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  • 1.
    Aubert, Salome
    et al.
    CHEO Res Inst, Canada.
    Barnes, Joel D.
    CHEO Res Inst, Canada.
    Abdeta, Chalchisa
    Haramaya Univ, Ethiopia.
    Nader, Patrick Abi
    Univ Moncton, Canada; CHU Montreal, Canada.
    Adeniyi, Ade F.
    Univ Ibadan, Nigeria; Nigerian Heart Fdn, Nigeria.
    Aguilar-Farias, Nicolas
    Univ La Frontera, Chile; Univ La Frontera, Chile.
    Andrade Tenesaca, Dolores S.
    Univ Cuenca, Ecuador.
    Bhawra, Jasmin
    Univ Waterloo, Canada.
    Brazo-Sayavera, Javier
    Univ Republ, Uruguay; Univ Republ, Uruguay.
    Cardon, Greet
    Univ Ghent, Belgium.
    Chang, Chen-Kang
    Natl Taiwan Univ Sport, Taiwan.
    Nystrom, Christine Delisle
    CHEO Res Inst, Canada; Karolinska Inst, Sweden.
    Demetriou, Yolanda
    Tech Univ Munich, Germany.
    Draper, Catherine E.
    Univ Witwatersrand, South Africa; Univ Cape Town, South Africa.
    Edwards, Lowri
    Swansea Univ, Wales.
    Emeljanovas, Arunas
    Lithuanian Sports Univ, Lithuania.
    Gaba, Ales
    Palacky Univ Olomouc, Czech Republic.
    Galaviz, Karla I.
    Emory Univ, GA 30322 USA.
    Gonzalez, Silvia A.
    CHEO Res Inst, Canada; Univ Los Andes, Colombia.
    Herrera-Cuenca, Marianella
    Univ Cent Venezuela, Venezuela; Fdn Bengoa Alimentac and Nutr, Venezuela; Observ Venezolano Salud, Venezuela.
    Huang, Wendy Y.
    Hong Kong Baptist Univ, Peoples R China.
    Ibrahim, Izzeldin A. E.
    Aspetar Orthoped and Sports Med Hosp, Qatar.
    Jurimae, Jaak
    Univ Tartu, Estonia.
    Kamppi, Katariina
    LIKES Res Ctr Phys Activ and Hlth, Finland.
    Katapally, Tarun R.
    Univ Regina, Canada.
    Katewongsa, Piyawat
    Mahidol Univ, Thailand.
    Katzmarzyk, Peter T.
    Pennington Biomed Res Ctr, LA 70808 USA.
    Khan, Asaduzzaman
    Univ Queensland, Australia.
    Korcz, Agata
    Poznan Univ Phys Educ, Poland.
    Kim, Yeon Soo
    Seoul Natl Univ, South Korea.
    Lambert, Estelle
    Univ Cape Town, South Africa.
    Lee, Eun-Young
    Queens Univ, Canada.
    Löf, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Loney, Tom
    Mohammed Bin Rashid Univ Med and Hlth Sci, U Arab Emirates.
    Lopez-Taylor, Juan
    Univ Guadalajara, Mexico.
    Liu, Yang
    Shanghai Univ Sport, Peoples R China.
    Makaza, Daga
    Natl Univ Sci and Technol, Zimbabwe.
    Manyanga, Taru
    CHEO Res Inst, Canada.
    Mileva, Bilyana
    BG Act Assoc, Bulgaria.
    Morrison, Shawnda A.
    Univ Primorska, Slovenia.
    Mota, Jorge
    Univ Porto, Portugal.
    Nyawornota, Vida K.
    Univ Ghana, Ghana.
    Ocansey, Reginald
    Univ Ghana, Ghana.
    Reilly, John J.
    Univ Strathclyde, Scotland.
    Roman-Vinas, Blanca
    Nutr Res Fdn, Spain; Univ Girona, Spain; Inst Salud Carlos III, Spain.
    Santos Silva, Diego Augusto
    Univ Fed Santa Catarina, Brazil.
    Saonuam, Pairoj
    Thai Hlth Promot Fdn ThaiHlth, Thailand.
    Scriven, John
    Jersey Sport Fdn, England.
    Seghers, Jan
    Katholieke Univ Leuven, Belgium.
    Schranz, Natasha
    Univ South Australia, Australia.
    Skovgaard, Thomas
    Univ Southern Denmark, Denmark.
    Smith, Melody
    Univ Auckland, New Zealand.
    Standage, Martyn
    Univ Bath, England.
    Starc, Gregor
    Univ Ljubljana, Slovenia.
    Stratton, Gareth
    Swansea Univ, Wales.
    Subedi, Narayan
    Tribhuvan Univ, Nepal.
    Takken, Tim
    Univ Med Ctr Utrecht, Netherlands.
    Tammelin, Tuija
    LIKES Res Ctr Phys Activ and Hlth, Finland.
    Tanaka, Chiaki
    JF Oberlin Univ, Japan.
    Thivel, David
    Univ Clermont Ferrand, France.
    Tladi, Dawn
    Univ Botswana, Botswana.
    Tyler, Richard
    Swansea Univ, Wales.
    Uddin, Riaz
    Univ Queensland, Australia; Stamford Univ Bangladesh, Bangladesh.
    Williams, Alun
    Sir Charles Froissard House, England.
    Wong, Stephen H. S.
    Chinese Univ Hong Kong, Peoples R China.
    Wu, Ching-Lin
    Natl Chung Hsing Univ, Taiwan.
    Zembura, Pawel
    Univ Warsaw, Poland.
    Tremblay, Mark S.
    CHEO Res Inst, Canada.
    Global Matrix 3.0 Physical Activity Report Card Grades for Children and Youth: Results and Analysis From 49 Countries2018In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 15, p. S251-S273Article in journal (Refereed)
    Abstract [en]

    Background: Accumulating sufficient moderate to vigorous physical activity is recognized as a key determinant of physical, physiological, developmental, mental, cognitive, and social health among children and youth (aged 5-17 y). The Global Matrix 3.0 of Report Card grades on physical activity was developed to achieve a better understanding of the global variation in child and youth physical activity and associated supports. Methods: Work groups from 49 countries followed harmonized procedures to develop their Report Cards by grading 10 common indicators using the best available data. The participating countries were divided into 3 categories using the United Nations human development index (HDI) classification (low or medium, high, and very high HDI). Results: A total of 490 grades, including 369 letter grades and 121 incomplete grades, were assigned by the 49 work groups. Overall, an average grade of "C-," "D+," and "C-" was obtained for the low and medium HDI countries, high HDI countries, and very high HDI countries, respectively. Conclusions: The present study provides rich new evidence showing that the situation regarding the physical activity of children and youth is a concern worldwide. Strategic public investments to implement effective interventions to increase physical activity opportunities are needed.

  • 2.
    Aubert, Salome
    et al.
    CHEO Res Inst, Canada.
    Barnes, Joel D.
    CHEO Research Institute, Ottawa, Ontario, Canada..
    Aguilar-Farias, Nicolas
    Univ La Frontera, Chile.
    Cardon, Greet
    Univ Ghent, Belgium.
    Chang, Chen-Kang
    Natl Taiwan Univ Sport, Taiwan.
    Nystrom, Christine Delisle
    Karolinska Inst, Sweden.
    Demetriou, Yolanda
    Tech Univ Munich, Germany.
    Edwards, Lowri
    Swansea Univ, Wales.
    Emeljanovas, Arunas
    Lithuanian Sports Univ, Lithuania.
    Gaba, Ales
    Palacky Univ Olomouc, Czech Republic.
    Huang, Wendy Y.
    Hong Kong Baptist Univ, Peoples R China.
    Ibrahim, Izzeldin A. E.
    Aspetar Orthoped and Sports Med Hosp, Qatar.
    Jurimae, Jaak
    Univ Tartu, Estonia.
    Katzmarzyk, Peter T.
    Pennington Biomed Res Ctr, LA 70808 USA.
    Korcz, Agata
    Poznan Univ Phys Educ, Poland.
    Kim, Yeon Soo
    Seoul Natl Univ, South Korea.
    Lee, Eun-Young
    Queens Univ, Canada.
    Löf, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Loney, Tom
    Mohammed Bin Rashid Univ Med and Hlth Sci, U Arab Emirates.
    Morrison, Shawnda A.
    Univ Primorska, Slovenia.
    Mota, Jorge
    Univ Porto, Portugal.
    Reilly, John J.
    Univ Strathclyde, Scotland.
    Roman-Vinas, Blanca
    Nutr Res Fdn, Spain; Univ Girona, Spain; Inst Salud Carlos III, Spain.
    Schranz, Natasha
    Univ South Australia, Australia.
    Scriven, John
    Jersey Sport Fdn, England.
    Seghers, Jan
    Katholieke Univ Leuven, Belgium.
    Skovgaard, Thomas
    Univ Southern Denmark, Denmark.
    Smith, Melody
    Univ Auckland, New Zealand.
    Standage, Martyn
    Univ Bath, England.
    Starc, Gregor
    Univ Ljubljana, Slovenia.
    Stratton, Gareth
    Swansea Univ, Wales.
    Takken, Tim
    Univ Med Ctr Utrecht, Netherlands.
    Tammelin, Tuija
    LIKES Res Ctr Phys Act and Hlth, Finland.
    Tanaka, Chiaki
    JF Oberlin Univ, Japan.
    Thivel, David
    Clermont Auvergne Univ, France.
    Tyler, Richard
    Swansea Univ, Wales.
    Williams, Alun
    Guernsey Educ Serv, England.
    Wong, Stephen H. S.
    Chinese Univ Hong Kong, Peoples R China.
    Zembura, Pawel
    Univ Warsaw, Poland.
    Tremblay, Mark S.
    CHEO Res Inst, Canada.
    Report Card Grades on the Physical Activity of Children and Youth Comparing 30 Very High Human Development Index Countries2018In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 15, p. S298-S314Article in journal (Refereed)
    Abstract [en]

    Background: To better understand the childhood physical inactivity crisis, Report Cards on physical activity of children and youth were prepared concurrently in 30 very high Human Development Index countries. The aim of this article was to present, describe, and compare the findings from these Report Cards. Methods: The Report Cards were developed using a harmonized process for data gathering, assessing, and assigning grades to 10 common physical activity indicators. Descriptive statistics were calculated after converting letter grades to interval variables, and correlational analyses between the 10 common indicators were performed using Spearmans rank correlation coefficients. Results: A matrix of 300 grades was obtained with substantial variations within and between countries. Low grades were observed for behavioral indicators, and higher grades were observed for sources of influence indicators, indicating a disconnect between supports and desired behaviors. Conclusion: This analysis summarizes the level and context of the physical activity of children and youth among very high Human Development Index countries, and provides additional evidence that the situation regarding physical activity in children and youth is very concerning. Unless a major shift to a more active lifestyle happens soon, a high rate of noncommunicable diseases can be anticipated when this generation of children reaches adulthood.

  • 3.
    Bexelius, Christin
    et al.
    Karolinska Institute.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition . Linköping University, Faculty of Health Sciences.
    Sandin, Sven
    Karolinska Institute.
    Trolle Lagerros, Ylva
    Karolinska Institute.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition . Linköping University, Faculty of Health Sciences.
    Litton, Jan-Eric
    Karolinska Institute.
    Measures of Physical Activity Using Cell Phones: Validation Using Criterion Methods2010In: JOURNAL OF MEDICAL INTERNET RESEARCH, ISSN 1438-8871, Vol. 12, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity is associated with reduced risks of many chronic diseases. Data collected on physical activity in large epidemiological studies is often based on paper questionnaires. The validity of these questionnaires is debated, and more effective methods are needed. Objective: This study evaluates repeated measures of physical activity level (PAL) and the feasibility of using a Java-based questionnaire downloaded onto cell phones for collection of such data. The data obtained were compared with reference estimates based on the doubly labeled water method and indirect calorimetry (PAL(ref)). Method: Using a Java-based cell phone application, 22 women reported their physical activity based on two short questions answered daily over a 14-day period (PAL(cell)). Results were compared with reference data obtained from the doubly labeled water method and indirect calorimetry (PAL(ref)). Results were also compared against physical activity levels assessed by two regular paper questionnaires completed by women at the end of the 14-day period (PAL(quest1) and PAL(quest2)). PAL(cell), PAL(quest1), and PAL(quest2) were compared with PAL(ref) using the Bland and Altman procedure. Results: The mean difference between PAL(cell), and PAL(ref) was small (0.014) with narrow limits of agreement (2SD = 0.30) Compared with PAL(ref) the mean difference was also small for PAL(quest1) and PAL(quest2) (0.004 and 0.07, respectively); however, the limits of agreement were wider (PAL(quest), 2SD = 0.50 and PAL(quest2), 2SD = 0.90). The test for trend was statistically significant for PAL(quest1) (slope of regression line = 0.79, P = .04) as well as for PAL(quest2) (slope of regression line = 1.58, P andlt; .001) when compared with PAL(ref). Conclusion: A Java-based physical activity questionnaire administered daily using cell phones produced PAL estimates that agreed well with PAL reference values. Furthermore, the limits of agreement between PAL obtained using cell phones, and reference values were narrower than for corresponding estimates obtained using paper questionnaires. Java-based questionnaires downloaded onto cell phones may be a feasible and cost-effective method of data collection for large-scale prospective studies of physical activity.

