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  • 1.
    Claesson, Anna-Lena
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Holm, Gunilla
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Ernersson, Åsa
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindström, Torbjörn
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Nyström, Fredrik
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Two weeks of overfeeding with candy, but not peanuts, increases insulin levels and body weight2009In: SCANDINAVIAN JOURNAL OF CLINICAL and LABORATORY INVESTIGATION, ISSN 0036-5513, Vol. 69, no 5, p. 598-605Article in journal (Refereed)
    Abstract [en]

    Objective: To study the effects of snacking based on fast acting carbohydrates (candy) or fat and protein (peanuts) in a prospective randomized, parallel intervention study. Methods: Basal metabolic rate (BMR) and cardiovascular risk factors were measured before and after hyper-alimentation by addition of 20 kcal/kg (84 kJ/kg) body weight of either candy or roasted peanuts, to the regular caloric intake, for two weeks in healthy subjects. Eleven men and 14 women completed the randomized study. Results: Energy-intake increased similarly in the groups (candy: +46.1 +/- 35%, peanuts: +46.8 +/- 28%, p = 0.96). Body-weight (candy: from 67.3 +/- 7.6 kg to 68.1 +/- 7.3 kg, p = 0.01, nuts: from 68.7 +/- 6.1 kg to 69.0 +/- 5.7 kg, p = 0.3) and waist circumference increased significantly only in the candy group. At the end of the study LDL cholesterol (candy: 2.6 +/- 0.4 mmol/L, peanuts: 2.1 +/- 0.4 mmol/L, p = 0.005) and ApoB/ApoA-1-ratio (candy: 0.68 +/- 0.16, peanuts: 0.53 +/- 0.11, p = 0.01) were higher in the candy group than in the peanut group. On the other hand, BMR increased only in the peanut group (candy: from 6.657 +/- 1.1 MJ/24 h to 6.762 +/- 1.1 MJ/24 h, p - 0.3, nuts: from 6.896 +/- 0.98 MJ/24 h to 7.256 +/- 1.1 MJ/24 h, p = 0.02). Conclusion: Two weeks of snacking based on peanuts does not cause the same negative metabolic effects as an isocaloric diet in which the snacking is based on short acting carbohydrates in the form of candy in non-obese healthy subjects.

  • 2.
    Ernersson, Åsa
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hyper-alimentation - effects on health and well-being.2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The general aim of this thesis was to prospectively examine the effects on health and well-being when healthy normal weight individuals increase their energy intake, mainly from fast food and simultaneously adopt a sedentary lifestyle.

    This thesis is based upon a prospective experimental study design where 18 healthy normal weight individuals, 12 men and 6 women, aged 26 (6.6) years, increased their energy intake with in average 70 % during four weeks. Simultaneously their physical activity was limited to a maximum of 5000 steps per day. An age and gender matched control group (n=18), was recruited and asked not to change their eatingand physical activity habits for four weeks. Long-term follow-up measurements were performed after 6 and 12 months and 2.5 years after the intervention.

    During the intervention body weight increased with 6.4 (2.8) kg and measurements of body composition showed an increase of both fat mass and fat free mass after the intervention. Lower physical and mental health scores on SF-36 as well as depressive symptoms were found compared to baseline. They were temporary and when followed up 6 and 12 months after the intervention, physical and mental health had returned to baseline values, despite a somewhat increased body weight. The main essence of adopting an obesity provoking behaviour was lack of energy emerging from five structures: influenced self-confidence, commitment to oneself and others, managing eating, feelings of tiredness and physical impact. Laboratory measurements showed an increase of ALT above reference limits in 14 of the 18 participants during the intervention and HTGC increased, although this was not related to the increase in ALT levels. Twelve months after the intervention an increase of body weight with 1.5 (2.4) kg was found compared to baseline (p=0.018), fat free mass was unchanged compared to baseline while fat mass had increased, + 1.4 (1.9) kg (p=0.01). Two and a half years after the intervention an increase of body weight with 3.1 (4.0) kg was found compared to baseline (p=0.01), while there was no change in controls compared to baseline, + 0.1 (2.5) kg (p=0.88).

