan circulation. Body compositions were compared to matched controls (n = 38). Linear regression analyses were used to investigate associations of biomarkers, leg pain, and lean mass on serum levels of 25-hydroxyvitamin D. Biomarkers were converted to z scores and differences were evaluated within the Fontan patients.Results: Our Fontan patients had a daily mean vitamin D intake of 9.9 µg and a mean serum 25-hydroxyvitamin D of 56 nmol/L. These factors were not associated with fat or lean mass, leg pain, or biomarkers of liver status. The Fontan patients had significantly less lean mass, but higher fat mass than controls. Male adolescents with Fontan circulation had a greater mean abdominal fat mass than male controls and higher cholesterol levels than females with Fontan circulation.Conclusion: Vitamin D intake and serum levels were not associated with body composition or liver biomarkers in the Fontan group, but the Fontan group had lower lean mass and higher fat mass than controls. The more pronounced abdominal fat mass in male adolescents with Fontan circulation might increase metabolic risks later in life.
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28. |
- Hansson, Lena, 1967-
(författare)
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When the paediatric heart is affected : impact on nutrition, growth and body composition from infancy to adolescence
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundChildren with complex congenital heart disease (CHD) and very low birth weight (VLBW) infants with a patent ductus arteriosus (PDA) are two distinct groups of patients with different clinical care needs. Irrespective of the type of heart condition, nutritional intake and growth is largely affected in these individuals during infancy. Although medical care for these conditions has significantly improved in the last several decades, there is still a considerable need for improvement in nutritional support to reach satisfactory growth and development in both these patient groups. In children with complex CHD, there often is underlying malnutrition related to the type and severity of cardiac defect, which constitutes the reason for increased energy metabolism and feeding difficulties. In VLBW infants with a haemodynamically significant PDA (hsPDA), additional fluid regulation may result in a subsequent decrease in macronutrient intake. Current knowledge regarding the consequences of growth restrictions and nutritional intake during infancy, as well as body composition and nutritional intake later in childhood, is scarce. The overall aim of this thesis was to explore energy and nutritional intakes in infants, children and adolescents with complex CHD or hsPDA, as well as investigate growth and body composition in these patient groups.Methods In this thesis, four observational studies were conducted. In paper I, the study population consisted of 11 CHD infants and 22 matched controls. A follow up study (paper III) was conducted on these CHD infants at 9 years of age and compared to a new set of age-matched controls (n=10). In paper II, 42 VLBW infants with hsPDA, and 48 referents with VLBW were studied. In paper IV, 44 children and adolescence with Fontan circulation were compared to 38 matched controls. From infancy to adolescence, data on energy, macro- and micronutrient intakes was retrieved from hospital records, from 3-day food diaries or from food frequency questionnaires. Further, anthropometric measures and dual-energy X-ray absorptiometry (DXA) scans were performed and venous blood samples were analysed. ResultsIn paper I, infants with complex CHD had a higher dietary fat intake and lower carbohydrate and iron intakes compared to controls. Additionally, energy intake did not meet the requirements for growth in the CHD infant cohort, resulting in significantly lower Body Mass index (BMI) for age z-score. In paper II, fluid intakes was restricted after hsPDA diagnosis in VLBW infants resulting in a decrease in energy and protein intakes. The z-score of weight change during the first 28 days of life depended on both PDA status and energy intake. In the follow-up study of the complex CHD infants (paper III), growth was comparable to controls at 9 years of age suggesting a catch-up effect. Despite comparable BMI z-scores, the children with CHD had a higher abdominal fat mass index (FMI) and higher daily intake of fat, particularly from saturated fats, compared to controls. In paper IV, the Fontan population had a daily mean vitamin D intake of 9.9 µg and a mean serum 25‑hydroxyvitamin D of 56 nmol/L however, 42% had below sufficient levels. These factors were not associated with lean mass index (LMI), Fat mass index (FMI), or biomarkers of liver status. The Fontan population had significantly less LMI, but higher FMI than controls. Male adolescents with Fontan circulation had a greater mean abdominal FMI than male controls and higher cholesterol levels than females with Fontan circulation.ConclusionInfants with complex CHD, and VLBW infants with hsPDA did not grow as expected with the energy and nutrition provided to them. Follow-up at 9 years of age showed children with complex CHD had caught-up in growth but had increased abdominal FMI and higher intake of saturated fatty acids. In children and adolescents with Fontan circulation, vitamin D levels and intake was not associated with body composition or liver biomarkers. However, it was noted that the Fontan population had a lower LMI and higher FMI compared to controls. Nutritional progress in children with heart conditions can promote growth and improve dietary quality between infancy and adolescence, potentially working to counteract later health risks.