  • 4.
    Bexelius, Christin
    et al.
    Karolinska Institutet.
    Sandin, Sven
    Karolinska Institutet.
    Trolle Lagerros, Ylva
    Karolinska Institutet.
    Litton, Jan-Eric
    Karolinska Institutet.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Estimation of Physical Activity Levels Using Cell Phone Questionnaires: A Comparison With Accelerometry for Evaluation of Between-Subject and Within-Subject Variations2011In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 13, no 3Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity promotes health and longevity. Further elaboration of the role of physical activity for human health in epidemiological studies on large samples requires accurate methods that are easy to use, cheap, and possible to repeat. The use of telecommunication technologies such as cell phones is highly interesting in this respect. In an earlier report, we showed that physical activity level (PAL) assessed using a cell phone procedure agreed well with corresponding estimates obtained using the doubly labeled water method. However, our earlier study indicated high within-subject variation in relation to between-subject variations in PAL using cell phones, but we could not assess if this was a true variation of PAL or an artifact of the cell phone technique. less thanbrgreater than less thanbrgreater thanObjective: Our objective was to compare within-and between-subject variations in PAL by means of cell phones with corresponding estimates using an accelerometer. In addition, we compared the agreement of daily PAL values obtained using the cell phone questionnaire with corresponding data obtained using an accelerometer. less thanbrgreater than less thanbrgreater thanMethods: PAL was measured both with the cell phone questionnaire and with a triaxial accelerometer daily during a 2-week study period in 21 healthy Swedish women (20 to 45 years of age and BMI from 17.7 kg/m(2) to 33.6 kg/m(2)). The results were evaluated by fitting linear mixed effect models and descriptive statistics and graphs. less thanbrgreater than less thanbrgreater thanResults: With the accelerometer, 57% (95% confidence interval [CI] 40%-66%) of the variation was within subjects, while with the cell phone, within-subject variation was 76% (95% CI 59%-83%). The day-to-day variations in PAL observed using the cell phone questions agreed well with the corresponding accelerometer results. less thanbrgreater than less thanbrgreater thanConclusions: Both the cell phone questionnaire and the accelerometer showed high within-subject variations. Furthermore, day-to-day variations in PAL within subjects assessed using the cell phone agreed well with corresponding accelerometer values. Consequently, our cell phone questionnaire is a promising tool for assessing levels of physical activity. The tool may be useful for large-scale prospective studies.

  • 5.
    Bonn, Stephanie E.
    et al.
    Karolinska Inst, Sweden.
    Löf, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Ostenson, Claes-Goeran
    Karolinska Inst, Sweden.
    Lagerros, Ylva Trolle
    Karolinska Inst, Sweden; Karolinska Univ Hosp Huddinge, Sweden.
    App-technology to improve lifestyle behaviors among working adults - the Health Integrator study, a randomized controlled trial2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 273Article in journal (Refereed)
    Abstract [en]

    BackgroundMobile health, mHealth is recognized as a strategy to improve lifestyle behaviors. Research targeting specific lifestyle behaviors has shown that interventions using smartphones can be effective. However, few studies have evaluated solutions with multicomponent interventions, tailoring the intervention to the specific needs of the participant using a combination of mHealth and conventional treatment. To accomplish this, we developed Health Integrator, an mHealth platform with services and offers in the areas of diet, physical activity, sleeping habits, stress, alcohol and tobacco use. In the system, the user selects an area of intervention together with a health coach and set weekly goals. This study protocol presents the design and methodology of the Health Integrator Study, a randomized controlled trial to promote improved lifestyle behaviors.MethodsA three-arm parallel randomized controlled trial (1:1:1) is conducted in the Stockholm County, Sweden. In total, 209 employees at a four different companies representing both white and blue collar workers, have been recruited.Participants are randomized to either a control group or to one of two intervention groups receiving a 3-month lifestyle behavior change program including either 1) use of Health Integrator and monthly health coaching sessions or 2) only Health Integrator.At baseline and follow-up after 3- and 6-months, all participants answer questionnaires assessing lifestyle behaviors and quality of life. At baseline and the 3-month follow-up (end of intervention period), weight, height, waist circumference and blood pressure are measured, and all participants wear an Actigraph accelerometer for 7days to assess physical activity. Blood lipid profile and HbA1c are measured among all participants at baseline. If baseline measures fall outside the normal range, a second measurement is done after 3months.DiscussionThe Health Integrator Intervention Study will evaluate if a personalized intervention combining mHealth and conventional programs for lifestyle change, with or without additional health coach sessions, can improve lifestyle behaviors and quality of life. Based on the results from this trial, Health Integrator can easily be implemented within a broad public.Trial registrationClinicalTrials.gov Identifier: NCT03579342. Retrospectively registered, first submitted May 8, 2018.

  • 6.
    Cadenas-Sanchez, Cristina
    et al.
    PROFITH, University of Granada, Spain; Novum, Karolinska Institutet, Sweden.
    Intemann, Timm
    University of Bremen, Germany; Novum, Karolinska Institutet, Sweden.
    Labayen, Idoia
    Public University of Navarra, Spain.
    Peinado, Ana B
    Universidad Politécnica de Madrid, Spain.
    Vidal-Conti, Josep
    University of the Balearic Islands, Spain.
    Sanchis-Moysi, Joaquin
    University of Las Palmas de Gran Canaria, Spain.
    Moliner-Urdiales, Diego
    LIFE reserach group, University Jaume I, Spain.
    Rodriguez Perez, Manuel A
    University of Almeria, Spain.
    Cañete Garcia-Prieto, Jorge
    Universidad de Castilla-La Mancha, Health and Social Research Center, Spain.
    Fernández-Santos, Jorge Del Rosario
    School of Education, University of Cádiz, Spain.
    Martinez-Tellez, Borja
    PROFITH, University of Granada, Spain.
    Vicente-Rodríguez, Germán
    University of Zaragoza, Spain.
    Löf, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ruiz, Jonatan R
    PROFITH, University of Granada, Spain; Novum, Karolinska Institutet, Sweden.
    Ortega, Francisco B
    PROFITH, University of Granada, Spain; Novum, Karolinska Institutet, Sweden.
    Physical fitness reference standards for preschool children: The PREFIT project.2019In: Journal of Science and Medicine in Sport, ISSN 1440-2440, E-ISSN 1878-1861, Vol. 22, no 4, p. 430-437, article id S1440-2440(18)30911-3Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Reference values are necessary for classifying children, for health screening, and for early prevention as many non-communicable diseases aggravate during growth and development. While physical fitness reference standards are available in children aged 6 and older, such information is lacking in preschool children. Therefore, the purposes of this study were (1) to provide sex-and age-specific physical fitness reference standards for Spanish preschool children; and (2) to study sex differences across this age period and to characterise fitness performance throughout the preschool period.

    DESIGN: Cross-sectional.

    METHODS: A total of 3179 preschool children (1678 boys) aged 2.8-6.4 years old from Spain were included in the present study. Physical fitness was measured using the PREFIT battery.

    RESULTS: Age- and sex-specific percentiles for the physical fitness components are provided. Boys performed better than girls in the cardiorespiratory fitness, muscular strength, and speed-agility tests over the whole preschool period studied and for the different percentiles. In contrast, girls performed slightly better than boys in the balance test. Older children had better performance in all fitness tests than their younger counterparts.

    CONCLUSIONS: Our study provides age- and sex-specific physical fitness reference standards in preschool children allowing interpretation of fitness assessment. Sexual dimorphism in fitness tests exists already at preschool age, and these differences become larger with age. These findings will help health, sport, and school professionals to identify preschool children with a high/very low fitness level, to examine changes in fitness over time, and to analyse those changes obtained due to intervention effects.

  • 7.
    Couto, Elisabeth
    et al.
    Karolinska Institute, Sweden .
    Sandin, Sven
    Karolinska Institute, Sweden .
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Ursin, Giske
    Cancer Registry Norway, Norway .
    Adami, Hans-Olov
    Karolinska Institute, Sweden .
    Weiderpass, Elisabete
    Karolinska Institute, Sweden .
    Mediterranean Dietary Pattern and Risk of Breast Cancer2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 2Article in journal (Refereed)
    Abstract [en]

    Background

    A Mediterranean diet has a recognized beneficial effect on health and longevity, with a protective influence on several cancers. However, its association with breast cancer risk remains unclear.

    Objective

    We aimed to investigate whether adherence to a Mediterranean dietary pattern influences breast cancer risk.

    Design

    The Swedish Women’s Lifestyle and Health cohort study includes 49,258 women aged 30 to 49 years at recruitment in 1991–1992. Consumption of foods and beverages was measured at enrollment using a food frequency questionnaire. A Mediterranean diet score was constructed based on the consumption of alcohol, vegetables, fruits, legumes, cereals, fish, the ratio of unsaturated to saturated fat, and dairy and meat products. Relative risks (RR) for breast cancer and specific tumor characteristics (invasiveness, histological type, estrogen/progesterone receptor status, malignancy grade and stage) associated with this score were estimated using Cox regression controlling for potential confounders.

    Results

    1,278 incident breast cancers were diagnosed. Adherence to a Mediterranean dietary pattern was not statistically significantly associated with reduced risk of breast cancer overall, or with specific breast tumor characteristics. A RR (95% confidence interval) for breast cancer associated with a two-point increment in the Mediterranean diet score was 1.08 (1.00–1.15) in all women, and 1.10 (1.01–1.21) and 1.02 (0.91–1.15) in premenopausal and postmenopausal women, respectively. When alcohol was excluded from the Mediterranean diet score, results became not statistically significant.

    Conclusions

    Adherence to a Mediterranean dietary pattern did not decrease breast cancer risk in this cohort of relatively young women.

  • 8.
    Delisle, Christine
    et al.
    Karolinska Institute, Sweden.
    Sandin, Sven
    Karolinska Institute, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Henriksson, Hanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institute, Sweden.
    Trolle-Lagerros, Ylva
    Karolinska Institute, Sweden.
    Larsson, Christel
    University of Gothenburg, Sweden.
    Maddison, Ralph
    University of Auckland, New Zealand.
    Ortega, Francisco B.
    University of Granada, Spain.
    Ruiz, Jonatan R.
    University of Granada, Spain.
    Silfvernagel, Kristin
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Karolinska Institute, Sweden.
    A web- and mobile phone-based intervention to prevent obesity in 4-year-olds (MINISTOP): a population-based randomized controlled trial2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 95Article in journal (Refereed)
    Abstract [en]

    Background: Childhood obesity is an increasing health problem globally. Overweight and obesity may be established as early as 2-5 years of age, highlighting the need for evidence-based effective prevention and treatment programs early in life. In adults, mobile phone based interventions for weight management (mHealth) have demonstrated positive effects on body mass, however, their use in child populations has yet to be examined. The aim of this paper is to report the study design and methodology of the MINSTOP (Mobile-based Intervention Intended to Stop Obesity in Preschoolers) trial. Methods/Design: A two-arm, parallel design randomized controlled trial in 300 healthy Swedish 4-year-olds is conducted. After baseline measures, parents are allocated to either an intervention-or control group. The 6-month mHealth intervention consists of a web-based application (the MINSTOP app) to help parents promote healthy eating and physical activity in children. MINISTOP is based on the Social Cognitive Theory and involves the delivery of a comprehensive, personalized program of information and text messages based on existing guidelines for a healthy diet and active lifestyle in pre-school children. Parents also register physical activity and intakes of candy, soft drinks, vegetables as well as fruits of their child and receive feedback through the application. Primary outcomes include body fatness and energy intake, while secondary outcomes are time spent in sedentary, moderate, and vigorous physical activity, physical fitness and intakes of fruits and vegetables, snacks, soft drinks and candy. Food and energy intake (Tool for Energy balance in Children, TECH), body fatness (pediatric option for BodPod), physical activity (Actigraph wGT3x-BT) and physical fitness (the PREFIT battery of five fitness tests) are measured at baseline, after the intervention (six months after baseline) and at follow-up (12 months after baseline). Discussion: This novel study will evaluate the effectiveness of a mHealth program for mitigating gain in body fatness among 4-year-old children. If the intervention proves effective it has great potential to be implemented in child-health care to counteract childhood overweight and obesity.