    Hyper-alimentation and limited physical activity during a short-term period of 4 weeks is sufficient to temporarily induce worsened HRQoL, cause depressive symptoms and lack of energy in healthy normal weight individuals. There were also temporary but clear effects on biochemical markers, suggesting that hyperalimentation per se can induce profound ALT elevations in less than 4 weeks. During the intervention both fat mass and fat-free mass increased while after 12 months there was only an increase of fat mass which was greater than expected from epidemiological studies. The marked difference between the increase in body weight in the intervention- and control group at 2.5 years also raises the question whether there is a long-term effect of increasing fat mass after a short period of hyperalimentation.

    List of papers
    1. An obesity provoking behaviour negatively influences young normal weight subjects' Health Related Quality of Life and causes depressive symptoms
    Open this publication in new window or tab >>An obesity provoking behaviour negatively influences young normal weight subjects' Health Related Quality of Life and causes depressive symptoms
    Show others...
    2010 (English)In: Eating Behaviors, ISSN 1471-0153, E-ISSN 1873-7358, Vol. 11, no 4, p. 247-252Article in journal (Refereed) Published
    Abstract [en]

    In many parts of the world the prevalence of a sedentary lifestyle in combination with high consumption of food has increased, which contributes to increased risk for becoming overweight. Our primary aim was, in an intervention, to examine the influence on health related quality of life (HRQoL) and mood in young normal weight subjects of both sexes, when adopting an obesity provoking behaviour by increasing the energy intake via fast food and simultaneously adopting a sedentary lifestyle. A secondary aim was to follow-up possible long-term effects on HRQoL and mood 6 and 12 months after this short-term intervention.

    In this prospective study, 18 healthy normal weight subjects (mean age 26 ± 6.6 years), mainly university students were prescribed doubled energy intake, and maximum 5000 steps/day, during 4 weeks. An age and sex matched control group (n = 18), who were asked to have unchanged eating habits and physical activity, was recruited. Before and after the intervention questionnaires including Short Form-36, Hospital Anxiety Depression scale, Center of Epidemiological Studies Depression scale, Sense of Coherence and Mastery scale were completed by the subjects in the intervention group and by the controls with 4 weeks interval. Six and 12 months after the intervention the subjects underwent the same procedure as at baseline and the controls completed the same questionnaires.

    During the intervention, subjects in the intervention group increased their bodyweight and developed markedly lower physical and mental health scores on Short Form-36 as well as depressive symptoms while no changes appeared in the controls. The increase of depressive symptoms was associated with increases of energy intake, body weight and body fat. When followed up, 6 and 12 months after the intervention, physical and mental health had returned completely to baseline values, despite somewhat increased body weight.

    In conclusion, adopting obesity provoking behaviour for 4 weeks decreases HRQoL and mood in young normal weight subjects. The effect is temporary and when followed up 6 and 12 months after the short-term intervention no remaining influence is found.

    Place, publisher, year, edition, pages
    Elsevier, 2010
    Keywords
    Depressive symptoms; Feeding behaviour; Lifestyle; Health related quality of life; Weight gain
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-60149 (URN)10.1016/j.eatbeh.2010.05.005 (DOI)000283484700007 ()
    Available from: 2010-10-06 Created: 2010-10-06 Last updated: 2017-12-12Bibliographically approved
    2. Young healthy individuals develop lack of energy when adopting an obesity provoking behaviour for 4 weeks: a phenomenological analysis
    Open this publication in new window or tab >>Young healthy individuals develop lack of energy when adopting an obesity provoking behaviour for 4 weeks: a phenomenological analysis
    2010 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 3, p. 565-571Article in journal (Refereed) Published
    Abstract [en]

    During the past 20 years, a sedentary lifestyle has become more common and simultaneously the consumption of energy-dense food has increased. These are two major risk factors associated with the increase of overweight and obesity, which is found in all ages over the world. The low well-being reported by obese individuals could be associated with increased food intake or it might be a specific consequence of obesity and lack of physical fitness. The aim of this study was to describe the experience of the phenomenon, adopting an obesity provoking behaviour, by increasing energy intake and simultaneously having a sedentary lifestyle for 4 weeks in healthy, normal-weight individuals of both genders. Eighteen healthy individuals (12 men and 6 women; median age 23, range 21-44 years) were included in an intervention, with a doubled energy intake and a maximum physical activity of 5000 steps per day during 4 weeks. After completing this intervention the participants were interviewed and asked to describe their experience during the past 4 weeks. A phenomenological approach was used to gain understanding of the phenomenon and analyses of the transcripts were performed in four steps according to Giorgis method. The main essence of the phenomenon, adopting an obesity provoking behaviour, was found to be lack of energy, related to emotional life, relations and life habits. Lack of energy emerged from five structures: influenced self-confidence, commitment to oneself and others, managing eating, feelings of tiredness and physical impact. These five structures were manifested through 12 constituents. These lifestyle changes decreased the sense of well-being in nonobese healthy individuals of both genders.