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29. |
- Hörnell, Agneta, 1964-, et al.
(författare)
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Maten i skolan - långt mellan kostråden och verkligheten
- 2009
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 106:5, s. 287-90
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Tidskriftsartikel (refereegranskat)abstract
- Skolan bör ha en positiv roll i folkhälsoarbetet, dels genom att ge eleverna kunskap om sambanden mellan hälsa, kost, fysisk aktivitet och livsstil, dels genom att erbjuda god och näringsriktig mat och möjlighet till regelbunden fysisk aktivitet. Skolmaten utgör fortfarande en utjämnande faktor när det gäller näringsintag mellan barn från resursstarka och resurssvaga områden. Svenska skolbarn till och med årskurs 9 garanteras kostnadsfri mat i skolan genom nu gällande lagstiftning. Livsmedelsverkets råd »Bra mat i skolan« och »Bra mat i förskolan« kompletterar de svenska näringsrekommendationerna och underlättar planeringen för måltider i skolan.
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30. |
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31. |
- Jakobsson, Mattias, et al.
(författare)
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A unique recent origin of the allotetraploid species Arabidopsis suecica: Evidence from nuclear DNA markers
- 2006
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Ingår i: Molecular biology and evolution. - : Oxford University Press (OUP). - 0737-4038 .- 1537-1719. ; 23:6, s. 1217-1231
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Tidskriftsartikel (refereegranskat)abstract
- A coalescent-based method was used to investigate the origins of the allotetraploid Arabidopsis suecica, using 52 nuclear microsatellite loci typed in eight individuals of A. suecica and 14 individuals of its maternal parent Arabidopsis thaliana, and four short fragments of genomic DNA sequenced in a sample of four individuals of A. suecica and in both its parental species A. thaliana and Arabidopsis arenosa. All loci were variable in A. thaliana but only 24 of the 52 microsatellite loci and none of the four sequence fragments were variable in A. suecica. We explore a number of possible evolutionary scenarios for A. suecica and conclude that it is likely that A. suecica has a recent, unique origin between 12,000 and 300,000 years ago. The time estimates depend strongly on what is assumed about population growth and rates of mutation. When combined with what is known about the history of glaciations, our results suggest that A. suecica originated south of its present distribution in Sweden and Finland and then migrated north, perhaps in the wake of the retreating ice.
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32. |
- Johansson, Kristina, et al.
(författare)
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D-Dimer is associated with first-ever intracerebral hemorrhage : a nested case-control study
- 2018
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Ingår i: Stroke. - : Lippincott Williams & Wilkins. - 0039-2499 .- 1524-4628. ; 49:9, s. 2034-2039
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose - Hypertension is the most important risk factor for intracerebral hemorrhage (ICH), but further characterization is needed for groups at high risk of ICH. One way to predict the risk of developing a disease is with plasma biomarkers. This study aimed to investigate the association between the biomarker, D-dimer, and ICH risk.Methods - This population-based, nested case-control study was conducted using data from 2 population-based surveys; the Vasterbotten Intervention Programme and MONICA Northern Sweden (Monitoring Trends and Determinants in Cardiovascular Disease). All participants underwent a health examination and blood sampling at baseline before the event. Cases (n=141) were diagnosed with a first-ever ICH between 1985 and March 2007. One or 2 controls (n=255) were matched to each case.Results - The median age was 60 years; 39% of participants were women; and the median time from blood sampling to ICH was 5.2 years. When D-dimer was evaluated as a continuous variable, it was significantly associated with ICH. After multivariable adjustment (for hypertension, body mass index, cholesterol levels, diabetes mellitus, and smoking), the odds ratio was 1.36 per SD of D-dimcr (95% CI, 1.05-1.77). When participants were stratified in 3 groups according to time from blood sampling at health examination to ICH, we found that the association between D-dimer levels and ICH was most pronounced in individuals with the shortest time from blood sampling to ICH event (<3.5 years; odds ratio, 1.78; 95% CI, 1.05-3.05).Conclusions - High plasma concentrations of D-dimer were associated with increased risk of a future ICH, after adjusting for cardiovascular risk factors. This association was predominantly driven by the cases with the shortest time from blood sampling to ICH event.