  • 9.
    Delisle Nystrom, Christine
    et al.
    Novum, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Henriksson, Hanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Trolle-Lagerros, Ylva
    Karolinska Institute, Sweden.
    Larsson, Christel
    University of Gothenburg, Sweden.
    Maddison, Ralph
    University of Auckland, New Zealand.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Novum, Sweden.
    A Mobile Phone Based Method to Assess Energy and Food Intake in Young Children: A Validation Study against the Doubly Labelled Water Method and 24 h Dietary Recalls2016In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 8, no 1, p. 50-Article in journal (Refereed)
    Abstract [en]

    Mobile phones are becoming important instruments for assessing diet and energy intake. We developed the Tool for Energy Balance in Children (TECH), which uses a mobile phone to assess energy and food intake in pre-school children. The aims of this study were: (a) to compare energy intake (EI) using TECH with total energy expenditure (TEE) measured via doubly labelled water (DLW); and (b) to compare intakes of fruits, vegetables, fruit juice, sweetened beverages, candy, ice cream, and bakery products using TECH with intakes acquired by 24 h dietary recalls. Participants were 39 healthy, Swedish children (5.5 +/- 0.5 years) within the ongoing Mobile-based Intervention Intended to Stop Obesity in Preschoolers (MINISTOP) obesity prevention trial. Energy and food intakes were assessed during four days using TECH and 24 h telephone dietary recalls. Mean EI (TECH) was not statistically different from TEE (DLW) (5820 +/- 820 kJ/24 h and 6040 +/- 680kJ/24 h, respectively). No significant differences in the average food intakes using TECH and 24 h dietary recalls were found. All food intakes were correlated between TECH and the 24 h dietary recalls (r = 0.665-0.896, p < 0.001). In conclusion, TECH accurately estimated the average intakes of energy and selected foods and thus has the potential to be a useful tool for dietary studies in pre-school children, for example obesity prevention trials.

  • 10.
    Delisle Nystrom, Christine
    et al.
    Karolinska Institute, Sweden.
    Henriksson, Pontus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. PROmoting FITness and Health Phys Actv Research Grp PROFIT, Spain.
    Alexandrou, Christina
    Karolinska Institute, Sweden.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institute, Sweden.
    The Tanita SC-240 to Assess Body Composition in Pre-School Children: An Evaluation against the Three Component Model2016In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 8, no 6, p. 371-Article in journal (Refereed)
    Abstract [en]

    Quick, easy-to-use, and valid body composition measurement options for young children are needed. Therefore, we evaluated the ability of the bioelectrical impedance (BIA) device, Tanita SC-240, to measure fat mass (FM), fat free mass (FFM) and body fatness (BF%) in 40 healthy, Swedish 5.5 years old children against the three component model (3C model). Average BF%, FM, and FFM for BIA were: 19.4% +/- 3.9%, 4.1 +/- 1.9 kg, and 16.4 +/- 2.4 kg and were all significantly different (p amp;lt; 0.001) from corresponding values for the 3C model (25.1% +/- 5.5%, 5.3 +/- 2.5 kg, and 15.2 +/- 2.0 kg). Bland and Altman plots had wide limits of agreement for all body composition variables. Significant correlations ranging from 0.81 to 0.96 (p amp;lt; 0.001) were found for BF%, FM, and FFM between BIA and the 3C model. When dividing the children into tertiles for BF%, 60% of children were classified correctly by means of BIA. In conclusion, the Tanita SC-240 underestimated BF% in comparison to the 3C model and had wide limits of agreement. Further work is needed in order to find accurate and easy-to-use methods for assessing body composition in pre-school children.

  • 11.
    Delisle Nyström, Christine
    et al.
    Karolinska Inst, Sweden; Eastern Ontario Res Inst, Canada.
    Soderstrom, Emmie
    Karolinska Inst, Sweden.
    Henriksson, Pontus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Henriksson, Hanna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. PROFITH, Univ Granada, Spain.
    Poortvliet, Eric
    Karolinska Inst, Sweden.
    Löf, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    The paediatric option for BodPod to assess body composition in preschool children: what fat-free mass density values should be used?2018In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 120, no 7, p. 797-802Article in journal (Refereed)
    Abstract [en]

    Air displacement plethysmography utilises a two-component model to assess body composition, which relies on assumptions regarding the density of fat-free mass (FFM). To date, there is no evidence as to whether Lohmans or Wells et al.s FFM density values are more accurate in young children. Therefore, the aims of this study were to compare total body fat percentage (TBF%) assessed using the BodPod with both Lohmans and Wells et al.s FFM density values with TBF% from the three-component (3C) model in forty healthy Swedish children aged 5.5 years. Average TBF% calculated using Lohmans FFM density values underestimated TBF% in comparison with the corresponding value assessed using the 3C model (22.2 (SD 5.7) and 25.1 (SD 5.5)%, respectively; P amp;lt;0.001). No statistically significant difference was observed between TBF% assessed using Wells et al.s FFM density values and the 3C model (24.9 (so 5.5) and 251 (so 5.5)%, respectively; P= 0.614). The Bland and Altman plots for TBF% using both Lohmans and Wells et al.s FFM density values did not show any bias across the range of body fatness (Lohman: r0.056, P= 0.733 and Wells el al.: r-0.006, P= 0.970). These results indicate that Wells Cl al.s FFM density values should be used when assessing body composition with the paediatric option for BodPod in 5-year-old children. However, future studies are needed to confirm these results in other populations, including a wider age range of children.

  • 12.
    Ek, Anna
    et al.
    Karolinska Inst, Sweden.
    Nystrom, Christine Delisle
    Karolinska Inst, Sweden.
    Chirita-Emandi, Adela
    Univ Med and Farm Timisoara, Romania; Louis Turcanu Clin Emergency Hosp Children, Romania.
    Tur, Josep A.
    Univ Balearic Isl, Spain; Inst Carlos III, Spain.
    Nordin, Karin
    Karolinska Inst, Sweden.
    Bouzas, Cristina
    Univ Balearic Isl, Spain; Inst Carlos III, Spain.
    Argelich, Emma
    Univ Balearic Isl, Spain; Inst Carlos III, Spain.
    Alfredo Martinez, J.
    Inst Carlos III, Spain; Univ Navarra, Spain; IMDEA Food Precis Nutr, Spain.
    Frost, Gary
    Imperial Coll London, England.
    Garcia-Perez, Isabel
    Imperial Coll London, England.
    Saez, Marc
    Univ Girona, Spain; Inst Carlos III, Spain.
    Paul, Corina
    Univ Med and Farm Timisoara, Romania; Clin Emergency Cty Hosp Timisoara, Romania.
    Löf, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Nowicka, Paulina
    Karolinska Inst, Sweden; Uppsala Univ, Sweden.
    A randomized controlled trial for overweight and obesity in preschoolers: the More and Less Europe study- an intervention within the STOP project2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 945Article in journal (Refereed)
    Abstract [en]

    BackgroundChildhood overweight and obesity is a serious public health issue with an increase being observed in preschool-aged children. Treating childhood obesity is difficult and few countries use standardized treatments. Therefore, there is a need to find effective approaches that are feasible for both health care providers and families. Thus, the overall aim of this study is to assess the acceptance and effectiveness of a parent support program (the More and Less, ML) for the management of overweight and obesity followed by a mobile health (mHealth) program (the MINISTOP application) in a socially diverse population of families.Methods/designA two-arm, parallel design randomized controlled trial in 300 2-to 6-year-old children with overweight and obesity from Romania, Spain and Sweden (n=100 from each). Following baseline assessments children are randomized into the intervention or control group in a 1:1 ratio. The intervention, the ML program, consists of 10-weekly group sessions which focus on evidence-based parenting practices, followed by the previously validated MINISTOP application for 6-months to support healthy eating and physical activity behaviors. The primary outcome is change in body mass index (BMI) z-score after 9-months and secondary outcomes include: waist circumference, eating behavior (Child Eating Behavior Questionnaire), parenting behavior (Comprehensive Feeding Practices Questionnaire), physical activity (ActiGraph wGT3x-BT), dietary patterns (based onmetabolic markers from urine and 24h dietary recalls), epigenetic and gut hormones (fasting blood samples), and the overall acceptance of the overweight and obesity management in young children (semi-structured interviews). Outcomes are measured at baseline and after: 10-weeks (only BMI z-score, waist circumference), 9-months (all outcomes), 15- and 21-months (all outcomes except physical activity, dietary patterns, epigenetics and gut hormones) post-baseline.DiscussionThis study will evaluate a parent support program for weight management in young children in three European countries. To boost the effect of the ML program the families will be supported by an app for 6-months. If the program is found to be effective, it has the potential to be implemented into routine care to reduce overweight and obesity in young children and the app could prove to be a viable option for sustained effects of the care provided.Trial registrationClinicalTrials.gov NCT03800823; 11 Jan 2019.

  • 13.
    Ek, Anna
    et al.
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Sandborg, Johanna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Delisle Nystrom, Christine
    Karolinska Inst, Sweden.
    Lindqvist, Anna-Karin
    Lulea Univ Technol, Sweden.
    Rutberg, Stina
    Lulea Univ Technol, Sweden.
    Löf, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Physical Activity and Mobile Phone Apps in the Preschool Age: Perceptions of Teachers and Parents2019In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 7, no 4, article id e12512Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity (PA) is already beneficial at the preschool age. In many countries, young children spend most of their days in the preschool setting, making it a common arena for PA interventions. Mobile health tools are becoming increasingly popular to promote PA in different populations; however, little is known about the interest for and how the preschool setting could incorporate such a tool. Objective: This study aimed to examine how teachers and parents perceive PA in preschool-aged children in general and their perceptions of how a mobile phone app could be used to promote PA in the preschool setting. Methods: Semistructured interviews were conducted with 15 teachers (93%, [14/15] women, mean age 43.5 years, 47%, [7/15] with a university degree and 10 parents [91%, 9/10] women, mean age 38.9 years, all with a university degree) recruited from 2 urban preschools in central Sweden. The interviews were recorded, fully transcribed, coded, and analyzed using thematic analysis by means of an inductive approach. Results: The analysis revealed 4 themes: (1) children are physically active by nature, (2) the environment as a facilitator or a barrier, (3) prerequisites of the adult world, and (4) an app in the preschool setting-challenges and possibilities. Parents and teachers perceived preschoolers as being spontaneously physically active; however, high-intensity PA was perceived as low. The PA was specifically performed during the day in the preschool. Identified facilitators of PA were access to safe and engaging outdoor environments such as forests, spacious indoor areas, and adult involvement. Adult involvement was considered especially important for children preferring sedentary activities. Identified barriers for PA were restricted indoor and outdoor space, rules for indoor activities, and lack of adult involvement because of time constraints. The teachers perceived that they had limited skills and experiences using apps in general, although they also acknowledged the increasing role of technological tools in the curriculum. Thus, the teachers expressed an interest for an app designed as a support tool for them, especially for situations when PA was limited because of perceived barriers. They suggested the app to include accessible information regarding the health benefits of PA in children linked to a library of activities for different settings and seasons. Parents suggested interactive app features including problem-solving tasks and music and dance, but not video clips as they made children passive. Conclusions: Vigorous PA was perceived as low in preschool-aged children. Future tailoring of interventions in the preschool setting should work around barriers and support facilitators to PA, especially PA of high intensity. In such work, an app could serve as a source of inspiration for PA in different ages, settings, and seasons and thus reduce environmental and structural inequalities in the preschool setting.

  • 14.
    Eriksson, Britt
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Henriksson, Hanna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Hannestad, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Body-composition development during early childhood and energy expenditure in response to physical activity in 1.5-y-old children2012In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 96, no 3, p. 567-573Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of childhood overweight and obesity has increased recently, but the mechanisms involved are incompletely known. Previous research has shown a correlation between the percentage of total body fat (TBF) and physical activity level (PAL). However, the PAL values used may involve a risk of spurious correlations because they are often based on predicted rather than measured estimates of resting energy metabolism. less thanbrgreater than less thanbrgreater thanObjectives: We studied the development of body composition during early childhood and the relation between the percentage of TBF and PAL on the basis of the measured resting energy metabolism. less thanbrgreater than less thanbrgreater thanDesign: Body composition was previously measured in 108 children when they were 1 and 12 wk old. When 44 of these children (21 girls and 23 boys) were 1.5 y old, their total energy expenditure and TBF were assessed by using the doubly labeled water method. Resting energy metabolism, which was assessed by using indirect calorimetry, was used to calculate PAL. less thanbrgreater than less thanbrgreater thanResults: Significant correlations were shown for TBF (r = 0.32, P = 0.035) and fat-free mass (r = 0.34, P = 0.025) between values (kg) assessed at 12 wk and 1.5 y of age. For TBF (kg) a significant interaction (P = 0.035) indicated a possible sex difference. PAL at 1.5 y was negatively correlated with the percentage of TBF (r = -0.40, P = 0.0076) and the increase in the percentage of TBF between 12 wk and 1.5 y (r = 0.38, P = 0.0105). less thanbrgreater than less thanbrgreater thanConclusions: The results indicate that body fatness and physical activity interact during early childhood and thereby influence obesity risk. Our results are based on a small sample, but nevertheless, they motivate additional studies in boys compared with girls regarding the development of body composition during early life.

