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  • 1.
    Alehagen, Urban
    et al.
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Johansson, Peter
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Björnstedt, Mikael
    Division of Pathology F42, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Rosén, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Post, Claes
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Aaseth, Jan
    Research Department, Innlandet Hospital Trust and Hedmark University College, Norway.
    Relatively high mortality risk in elderly Swedish subjects with low selenium status2016In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 70, no 1, p. 91-96Article in journal (Refereed)
    Abstract [en]

    Background/Objectives: 

    The daily dietary intake of selenium (Se), an essential trace element, is still low in Sweden in spite of decades of nutritional information campaigns and the effect of this on the public health is presently not well known. The objective of this study was to determine the serum Se levels in an elderly Swedish population and to analyze whether a low Se status had any influence on mortality.

    Subjects/Methods: 

    Six-hundred sixty-eight (n=668) elderly participants were invited from a municipality and evaluated in an observational study. Individuals were followed for 6.8 years and Se levels were re-evaluated in 98 individuals after 48 months. Clinical examination of all individuals included functional classification, echocardiography, electrocardiogram and serum Se measurement. All mortality was registered and endpoints of mortality were assessed by Kaplan–Meier plots, and Cox proportional hazard ratios adjusted for potential confounding factors were calculated.

    Results: 

    The mean serum Se level of the study population (n=668) was 67.1 μg/l, corresponding to relatively low Se intake. After adjustment for male gender, smoking, ischemic heart disease, diabetes, chronic obstructive pulmonary disease and impaired heart function, persons with serum Se in the lowest quartile had 43% (95% confidence interval (CI): 1.02–2.00) and 56% (95% CI: 1.03–2.36) increased risk for all-cause and cardiovascular mortality, respectively. The result was not driven by inflammatory effects on Se concentration in serum.

    Conclusion: 

    The mean serum Se concentration in an elderly Swedish population was 67.1 μg/l, which is below the physiological saturation level for several selenoprotein enzymes. This result may suggest the value of modest Se supplementation in order to improve the health of the Swedish population.

  • 2.
    Christensson, Lennart
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Unosson, Mitra
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evaluation of nutritional assessment techniques in elderly people newly admitted to municipal care2002In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 56, no 9, p. 810-818Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the Subjective Global Assessment (SGA) and the Mini Nutritional Assessment (MNA) with regard to validity using a combination of anthropometric and serum-protein measurements as standard criteria to assess protein-energy malnutrition (PEM).

    Design: Cross-sectional study with consecutive selection of residents aged 65 y.

    Setting: A municipality in the south of Sweden.

    Subjects: During a year, starting in October 1996, 148 females and 113 males, aged 65-104 y of age, newly admitted to special types of housing for the elderly, were included in the study.

    Results: According to SGA, 53% were assessed as malnourished or moderately malnourished on admission. The corresponding figure from MNA was 79% malnourished or at risk of malnutrition. Both tools indicated that anthropometric values and serum proteins were significantly lower in residents classified as being malnourished (P<0.05). Sensitivity in detecting PEM was in SGA 0.93 and in MNA 0.96 and specificity was 0.61 and 0.26, respectively. Using regression analysis, weight index and serum albumin were the best objective nutritional parameters in predicting the SGA- and MNA classifications. Item 'muscle wasting' in SGA and 'self-experienced health status' in MNA showed most predictive power concerning the odds of being assessed as malnourished.

    Conclusions: SGA was shown to be the more useful tool in detecting residents with established malnutrition and MNA in detecting residents who need preventive nutritional measures.

  • 3.
    Delisle Nyström, C.
    et al.
    Karolinska Institute, Sweden.
    Pomeroy, J.
    Marshfield Clin Research Institute, WI USA.
    Henriksson, P.
    Karolinska Institute, Sweden; University of Granada, Spain.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Ortega, F. B.
    Karolinska Institute, Sweden; University of Granada, Spain.
    Maddison, R.
    Deakin University, Australia.
    Migueles, J. H.
    University of Granada, Spain.
    Löf, M.
    Karolinska Institute, Sweden.
    Evaluation of the wrist-worn ActiGraph wGT3x-BT for estimating activity energy expenditure in preschool children2017In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 71, no 10, p. 1212-1217Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Easy-to-use and accurate methods to assess free-living activity energy expenditure (AEE) in preschool children are required. The aims of this study in healthy preschool children were to (a) evaluate the ability of the wrist-worn ActiGraph wGT3x-BT to predict free-living AEE and (b) assess wear compliance using a 7-day, 24-h protocol. SUBJECTS/METHODS: Participants were 40 Swedish children (5.5 +/- 0.2 years) in the Mobile-based intervention intended to stop obesity in preschoolers (MINISTOP) obesity prevention trial. Total energy expenditure (TEE) was assessed using the doubly labeled water method during 14 days. AEE was calculated as (TEEx0.9) minus predicted basal metabolic rate. The ActiGraph accelerometer was worn on the wrist for 7 days and outputs used were mean of the daily and awake filtered vector magnitude (mean VM total and mean VM waking). RESULTS: The ActiGraph was worn for 7 (n = 34, 85%), 6 (n = 4, 10%), 5 (n = 1, 2.5%) and 4 (n = 1, 2.5%) days (a valid day was. 600 awake minutes). Alone, mean VM total and mean VM waking were able to explain 14% (P = 0.009) and 24% (P = 0.001) of the variation in AEE, respectively. By incorporating fat and fat-free mass in the models 58% (mean VM total) and 62% (mean VM waking) in the variation of AEE was explained (P amp;lt; 0.001). CONCLUSIONS: The wrist-worn ActiGraph wGT3x-BT in combination with body composition variables explained up to the 62% of the variation in AEE. Given the high wear compliance, the wrist-worn ActiGraph has the potential to provide useful information in studies where physical activity in preschool children is measured.

