| 1. |
- Rapp [Nordin], Erika, 1970-
(author)
-
Sensory, attitudinal, and contextual aspects of the meal : health implications and connections with risk factors for coronary heart disease and obesity
- 2008
-
Doctoral thesis (other academic/artistic)abstract
- Det övergripande syftet var att undersöka mat- och måltidsrelaterade faktorer som bidragande orsak till övervikt och hjärt-kärlsjukdom.I en sensorisk studie jämfördes individer som insjuknat i hjärtinfarkt med en frisk kontroll-grupp med avseende på preferens för mat med hög respektive låg fetthalt, smakkänslighet för grundsmakerna (surt, beskt, salt, sött, umami och metalliskt) samt det beska ämnet 6-n-propylthiouracil (PROP). Undersökningsgruppen hade mer ogynnsam metabolisk profil, vilket kan indikera högre intag av fet, energirik mat och mindre intag av frukt och grönsaker, jämfört med kontrollgruppen. Det påvisades emellertid ingen signifikant skillnad i smakkänslighet mel-lan grupperna. När grupperna slogs samman konstaterades däremot att känslighet för surt var relaterat till lågt body mass index (BMI), och känslighet för beska var relaterat till lågt HDL-kolesterol samt högt BMI och bukfetma. Det indikerar ett samband mellan riskprofil, smak-känslighet och matvanor. Upplevd beska kan vara en bidragande orsak till låg konsumtion av frukt och grönsaker. Båda grupperna föredrog generellt mat med hög fetthalt, varför preferens för hög fetthalt i sig inte kan anses vara en bidragande riskfaktor för insjuknande i hjärtinfarkt. För hälften av rätterna påvisades emellertid ingen signifikant skillnad i preferens för hög- respek-tive låg fetthalt. För att undersöka hur sensoriska egenskaper förändras vid olika fetthalter stu-derades två såser med varierande smörmängd. Totalt sett minskade smakegenskaperna (tomat, vitlök, timjan, kyckling, syrlighet) när mer smör tillsattes, medan smörsmaken och såsernas vis-kositet ökade. Stor skillnad i smörmängd (energiinnehåll) frambringar däremot endast små smakförändringar.I en enkätstudie påvisades att matvanor och inställning till mat och hälsa skilde sig mellan män och kvinnor samt beroende av BMI. En klusteranalys resulterade i tre grupper, varav en grupp med jämn könsfördelning som i genomsnitt hade högre BMI och sämre matvanor. I den gruppen ingick kvinnor som är mindre intresserade av sin hälsa och män som är mer fokuserade på mat som njutning, vilket indikerar att orsakerna till ohälsosamma matvanor skiljer sig mellan kvinnor och män. I en öppen fråga beskrevs essensen i en god måltid innefatta både krav på maten (råvaror, maträtter, menyer, sensoriska egenskaper samt näring och mättnad) och krav på sammanhanget (estetik, gemenskap, lugn och ro, och sinnesstämning). Att identifiera indivi-ders olika anspråk på en god måltid kan vara komplementära kunskaper till hjälp vid föränd-ring av mat- och måltidsvanor. Slutligen bidrog en litteraturfördjupning till kunskaper om mat- måltidsupplevelser med fokus på uppskattning och tillfredsställelse i relation till hälsotillstånd.Resultaten indikerar att det är av betydelse att identifiera enskilda individers förutsättningar och preferenser för mat och måltider vad gäller smak, matvanor och kontext i vardagen för att underlätta intervention och hälsofrämjande arbete.
|
|
| 2. |
- Gulliksson, Mats, 1954-
(author)
-
Studies of Secondary Prevention after Coronary Heart Disease with Special Reference to Determinants of Recurrent Event Rate
- 2009
-
Doctoral thesis (other academic/artistic)abstract
- Objectives. The first aim was to examine the effects of secondary prevention with a focus on determinants in the risk of recurrent coronary heart disease (CHD). The second aim was to analyse the effects of a cognitive behavioural therapy (CBT) intervention on the risk of recurrent cardiovascular disease (CVD) and to investigate the psychosocial situation of CHD patients. Material and methods. Papers I and II were based on the Swedish Acute Myocardial Infarction Statistics Register, 1969 to 2001: 775,901 events in 589,341 subjects. Papers III and IV were based on The Secondary Prevention in Uppsala Primary Care project (SUPRIM), a randomized controlled clinical trial in 362 CHD patients. Results. The risk of a recurrent acute myocardial infarction (AMI) event was highly dependent on time from the previous event, with the greatest risk immediately after an AMI event. In addition, sex, age, and AMI number influenced the general risk level. Furthermore, there has been a major decline in recurrence risk over 30 years, and there were considerable geographical differences in risk, best explained by residential area population density, with a high recurrent AMI risk in areas with the lowest and the highest population densities, and the lowest risk in areas with moderate population density. Disease status and sex were determinants of psychological well-being the first year after a CHD event. Sex seemed to be the stronger determinant. The CBT intervention focused on stress management during one year in patients with CHD. There was significantly improved outcome in the intervention group on recurrent CVD and recurrent AMI during a 9 year follow up. A dose-response relationship was demonstrated between attendance rate at intervention group meetings and outcome, the higher the attendance rate the better the outcome. Conclusions. The risk of a recurrent AMI event was dependent on time from the previous event, with major improvement seen in recent decades. Regional differences were best explained by population density. Female CHD patients were at high risk concerning well-being after a coronary event, which deserves special attention. The CBT intervention for CHD patients improved outcomes concerning the risk of recurrent CVD and AMI events.