    Place, publisher, year, edition, pages
    Blackwell Publishing Ltd, 2010
    Keywords
    eating, energy intake, food habits, health, lifestyle, weight gain
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-58951 (URN)10.1111/j.1471-6712.2009.00750.x (DOI)000281000800018 ()
    Available from: 2010-09-03 Created: 2010-09-03 Last updated: 2017-12-12
    3. Fast-food-based hyper-alimentation can induce rapid and profound elevation of serum alanine aminotransferase in healthy subjects
    Open this publication in new window or tab >>Fast-food-based hyper-alimentation can induce rapid and profound elevation of serum alanine aminotransferase in healthy subjects
    Show others...
    2008 (English)In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 57, no 5, p. 649-654Article in journal (Refereed) Published
    Abstract [en]

     Objective: To study the effect of fast-food-based hyperalimentation on liver enzymes and hepatic triglyceride content (HTGC).

    Design: Prospective interventional study with parallel control group.

    Setting: University Hospital of Linko¨ping, Sweden.

    Participants: 12 healthy men and six healthy women with a mean (SD) age of 26 (6.6) years and a matched control group.

    Intervention: Subjects in the intervention group aimed for a body weight increase of 5–15% by eating at least two fast-food-based meals a day with the goal to double the regular caloric intake in combination with adoption of a sedentary lifestyle for 4 weeks.

    Main outcome measures: Weekly changes of serum aminotransferases and HTGC measured by proton nuclear magnetic resonance spectroscopy at baseline and after the intervention.

    Results: Subjects in the intervention group increased from 67.6 (9.1) kg to 74.0 (11) kg in weight (p,0.001). Serum ALT increased from 22.1 (11.4) U/l at study start to an individual mean maximum level of 97 (103) U/l (range 19.4–447 U/l). Eleven of the 18 subjectspersistently showed ALT above reference limits (women .19 U/l, men .30 U/l) during the intervention. Sugar (mono- and disaccharides) intake during week 3 correlated with the maximal ALT/baseline ALT ratio(r=0.62, p=0.006). HTGC increased from 1.1 (1.9)% to 2.8 (4.8)%, although this was not related to the increase in ALT levels. ALT levels were unchanged in controls.

    Conclusion: Hyper-alimentation per se can induce profound ALT elevations in less than 4 weeks. Our study clearly shows that in the evaluation of subjects with elevated ALT the medical history should include not only questions about alcohol intake but also explore whetherrecent excessive food intake has occurred.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-60150 (URN)10.1136/gut.2007.131797 (DOI)000254918200018 ()
    Available from: 2010-10-06 Created: 2010-10-06 Last updated: 2019-06-14
    4. Long-term increase of fat mass after a four week intervention with fast food based hyper-alimentation and limitation of physical activity
    Open this publication in new window or tab >>Long-term increase of fat mass after a four week intervention with fast food based hyper-alimentation and limitation of physical activity
    2010 (English)In: Nutrition & Metabolism, ISSN 1743-7075, Vol. 7, no 68Article in journal (Refereed) Published
    Abstract [en]

    Background: A sedentary lifestyle and increased consumption of energy dense food have become more common in many parts of the world. The aim of this study was to study long term effects on body composition after a four week intervention with fast food based hyper-alimentation and limited physical activity in young normal weight subjects.

    Method: Eighteen subjects, mean age 26 (6.6) years, increased their energy intake with in average 70% and physical activity were not to exceed 5000 steps/day. Body composition was measured by Dual energy x-ray (DXA) at baseline, after the intervention and after 12 months. A matched control group was also included. ANOVA and Student's paired and unpaired t-test were used.