  • 15.
    Eriksson, Britt
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition . Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition . Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition . Linköping University, Faculty of Health Sciences.
    Body composition in full-term healthy infants measured with air displacement plethysmography at 1 and 12 weeks of age2010In: ACTA PAEDIATRICA, ISSN 0803-5253, Vol. 99, no 4, p. 563-568Article in journal (Refereed)
    Abstract [en]

    Aim: To use Pea Pod, a device based on air displacement plethysmography, to study body composition of healthy, full-term infants born to well-nourished women with a western life-style. Methods: Body composition was assessed in 53 girls and 55 boys at 1 week (before 10 days of age) and at 12 weeks (between 77 and 91 days of age). Results: At 1 week girls contained 13.4 +/- 3.7% body fat and boys 12.5 +/- 4.0%. At 12 weeks, these figures were 26.3 +/- 4.2% (girls) and 26.4 +/- 5.1% (boys). Body fat (%) did not differ significantly between the genders. Body fat (%) at the two measurements was not correlated. At 1 week, the weight (r = 0.20, p = 0.044) and BMI (r = 0.26, p = 0.007) of the infants, but not their body fat (g, %) or fat free mass (g), correlated with BMI before pregnancy in their mothers. Conclusions: Pea Pod has potential for use in studies investigating the effect of external (i.e. nutritional status) and internal (i.e. age, gender, gestational age at birth) factors on infant body composition. This may be of value when studying relationships between the nutritional situation during early life and adult health.

  • 16.
    Eriksson, Britt
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Hannestad, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Fat-free mass hydration in newborns: assessment and implications for body composition studies2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 5, p. 680-686Article in journal (Refereed)
    Abstract [en]

    Equipment (Pea Pod) for assessing infant body density accurately and conveniently has recently become available. This density can be converted to body composition using the “Fomon” or the “Butte” model. These models differ regarding the water content in fat-free mass (hydration factor, HF). We assessed HF and its biological variability in newborns and compared results calculated using the two models at one and 12 weeks. Body volume and body weight were measured in 12 infants less than 10 days old using Pea Pod. Their total body water was assessed using isotope dilution. Their HF was found to be 80.9% with low biological variability (0.81% of average HF). Further, Pea Pod was used to assess body density of 108 infants at one and 12 weeks of age. Values for body fat (%) calculated using the “Butte” model were significantly lower than when using the “Fomon” model at one week (p<0.05) and 12 weeks (p<0.01). The difference between the two models was particularly large at one week, probably due to their different HF-values. Our HF-value is in agreement with that in the “Fomon” model and our results support the conclusion that this model is preferable when calculating body composition in infants.

  • 17.
    Eriksson, Britt
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition . Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition . Linköping University, Faculty of Health Sciences.
    Olausson, Hanna
    University of Gothenburg.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition . Linköping University, Faculty of Health Sciences.
    Body fat, insulin resistance, energy expenditure and serum concentrations of leptin, adiponectin and resistin before, during and after pregnancy in healthy Swedish women.2010In: The British journal of nutrition, ISSN 1475-2662, Vol. 103, no 1, p. 50-57Article in journal (Refereed)
    Abstract [en]

    Healthy human pregnancy is associated with changes in food intake, body fatness, energy expenditure and insulin resistance. However, available knowledge is limited regarding the physiological basis of these changes. Published evidence suggests that so-called adipokines (i.e. leptin, adiponectin and resistin) have significant roles when such changes are established. We explored, throughout a complete pregnancy, relationships between total body fat (TBF), energy expenditure, insulin resistance (homeostasic model of insulin resistance, HOMA-IR) and serum concentrations of leptin, adiponectin and resistin. Such concentrations were assessed before pregnancy in gestational weeks 8, 14, 20, 32 and 35, and 2 weeks postpartum in twenty-three healthy women. TBF, BMR (n 23) and HOMA-IR (n 17) were assessed before pregnancy in gestational weeks 14 and 32 and 2 weeks postpartum. TBF (%) was correlated with HOMA-IR (r 0.68-0.79, P < 0.01) and with serum leptin (r 0.85-0.88, P < 0.001) before and during pregnancy. Serum leptin was correlated with HOMA-IR (r 0.53-0.70, P < 0.05) before and during pregnancy. Serum adiponectin was inversely correlated with HOMA-IR in gestational week 32 (r - 0.52, P < 0.05). When HOMA-IR was regressed on TBF (%), the slope of the regression line was 0.046 before pregnancy, which was significantly (P < 0.05) different from the corresponding value, 0.111, in gestational week 32. The results indicate that pregnancy has an enhancing effect on the relationship between body fatness and insulin resistance. This effect, possibly mediated by leptin, may represent a mechanism by which offspring size is regulated in response to the nutritional situation of the mother.

  • 18.
    Eriksson, Britt
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition . Linköping University, Faculty of Health Sciences.
    Olsson, Hanna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition . Linköping University, Faculty of Health Sciences.
    Hannestad, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition . Linköping University, Faculty of Health Sciences.
    Body composition and energy expenditure in response to physical activity in 1.5-year-old children studied by means of the doubly labeled water methodManuscript (preprint) (Other academic)
    Abstract [en]

    During recent decades the prevalence of overweight and obesity in childhood has increased and studies of the mechanisms involved are motivated. Previous research has shown a correlation between total body fat (TBF) (%) and physical activity level (PAL) but the assessment of PAL has often involved a risk for spurious correlations. Thus we compared PAL calculated using basal metabolic rate (BMR) predicted from equations, based on body weight (PALBMR) and associated with a risk for spurious correlations, with PAL calculated using sleeping metabolic rate (SMR) assessed using indirect calorimetry (PALSMR) in 20 healthy children aged 1.5 years. Total energy expenditure and body fatness were assessed using the doubly labelled water method. Body fatness of these children was also assessed at one week and three months of age. PALBMR was significantly (r=-0.48, p=0.03) correlated with TBF (%) while PALSMR was not. Furthermore, the increase in body fatness between three months and 1.5 years was significantly (r=-0.52, p=0.02) correlated with PALSMR at the age of 1.5 years. Our results indicate complex relationships between body fatness and physical activity in early life. When conducting studies in this area, resting energy metabolism should be measured rather than predicted using equations based on body weight.

  • 19.
    Forsum, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Eriksson, Britt
    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, Hanna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Henriksson, Pontus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Löf, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Fat and fat-free mass of healthy Swedish children show tracking during early life, but there are differences2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 9, p. 1704-1708Article in journal (Refereed)
    Abstract [en]

    Aim Obesity may start early in life. We investigated relationships between size and body composition variables in infancy and at 4 years of age using valid estimates of body composition. The results were compared to those obtained when body mass index (BMI) was used to estimate body fatness at 4 years. Methods Using air displacement plethysmography, size, fat mass and fat-free mass were studied, between 2007 and 2015, in 253 full-term healthy Swedish children at 1 week, 12 weeks and 4 years of age. Results Positive associations between variables in infancy and at 4 years were found at 1 and 12 weeks for weight, height, BMI, fat-free mass and fat-free mass index (p amp;lt;= 0.002) and for fat mass, per cent body fat and fat mass index (p amp;lt;= 0.04) at 12 weeks. Fat mass gained during infancy correlated positively (p amp;lt;= 0.031) with per cent fat mass, fat mass index and BMI, all at 4 years. In girls, gains in fat-free mass during infancy correlated with BMI (p = 0.0005) at 4 years. Conclusion The results provide information regarding body composition trajectories during early life and demonstrate limitations of BMI as a proxy for body fatness when relating early weight gain to variables, relevant for later obesity risk.

  • 20.
    Forsum, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Eriksson, Britt
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Olausson, Hanna
    Gothenburg University, Gothenburg, Sweden.
    Olhager, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Maternal body composition in relation to infant growth and fatness2008In: International Journal of Body Composition Research, ISSN 1479-456X, Vol. 6, p. 131-140Article in journal (Refereed)
  • 21.
    Forsum, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Flinke Carlsson, Eva
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Henriksson, Hanna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Henriksson, Pontus
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Karolinska Institutet, Stockholm, Sweden .
    BMI kan inte säkert identifiera 4-åringar med hög kroppsfetthalt2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 36Article in journal (Other academic)
  • 22.
    Forsum, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Flinke Carlsson, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Henriksson, Hanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Henriksson, Pontus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden.
    Total body fat content versus BMI in 4-year-old healthy Swedish children.2013In: Journal of Obesity, ISSN 2090-0708, E-ISSN 2090-0716, Vol. 2013, article id 206715Article in journal (Refereed)
    Abstract [en]

    Childhood overweight and obesity, a worldwide problem, is generally identified using BMI (body mass index). However, this application of BMI has been little investigated in children below 5 years of age due to a lack of appropriate methods to assess body composition. Therefore, we used air displacement plethysmography (ADP) to study 4.4-year old boys and girls since this method is accurate in young children if they accept the requirements of the measurement. The purpose was to analyze the relationship between BMI and body fat in these children. Body composition was assessed in 76 (43 boys, 33 girls) of the 84 children brought to the measurement session. Boys and girls contained 25.2 ± 4.7 and 26.8 ± 4.0% body fat, respectively. BMI-based cut-offs for overweight could not effectively identify children with a high body fat content. There was a significant (P < 0.001) but weak (r = 0.39) correlation between BMI and body fat (%). In conclusion, requirements associated with a successful assessment of body composition by means of ADP were accepted by most 4-year-olds. Furthermore, BMI-based cut-offs for overweight did not effectively identify children with a high body fatness and BMI explained only a small proportion of the variation in body fat (%) in this age group.

  • 23.
    Forsum, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Henriksson, Pontus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Karolinska Institute, Novum, Sweden.
    The Two-Component Model for Calculating Total Body Fat from Body Density: An Evaluation in Healthy Women before, during and after Pregnancy2014In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 6, no 12, p. 5888-5899Article in journal (Refereed)
    Abstract [en]

    A possibility to assess body composition during pregnancy is often important. Estimating body density (D-B) and use the two-component model (2CM) to calculate total body fat (TBF) represents an option. However, this approach has been insufficiently evaluated during pregnancy. We evaluated the 2CM, and estimated fat-free mass (FFM) density and variability in 17 healthy women before pregnancy, in gestational weeks 14 and 32, and 2 weeks postpartum based on D-B (underwater weighing), total body water (deuterium dilution) and body weight, assessed on these four occasions. TBF, calculated using the 2CM and published FFM density (TBF2CM), was compared to reference estimates obtained using the three-component model (TBF3CM). TBF2CM minus TBF3CM (mean +/- 2SD) was -1.63 +/- 5.67 (p = 0.031), -1.39 +/- 7.75 (p = 0.16), -0.38 +/- 4.44 (p = 0.49) and -1.39 +/- 5.22 (p = 0.043) % before pregnancy, in gestational weeks 14 and 32 and 2 weeks postpartum, respectively. The effect of pregnancy on the variability of FFM density was larger in gestational week 14 than in gestational week 32. The 2CM, based on D-B and published FFM density, assessed body composition as accurately in gestational week 32 as in non-pregnant adults. Corresponding values in gestational week 14 were slightly less accurate than those obtained before pregnancy.

  • 24.
    Forsum, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Janerot Sjöberg, Birgitta
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Löf, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    MET-values of standardised activities in relation to body fat: studies in pregnant and non-pregnant women2018In: Nutrition & Metabolism, ISSN 1743-7075, E-ISSN 1743-7075, Vol. 15, article id 45Article in journal (Refereed)
    Abstract [en]

    Background: Physical activity is associated with health in women. Published MET-values (MET: metabolic equivalent of task) may assess physical activity and energy expenditure but tend to be too low for subjects with a high total body fat (TBF) content and therefore inappropriate for many contemporary women. The MET-value for an activity is the energy expenditure of a subject performing this activity divided by his/her resting energy expenditure, often assumed to be 4.2 kJ/kg/h. Relationships between TBF and MET have been little studied although overweight and obesity is common in women. Available data indicate that MET-values decrease during pregnancy but more studies in pregnant contemporary women are needed. Subjects and methods: Using indirect calorimetry we measured energy expenditure and assessed MET-values in women, 22 non-pregnant (BMI: 18-34) and 22 in gestational week 32 (non-pregnant BMI: 18-32) when resting, sitting, cycling (30 and 60 watts), walking (3.2 and 5.6 km/h) and running (8 km/h). Relationships between TBF and MET-values were investigated and used to predict modified MET-values. The potential of such values to improve calculations of total energy expenditure of women was investigated. Results: The resting energy expenditure was below 4.2 kJ/kg/h in both groups of women. Women in gestational week 32 had a higher resting energy metabolism (p amp;lt; 0.001) and 7-15% lower MET-values (p amp;lt; 0.05) than non-pregnant women. MET-values of all activities were correlated with TBF (p amp;lt; 0.05) in non-pregnant women and modified MET-values improved estimates of total energy expenditure in such women. In pregnant women, correlations (p amp;lt;= 0.03) between TBF and MET were found for running (8 km/h) and for walking at 5.6 km/h. Conclusions: Our results are relevant when attempts are made to modify the MET-system in contemporary pregnant and non-pregnant women. MET-values were decreased in gestational week 32, mainly due to an increased resting energy metabolism and studies describing how body composition affects the one MET-value (i.e. the resting energy metabolism in kJ/kg/h) during pregnancy are warranted. Studies of how pregnancy and TBF affect MET-values of high intensity activities are also needed. Corrections based on TBF may have a potential to improve the MET-system in non-pregnant women.