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33. |
- Johansson, Kristina, et al.
(författare)
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Factor XII as a Risk Marker for Hemorrhagic Stroke : A Prospective Cohort Study
- 2017
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Ingår i: Cerebrovascular diseases extra. - : S. Karger. - 1664-5456. ; 7:1, s. 84-94
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Coagulation factor XII (FXII) is involved in pathological thrombus formation and is a suggested target of anticoagulants. It is unclear whether FXII levels are correlated with cardiovascular risk factors and whether they are associated with myocardial infarction or ischemic or hemorrhagic stroke. The aim of this study was to investigate the correlation between FXII and cardiovascular risk factors in the general population. We also aimed to study the associations between FXII levels and future myocardial infarction and ischemic and hemorrhagic stroke.METHODS: This prospective cohort study measured FXII levels in 1,852 randomly selected participants in a health survey performed in northern Sweden in 1994. Participants were followed until myocardial infarction, stroke, death, or until December 31, 2011.RESULTS: During the median follow-up of 17.9 years, 165 individuals were diagnosed with myocardial infarction, 108 with ischemic stroke, and 30 with hemorrhagic stroke. There were weak correlations between FXII and body mass index, cholesterol, and hypertension. There was no association between FXII and myocardial infarction or ischemic stroke, neither in univariable Cox regression analysis nor after adjustment for age, sex, smoking, body mass index, cholesterol, hypertension, and diabetes. In univariable Cox regression analysis, the hazard ratio for the association between FXII levels and hemorrhagic stroke was 1.42 per SD (95% confidence interval: 0.99-2.05). In the multivariable model, higher levels of FXII were associated with increased risk of hemorrhagic stroke (hazard ratio 1.51 per SD; 95% confidence interval: 1.03-2.21).CONCLUSION: We found an independent association between FXII levels and the risk of hemorrhagic stroke, but not between FXII levels and ischemic stroke or myocardial infarction.
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34. |
- Johansson, Kristina, et al.
(författare)
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Factor XII Concentrations and Risk of Intracerebral Haemorrhage : A Prospective Case-Referent Study
- 2021
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier. - 1052-3057 .- 1532-8511. ; 30:3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: In a previous pilot study, we found an association between high factorXII levels and risk of haemorrhagic stroke suggesting that factor XII is a risk markerfor intracerebral haemorrhage (ICH). The aim of this study was to further investigate the association between factor XII and risk of ICH in a larger population.Materials and Methods:This study was conducted as a prospective nested case-referent study. All participants underwent a health examination and blood sampling for factor XII analysis at baseline. Cases were defined as participants who were diagnosed with a first-ever ICH between 1985 and 2000. Two referents were matched to eachcase.Results:We identified 70 individuals withfirst-ever ICH and 137 matchedreferents who had undergone a health examination and donated blood samples Factor XII Concentrations and Risk of Intracerebral Haemorrhage. A Prospective Case-Referent Studybefore the ICH event. The mean age was 54 years, and 33% were women. The median time-to-event was 3.5 years (range 0.04 to 10.2 years). Conditional logistic regression showed no association between factor XII and risk of ICH, (odds ratio1.06 per SD; [95% confidence interval: 0.57–1.97] in a multivariable model).Conclusions: A previous finding of an association between high concentration of factor XII and risk of ICH could not be replicated in this larger study
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35. |
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36. |
- Johansson, Ulrica, 1974-, et al.