    Result: During the intervention body weight increased with 6.4 (2.8) kg and DXA measurements showed increases of both fat free mass and fat mass. Six months after the intervention the subjects had lost most of the weight gain, - 4.7 (3.1) kg. Twelve months after the intervention body weight had increased with 1.5 (2.4) kg compared to baseline (p = 0.018). DXA measurements at 12 months showed unchanged fat free mass compared to baseline but higher fat mass, + 1.4 (1.9) kg (p = 0.01). After 2.5 years the increase of body weight was 3.1 (4.0) kg (p = 0.01) while there was no change in controls compared to baseline, + 0.1(2.5) kg (p = 0.88).

    Conclusion: One year after a short term intervention with increased fast food based hyper-alimentation there was an increase of fat mass but unchanged fat free mass. As the change of fat mass was larger than expected from prospective epidemiological studies and as there was no increase of body weight in controls it raises the issue whether there is a long-term effect to increase fat mass of a short period of hyper-alimentation.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-60152 (URN)10.1186/1743-7075-7-68 (DOI)000282491900001 ()20738843 (PubMedID)
    Note
    Original Publication: Åsa Ernersson, Fredrik Nyström and Torbjörn Lindström, Long-term increase of fat mass after a four week intervention with fast food based hyper-alimentation and limitation of physical activity, 2010, Nutrition & Metabolism, (7), 68. http://dx.doi.org/10.1186/1743-7075-7-68 Copyright: BioMed Central http://www.biomedcentral.com/ Available from: 2010-10-06 Created: 2010-10-06 Last updated: 2013-09-10
  • 3.
    Ernersson, Åsa
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
    Berggren, B.
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindström, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
    Lower fear of hypoglycaemia in patients with type 1 diabetes of short duration2012In: 17th FEND Annual Conference 2012, page 19, 2012Conference paper (Other academic)
    Abstract [en]

    Background

    Fear of hypoglycaemia is common in patients with type 1 diabetes and many patients deliberately aim at higher blood glucose than recommended to avoid hypoglycaemia. Patient empowerment is a process whereby patients have the skills, attitudes, and self-awareness necessary to influence the quality of their lives. An empowered patient has sufficient knowledge to take relevant decisions about their illness, medical treatment and their own health.

    Aim

    The aim was to study empowerment, fear of hypoglycaemia and problem areas among patients with type1 diabetes.

    Method

    Four hundred fifty-seven patients, mean age 48.5 (±15.4) years, completed an questionnaire including questions on the duration of diabetes, episodes of severe hypoglycaemias and metabolic control, the Swedish Diabetes Empowerment Scale – 23 (Swe-DES-23), Fear of Hypoglycaemia Survey (HFS) and the Problem Areas in Diabetes scale (SWE-PAID-20) .

    Results

    The level of HbA1c was not associated with fear of hypoglycaemia while patients with newly diagnosed (0-5 years) diabetes had significantly lower (p=0.001) fear of hypoglycaemia than those with longer duration. Episodes of severe hypoglycaemia during the last year also influenced the rating on HFS. HFS was 24.7(11.6) in those with no episodes, 30.5(13.9) 1 episode, 33.0(15.4) 2-4 episodes (all p<0.01). Patients with HbA1c ≥ 8.0 % rated lower empowerment (SWE-DES-23) compared to those who had an HbA1c between 6.1-7.9% (p=0.02) and compared to those with HbA1c lower or equal to 6.0 % (p<0.001).

    On the SWE-PAID-20 patients with HbA1c ≥8 % scored in average 32.2(20.5) while those with HbA1c ≤6.0% scored 20.0(17.6) (p<0.001) (higher value indicates more emotional distress related to diabetes).

    Conclusion

    Patients with poor metabolic control, HbA1c ≥8 % are less empowered and also experiences more emotional distress related to their diabetes. Fear of hypoglycaemia was lowest in patient with up to 5 years duration of type 1 diabetes. HbA1c was not associated with fear of hypoglycaemia while repeated episodes of severe hypoglycaemia during the last year increased this fear.

