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  • 1. Akner, Gunnar
    et al.
    Bosaeus, Ingvar
    Forsum, Elisabet
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Nutrition.
    Thesleff, Peter
    Diagnostiskt prov i klinisk nutrition för läkarstuderande. Provresultat visar att utbildningen i klinisk nutrition måste förbättras.2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 2604-2610Article in journal (Other academic)
  • 2.
    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.

  • 3.
    Brantsaeter, Anne Lise
    et al.
    Norwegian Institute Public Heatlh, Norway .
    Olafsdottir, Anna S.
    University of Iceland, Iceland .
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Olsen, Sjurdur F.
    Statens Serum Institute, Denmark .
    Thorsdottir, Inga
    Landspitali University Hospital, Iceland .
    Does milk and dairy consumption during pregnancy influence fetal growth and infant birthweight? A systematic literature review2012In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 56Article, review/survey (Refereed)
    Abstract [en]

    It is increasingly acknowledged that the maternal diet influences fetal development and health of the child. Milk and milk products contribute essential nutrients and bioactive substances; they are of ample supply and have a long tradition in Nordic countries. To revise and update dietary guidelines for pregnant women valid in Nordic countries, the Pregnancy and Lactation expert group within the NNR5 project identified a need to systematically review recent scientific data on infant growth measures and maternal milk consumption. The objective of this study was to assess the influence of milk and dairy consumption during pregnancy on fetal growth through a systematic review of studies published between January 2000 and December 2011. A literature search was run in June 2011. Two authors independently selected studies for inclusion from the 495 abstracts according to predefined eligibility criteria. A complementary search in January 2012 revealed 64 additional abstracts published during the period June to December 2011, among them one study of interest previously identified. Of the 33 studies extracted, eight were relevant research papers. Five were prospective cohort studies (including a retrospective chart review), one was a case-control study, and two were retrospective cohort studies. For fetal length or infant birth length, three studies reported no association and two reported positive associations with milk or dairy consumption. For birthweight related outcomes, two studies reported no associations, and four studies reported positive associations with milk and/or dairy consumption. There was large heterogeneity in exposure range and effect size between studies. A beneficial fetal growth-increase was most pronounced for increasing maternal milk intake in the lower end of the consumption range. Evidence from prospective cohort studies is limited but suggestive that moderate milk consumption relative to none or very low intake, is positively associated with fetal growth and infant birthweight in healthy, Western populations.

  • 4.
    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.

  • 5.
    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.

  • 6.
    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.

  • 7.
    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.

  • 8.
    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.

  • 9.
    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.

  • 10.
    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.

  • 11.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Editorial Material: Invited commentary: nutrition during growth and reproduction: studies demonstrating possibilities and difficulties2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, no 23484Article in journal (Other academic)
    Abstract [en]

    n/a

  • 12.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Energy requirements during pregnancy: old questions and new findings2004In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 79, no 6, p. 933-934p. 933-934Article in journal (Other academic)
    Abstract [en]

    n/a

  • 13.
    Forsum, Elisabet
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery.
    High birth weight and type 1 diabetes - many questions still without answers2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, p. 404-406Article in journal (Other academic)
  • 14.
    Forsum, Elisabet
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Nutrition.
    Maternal physiology and nutrition during reproduction2002In: Nutrition in Early Life / [ed] Jane Morgan, Linköping: Linköpings universitet , 2002, p. 73-90Chapter in book (Other academic)
    Abstract [en]

    The publication of the Department of Health White Paper "The Health of the Nation" (1992) and "Our Healthier Nation" (1998) gave emphasis to the importance of nutritional health of the nation at all ages. It is clear that the achievement of specific targets for pregnancy and infancy as set out in the White Paper will involve the training of all health care professionals in nutrition education. This book responds to the challenge and focuses on good nutrition for and during pregnancy, in low birth weight infants, and during infancy. It has a strong public health emphasis, dealing with health prevention issues for the Nation s younger population. The text is written as a scientific reference book for those seeking to apply science in the support of a successful pregnancy and in the prevention of nutritional problems during foetal and early post natal life. The importance of optimal nutrition during these periods of life is emphasised by the overwhelming evidence that nutritional problems in early embryonic life may cause congenital malformations and during late foetal life and early post natal life may set the molecular programme for later disease development.