(författare)
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A randomized, controlled trial of a Nordic, protein-reduced complementary diet: effects on dietary intake, biomarkers and growth until 18 months of age
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Plant-based foods introduced during complementary feeding (CF) can contribute to long-term health andclimate friendly diet, but longitudinal multicomponent approaches are lacking.Objectives: To investigate the effects of a protein-reduced, Nordic complementary diet on dietary intake, biomarkers andgrowth and compared to the current Swedish dietary recommendations for infants until 18 mo of age.Design: Healthy, term infants (n=250) were recruited and randomly allocated to either a Nordic diet group (NG) or aconventional diet group (CG). From 4-6 mo of age, the NG followed a taste portions schedule with Nordic fruitand vegetables. From 6 mo up to 18 mo of age, the NG was supplied with Nordic homemade baby food recipes,protein-reduced baby food products and parental support. The CG followed the current Swedish dietaryrecommendations for infants. Dietary intake data, biomarkers and anthropometry were collected frombaseline up to 18 mo of age.Results: Of the 250 infants, 82% (n=206) completed the study. The NG consumed daily 42-45% more fruit andvegetables compared to the CG at 12 and 18 mo of age (p<0.001). Plasma folate was higher in the NGcompared to the CG at 12 mo (p<0.001) and 18 mo of age (p=0.003) and protein intake and blood ureanitrogen (BUN) were lower at both 12 and 18 mo of age (p<0.001). There were no group differences in energyintake (EI), growth, iron status or other biomarkers.Conclusions: The NG consumed significantly more plant-based Nordic foods compared to CG, a difference that lasted at leastuntil 18 mo of age. The lower protein intake in the NG had no effect on growth or iron status. The introductionof a protein-reduced, Nordic diet during CF is safe and feasible, and benefits a sustainable environment andhealth already during infancy and early childhood.
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37. |
- Johansson, Ulrica, 1974-, et al.
(författare)
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A randomized, controlled trial of a Nordic, protein-reduced complementary diet in infants : effects on body composition, growth, biomarkers, and dietary intake at 12 and 18 months
- 2023
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Ingår i: American Journal of Clinical Nutrition. - : Elsevier. - 0002-9165 .- 1938-3207. ; 117:6, s. 1219-1231
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Tidskriftsartikel (refereegranskat)abstract
- Background: High intake of protein and low intake of plant-based foods during complementary feeding can contribute to negative long-term health effects.Objectives: To investigate the effects of a protein-reduced, Nordic complementary diet on body composition, growth, biomarkers, and dietary intake, compared with current Swedish dietary recommendations for infants at 12 and 18 mo.Methods: Healthy, term infants (n = 250) were randomly allocated to either a Nordic group (NG) or a conventional group (CG). From 4 to 6 mo, NG participants received repeated exposures of Nordic taste portions. From 6 to 18 mo, NG was supplied with Nordic homemade baby food recipes, protein-reduced baby food products, and parental support. CG followed the current Swedish dietary recommendations. Measurements of body composition, anthropometry, biomarkers, and dietary intake were collected from baseline and at 12 and 18 mo.Results: Of the 250 infants, 82% (n = 206) completed the study. There were no group differences in body composition or growth. In NG, protein intake, blood urea nitrogen and plasma IGF-1 were lower compared to CG at 12 and 18 mo. Infants in NG consumed 42% to 45% more fruits and vegetables compared to CG at 12 and 18 mo, which was reflected in a higher plasma folate at 12 and 18 mo. There were no between-group differences in EI or iron status.Conclusions: Introduction of a predominantly plant-based, protein-reduced diet as part of complementary feeding is feasible and can increase fruit and vegetable intake.This trial was registered at clinicaltrials.gov as NCT02634749.