  • 4.
    Ernersson, Åsa
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Gastroentorology.
    Löfgren, U-A
    Berggren, B
    Lindström, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
    Fear of hypoglycaemia and empowerment in patients with type 1 diabetes2012Conference paper (Other academic)
  • 5.
    Ernersson, Åsa
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sepa Frostell, Anneli
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Lindström, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    An obesity provoking behaviour negatively influences young normal weight subjects' Health Related Quality of Life and causes depressive symptoms2010In: Eating Behaviors, ISSN 1471-0153, E-ISSN 1873-7358, Vol. 11, no 4, p. 247-252Article in journal (Refereed)
    Abstract [en]

    In many parts of the world the prevalence of a sedentary lifestyle in combination with high consumption of food has increased, which contributes to increased risk for becoming overweight. Our primary aim was, in an intervention, to examine the influence on health related quality of life (HRQoL) and mood in young normal weight subjects of both sexes, when adopting an obesity provoking behaviour by increasing the energy intake via fast food and simultaneously adopting a sedentary lifestyle. A secondary aim was to follow-up possible long-term effects on HRQoL and mood 6 and 12 months after this short-term intervention.

    In this prospective study, 18 healthy normal weight subjects (mean age 26 ± 6.6 years), mainly university students were prescribed doubled energy intake, and maximum 5000 steps/day, during 4 weeks. An age and sex matched control group (n = 18), who were asked to have unchanged eating habits and physical activity, was recruited. Before and after the intervention questionnaires including Short Form-36, Hospital Anxiety Depression scale, Center of Epidemiological Studies Depression scale, Sense of Coherence and Mastery scale were completed by the subjects in the intervention group and by the controls with 4 weeks interval. Six and 12 months after the intervention the subjects underwent the same procedure as at baseline and the controls completed the same questionnaires.

    During the intervention, subjects in the intervention group increased their bodyweight and developed markedly lower physical and mental health scores on Short Form-36 as well as depressive symptoms while no changes appeared in the controls. The increase of depressive symptoms was associated with increases of energy intake, body weight and body fat. When followed up, 6 and 12 months after the intervention, physical and mental health had returned completely to baseline values, despite somewhat increased body weight.

    In conclusion, adopting obesity provoking behaviour for 4 weeks decreases HRQoL and mood in young normal weight subjects. The effect is temporary and when followed up 6 and 12 months after the short-term intervention no remaining influence is found.

  • 6.
    Ernersson, Åsa
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindström, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik H.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Young healthy individuals develop lack of energy when adopting an obesity provoking behaviour for four weeks; A phenomenological2008Conference paper (Refereed)
  • 7.
    Ernersson, Åsa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lindström, Torbjörn
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Nyström, Fredrik
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Young healthy individuals develop lack of energy when adopting an obesity provoking behaviour for 4 weeks: a phenomenological analysis2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 3, p. 565-571Article in journal (Refereed)
    Abstract [en]

    During the past 20 years, a sedentary lifestyle has become more common and simultaneously the consumption of energy-dense food has increased. These are two major risk factors associated with the increase of overweight and obesity, which is found in all ages over the world. The low well-being reported by obese individuals could be associated with increased food intake or it might be a specific consequence of obesity and lack of physical fitness. The aim of this study was to describe the experience of the phenomenon, adopting an obesity provoking behaviour, by increasing energy intake and simultaneously having a sedentary lifestyle for 4 weeks in healthy, normal-weight individuals of both genders. Eighteen healthy individuals (12 men and 6 women; median age 23, range 21-44 years) were included in an intervention, with a doubled energy intake and a maximum physical activity of 5000 steps per day during 4 weeks. After completing this intervention the participants were interviewed and asked to describe their experience during the past 4 weeks. A phenomenological approach was used to gain understanding of the phenomenon and analyses of the transcripts were performed in four steps according to Giorgis method. The main essence of the phenomenon, adopting an obesity provoking behaviour, was found to be lack of energy, related to emotional life, relations and life habits. Lack of energy emerged from five structures: influenced self-confidence, commitment to oneself and others, managing eating, feelings of tiredness and physical impact. These five structures were manifested through 12 constituents. These lifestyle changes decreased the sense of well-being in nonobese healthy individuals of both genders.

  • 8.
    Ernersson, Åsa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Lindström, Torbjörn
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Long-term increase of fat mass after a four week intervention with fast food based hyper-alimentation and limitation of physical activity2010In: Nutrition & Metabolism, ISSN 1743-7075, Vol. 7, no 68Article in journal (Refereed)
    Abstract [en]

    Background: A sedentary lifestyle and increased consumption of energy dense food have become more common in many parts of the world. The aim of this study was to study long term effects on body composition after a four week intervention with fast food based hyper-alimentation and limited physical activity in young normal weight subjects.