|
|
| 3. |
- Norberg, Margareta, 1951-
(author)
-
Identifying risk of type 2 diabetes : epidemiologic perspectives from biomarkers to lifestyle
- 2006
-
Doctoral thesis (other academic/artistic)abstract
- Type 2 diabetes is a significant health problem because of its high prevalence and strong association with cardiovascular morbidity and mortality. An increase of type 2 diabetes is predicted due to increasing obesity and sedentary lifestyle habits. The development from latent to diagnostic disease spans many years and during this time it is possible to prevent or postpone type 2 diabetes using lifestyle and pharmacological interventions. The objective of this thesis is to investigate and describe early patterns and risk indicators of type 2 diabetes. The focus is on type 2 diabetes as one component in metabolic syndrome, i.e. the clustering of several cardiovascular risk markers. Two studies based on the Västerbotten Intervention Programme (VIP) provided the data; one case-referent study nested within VIP which includes 237 diabetes cases that were clinically diagnosed 5.4 years after the health survey, each with two referents; and one panel study with 5 consecutive annual cohorts including subjects that participated in VIP between1990 and 1994 and returned to a follow-up after 10 years, a total of 16 492 individuals. Associations between risk markers and type 2 diabetes or metabolic syndrome are evaluated by several statistical techniques. A model of metabolic syndrome is hypothesized. A prediction model for developing type 2 diabetes among middle-aged individuals is proposed, where high risk is defined as having at least two out of three risk criteria (fasting plasma glucose ≥6.1 mmol/L, HbA1c ≥4.7% (Swedish Mono-S standard) and BMI ≥27 in men and BMI ≥30 in women). With positive predictive values of 32% in men and 46% in women, this model performs at least as well as other published prediction models. Information on family history of diabetes does not improve the result and the cumbersome oral glucose tolerance test is not needed. Therefore this model should be feasible for use in routine care. A model of metabolic syndrome with five composite factors, based on 14 variables including markers produced by adipose tissue and b-cells, suggest that obesity with insulin resistance and b-cell decompensation are the core perturbations in the early stages of type 2 diabetes, while inflammation and dyslipidemia could not be shown to be independent early risk indicators. The composite factors do not improve the prediction as compared to the single markers of fasting glucose, BMI and proinsulin and, possibly blood pressure values. Stress (measured as passive or tense working conditions) and weak social support (measured as emotional support), are suggested to be strong risk indicators along with high BMI for type 2 diabetes in women. In men BMI is predictive, but the stress variables are not shown to be associated with future type 2 diabetes. A social gap is indicated by double risk of metabolic syndrome among subjects with low (≤ 9 years at school) compared to high education (≥ 13 years). High consumption of Swedish smokeless tobacco, snuff (>4 cans/week), is independently associated with metabolic syndrome, obesity and hypertriglyceridemia, but not with dysregulation of glucose. To conclude, single markers, that are commonly used in daily practice, are useful and sufficient for identification of subjects that are in the early stages of type 2 diabetes. Obesity with insulin resistance and b-cell decompensation are the core perturbations in early development to T2DM. Lifestyle, socioeconomic and psychosocial markers, in addition to biomarkers, are important determinants of future type 2 diabetes and metabolic syndrome, albeit not similarly among men and women.