  • 4.
    Henriksson, Hanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institute, Sweden; University of Granada, Spain.
    Eriksson, Britt
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Flinke Carlsson, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Henriksson, Pontus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. University of Granada, Spain.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institute, Sweden.
    Longitudinal assessment of body composition in healthy Swedish children from 1 week until 4 years of age2017In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 71, no 11, p. 1345-1352Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Knowledge of longitudinal body composition development is required to identify the mechanisms behind childhood overweight and obesity and to prevent these conditions. However, accurate data on this development in early childhood are lacking. Our aim was to describe the longitudinal body composition development in healthy young Swedish children. SUBJECTS/METHODS: Body size and composition were assessed in 26 children using air-displacement plethysmography (1 and 12 weeks and 4.4 years of age) and isotope dilution (1.5 and 3 years of age) and compared with available reference data. RESULTS: Body fat (%) for boys (n = 16) was 12.8 +/- 3.9 (1 week), 25.6 +/- 4.8 (12 weeks), 28.2 +/- 3.8 (1.5 years), 27.3 +/- 5.1 (3 years) and 26.1 +/- 3.5 (4.4 years). For girls (n = 10) these values were 15.3 +/- 2.9, 25.7 +/- 3.9, 27.9 +/- 3.3, 26.3 +/- 7.2 and 26.0 +/- 5.3, respectively. These values were above the Fomon reference values at 1.5 years of age and later and higher than the Butte reference (Po0.05) for boys at 1.5 years of age. At all ages the coefficients of variation were higher for body fat (%) (12-30%) than for BMI (4-11%). CONCLUSIONS: At 4 years of age our children had more body fat than indicated by reference data. This high level may have already been established at 1.5 years of age but our small sample and the lack of appropriate reference data limit the possibility of drawing firm conclusions. Our results demonstrate the limitations of BMI when investigating overweight and obesity in early life and highlight the need for appropriate reference body composition data in infants and young children.

  • 5.
    Lindahl, Gabriel
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Abrahamsson, Annelie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Dabrosin, Charlotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Dietary flaxseed and tamoxifen affect the inflammatory microenvironment in vivo in normal human breast tissue of postmenopausal women2019In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 73, no 9, p. 1250-1259Article in journal (Refereed)
    Abstract [en]

    Background Anti-oestrogens such as tamoxifen, decrease the risk of breast cancer but are unsuitable for prevention because of their side-effects. Diet modifications may be a breast cancer prevention strategy. Here, we investigated if a diet addition of flaxseed, which can be converted to the phytoestrogen enterolactone by the gut microbiota, exhibited similar effects as tamoxifen on normal human breast tissue in vivo, with special emphasis on inflammatory mediators implicated in cancer progression. Subjects A total of 28 postmenopausal women were included. Thirteen women added 25 g of ground flaxseed per day and 15 were treated with tamoxifen as an adjuvant for early breast cancer for 6 weeks. Microdialysis of normal breast tissue and, as a control, in subcutaneous abdominal fat was performed for sampling of extracellular proteins in vivo before and after exposures. Results Enterolactone levels increased significantly after flaxseed. IL-1Ra and IL-1Ra/IL-1 beta ratio in the breast increased in a similar fashion after the two different treatments. Flaxseed also increased breast specific levels of IL-1RT2, IL-18 and sST2 and an overall increase of MMP-9. These changes correlated significantly with enterolactone levels. Tamoxifen decreased breast tissue levels of IL-8 and IL-18. None of the treatments induced any changes of IL-1 beta, IL-1RT1, IL-18BP, IL-33, IL-6, IL-6RA, MMP-1, MMP-2 and MMP-3. Conclusions We conclude that dietary flaxseed and tamoxifen exert both similar and different effects, as listed above, on normal breast tissue in vivo and that a relatively modest diet change can induce significant effects on the breast microenvironment.