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38. |
- Johansson, Ulrica, 1974-, et al.
(författare)
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Acceptance of a Nordic, Protein-Reduced Diet for Young Children during Complementary Feeding : A Randomized Controlled Trial
- 2021
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Ingår i: Foods. - Basel : MDPI. - 2304-8158. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Early life is critical for developing healthy eating patterns. This study aimed to investigate the effects of a Nordic, protein-reduced complementary diet (ND) compared to a diet following the current Swedish dietary guidelines on eating patterns and food acceptance. At 4–6 months (mo) of age infants were randomized to a Nordic group (NG, n = 41) or a Conventional group (CG, n = 40), and followed until 18 mo of age. Daily intake of fruits and vegetables (mean ± sd) at 12 mo was significantly higher in the NG compared to the CG: 341 ± 108 g/day vs. 220 ± 76 g/day (p < 0.001), respectively. From 12 to 18 mo, fruit and vegetable intake decreased, but the NG still consumed 32% more compared to the CG: 254 ± 99 g/day vs. 193 ± 67 g/day (p = 0.004). To assess food acceptance, both groups were tested with home exposure meals at 12 and 18 mo. No group differences in acceptance were found. We find that a ND with parental education initiates healthy eating patterns during infancy, but that the exposure meal used in the present study was insufficient to detect major differences in food acceptance. This is most likely explained by the preparation of the meal. Nordic produce offers high environmental sustainability and favorable taste composition to establish healthy food preferences during this sensitive period of early life.
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39. |
- Johansson, Ulrica, et al.
(författare)
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Active Image-Assisted Food Records in Comparison to Regular Food Records : A Validation Study against Doubly Labeled Water in 12-Month-Old Infants
- 2018
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Ingår i: Nutrients. - : MDPI. - 2072-6643. ; 10:12
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Tidskriftsartikel (refereegranskat)abstract
- Overreporting of dietary intake in infants is a problem when using food records (FR), distorting possible relationships between diet and health outcomes. Image-assisted dietary assessment may improve the accuracy, but to date, evaluation in the pediatric setting is limited. The aim of the study was to compare macronutrient and energy intake by using an active image-assisted five-day FR against a regular five-day FR, and to validate image-assistance with total energy expenditure (TEE), was measured using doubly labeled water. Participants in this validation study were 22 healthy infants randomly selected from the control group of a larger, randomized intervention trial. The parents reported the infants’ dietary intake, and supplied images of main course meals taken from standardized flat-surfaced plates before and after eating episodes. Energy and nutrient intakes were calculated separately using regular FR and image-assisted FRs. The mean (± standard deviations) energy intake (EI) was 3902 ± 476 kJ/day from the regular FR, and 3905 ± 476 kJ/day from the FR using active image-assistance. The mean EI from main-course meals when image-assistance was used did not differ (1.7 ± 55 kJ, p = 0.89) compared to regular FRs nor did the intake of macronutrients. Compared to TEE, image-assisted FR overestimated EI by 10%. Without validation, commercially available software to aid in the volume estimations, food item identification, and automation of the image processing, image-assisted methods remain a more costly and burdensome alternative to regular FRs in infants. The image-assisted method did, however, identify leftovers better than did regular FR, where such information is usually not readily available. View Full-Text
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40. |
- Johansson, Ulrica, 1974-
(författare)
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Complementary feeding based on Nordic foods : effects on nutrient intake, growth, biomarkers and eating behavior