  • 25.
    Forsum, Elisabet
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Nutrition .
    Löf, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Nutrition .
    Energy metabolism during human pregnancy2007In: Annual review of nutrition (Print), ISSN 0199-9885, E-ISSN 1545-4312, Vol. 27, p. 277-292Article, review/survey (Refereed)
    Abstract [en]

    This review summarizes information regarding how human energy metabolism is affected by pregnancy, and current estimates of energy requirements during pregnancy are presented. Such estimates can be calculated using either increases in basal metabolic rate (BMR) or increases in total energy expenditure (TEE). The two modes of calculation give similar results for a complete pregnancy but different distributions of energy requirements in the three trimesters. Recent information is presented regarding the effect of pregnancy on BMR, TEE, diet-induced thermogenesis, and physical activity. The validity of energy intake (EI) data recendy assessed in well-nourished pregnant women was evaluated using information regarding energy metabolism during pregnancy. The results show that underreporting of EI is common during pregnancy and indicate that additional longitudinal studies, taking the total energy budget during pregnancy into account, are needed to satisfactorily define energy requirements during the three trimesters of gestation. Copyright © 2007 by Annual Reviews. All rights reserved.

  • 26.
    Forsum, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Karolinska Institutet, Stockholm, Sweden .
    Henriksson, Hanna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Evaluations of Actiheart, IDEEA and RT3 monitors for estimating activity energy expenditure in  free-living women2013In: Journal of Nutritional Science, ISSN 2048-6790, E-ISSN 2048-6790, Vol. 2, no e31Article in journal (Refereed)
    Abstract [en]

    Activity energy expenditure (AEE) during free-living conditions can be assessed using devices based on different principles. To make proper comparisons of different devices' capacities to assess AEE, they should be evaluated in the same population. Thus, in the present study we evaluated, in the same group of subjects, the ability of three devices to assess AEE in groups and individuals during free-living conditions. In twenty women, AEE was assessed using RT3 (three-axial accelerometry) (AEERT3), Actiheart (a combination of heart rate and accelerometry) (AEEActi) and IDEEA (a multi-accelerometer system) (AEEIDEEA). Reference AEE (AEEref) was assessed using the doubly labelled water method and indirect calorimetry. Average AEEActi was 5760 kJ per 24 h and not significantly different from AEEref (5020 kJ per 24 h). On average, AEERT3 and AEEIDEEA were 2010 and 1750 kJ per 24 h lower than AEEref, respectively (P < 0·001). The limits of agreement (± 2 sd) were 2940 (Actiheart), 1820 (RT3) and 2650 (IDEEA) kJ per 24 h. The variance for AEERT3 was lower than for AEEActi (P = 0·006). The RT3 classified 60 % of the women in the correct activity category while the corresponding value for IDEEA and Actiheart was 30 %. In conclusion, the Actiheart may be useful for groups and the RT3 for individuals while the IDEEA requires further development. The results are likely to be relevant for a large proportion of Western women of reproductive age and demonstrate that the procedure selected to assess physical activity can greatly influence the possibilities to uncover important aspects regarding interactions between physical activity, diet and health.

  • 27.
    Forsum, Elisabet
    et al.
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Olausson, Hanna
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Olhager, Elisabeth
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Maternal body composition in relation to infant birth weight and subcutaneous adipose tissue2006In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 96, no 2, p. 408-414Article in journal (Refereed)
    Abstract [en]

    Infant birth weight has increased recently, representing an obstetric and potentially a public health problem since high birth weight involves a risk of obesity later in life. Maternal nutritional status is important for fetal growth and therefore relationships between maternal body weight and composition v. birth weight and infant subcutaneous adipose tissue were investigated in twenty-three healthy women and their newborn infants using multiple and simple linear regression analysis. Furthermore, using previously published data for nineteen infants, it was demonstrated that an anthropometric method could provide useful estimates of the amount of subcutaneous adipose tissue. Birth weight was correlated with the maternal content of total body fat (TBF) both before pregnancy and in gestational week 32 and, together with gestational age at birth, TBF (%) before pregnancy explained 45% of the variation in birth weight. This figure was not increased when gestational gains in weight or TBF were added to the model. Furthermore, in infants, birth weight correlated with the amount of their subcutaneous adipose tissue. Together maternal TBF (%) and amount of subcutaneous adipose tissue in infants explained 61–63% of the variation in birth weight while the amount of infant subcutaneous adipose tissue alone explained only 55%. The maternal TBF content is likely to be important for the recent increase in birth weight. This factor probably causes a general augmentation in fetal growth rather than a specific stimulation of adipose tissue growth.

  • 28.
    Forsum, Elisabet
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery.
    Löf, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery.
    Schoeller, Dale A
    Calculation of energy expenditure in women using the MET system2006In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 38, no 8, p. 1520-1525Article in journal (Refereed)
    Abstract [en]

    Purpose: Interpretation of physical activity as energy expenditure requires adjustment for body size. This is usually accomplished by means of the MET system, which assumes a basal metabolic rate (BMR) of 4.184 kJ·kg -1·h-1 and, when the standard calculation is used, that the energy costs of different activities are proportional to BMR. These relationships may be altered by increases in percent total body fat (% TBF), and this paper examines relationships between % TBF and total energy expenditure (TEE) obtained using the standard and a proposed calculation. Methods: Published data regarding body composition, physical activity (heart rate recording), and BMR in 11 American women (before and after weight gain) and in 15 Swedish women (before and during pregnancy) were used to calculate TEE. Reference estimates of TEE were obtained using doubly labeled water. Results: In Swedish women, reference TEE minus standard TEE (MJ·24 h-1) was 1.37 ± 1.29 (P < 0.01) before and 1.03 ± 1.13 (P < 0.05) during pregnancy. For proposed TEE these differences were 0.43 ± 1.63 (P > 0.05) and 0.31 ± 1.28 (P > 0.05) (MJ·24 h-1), respectively. In American women before and after weight gain, reference TEE minus standard TEE (MJ·24 h-1) were 0.38 ± 1.79 (P > 0.05) and 1.39 ± 2.36 (P > 0.05), respectively, whereas the corresponding differences for proposed TEE (MJ·24 h-1) were -0.52 ± 2.20 (P > 0.05) and 0.21 ± 2.36 (P > 0.05), respectively. In Swedish women before pregnancy and American women after weight gain (N = 26, BMI = 18-39), significant (P < 0.001) relationships were found for standard TEE/proposed TEE (y) versus % TBF, (x, r = -0.65) and versus BMI (x, r = -0.70). Conclusions: In individuals with a TBF content typical for contemporary Western women, standard TEE is lower than proposed TEE. This bias increases as the TBF content of subjects increases. The results indicate that proposed TEE is more accurate than standard TEE, but this requires confirmation. Copyright © 2006 by the American College of Sports Medicine.

  • 29.
    Hedelin, Maria
    et al.
    Folkhalsan Research Centre.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Andersson, Therese M -L
    Karolinska Institute.
    Adlercreutz, Herman
    University of Helsinki.
    Weiderpass, Elisabete
    Karolinska Institute.
    Dietary Phytoestrogens and the Risk of Ovarian Cancer in the Womens Lifestyle and Health Cohort Study2011In: CANCER EPIDEMIOLOGY BIOMARKERS and PREVENTION, ISSN 1055-9965, Vol. 20, no 2, p. 308-317Article in journal (Refereed)
    Abstract [en]

    Background: Dietary intake of phytoestrogens has been inversely associated to hormone-dependent cancers, such as prostate and breast cancers. Few studies have investigated the association between ovarian cancer and intake of phytoestrogens. We evaluated the associations between intake of phytoestrogens (isoflavonoids/lignans/coumestrol) and fiber (vegetable/cereal) and risk of ovarian cancer. Methods: In 1991-1992 a prospective population-based cohort study among Swedish women was conducted, including 47,140 women with complete dietary questionnaire data. During follow-up until December 2007, 163 women developed invasive (n = 117) and borderline (n = 46) ovarian cancers. The median follow-up time was 16 years and total person year was 747,178. Cox proportional hazards models were conducted to estimate multivariate risk ratios, 95% CI for associations with risk of ovarian cancer. Results: We found no association between intake of phytoestrogens or fiber and overall ovarian cancer risk. In addition, we found no statistically significant association between intake of specific food items rich in phytoestrogens (berries, nuts, beans/soy, and crisp or whole-grain bread) and ovarian cancer risk overall. Fiber and coumestrol was inversely associated with borderline ovarian cancer, but not with invasive ovarian cancer. Conclusions: We found no association between intake of phytoestrogens or fiber and overall ovarian cancer risk. Impact: Phytoestrogens do not play a major etiologic role in ovarian cancer, at least among women in this Swedish cohort with low bean/soy intake. However, our results of a difference in the effect of fiber or coumestrol between invasive and borderline ovarian cancer need to be evaluated in larger studies.

  • 30.
    Hedelin, Maria
    et al.
    Karolinska Institutet.
    Löf, Marie
    Karolinska Institutet.
    Olsson, Marita
    Karolinska Institutet.
    Adlercreutz, Herman
    University of Helsinki.
    Sandin, Sven
    Karolinska Institutet.
    Weiderpass, Elisabete
    Karolinska Institutet.
    Dietary phytoestrogens are not associated with risk of overall breast cancer but diets rich in coumestrol are inversely associated with risk of estrogen receptor and progesterone receptor negative breast tumors in Swedish women.2008In: The Journal of nutrition, ISSN 1541-6100, Vol. 138, no 5, p. 938-45Article in journal (Refereed)
    Abstract [en]

    Results from epidemiological and experimental studies indicate that phytoestrogens may protect against breast cancer. Because one of the biological effects of phytoestrogens is probably estrogenic, it's possible that the preventive effect on breast cancer differs by estrogen receptor (ER) or progesterone receptor (PR) status of the tumor. We evaluated the associations between dietary phytoestrogen (isoflavonoids, lignans, and coumestrol) intake and risk of breast cancer and whether the ER/PR statuses of the tumor influence this relationship. In 1991-2 a prospective population-based cohort study among Swedish pre- and postmenopausal women was performed, making questionnaire data available for 45,448 women. A total of 1014 invasive breast cancers were diagnosed until December 2004. Cox proportional hazards models were performed to estimate multivariate risk ratios, 95% CI for associations with risk of breast cancer. Intakes of lignan, isoflavonoid, or coumestrol were not associated with breast cancer risk overall or before or after 50 y of age. The effects of lignans or isoflavonoids were independent of receptor status. However, intake of coumestrol was associated with decreased risk of receptor negative tumors (ER-PR-) but not positive tumors. The risk of ER-PR- tumors was significantly lower (50%) in women with intermediate coumestrol intake compared with those who did not consume any. In conclusion, we found no association between intake of isoflavonoids or lignans and breast cancer risk. Our results of a decreased risk of ER-PR- tumors in women with intermediate intake of coumestrol could be due to chance because of the low intake. The results should be confirmed in other studies.

  • 31.
    Hedelin, Maria
    et al.
    University of Gothenburg, Sweden; Karolinska Institute, Sweden.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institute, Sweden.
    Sandin, Sven
    Karolinska Institute, Sweden.
    Adami, Hans-Olov
    Karolinska Institute, Sweden; Harvard University, MA 02115 USA.
    Weiderpass, Elisabete
    Karolinska Institute, Sweden; Cancer Registry Norway, Norway; Arctic University of Norway, Norway; Folkhalsan Research Centre, Finland.
    Prospective Study of Dietary Phytoestrogen Intake and the Risk of Colorectal Cancer2016In: Nutrition and Cancer, ISSN 0163-5581, E-ISSN 1532-7914, Vol. 68, no 3, p. 388-395Article in journal (Refereed)
    Abstract [en]

    Dietary phytoestrogen intake has been inversely associated with the risk of prostate and breast cancer and might also affect the risk of colorectal cancer. We evaluated the associations between dietary lignan intake, dietary isoflavonoid intake, dietary coumestrol intake, and dietary enterolignans and equol intake, and risk of colorectal cancer. Data from the Womens Lifestyle and Health (WLH) Cohort study was used. The WLH study is a prospective population-based cohort study including 48,268 Swedish women aged 30-49years at the time of enrolment in 1991-92. Follow-up for colorectal cancer incidence, death, and emigration until the end of 2010 was performed through record linkage to the Swedish Cancer Registry and Total Population Register. During follow-up 206 incident colorectal cancer cases were identified. Cox proportional hazards models were fitted to estimate adjusted risk ratios with 95% confidence intervals. We found no statistically significant association between the intake of dietary lignans, dietary isoflavonoids, coumestrol, or enterolignans and equol, and risk of colorectal cancer. We found no association between dietary phytoestrogen intake and the risk of colorectal cancer. However, since the number of cancer cases was small, our results need to be confirmed. Future studies should investigate colon and rectal cancer separately.