  • 6.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Physical activity pattern and activity energy expenditure in healthy pregnant and non-pregnant Swedish women2011In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 65, no 12, p. 1295-1301Article in journal (Refereed)
    Abstract [en]

    Background/Objectives: Energy costs of pregnancy approximate 320 MJ in well-nourished women, but whether or not these costs may be partly covered by modifications in activity behavior is incompletely known. In healthy Swedish women: (1) to evaluate the potential of the Intelligent Device for Energy Expenditure and Physical Activity (IDEEA) to assess energy expenditure during free-living conditions, (2) to assess activity pattern, walking pace and energy metabolism in pregnant women and non-pregnant controls, and (3) to assess the effect on energy expenditure caused by changes in physical activity induced by pregnancy. less thanbrgreater than less thanbrgreater thanSubjects/Methods: Activity pattern was assessed using the IDEEA in 18 women in gestational week 32 and in 21 non-pregnant women. Activity energy expenditure (AEE) was assessed using IDEEA, as well as using the doubly labelled water method and indirect calorimetry. less thanbrgreater than less thanbrgreater thanResults: AEE using the IDEEA was correlated with reference estimates in both groups (r = 0.4-0.5; Pandlt;0.05). Reference AEE was 0.9 MJ/24 h lower in pregnant than in non-pregnant women. Pregnant women spent 92 min/24 h more on sitting, lying, reclining and sleeping (P = 0.020), 73 min/24 h less on standing (P = 0.037) and 21 min/24 h less on walking and using stairs (P = 0.049), and walked at a slower pace (1.1 +/- 0.1 m/s versus 1.2 +/- 0.1 m/s; P = 0.014) than did non-pregnant controls. The selection of less demanding activities and slower walking pace decreased energy costs by 720 kJ/24 h and 80 kJ/24 h, respectively. less thanbrgreater than less thanbrgreater thanConclusion: Healthy moderately active Swedish women compensated for the increased energy costs of pregnancy by 0.9 MJ/24 h. The compensation was mainly achieved by selecting less demanding activities.

  • 7.
    Sandin, Anna
    et al.
    Barnkliniken, Umeå lasarett.
    Annus, T
    Tartu University Childrens Hospital, Tartu, Estonia.
    Björkstén, Bengt
    Institute of Environment, Karolinska Institute, Stockholm.
    Nilsson, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Riikjärv, M-A
    Tallin Childrens Hospital, Tallin, Estonia.
    van Hage-Hamsten, M
    Medicinkliniken, Klinisk immunologi och allergi, Karolinska institutet, Stockholm.
    Bråbäck, Lennart
    Dept of Public Health and Research, Sundsvall.
    Prevalence of self-reported food allergy and IgE antibodies to food allergens in Swedish and Estonian schoolchildren2005In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 59, no 3, p. 399-403Article in journal (Refereed)
    Abstract [en]

    Objective: To compare the prevalence of self-reported food allergy and IgE antibodies to food allergens in wheezing and non-wheezing Estonian and Swedish schoolchildren, in the light of the disparities in the standard of living, food consumption and prevalence of respiratory allergies that still exist between Estonia and the Scandinavian countries. Design and setting: As a part of the ISAAC Phase II study, children from a random sample of schools in Tallinn in Estonia and Linköping and Östersund in Sweden participated in skin prick tests to inhalant allergens and the parents replied to questionnaires. IgE antibodies against a panel of food allergens (egg white, milk, soy bean, fish, wheat and peanut) were taken from children with questionnaire-reported wheezing and a random sample of nonwheezing children. Subjects: Children aged 10-11 y. Results: The prevalence of self-reported food allergy was similar in Estonia and Sweden and about twice as high in wheezing children than in nonwheezing children. In Estonia, however, 3% of the children with perceived food allergy reported reactions from at least four different foods, as compared to 31% in Sweden. The prevalence of sensitisation to food allergens was similar in wheezing and nonwheezing children in Estonia (8%) while, in Swedish children, IgE antibodies to food allergens were more likely among wheezing children (Linköping 38 vs 11%, crude OR 5.1, 95% CI 2.2-11.6, and Östersund 24 vs 7%, crude OR 4.1, 95% CI 1.9-8.5). Conclusion: Our study suggests that IgE-mediated food reactions were less likely in Estonian schoolchildren. Moreover, the perception of food allergy and thereby the meaning of self-reported food allergy appears to be different in the two countries. © 2005 Nature Publishing Group. All rights reserved.

  • 8.
    Söderhamn, Ulrika
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Bachrach-Lindström, Margareta
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna-Christina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Self-care ability and sense of coherence in older nutritional at-risk patients2008In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 62, p. 96-103Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate self-care ability and sense of coherence in geriatric rehabilitation patients nutritionally screened using the Nutritional Form For the Elderly and to relate the patients' perceived health to self-care ability and sense of coherence.