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Early nutrition is fundamental to growth and development. Infants develop long lasting food preferences very early in life from food exposures when the brain is impressionable and sensory pathways are receptive. Early food experiences from bitter and sour tastes found in fruits and vegetables can establish longlasting food preferences and healthy eating behavior. Fruits and vegetables can protect against future non-communicable diseases such as cardiovascular diseases, type 2 diabetes, overweight, obesity and cancer. Nordic fruits, berries and vegetables offer high environmental sustainability and favorable taste compositionto establish a variety of food preferences. In this thesis, the focus is on early feeding among healthy, full-term infants and how to establish eating based on Nordic foods.Methods: The thesis is based on the randomized, controlled trial Optimized complementary feeding study (OTIS), with three papers on the outcomes of the trial and one validation paper. In the trial, the experimental Nordic group (n=125) consumed a diet based on Nordic foods, reduced in protein whereas the control group (n=125) followed the current nutritional recommendations for infants from the Swedish Food Agency. The Nordic group was exposed to a variety of flavors from Nordic, homemade fruit, berry and vegetable purées according to a taste portion schedule with repeated exposures for 24 days during 4-6 months of age. From 6 to 18 months of age the Nordic group experienced a multicomponent intervention of homemade Nordic baby food recipes, family recipes and protein-reduced baby food products together with parental support through social media. The control group followed the Swedish recommendations on how to introduce taste portions and solid foods and were supplied with commercial baby food products with regular content. At baseline, 9, 12 and 18 months of age anthropometry, blood samples, urine samples, questionnaires and dietary data were collected.Results: Of the 250 infants, 82% (n=206) finished the study until 18 months of age. The attrition rate was higher in the Nordic group (p=0.012). The Nordic group consumed more plant-based foods as fruits, berries, roots and vegetables during the entire study period except at 6 months of age. The protein intake was higher in the control group throughout the study. Plasma urea was higher in the control group as a response to the higher protein intake and plasma folate was higher in the Nordic group as a reflection of the higher fruit and vegetables intake. There were no differences in growth, total energy intake, iron status, breastfeeding durationor any demographic variables between the groups.Conclusions: A Nordic diet, reduced in protein, increasedthe daily intake of fruit, berries, roots and vegetables, establishing a preferable eating pattern lasting over 12 months. Parental support and systematical flavor learning of Nordic foods may have impacted the infants’ dietary intake in the Nordic group. The Nordic diet is both feasible and safe for infants’ growth, nutritional requirements and development during complementary feeding period between 4-18 months of age. Thus, it may serve as a healthy and environmentally sustainable alternative to future infants and their parents.
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41. |
- Johansson, Ulrica, et al.
(författare)
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Protein-Reduced Complementary Foods Based on Nordic Ingredients Combined with Systematic Introduction of Taste Portions Increase Intake of Fruits and Vegetables in 9 Month Old Infants : A Randomised Controlled Trial
- 2019
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Ingår i: Nutrients. - : MDPI. - 2072-6643. ; 11:6
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Tidskriftsartikel (refereegranskat)abstract
- Fruits and vegetables are healthy foods but under-consumed among infants and children. Approaches to increase their intake are urgently needed. This study investigated the effects of a systematic introduction of taste portions and a novel protein-reduced complementary diet based on Nordic foods on fruit and vegetable intake, growth and iron status to 9 months of age. Healthy, term infants (n = 250) were recruited and randomly allocated to either a Nordic diet group (NG) or a conventional diet group (CG). Infants were solely breast- or formula-fed at study start. From 4 to 6 months of age, the NG followed a systematic taste portions schedule consisting of home-made purées of Nordic produce for 24 days. Subsequently, the NG was supplied with baby food products and recipes of homemade baby foods based on Nordic ingredients but with reduced protein content compared to the CG. The CG was advised to follow current Swedish recommendations on complementary foods. A total of 232 participants (93%) completed the study. The NG had significantly higher intake of fruits and vegetables than the CG at 9 months of age; 225 ± 109 g/day vs. 156 ± 77 g/day (p < 0.001), respectively. Energy intake was similar, but protein intake was significantly lower in the NG (−26%, p < 0.001) compared to the CG. This lower protein intake was compensated for by higher intake of carbohydrate from fruits and vegetables. No significant group differences in growth or iron status were observed. The intervention resulted in significantly higher consumption of fruits and vegetables in infants introduced to complementary foods based on Nordic ingredients.
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42. |
- Karlsland Åkeson, Pia, et al.