  • 32.
    Henriksson, Hanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Bonn, E. Stephanie
    Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Bergström, Anna
    Karolinska Institutet, Institute of Enviromental Medicine, Stockholm, Sweden.
    Bälter, Katarina
    Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Bälter, Olle
    Royal Institute of Technology, School of Computer Science and Communication, Stockholm, Sweden.
    Delisle, Christine
    Karolinska Institutet, Department of Biosciences and Nutrition, Huddinge, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Karolinska Institutet, Department of Biosciences and Nutrition, Huddinge, Sweden.
    A New Mobile Phone-Based Tool for Assessing Energy and Certain Food Intakes in Young Children: A Validation Study2015In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 3, no 2, article id e38Article in journal (Refereed)
    Abstract [en]

    Background: Childhood obesity is an increasing health problem globally. Obesity may be established already at pre-school age. Further research in this area requires accurate and easy-to-use methods for assessing the intake of energy and foods. Traditional methods have limited accuracy, and place large demands on the study participants and researchers. Mobile phones offer possibilities for methodological advancements in this area since they are readily available, enable instant digitalization of collected data, and also contain a camera to photograph pre- and post-meal food items. We have recently developed a new tool for assessing energy and food intake in children using mobile phones called the Tool for Energy Balance in Children (TECH). Objective: The main aims of our study are to (1) compare energy intake by means of TECH with total energy expenditure (TEE) measured using a criterion method, the doubly labeled water (DLW) method, and (2) to compare intakes of fruits and berries, vegetables, juice, and sweetened beverages assessed by means of TECH with intakes obtained using a Web-based food frequency questionnaire (KidMeal-Q) in 3 year olds. Methods: In this study, 30 Swedish 3 year olds were included. Energy intake using TECH was compared to TEE measured using the DLW method. Intakes of vegetables, fruits and berries, juice, as well as sweetened beverages were assessed using TECH and compared to the corresponding intakes assessed using KidMeal-Q. Wilcoxon matched pairs test, Spearman rank order correlations, and the Bland-Altman procedure were applied. Results: The mean energy intake, assessed by TECH, was 5400 kJ/24h (SD 1500). This value was not significantly different (P=.23) from TEE (5070 kJ/24h, SD 600). However, the limits of agreement (2 standard deviations) in the Bland-Altman plot for energy intake estimated using TECH compared to TEE were wide (2990 kJ/24h), and TECH overestimated high and underestimated low energy intakes. The Bland-Altman plots for foods showed similar patterns. The mean intakes of vegetables, fruits and berries, juice, and sweetened beverages estimated using TECH were not significantly different from the corresponding intakes estimated using KidMeal-Q. Moderate but statistically significant correlations (ρ=.42-.46, P=.01-.02) between TECH and KidMeal-Q were observed for intakes of vegetables, fruits and berries, and juice, but not for sweetened beverages. Conclusion: We found that one day of recordings using TECH was not able to accurately estimate intakes of energy or certain foods in 3 year old children.

  • 33.
    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.

  • 34.
    Henriksson, Hanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Britt
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Flinke Carlsson, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Development of body composition and its relationship with physical activity: A longitudinal study of Swedish children until 4·5 years of age2015Manuscript (preprint) (Other academic)
    Abstract [en]

    In order to develop strategies to prevent early childhood obesity more knowledge about longitudinal body composition development is needed. Previous studies have shown that there is a negative relationship between the physical activity level (PAL) and total body fat (TBF) in children. The aims of this study were: 1) To describe the longitudinal development of body composition from 1 week to 4·5 years of age. 2) To study the relationships between measures of body composition and PAL at 3 years of age. 3) To compare the relationships between body composition measures and PAL at 3 years of age to the corresponding relationships at 1·5 years of age. Body composition was measured using air-displacement plethysmography at 1 week, 12 weeks and at 4·5 years of age. At 1·5 and 3 years body composition and PAL were assessed using the doubly labelled water method and indirect calorimetry. The results showed that TBF% and fat mass index (FMI) were higher than corresponding reference values, during infancy and childhood. We found a relationship between TBF% and PAL at 3 years of age but this was explained by a relationship between PAL and fat-free mass index (FFMI). The corresponding relationship at 1·5 years of age could not be explained by a relationship between PAL and FFMI. In conclusion, the children in this study had higher body fatness compared to the corresponding reference values. This may indicate an identification of a secular trend in body composition development which is characterized by a high body fatness. Our findings also suggest that body fatness might counteract physical activity at 1·5 years of age when the capacity to perform physical activity is limited, however this result was not observed at 3 years of age when such a capacity has been developed.

  • 35.
    Henriksson, Hanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Karolinska Institute, Sweden .
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Evaluation of Actiheart and a 7d activity diary for estimating free-living total and activity energy expenditure using criterion methods in 1 center dot 5- and 3-year-old children2014In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 111, no 10, p. 1830-1840Article in journal (Refereed)
    Abstract [en]

    Accurate and easy-to-use methods to assess free-living energy expenditure in response to physical activity in young children are scarce. In the present study, we evaluated the capacity of (1) 4d recordings obtained using the Actiheart (mean heart rate (mHR) and mean activity counts (mAC)) to provide assessments of total energy expenditure (TEE) and activity energy expenditure (AEE) and (2) a 7d activity diary to provide assessments of physical activity levels (PAL) using three sets of metabolic equivalent (MET) values (PAL(Torun), PAL(Adolph) and PAL(Ainsworth)) in forty-four and thirty-one healthy Swedish children aged 1 center dot 5 and 3 years, respectively. Reference TEE, PAL(ref) and AEE were measured using criterion methods, i.e. the doubly labelled water method and indirect calorimetry. At 1 center dot 5 years of age, mHR explained 8% (P=0 center dot 006) of the variation in TEE above that explained by fat mass and fat-free mass. At 3 years of age, mHR and mAC explained 8 (P=0 center dot 004) and 6 (P=0 center dot 03)% of the variation in TEE and AEE, respectively, above that explained by fat mass and fat-free mass. At 1 center dot 5 and 3 years of age, average PAL(Ainsworth) values were 1 center dot 44 and 1 center dot 59, respectively, and not significantly different from PAL(ref) values (1 center dot 39 and 1 center dot 61, respectively). By contrast, average PAL(Torun) (1 center dot 5 and 3 years) and PAL(Adolph) (3 years) values were lower (Pless than0 center dot 05) than the corresponding PAL(ref) values. In conclusion, at both ages, Actiheart recordings explained a small but significant fraction of free-living energy expenditure above that explained by body composition variables, and our activity diary produced mean PAL values in agreement with reference values when using MET values published by Ainsworth.

  • 36.
    Henriksson, Pontus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. University of Granada, Spain.
    Cadenas-Sanchez, Cristina
    University of Granada, Spain.
    Leppanen, Marja H.
    University of Jyvaskyla, Finland.
    Delisle Nystrom, Christine
    Karolinska Institute, Sweden.
    Ortega, Francisco B.
    University of Granada, Spain; Karolinska Institute, Sweden.
    Pomeroy, Jeremy
    Marshfield Clin Research Fdn, WI 54449 USA.
    Ruiz, Jonatan R.
    University of Granada, Spain; Karolinska Institute, Sweden.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institute, Sweden.
    Associations of Fat Mass and Fat-Free Mass with Physical Fitness in 4-Year-Old Children: Results from the MINISTOP Trial2016In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 8, no 8, p. 473-Article in journal (Refereed)
    Abstract [en]

    Physical fitness is a powerful marker of health in youth. Studies in adolescents and adults suggest that higher fat mass is related to worse physical fitness. However, there is limited knowledge whether fat mass and fat-free mass are associated with physical fitness already in preschoolers. Baseline data from the MINISTOP (Mobile-based INtervention Intended to STop Obesity in Preschoolers) trial was utilized for this cross-sectional analysis. Body composition was assessed using air-displacement plethysmography. Fat mass index [fat mass (kg)/height(2) (m)] and fat-free mass index [fat-free mass (kg)/height(2) (m)] were used to provide height-adjusted measures of body composition. Physical fitness was measured using the PREFIT (FITness testing in PREschool children) battery, which assesses cardiorespiratory fitness, upper-body and lower-body muscular strength as well as motor fitness. In total, this study included 303 children (168 boys and 135 girls), who were on average 4.48 +/- 0.15 years old. Higher fat mass index was associated with worse cardiorespiratory fitness (standardized beta = -0.17, p = 0.002), lower-body muscular strength (beta = -0.17, p = 0.003) and motor fitness (beta = -0.21, p amp;lt; 0.001) in regression analyses adjusted for age, sex and mutually adjusted for fat-mass index and fat-free mass index. Conversely, higher fat-free mass index was associated with better cardiorespiratory fitness (beta = 0.18, p = 0.002), upper-body muscular strength (beta = 0.39, p amp;lt; 0.001), lower-body muscular strength (beta = 0.22, p amp;lt; 0.001) and motor fitness (beta = 0.17, p = 0.004). Thus, fat mass and fat-free mass in preschoolers appear to have joint but opposite associations with physical fitness, an important marker for current and future health.

  • 37.
    Henriksson, Pontus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Eriksson, B
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Gestational weight gain according to Institute of Medicine recommendations in relation to infant size and body composition.2015In: Pediatric Obesity, ISSN 2047-6302, E-ISSN 2047-6310, Vol. 10, no 5, p. 388-394Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Intrauterine life may be a critical period for programming childhood obesity; however, there is insufficient knowledge concerning how gestational weight gain (GWG) affects infant fat mass (FM) and fat-free mass (FFM).

    OBJECTIVES: The aim of this study was to investigate relationships between GWG according to Institute of Medicine (IOM) recommendations and infant size, FM and FFM. We also investigated if the associations were different for normal-weight and overweight/obese women.

    METHODS: This study included 312 healthy Swedish mother-infant pairs. Infant body composition at 1 week of age was assessed using air-displacement plethysmography. Maternal GWG was defined as below, within or above the 2009 IOM recommendations. Multiple regression analyses were used.

    RESULTS: Compared with women whose weight gain was within IOM recommendations, women with weight gain below the recommendations had infants that were shorter (-0.7 cm, P = 0.008) when adjusting for confounders. Normal-weight women exceeding IOM recommendations had infants with higher FM (+58 g, P = 0.008) compared with normal-weight women who gained within the recommendations. No corresponding association was observed for overweight/obese women.

    CONCLUSIONS: Inadequate GWG was associated with shorter infants, while excessive GWG was associated with greater infant FM for women who were of normal weight before pregnancy.

  • 38.
    Henriksson, Pontus
    et al.
    Karolinska Inst, Sweden; Univ Granada, Spain; Karolinska Inst, Sweden.
    Henriksson, Hanna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Granada, Spain.
    Tynelius, Per
    Karolinska Inst, Sweden; Stockholm Cty Council, Sweden; Karolinska Inst, Sweden.
    Berglind, Daniel
    Karolinska Inst, Sweden.
    Löf, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Lee, I-Min
    Harvard Med Sch, MA 02115 USA; Harvard TH Chan Sch Publ Hlth, MA USA.
    Shiroma, Eric J.
    NIA, MD 20892 USA.
    Ortega, Francisco B.
    Karolinska Inst, Sweden; Univ Granada, Spain.
    Fitness and Body Mass Index During Adolescence and Disability Later in Life A Cohort Study2019In: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 170, no 4, p. 230-+Article in journal (Refereed)
    Abstract [en]

    Background: Low physical fitness, obesity, and the combination of the two in adolescence may be related to risk for disability in adulthood, but this has rarely been studied. Objective: To examine individual and combined associations of cardiorespiratory fitness and obesity in male adolescents with later receipt of a disability pension due to all and specific causes. Design: Population-based cohort study. Setting: Sweden. Participants: 1 079 128 Swedish adolescents aged 16 to 19 years who were conscripted into the military between 1972 and 1994. Measurements: Cardiorespiratory fitness and body mass index (BMI) were measured at conscription and were related to information on later receipt of a disability pension obtained from the Social Insurance Agency. Results: Over a median follow-up of 28.3 years, 54 304 men were granted a disability pension. Low cardiorespiratory fitness was strongly associated with later receipt of a disability pension due to all causes (hazard ratio, 3.74 [95% CI, 3.55 to 3.95] for lowest vs. highest fitness decile) and specific causes (psychiatric, musculoskeletal, injuries, nervous system, circulatory, and tumors). Obesity was associated with greater risk for receipt of a disability pension due to all and specific causes, with the greatest risks observed for class II and III obesity. Compared with being unfit, being moderately or highly fit was associated with attenuated risk for receipt of a disability pension across BMI categories. Limitation: The cohort did not include women, had data on smoking and alcohol intake only in a subsample, and lacked repeated measures of exposures and covariates. Conclusion: Low cardiorespiratory fitness, obesity, and the combination of the two were strongly associated with later chronic disability due to a wide range of diseases and causes. Although additional well-designed studies are required, these findings support the importance of high cardiorespiratory fitness and healthy body weight during adolescence to prevent later chronic disease.