    Method: Eighteen subjects, mean age 26 (6.6) years, increased their energy intake with in average 70% and physical activity were not to exceed 5000 steps/day. Body composition was measured by Dual energy x-ray (DXA) at baseline, after the intervention and after 12 months. A matched control group was also included. ANOVA and Student's paired and unpaired t-test were used.

    Result: During the intervention body weight increased with 6.4 (2.8) kg and DXA measurements showed increases of both fat free mass and fat mass. Six months after the intervention the subjects had lost most of the weight gain, - 4.7 (3.1) kg. Twelve months after the intervention body weight had increased with 1.5 (2.4) kg compared to baseline (p = 0.018). DXA measurements at 12 months showed unchanged fat free mass compared to baseline but higher fat mass, + 1.4 (1.9) kg (p = 0.01). After 2.5 years the increase of body weight was 3.1 (4.0) kg (p = 0.01) while there was no change in controls compared to baseline, + 0.1(2.5) kg (p = 0.88).

    Conclusion: One year after a short term intervention with increased fast food based hyper-alimentation there was an increase of fat mass but unchanged fat free mass. As the change of fat mass was larger than expected from prospective epidemiological studies and as there was no increase of body weight in controls it raises the issue whether there is a long-term effect to increase fat mass of a short period of hyper-alimentation.

  • 9.
    Kechagias, Stergios
    et al.
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Ernersson, Åsa
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Dahlqvist Leinhard, Olof
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Faculty of Health Sciences.
    Lundberg, Peter
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics.
    Lindström, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Nyström, Fredrik
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Länne, Toste
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Fast-food-based hyper-alimentation can induce rapid and profound elevation of serum alanine aminotransferase in healthy subjects2008In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 57, no 5, p. 649-654Article in journal (Refereed)
    Abstract [en]

     Objective: To study the effect of fast-food-based hyperalimentation on liver enzymes and hepatic triglyceride content (HTGC).

    Design: Prospective interventional study with parallel control group.

    Setting: University Hospital of Linko¨ping, Sweden.

    Participants: 12 healthy men and six healthy women with a mean (SD) age of 26 (6.6) years and a matched control group.

    Intervention: Subjects in the intervention group aimed for a body weight increase of 5–15% by eating at least two fast-food-based meals a day with the goal to double the regular caloric intake in combination with adoption of a sedentary lifestyle for 4 weeks.

    Main outcome measures: Weekly changes of serum aminotransferases and HTGC measured by proton nuclear magnetic resonance spectroscopy at baseline and after the intervention.

    Results: Subjects in the intervention group increased from 67.6 (9.1) kg to 74.0 (11) kg in weight (p,0.001). Serum ALT increased from 22.1 (11.4) U/l at study start to an individual mean maximum level of 97 (103) U/l (range 19.4–447 U/l). Eleven of the 18 subjectspersistently showed ALT above reference limits (women .19 U/l, men .30 U/l) during the intervention. Sugar (mono- and disaccharides) intake during week 3 correlated with the maximal ALT/baseline ALT ratio(r=0.62, p=0.006). HTGC increased from 1.1 (1.9)% to 2.8 (4.8)%, although this was not related to the increase in ALT levels. ALT levels were unchanged in controls.

    Conclusion: Hyper-alimentation per se can induce profound ALT elevations in less than 4 weeks. Our study clearly shows that in the evaluation of subjects with elevated ALT the medical history should include not only questions about alcohol intake but also explore whetherrecent excessive food intake has occurred.

  • 10.
    Mufunda, Esther
    et al.
    Department of Health Sciences, Zimbabwe Open University, Harare, Zimbabwe.
    Ernersson, Åsa
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Hjelm, Katarina
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Limited knowledge of diabetes in patients attending an outpatient diabetes clinic at a referral hospital in Zimbabwe: a cross-sectional study2018In: Pan African Medical Journal, ISSN 1937-8688, E-ISSN 1937-8688, Vol. 29, article id 144Article in journal (Refereed)
    Abstract [en]

    Diabetes mellitus (DM) has increased globally, with a significant increase noted in African communities. Self-care health-related behavior is determined by beliefs about health and illness which are based on the person?s knowledge of diabetes. The present study aimed to assess patients diabetes awareness and level of diabetes knowledge in Zimbabwean adults with diabetes attending an outpatient diabetes clinic at a main referral hospital.

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