(författare)
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Serum Vitamin D Depends Less on Latitude Than on Skin Color and Dietary Intake During Early Winter in Northern Europe
- 2016
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Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - : Lippincott Williams & Wilkins. - 0277-2116 .- 1536-4801. ; 62:4, s. 643-649
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate if dietary vitamin D intake is adequate for sufficient vitamin D status during early winter in children living in Sweden, irrespective of latitude or skin color.METHODS: As part of a prospective, comparative, two-center intervention study in northern (63°N) and southern (55°N) Sweden, dietary intake, serum 25-hydroxyvitamin D (S-25(OH) D), associated laboratory variables, and socio-demographic data were studied in 5 to 7-year-old children with fair and dark skin in November and December.RESULTS: 206 children with fair/dark skin were included, 44/41 and 64/57 children in northern and southern Sweden, respectively. Dietary vitamin D intake was higher in northern than southern Sweden (p=0.001), irrespective of skin color, partly due to higher consumption of fortified foods, but only met 50-70% of national recommendations (10 μg/day). S-25(OH) D was higher in northern than southern Sweden, in children with fair (67 vs. 59 nmol/L; p < 0.05) and dark skin (56 vs. 42 nmol/L; p < 0.001). S-25(OH) D was lower in dark than fair skinned children at both sites (p < 0.01), and below 50 nmol/L in 40 and 75% of dark-skinned children in northern and southern Sweden, respectively.CONCLUSIONS: Insufficient vitamin D status was common during early winter in children living in Sweden, particularly in those with dark skin. Although, higher dietary vitamin D intake in northern than southern Sweden attenuated the effects of latitude, a northern country of living combined with darker skin and vitamin D intake below recommendations are important risk factors for vitamin D insufficiency.
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43. |
- Karlsson Lind, Linnéa, et al.
(författare)
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Valproic acid utilization among girls and women in Stockholm : Impact of regulatory restrictions
- 2018
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Ingår i: Epilepsia open. - : Wiley-Blackwell Publishing Inc.. - 2470-9239. ; 3:3, s. 357-363
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Tidskriftsartikel (refereegranskat)abstract
- Objective: In November 2014, the European Medicines Agency (EMA) strengthened restrictions on the use of valproic acid in girls and women of childbearing potential. The objective of this study was to determine whether there has been a change in initiations of valproic acid treatment to females after the regulatory restrictions and to assess if such changes differed between indications (epilepsy and psychiatric disorder).Methods: An interrupted time-series analysis was conducted using all initiations of valproic acid in Stockholm, Sweden. from January 2011 to June 2017. Female and male patients aged 0-45 years with a recorded diagnosis of epilepsy and/or a psychiatric disorder were compared.Results: Before the EMA warning, a decline in trend of valproic acid initiations was seen in patients with epilepsy. After the warning, a significant decrease of valproic acid initiations was seen in women with a psychiatric disorder, but not in women with epilepsy.Significance: The regulatory warning appeared to have significantly influenced valproic acid initiations in women of childbearing age with a psychiatric disorder. No effect was seen in women with epilepsy, probably because the decline had started long before.
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44. |
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45. |
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46. |
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47. |
- Lind, Lars, et al.
(författare)
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The haemodynamic response to hyperinsulinaemia in hypertensive subjects
- 1999
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Ingår i: Journal of Human Hypertension. - 0950-9240 .- 1476-5527. ; 13:1, s. 41-45
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Tidskriftsartikel (refereegranskat)abstract
- In order to study if the vasodilatory action of insulin is impaired in essential hypertension, 24 untreated patients were challenged with a 2 h euglycaemic hyperinsulinaemic clamp (56 E/m2). Cardiac index (CI) was measured by thoracic impedance cardiography and leg blood flow (LBF) by Doppler ultrasound. During the clamp procedure a significant decline in blood pressure was seen (3.0-5.6% over 120 min, P < 0.001). However, no significant effects on ejection fraction (+6 +/- 8 s.d.%), CI (-1 +/- 2%), heart rate (+2 +/- 1%) or total peripheral resistance (TPRI, -0.5 +/- 2%) were found. LBF increased by 22 +/- 35% (P < 0.005). These haemodynamic effects of insulin were not related to age, sex, body mass index, blood pressure or the insulin-mediated glucose uptake during the clamp. In conclusion, insulin increased LBF, but no changes in CI and TPRI were seen in the hypertensive patients. Furthermore, no association between the ability of insulin to induce vasodilatation and to promote glucose uptake was seen.