  • 39.
    Henriksson, Pontus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden; Univ Granada, Spain.
    Leppanen, Marja H.
    Univ Jyvaskyla, Finland.
    Henriksson, Hanna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Granada, Spain.
    Nystrom, Christine Delisle
    Karolinska Inst, Sweden; Childrens Hosp Eastern Ontario, Canada.
    Cadenas-Sanchez, Cristina
    Univ Granada, Spain.
    Ek, Anna
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Ruiz, Jonatan R.
    Karolinska Inst, Sweden; Univ Granada, Spain.
    Ortega, Francisco B.
    Karolinska Inst, Sweden; Univ Granada, Spain.
    Löf, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Physical fitness in relation to later body composition in pre-school children2019In: Journal of Science and Medicine in Sport, ISSN 1440-2440, E-ISSN 1878-1861, Vol. 22, no 5, p. 574-579Article in journal (Refereed)
    Abstract [en]

    Objectives

    Although physical fitness is considered a marker of health in youth, little is known whether physical fitness in pre-school age is related to later body composition. Thus, this study investigated (i) associations of physical fitness at 4.5 years of age with body composition 12 months later and (ii) whether improvements in physical fitness during the 12-month follow-up were associated with changes in body composition.

    Design

    This study included 142 children, measured at 4.5 and 5.5 years, from the control group of the MINISTOP trial.

    Methods

    Physical fitness (cardiorespiratory fitness, lower- and upper-body muscular strength and motor fitness) was measured using the PREFIT test battery. Body composition was assessed using air-displacement plethysmography.

    Results

    In adjusted regression analyses, greater cardiorespiratory fitness, lower-body muscular strength and motor fitness at 4.5 years were associated with a lower fat mass index at 5.5 years (standardized β= −0.182 to −0.229, p ≤ 0.028). Conversely, greater cardiorespiratory fitness, lower- and upper-body muscular strength as well as motor fitness at 4.5 years of age were associated with a higher fat-free mass index (standardized β = 0.255–0.447, p ≤ 0.001). Furthermore, improvements in cardiorespiratory fitness, lower-body muscular strength and motor fitness during the 12-month follow-up period were associated with decreases in fat mass index and/or % fat mass.

    Conclusions

    In conclusion, the results of this study provide evidence of the importance of physical fitness early in life. Nevertheless, further studies are needed in order to clarify the influence of physical fitness in the pre-school age with later health outcomes.

  • 40.
    Henriksson, Pontus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Assessment and prediction of thoracic gas volume in pregnant women: an evaluation in relation to body composition assessment using air displacement plethysmography2013In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 109, no 1, p. 111-117Article in journal (Refereed)
    Abstract [en]

    Assessment of body fat (BF) in pregnant women is important when investigating the relationship between maternal nutrition and offspring health. Convenient and accurate body composition methods applicable during pregnancy are therefore needed. Air displacement plethysmography, as applied in Bod Pod, represents such a method since it can assess body volume (BV) which, in combination with body weight, can be used to calculate body density and body composition. However, BV must be corrected for the thoracic gas volume (TGV) of the subject. In non-pregnant women, TGV may be predicted using equations, based on height and age. It is unknown, however, whether these equations are valid during pregnancy. Thus, we measured the TGV of women in gestational week 32 (n 27) by means of plethysmography and predicted their TGV using equations established for non-pregnant women. Body weight and BV of the women was measured using Bod Pod. Predicted TGV was significantly (P = 0.033) higher than measured TGV by 6% on average. Calculations in hypothetical women showed that this overestimation tended to be more pronounced in women with small TGV than in women with large TGV. The overestimation of TGV resulted in a small but significant (P = 0.043) overestimation of BF, equivalent to only 0.5% BF, on average. A Bland-Altman analysis showed that the limits of agreement were narrow (from -1.9 to 2.9% BF). Thus, although predicted TGV was biased and too high, the effect on BF was marginal and probably unimportant in many situations.

  • 41.
    Jung, Seungyoun
    et al.
    Harvard University, MA USA .
    Spiegelman, Donna
    Harvard University, MA USA .
    Baglietto, Laura
    Cancer Council Victoria, Australia .
    Bernstein, Leslie
    City Hope National Medical Centre, CA USA .
    Boggs, Deborah A.
    Boston University, MA USA .
    van den Brandt, Piet A.
    Maastricht University, Netherlands .
    Buring, Julie E.
    Harvard University, MA USA .
    Cerhan, James R.
    Mayo Clin, MN USA .
    Gaudet, Mia M.
    Amer Cancer Soc, GA USA .
    Giles, Graham G.
    Cancer Council Victoria, Australia .
    Goodman, Gary
    Fred Hutchinson Cancer Research Centre, WA USA .
    Hakansson, Niclas
    Karolinska Institute, Sweden .
    Hankinson, Susan E.
    Harvard University, MA USA .
    Helzlsouer, Kathy
    St Johns Mercy Medical Centre, MD USA .
    Horn-Ross, Pamela L.
    Cancer Prevent Institute Calif, CA USA .
    Inoue, Manami
    National Cancer Centre, Japan .
    Krogh, Vittorio
    Fdn IRCCS Ist Nazl Tumori Milano, Italy .
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    McCullough, Marjorie L.
    Amer Cancer Soc, GA USA .
    Miller, Anthony B.
    University of Toronto, Canada .
    Neuhouser, Marian L.
    Fred Hutchinson Cancer Research Centre, WA USA .
    Palmer, Julie R.
    Boston University, MA USA .
    Park, Yikyung
    NCI, MD USA .
    Robien, Kim
    University of Minnesota, MN USA .
    Rohan, Thomas E.
    Albert Einstein Coll Med, NY USA .
    Scarmo, Stephanie
    NYU, NY 10016 USA .
    Schairer, Catherine
    NCI, MD USA .
    Schouten, Leo J.
    Maastricht University, Netherlands .
    Shikany, James M.
    University of Alabama Birmingham, AL USA .
    Sieri, Sabina
    Fdn IRCCS Ist Nazl Tumori Milano, Italy .
    Tsugane, Schoichiro
    National Cancer Centre, Japan .
    Visvanathan, Kala
    Johns Hopkins Bloomberg School Public Heatlh, MD USA .
    Weiderpass, Elisabete
    Karolinska Institute, Sweden .
    Willett, Walter C.
    Harvard University, MA USA .
    Wolk, Alicja
    Karolinska Institute, Sweden .
    Zeleniuch-Jacquotte, Anne
    NYU, NY USA .
    Zhang, Shumin M.
    Brigham and Womens Hospital, MA USA .
    Zhang, Xuehong
    Brigham and Womens Hospital, MA USA .
    Ziegler, Regina G.
    NCI, MD USA .
    Smith-Warner, Stephanie A:
    Harvard University, MA USA .
    Fruit and Vegetable Intake and Risk of Breast Cancer by Hormone Receptor Status2013In: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 105, no 3, p. 219-236Article in journal (Refereed)
    Abstract [en]

    Estrogen receptornegative (ER) breast cancer has few known or modifiable risk factors. Because ER tumors account for only 15% to 20% of breast cancers, large pooled analyses are necessary to evaluate precisely the suspected inverse association between fruit and vegetable intake and risk of ER breast cancer. less thanbrgreater than less thanbrgreater thanAmong 993 466 women followed for 11 to 20 years in 20 cohort studies, we documented 19 869 estrogen receptor positive (ER) and 4821 ER breast cancers. We calculated study-specific multivariable relative risks (RRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression analyses and then combined them using a random-effects model. All statistical tests were two-sided. less thanbrgreater than less thanbrgreater thanTotal fruit and vegetable intake was statistically significantly inversely associated with risk of ER breast cancer but not with risk of breast cancer overall or of ER tumors. The inverse association for ER tumors was observed primarily for vegetable consumption. The pooled relative risks comparing the highest vs lowest quintile of total vegetable consumption were 0.82 (95% CI 0.74 to 0.90) for ER breast cancer and 1.04 (95% CI 0.97 to 1.11) for ER breast cancer (Pcommon-effects by ER status andlt; .001). Total fruit consumption was non-statistically significantly associated with risk of ER breast cancer (pooled multivariable RR comparing the highest vs lowest quintile 0.94, 95% CI 0.85 to 1.04). less thanbrgreater than less thanbrgreater thanWe observed no association between total fruit and vegetable intake and risk of overall breast cancer. However, vegetable consumption was inversely associated with risk of ER breast cancer in our large pooled analyses.

  • 42.
    Jung, Seungyoun
    et al.
    Harvard TH Chan School Public Heatlh, MA USA; University of Maryland, MD 21201 USA.
    Wang, Molin
    Harvard TH Chan School Public Heatlh, MA USA; Harvard TH Chan School Public Heatlh, MA USA.
    Anderson, Kristin
    University of Minnesota, MN USA; University of Minnesota, MN USA.
    Baglietto, Laura
    Cancer Council Victoria, Australia; University of Melbourne, Australia.
    Bergkvist, Leif
    Central Hospital Vasteras, Sweden; Central Hospital Vasteras, Sweden.
    Bernstein, Leslie
    Beckman Research Institute, CA USA; City Hope National Medical Centre, CA 91010 USA.
    van den Brandt, Piet A.
    Maastricht University, Netherlands.
    Brinton, Louise
    NCI, MD 20892 USA.
    Buring, Julie E.
    Harvard TH Chan School Public Heatlh, MA USA; Harvard Medical Sch, MA USA.
    Eliassen, A. Heather
    Harvard TH Chan School Public Heatlh, MA USA; Brigham and Womens Hospital, MA USA; Harvard Medical Sch, MA USA.
    Falk, Roni
    NCI, MD 20892 USA.
    Gapstur, Susan M.
    Amer Cancer Soc, GA 30329 USA.
    Giles, Graham G.
    Cancer Council Victoria, Australia; University of Melbourne, Australia.
    Goodman, Gary
    Fred Hutchinson Cancer Research Centre, WA 98104 USA.
    Hoffman-Bolton, Judith
    Johns Hopkins Bloomberg School Public Heatlh, MD USA.
    Horn-Ross, Pamela L.
    Cancer Prevent Institute Calif, CA USA.
    Inoue, Manami
    National Cancer Centre, Japan; University of Tokyo, Japan.
    Kolonel, Laurence N.
    University of Hawaii, HI 96822 USA.
    Krogh, Vittorio
    Fdn IRCCS Ist Nazl Tumori, Italy.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Maas, Paige
    NCI, MD 20892 USA.
    Miller, Anthony B.
    University of Toronto, Canada.
    Neuhouser, Marian L.
    Fred Hutchinson Cancer Research Centre, WA 98104 USA.
    Park, Yikyung
    Washington University, MO 63110 USA.
    Robien, Kim
    George Washington University, DC USA.
    Rohan, Thomas E.
    Albert Einstein Coll Med, NY 10467 USA.
    Scarmo, Stephanie
    NYU, NY USA.
    Schouten, Leo J.
    Maastricht University, Netherlands.
    Sieri, Sabina
    Fdn IRCCS Ist Nazl Tumori, Italy.
    Stevens, Victoria L.
    Amer Cancer Soc, GA 30329 USA.
    Tsugane, Schoichiro
    National Cancer Centre, Japan.
    Visvanathan, Kala
    Johns Hopkins Bloomberg School Public Heatlh, MD USA.
    Wilkens, Lynne R.
    University of Hawaii, HI 96822 USA.
    Wolk, Alicja
    Karolinska Institute, Sweden.
    Weiderpass, Elisabete
    Karolinska Institute, Sweden; University of Tromso, Norway; Cancer Registry Norway, Norway; Folkhalsan Research Centre, Finland.
    Willett, Walter C.
    Harvard TH Chan School Public Heatlh, MA USA; Harvard TH Chan School Public Heatlh, MA USA; Brigham and Womens Hospital, MA USA; Harvard Medical Sch, MA USA.
    Zeleniuch-Jacquotte, Anne
    NYU, NY USA.
    Zhang, Shumin M.
    Harvard Medical Sch, MA USA.
    Zhang, Xuehong
    Brigham and Womens Hospital, MA USA; Harvard Medical Sch, MA USA.
    Ziegler, Regina G.
    NCI, MD 20892 USA.
    Smith-Warner, Stephanie A.
    Harvard TH Chan School Public Heatlh, MA USA.
    Alcohol consumption and breast cancer risk by estrogen receptor status: in a pooled analysis of 20 studies2016In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 45, no 3, p. 916-928Article in journal (Refereed)
    Abstract [en]

    Background: Breast cancer aetiology may differ by estrogen receptor (ER) status. Associations of alcohol and folate intakes with risk of breast cancer defined by ER status were examined in pooled analyses of the primary data from 20 cohorts. Methods: During a maximum of 6-18 years of follow-up of 1 089 273 women, 21 624 ER+ and 5113 ER- breast cancers were identified. Study-specific multivariable relative risks (RRs) were calculated using Cox proportional hazards regression models and then combined using a random-effects model. Results: Alcohol consumption was positively associated with risk of ER+ and ER- breast cancer. The pooled multivariable RRs (95% confidence intervals) comparing amp;gt;= 30 g/d with 0 g/day of alcohol consumption were 1.35 (1.23-1.48) for ER+ and 1.28 (1.10-1.49) for ER+ breast cancer (P-trend amp;lt;= 0.001; Pcommon-effects by ER status: 0.57). Associations were similar for alcohol intake from beer, wine and liquor. The associations with alcohol intake did not vary significantly by total (from foods and supplements) folate intake (P-interaction amp;gt;= 0.26). Dietary (from foods only) and total folate intakes were not associated with risk of overall, ER+ and ER- breast cancer; pooled multivariable RRs ranged from 0.98 to 1.02 comparing extreme quintiles. Following-up US studies through only the period before mandatory folic acid fortification did not change the results. The alcohol and folate associations did not vary by tumour subtypes defined by progesterone receptor status. Conclusions: Alcohol consumption was positively associated with risk of both ER+ and ER- breast cancer, even among women with high folate intake. Folate intake was not associated with breast cancer risk.