|
|
| 4. |
- Andersson, Per
(author)
-
Predicting Health Behaviour – Population-Based Studies of Knowledge and Behaviour Related to Cardiovascular Diseases
- 2006
-
Doctoral thesis (other academic/artistic)abstract
- The overall aim was to study factors that affect behaviour related to CVD (cardiovascular diseases). Study I tested whether gender, education and so-cioeconomic status correlated to knowledge about risk factors, and Study II studied knowledge and risk behaviour from a national perspective (Sweden versus Poland). Furthermore, Study III examined whether obese people dif-fered from people of normal weight regarding knowledge about risk factors, and Study IV examined whether risk behaviour is affected by personal ex-perience of illness and family history of CVD. The studies are population-based with cross-sectional design. Data were obtained by questionnaires and by screening results of risk factors related to CVD. The studies were carried out among 50-year old men and women in Västmanland, Sweden (n=1011) and in Wroclaw, Poland (n=1043).The results show that women are more knowledgeable than men about the risk factors for CVD, and that low education is associated with insufficient knowledge about CVD (Study I). The discrepancy between knowledge and behaviour was greater among the Poles than it was among the Swedes (Study II). Obese individuals did not differ significantly from individuals with a normal weight regarding knowledge of cardiovascular risk factors when education was controlled for (Study III). Individuals with a personal experience of illness may be more inclined to change smoking behaviour than the average person (Study IV).In conclusion, knowledge about risk factors for CVD varies with education, gender and, to a certain degree, nationality. However, knowledge does not only consist of the conditions of behaviour change. The results in the thesis substantiate theories suggesting that change in risk behaviour is a process over time. Predictors of risk behaviours on the individual level as well as national level are of importance, and needs to be considered in the every day practice of health care professionals.
|
|
| 5. |
- Wennberg, Patrik, 1972-
(author)
-
Beyond the established risk factors of myocardial infarction : lifestyle factors and novel biomarkers
- 2009
-
Doctoral thesis (other academic/artistic)abstract
- Age, male sex, hypertension, smoking, diabetes, dyslipidaemia, and obesity are considered as established risk factors for cardiovascular diseases. Several of these established cardiovascular risk factors are strongly influenced by lifestyle. Novel biomarkers from different mechanistic pathways have been associated with cardiovascular risk, but their clinical utility is still uncertain. The overall objective of the thesis was to evaluate the associations between certain lifestyle factors (physical activity and snuff use), biomarkers reflecting the haemostatic and the inflammatory systems and risk of a future first-ever myocardial infarction. A prospective incident nested case-control study design was used with a total of 651 cases of myocardial infarction and 2238 matched controls from the population-based Northern Sweden Health and Disease Study. The effects of commuting activity, occupational and leisure time physical activity on risk of myocardial infarction were studied. A clearly increased risk of myocardial infarction was found for car commuting compared to active commuting (walking, cycling or going by bus). High versus low leisure time physical activity was associated with decreased risk of myocardial infarction. Low occupational physical activity was associated with risk of myocardial infarction in men. The risk of myocardial infarction or sudden cardiac death was studied in male snuff users compared to non-tobacco users. No increased risk was found for myocardial infarction or sudden cardiac death among snuff users without a previous history of smoking. However, for sudden cardiac death the study did not have statistical power to detect small differences in risk. Plasma levels of haemostatic markers have previously shown to be associated with risk of myocardial infarction, but as haemostatic markers are also acute-phase reactants, it is not clear if their association with myocardial infarction is independent of inflammatory markers. In the present study, the haemostatic markers D-dimer, von Willebrand factor (VWF), tissue plasminogen activator (t-PA), and tissue plasminogen activator/plasminogen activator inhibitor-1 complex (t-PA/PAI-1 complex) were associated with risk of myocardial infarction after adjustment for established risk factors and the inflammatory markers C-reactive protein (CRP) and interleukin 6 (IL-6). Furthermore, the addition of eight haemostatic and inflammatory markers could improve the predictive ability for future myocardial infarction beyond that of a model utilizing only established risk factors. Established risk factors and novel biomarkers were explored as potential mediators of the reduced risk of myocardial infarction related to active commuting. A combination of established risk factors, haemostatic and inflammatory markers appeared to explain a substantial proportion (40%) of the difference in risk for myocardial infarction between active commuters and car commuters. IL-6, t-PA, t-PA/PAI-1 complex, apo B/apo A-1 ratio, and BMI seemed to be the largest potential mediators when tested individually. In conclusion, regular physical activity such as active commuting is associated with reduced risk of a first-ever myocardial infarction. This effect could in part be mediated through a beneficial influence on haemostasis and inflammation, as well as a positive impact on established risk factors. Several haemostatic markers are associated with risk of myocardial infarction independent of established risk factors and inflammatory markers. The combination of haemostatic and inflammatory markers may enhance predictive ability beyond established risk factors. Our findings do not support the hypothesis that snuff use increases the risk of myocardial infarction.
|
|