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48. |
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49. |
- Lind, Marcus, et al.
(författare)
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Cystatin C and creatinine as markers of bleeding complications, cardiovascular events and mortality during oral anticoagulant treatment
- 2013
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Ingår i: Thrombosis Research. - : Pergamon-Elsevier. - 0049-3848 .- 1879-2472. ; 132:2, s. E77-E82
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Impaired kidney function has been linked to both ischemic events as well as bleeding complications in several clinical conditions. Our aim was to investigate if cystatin C, creatinine and calculated glomerular filtration rate (eGFR) were related to future risk of bleeding complications, cardiovascular events or all-cause mortality during oral anticoagulant treatment.Materials and methods: In a cohort study, 719 patients on long-term vitamin K antagonist (VKA) treatment were followed for a mean of 4.2 years. Blood sampling was taken at inclusion and patients were followed prospectively. Cystatin C and creatinine were analysed and eGFR was calculated. All medical records were reviewed. Major bleeding events, myocardial infarctions, strokes, arterial emboli, and deaths were recorded and classified.Results: After adjustment for age, no association between cystatin C, creatinine or eGFR and major bleeding was found. Cystatin C was independently associated with cardiovascular events (hazard ratio 1.50 (95% CI: 1.27-1.77)) and all-cause mortality (hazard ratio 1.62 (95% CI: 1.38-1.90)). Creatinine was only associated with all-cause mortality, while eGFR was not associated with any of the outcomes.Conclusions: Our findings underscore the superiority of cystatin C as a marker of cardiovascular risk compared to creatinine or eGFR. VKA-treated patients with increased cystatin C levels should be considered to be at an increased risk of cardiovascular events, and not bleeding complications.
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50. |
- Lind, Marcus, et al.
(författare)
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D-dimer predicts major bleeding, cardiovascular events and all-cause mortality during warfarin treatment
- 2014
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Ingår i: Clinical Biochemistry. - : Elsevier BV. - 0009-9120 .- 1873-2933. ; 47:7-8, s. 570-573
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Previous studies have shown that biomarkers in blood plasma can predict bleeding complications during anticoagulant treatment as well as thromboembolic events and may improve existing risk stratification schemes in patients on or considered for oral anticoagulant treatment. The aim of this study was to investigate if levels of D-dimer, tissue plasminogen activator (tPA) and its complex with plasminogen inhibitor type 1 (tPA/PAI-1 complex) can predict major bleedings, cardiovascular events and all-cause mortality in patients with warfarin treatment.Design and methods: In a longitudinal cohort study, 719 patients on oral anticoagulant treatment were followed for a total of 3001 treatment years. Major bleeding, stroke, arterial emboli, myocardial infarction and death were recorded and classified. Blood samples collected at baseline were analyzed for D-dimer, tPA, and tPA/PAI-1 complex.Results: In multivariate Cox regression analysis, high levels of D-dimer were associated with major bleeding (HR 1.27 per SD; 95% CI: 1.01-1.60), cardiovascular events (HR 1.23 per SD; 95% CI: 1.05-1.45) and all-cause mortality (HR 1.25 per SD; 95% CI: 1.06-1.47). Neither tPA nor the tPA/PAI-1 complex was associated with major bleeding, cardiovascular events or all-cause mortality.Conclusion: We conclude that high levels of D-dimer predict major bleeding, cardiovascular events and all-cause mortality during warfarin treatment. (C) 2014 The Canadian Society of Clinical Chemists.
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