  • 43.
    Kuper, Hannah
    et al.
    University of London.
    Yang, Ling
    University of Oxford.
    Sandin, Sven
    Karolinska Institute.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Adami, Hans-Olov
    Karolinska Institute.
    Weiderpass, Elisabete
    Samfundet Folkhalsan.
    Prospective Study of Solar Exposure, Dietary Vitamin D Intake, and Risk of Breast Cancer among Middle-aged Women2009In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 18, no 9, p. 2558-2561Article in journal (Other academic)
    Abstract [en]

    The relationship between solar exposure or dietary vitamin D intake and breast cancer risk has not been fully elucidated. These associations were studied within the Womens Lifestyle and Health Cohort Study, a cohort of 49,259 Swedish women ages 30 to 50 years at baseline (1991-1992). Women were asked about solar exposure and completed a food frequency questionnaire and were followed-up through linkages to national registries until December 2004. In the current analyses, 41,889 women were included, 840 of whom were diagnosed with breast cancer during follow-up. Breast cancer risk was not related to solar exposure variables, including sun sensitivity, annual number of sunburns, time spent on sunbathing vacations, or solarium use at any age period of exposure. There was also no association with dietary vitamin D intake or supplementary multivitamin use. These relationships were not modified after stratifying by estrogen or progesterone receptor status.

  • 44.
    Lagiou, Pagona
    et al.
    University of Athens, Greece Harvard University, MA 02115 USA .
    Sandin, Sven
    Karolinska Institute, Sweden .
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Trichopoulos, Dimitrios
    Harvard University, USA Academic Athens, Greece .
    Adami, Hans-Olov
    Harvard University, USA Karolinska Institute, Sweden .
    Weiderpass, Elisabete
    Karolinska Institute, Sweden Cancer Registry Norway, Norway Samfundet Folkhalsan, Finland .
    Letter: Research authors reply to Campillo-Soto and Freedhoff2012In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 345, no e5112Article in journal (Other academic)
    Abstract [en]

    n/a

  • 45.
    Lagiou, Pagona
    et al.
    University of Athens, Greece Harvard University, MA 02115 USA .
    Sandin, Sven
    Karolinska Institute, Sweden .
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Trichopoulos, Dimitrios
    Harvard University, MA 02115 USA Academic Athens, Greece .
    Adami, Hans-Olov
    Harvard University, MA 02115 USA Karolinska Institute, Sweden .
    Weiderpass, Elisabete
    Karolinska Institute, Sweden Cancer Registry Norway, Norway University of Tromso, Norway Samfundet Folkhalsan, Finland .
    Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study2012In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 344Article in journal (Refereed)
    Abstract [en]

    Objective To study the long term consequences of low carbohydrate diets, generally characterised by concomitant increases in protein intake, on cardiovascular health. Design Prospective cohort study. Setting Uppsala, Sweden. Participants From a random population sample, 43 396 Swedish women, aged 30-49 years at baseline, completed an extensive dietary questionnaire and were followed-up for an average of 15.7 years. Main outcome measures Association of incident cardiovascular diseases (ascertained by linkage with nationwide registries), overall and by diagnostic category, with decreasing carbohydrate intake (in tenths), increasing protein intake (in tenths), and an additive combination of these variables (low carbohydrate-high protein score, from 2 to 20), adjusted for intake of energy, intake of saturated and unsaturated fat, and several non-dietary variables. Results A one tenth decrease in carbohydrate intake or increase in protein intake or a 2 unit increase in the low carbohydrate-high protein score were all statistically significantly associated with increasing incidence of cardiovascular disease overall (n=1270)-incidence rate ratio estimates 1.04 (95% confidence interval 1.00 to 1.08), 1.04 (1.02 to 1.06), and 1.05 (1.02 to 1.08). No heterogeneity existed in the association of any of these scores with the five studied cardiovascular outcomes: ischaemic heart disease (n=703), ischaemic stroke (n=294), haemorrhagic stroke (n=70), subarachnoid haemorrhage (n=121), and peripheral arterial disease (n=82). Conclusions Low carbohydrate-high protein diets, used on a regular basis and without consideration of the nature of carbohydrates or the source of proteins, are associated with increased risk of cardiovascular disease.

  • 46.
    Leppanen, Marja H.
    et al.
    Univ Jyvaskyla, Finland; Karolinska Inst, Sweden.
    Henriksson, Pontus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Henriksson, Hanna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nystrom, Christine Delisle
    Karolinska Inst, Sweden; Eastern Ontario Res Inst, Canada.
    Llorente-Cantarero, Francisco Jesus
    Univ Seville, Spain; Univ Cordoba, Spain.
    Löf, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Physical Activity Level Using Doubly-Labeled Water in Relation to Body Composition and Physical Fitness in Preschoolers2019In: Medicina (Kaunas), ISSN 1010-660X, E-ISSN 1648-9144, Vol. 55, no 1, article id UNSP 2Article in journal (Refereed)
    Abstract [en]

    Background and objectives: There is a lack of studies investigating associations of physical activity level (PAL) and activity energy expenditure (AEE) using the doubly-labeled water (DLW) method with body composition and physical fitness in young children. Thus, we aimed to examine cross-sectional associations of PAL and AEE with body composition indices and physical fitness components in Swedish preschool children. Materials and methods: PAL was calculated as total energy expenditure measured using DLW divided by the predicted basal metabolic rate in 40 children aged 5.5 (standard deviation 0.2) years. AEE was calculated as total energy expenditure minus basal metabolic rate and the thermic effect of food, and divided by fat-free mass. Body composition was assessed using the 3-component model by combining measurements based on isotope dilution and air-displacement plethysmography. Physical fitness (muscular strength, motor fitness, and cardiorespiratory fitness) was evaluated using the PREFIT test battery. Multiple linear regression models were conducted. Results: PAL and AEE were negatively associated with body mass index, percent body fat, and fat mass index (PAL: standardized beta -0.35, -0.41, and -0.45, all p amp;lt; 0.036; AEE: standardized beta -0.44, -0.44, and -0.47, all p amp;lt; 0.006, respectively). Furthermore, PAL and AEE were positively associated with the standing long jump test (PAL: standardized beta 0.37, p = 0.017; AEE: standardized beta 0.38, p = 0.014). There were no statistically significant associations found regarding PAL or AEE with fat-free mass index or any other physical fitness test. Conclusions: Greater PAL and AEE at the age 5.5 were significantly associated with body fatness and improved lower-body muscular strength. Therefore, increasing physical activity, and thus energy expenditure, at young ages may be beneficial for preventing overweight/obesity. However, further studies with larger sample sizes are needed to confirm the results.

  • 47.
    Leppänen, M. H.
    et al.
    University of Jyvaskyla, Finland.
    Delisle Nyström, C.
    Karolinska Institute, Sweden.
    Henriksson, Pontus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. University of Granada, Spain.
    Pomeroy, J.
    Marshfield Clin Research Fdn, WI USA.
    Ruiz, J. R.
    University of Granada, Spain.
    Ortega, F. B.
    University of Granada, Spain.
    Cadenas-Sanchez, C.
    University of Granada, Spain.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institute, Sweden.
    Physical activity intensity, sedentary behavior, body composition and physical fitness in 4-year-old children: results from the ministop trial2016In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 40, no 7, p. 1126-1133Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Existing knowledge on associations of physical activity (PA) and sedentary behavior (SB) with body composition and physical fitness in preschoolers is limited. OBJECTIVE: To examine associations of PA and SB with body composition and physical fitness in healthy Swedish 4-year-old children. METHODS: We utilized baseline data collected in 2014 for the population-based MINISTOP trial (n = 307). Light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA), moderate-to-vigorous PA (MVPA) and SB were measured using accelerometry (ActiGraph-wGT3x-BT). Body composition was measured using air-displacement plethysmography, and physical fitness (that is, cardiorespiratory fitness, lower and upper body muscular strength and motor fitness) was measured using the PREFIT fitness test battery. Multiple linear regression models adjusted for relevant confounders, and in addition, isotemporal substitution models were applied. RESULTS: Greater MVPA was associated with lower fat mass percent (%FM, P = 0.015), and greater VPA and MVPA were associated with higher fat-free mass index (FFMI, P = 0.002 and P = 0.011). In addition, greater VPA and MVPA were associated with higher scores for all physical fitness tests (P = 0.042 to Pamp;lt;0.001). The results for MVPA were primarily due to VPA. SB was associated with weaker handgrip strength (P = 0.031) when PA was not adjusted, but after adjusting also for VPA, the significant association disappeared (P = 0.25). Substituting 5 min per day of SB, LPA or MPA with 5 min per day of VPA was associated with higher FFMI and better scores for cardiorespiratory fitness and motor fitness. Correspondingly, substituting 5 min per day of VPA with SB or LPA was associated with weaker performance for lower muscular strength. CONCLUSIONS: Time spent on VPA was associated with higher FFMI and better physical fitness. The results suggest that promoting VPA may be important to improve childhood body composition and physical fitness already at an early age.

  • 48.
    Leppänen, Marja H.
    et al.
    University of Jyvaskyla, Finland.
    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; Karolinska Institute, Sweden.
    Delisle Nyström, Christine
    Karolinska Institute, Sweden.
    Henriksson, Hanna
    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.
    Ortega, Francisco B.
    University of Granada, Spain.
    Pomeroy, Jeremy
    Marshfield Clin Research Fdn, WI USA.
    Ruiz, Jonatan R.
    University of Granada, Spain.
    Cadenas-Sanchez, Cristina
    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 Physical Activity, Body Composition, and Physical Fitness in Preschoolers2017In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 49, no 10, p. 2078-2085Article in journal (Refereed)
    Abstract [en]

    Purpose: This study aimed to investigate longitudinal associations of objectively measured physical activity (PA) and sedentary behavior (SB) with body composition and physical fitness at a 12-month follow-up in healthy Swedish 4-yr-old children. Methods: The data from the population-based MINISTOP trial were collected between 2014 and 2016, and this study included the 138 children who were in the control group. PA and SB were assessed using the wrist-worn ActiGraph (wGT3x-BT) accelerometer during seven 24-h periods and, subsequently, defined as SB, light-intensity PA, moderate-intensity PA, vigorous-intensity PA (VPA), and moderate-to-vigorous PA (MVPA). Body composition was measured using air-displacement plethysmography and physical fitness (cardiorespiratory fitness, lower and upper muscular strength as well as motor fitness) by the PREFIT fitness battery. Linear regression and isotemporal substitution models were applied. Results: Greater VPA and MVPA at the age of 4.5 yr were associated with higher fat-free mass index (FFMI) at 5.5 yr (P amp;lt; 0.001 and P = 0.044, respectively). Furthermore, greater VPA and MVPA at the age of 4.5 yr were associated with higher scores for cardiorespiratory fitness, lower body muscular strength, and motor fitness at 12-month follow-up (P = 0.001 to P = 0.031). Substituting 5 min.d(-1) of SB, light-intensity PA, or moderate-intensity PA for VPA at the age of 4.5 yr were associated with higher FFMI, and with greater upper and lower muscular strength at 12-month follow-up (P amp;lt; 0.001 to P = 0.046). Conclusion: Higher VPA and MVPA at the age of 4.5 yr were significantly associated with higher FFMI and better physical fitness at 12-month follow-up. Our results indicate that promoting high-intensity PA at young ages may have long-term beneficial effects on childhood body composition and physical fitness, in particular muscular strength.

  • 49.
    Lindqvist, Anna-Karin
    et al.
    Lulea Univ Technol, Sweden.
    Löf, Marie
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Ek, Anna
    Karolinska Inst, Sweden.
    Rutberg, Stina
    Lulea Univ Technol, Sweden.
    Active School Transportation in Winter Conditions: Biking Together Is Warmer2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 2, article id 234Article in journal (Refereed)
    Abstract [en]

    There has been a decline in childrens use of active school transportation (AST) while there is also limited research concerning AST in winter conditions. This study aimed to explore the prerequisites and experiences of schoolchildren and parents participating in an empowerment- and gamification-inspired intervention to promote students AST in winter conditions. Methods: Thirty-five students, who were aged 12-13 years, and 34 parents from the north of Sweden participated in the study. Data were collected using photovoice and open questions in a questionnaire and analyzed using qualitative content analysis. Results: The results show that involvement and togetherness motivated the students to use AST. In addition, during the project, the parents changed to have more positive attitudes towards their childrens use of AST. The students reported that using AST during wintertime is strenuous but rewarding and imparts a sense of pride. Conclusion: Interventions for increasing students AST in winter conditions should focus on the motivational aspects for both children and parents. For overcoming parental hesitation with regards to AST during winter, addressing their concerns and empowering the students are key factors. To increase the use of AST all year around, targeting the challenges perceived during the winter is especially beneficial.

  • 50.
    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.

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