    Design: Cross-sectional study.

    Setting: A geriatric rehabilitation ward in a hospital in western Sweden.

    Subjects: A sample of 172 consecutively recruited patients (65+ years) fulfilled the inclusion criteria. One hundred forty-four patients were included in the study because 16 patients refused to take part and 12 could not complete the entire data collection procedure.

    Methods: Interviews, using one instrument for nutritional screening and other instruments measuring self-care ability and sense of coherence and one question about perceived health, were performed.

    Results: Patients at medium or high risk for undernutrition had lower self-care ability (P<0.001) and weaker sense of coherence (P=0.007) than patients at low risk for undernutrition. Lower self-care ability, being single and admitted from another hospital ward was found to be predictors for being at medium or high risk for undernutrition. Patients who perceived good health had higher self-care ability (P<0.001) and stronger sense of coherence (P<0.001) than patients who perceived ill health.

    Conclusions: There is an indication that older patients at low risk for undernutrition have a greater capability to care for themselves than patients at medium or high risk for undernutrition. Perceived ill health in older patients is associated with lower self-care ability and weaker sense of coherence.

    Sponsorship: Supported by grants from The Research and Development Council Fyrbodal, Trollhättan; The Lions Research Foundation, Linköping, Sweden.

  • 9.
    Tennefors, Catharina
    et al.
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Coward, WA
    MRC, Human Nutrition Research, Cambridge, UK.
    Hernell, O
    Department of Clinical Sciences, Pediatrics, Umeå University, Sweden.
    Wright, A
    MRC, Human Nutrition Research, Cambridge, UK.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Total energy expenditure and physical activity level in healthy young Swedish children 9 or 14 months of age2003In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 57, no 5, p. 647-653Article in journal (Refereed)
    Abstract [en]

    Objectives: To measure total energy expenditure (TEE) and total body water (TBW) in healthy Swedish children 9 or 14 months of age. To compare their TEE with current recommendations for energy intake. To define their body composition and relate this to energy expenditure.

    Design: Children were investigated at 9 or 14 months. The following variables were measured: TEE and TBW (by the doubly labelled water method), weight and length. Total body fat (TBF), sleeping metabolic rate, activity energy expenditure and physical activity level (PAL) were calculated.

    Subjects: Thirty infants 9 months of age and 29 children 14 months of age.

    Results: TEE was 32338, 32229, 31323 and 33128 kJ/kg/day in 9-month-old girls, 9-month-old boys, 14-month-old girls and 14-month-old boys, respectively. At 9 months of age girls and boys contained 29.64.8 and 29.74.5% TBF, respectively. At 14 months the corresponding figures were 29.14.3 and 28.24.3%. There was a significant negative relationship between PAL and %TBF (r=-0.81, P<0.001, n=59).

    Conclusions: Measured TEE plus calculated energy cost of growth confirm previous estimates that the physiological energy requirements of children 9 and 14 months of age are 15–20% lower than current recommendations for energy intake. One possible interpretation of the relationship between PAL and %TBF is that children with a high TBF content are less physically active than children with less TBF. However, this relationship needs further studies.

  • 10.
    Tennefors, Catharina
    et al.
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery. Linköping University, Faculty of Health Sciences.
    Assessment of body fatness in young children using the skinfold technique and BMI vs body water dilution2004In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 58, no 3, p. 541-547Article in journal (Refereed)
    Abstract [en]

    Objective: To compare body fatness estimated using a skinfold technique and body mass index (BMI) with body fatness estimated using the body water dilution method in healthy Swedish children 9 or 14 months of age.

    Methods: Total body fat (TBF) was calculated from total body water, estimated using the doubly labelled water method, and body weight. When expressed in per cent of body weight, these estimates (%TBF-BWD) represented reference values for body fatness. Body fatness was also calculated from skinfold thickness (%TBF-SFT) and as BMI. The children were ranked and grouped into five groups with an increasing level of body fatness using BMI, %TBF-SFT and %TBF-BWD, respectively.

    Subjects: A total of 30 infants 9 months of age and 29 children 14 months of age.

    Results: On average, the children (n=59) had a BMI=17.51.6 kg/m2 and contained 27.83.7 %TBF-SFT and 29.14.4 %TBF-BWD. %TBF-BWD minus %TBF-SFT was=1.354.06%. By measuring %TBF-SFT or BMI, about 35% of the children could be classified in the correct group with respect to body fatness. Serious misclassification (ie two or more groups too high or too low) was, however, more common for %TBF-SFT (29%) than for BMI (17%).

    Conclusions: The capacity of BMI to place children in the correct body fatness group was poor although not quite as poor as the corresponding capacity of the skinfold technique. The latter method produced inaccurate and imprecise estimates of body fatness.

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