  • 15.
    Forsum, Elisabet
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Nutrition.
    Boström, Karin
    Eriksson, Britt
    Olin-Skoglund, Sabina
    Kvinnans vikt före och under graviditet har betydelse för barnet. Riktlinjer från USA skulle gagna svensk folkhälsa.2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, p. 3954-3958Article in journal (Other academic)
  • 16.
    Forsum, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Brantsaeter, Anne Lise
    Norwegian Institute Public Heatlh, Norway .
    Olafsdottir, Anna-Sigrid
    Landspitali University Hospital, Iceland .
    Olsen, Sjurdur F.
    Statens Serum Institute, Denmark .
    Thorsdottir, Inga
    Landspitali University Hospital, Iceland .
    Weight loss before conception: A systematic literature review2013In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 57Article, review/survey (Refereed)
    Abstract [en]

    The prevalence of overweight and obesity in women has increased during the last decades. This is a serious concern since a high BMI before conception is an independent risk factor for many adverse outcomes of pregnancy. Therefore, dietary counseling, intended to stimulate weight loss in overweight and obese women prior to conception has recently been recommended. However, dieting with the purpose to lose weight may involve health risks for mother and offspring. We conducted a systematic literature review to identify papers investigating the effects of weight loss due to dietary interventions before conception. The objective of this study is to assess the effect of weight loss prior to conception in overweight or obese women on a number of health-related outcomes in mother and offspring using studies published between January 2000 and December 2011. Our first literature search produced 486 citations and, based on predefined eligibility criteria, 58 were selected and ordered in full text. Two group members read each paper. Fifteen studies were selected for quality assessment and two of them were considered appropriate for inclusion in evidence tables. A complementary search identified 168 citations with four papers being ordered in full text. The two selected studies provided data for overweight and obese women. One showed a positive effect of weight loss before pregnancy on the risk of gestational diabetes and one demonstrated a reduced risk for large-for-gestational-age infants in women with a BMI above 25 who lost weight before pregnancy. No study investigated the effect of weight loss due to a dietary intervention before conception. There is a lack of studies on overweight and obese women investigating the effect of dietary-induced weight loss prior to conception on health-related variables in mother and offspring. Such studies are probably lacking since they are difficult to conduct. Therefore, alternative strategies to control the body weight of girls and women of reproductive age are needed.

  • 17.
    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)
  • 18.
    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)
  • 19.
    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.

  • 20.
    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.
    Flinke Carlsson, Eva
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Olhager, Elisabeth
    Lund University, Lund, Sweden.
    Premature birth was not associated with increased body fatness in four-year-old boys and girls2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed)
    Abstract [en]

    Aim Premature birth is a worldwide problem and increases the risk of chronic disease later in life. Prematurely born infants may have a high percentage of body fat at term-equivalent age, but it is unclear if this characteristic is maintained in childhood. Therefore, we compared the size and body composition of four-year-old prematurely born children to such values of full-term controls. Methods Between 2013 and 2015, we assessed weight, height, fat mass and fat-free mass, using air displacement plethysmography in 188 reasonably healthy prematurely born four-year-olds (98 boys). Results At four years of age, prematurely born children (gestational weeks at birth: 23.3-36.9) tended to be lighter and shorter and to contain less fat mass and fat-free mass than did full-term controls. The gestational age at birth of the prematurely born children correlated positively and significantly (P amp;lt; .05) with height, weight, body mass index, fat mass (kg, %), fat mass index and fat-free mass (kg) in girls but not in boys. Conclusion Prematurity was not associated with increased body fatness in our four-year-olds. Our findings are relevant in relation to previously published results showing that premature birth is associated with chronic disease later in life.

  • 21.
    Forsum, Elisabet
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Nutrition.
    Forsberg, A M
    Nilsson, E
    Bergström, J
    Hultman, E
    Electrolytes, water, RNA, total creatine and calculated resting membrane potential in muscle tissue from pregnant women.2000In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 44, p. 144-149Article in journal (Refereed)
  • 22.
    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.

  • 23.
    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.

  • 24.
    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.

  • 25.
    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.

  • 26.
    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.

  • 27.
    Forsum, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Olhager, Elisabeth
    Lund University, Sweden.
    Törnqvist, Caroline
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    An Evaluation of the Pea Pod System for Assessing Body Composition of Moderately Premature Infants2016In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 8, no 4, p. 238-Article in journal (Refereed)
    Abstract [en]

    (1) Background: Assessing the quality of growth in premature infants is important in order to be able to provide them with optimal nutrition. The Pea Pod device, based on air displacement plethysmography, is able to assess body composition of infants. However, this method has not been sufficiently evaluated in premature infants; (2) Methods: In 14 infants in an age range of 3-7 days, born after 32-35 completed weeks of gestation, body weight, body volume, fat-free mass density (predicted by the Pea Pod software), and total body water (isotope dilution) were assessed. Reference estimates of fat-free mass density and body composition were obtained using a three-component model; (3) Results: Fat-free mass density values, predicted using Pea Pod, were biased but not significantly (p &gt; 0.05) different from reference estimates. Body fat (%), assessed using Pea Pod, was not significantly different from reference estimates. The biological variability of fat-free mass density was 0.55% of the average value (1.0627 g/mL); (4) Conclusion: The results indicate that the Pea Pod system is accurate for groups of newborn, moderately premature infants. However, more studies where this system is used for premature infants are needed, and we provide suggestions regarding how to develop this area.

  • 28.
    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.

  • 29.
    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.

  • 30.
    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.

  • 31.
    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.

  • 32.
    Henriksson, Pontus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Lof, M.
    Karolinska Institute, Sweden.
    Söderkvist, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Pathology and Clinical Genetics.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Variation in the fat mass and obesity-related (FTO) genotype is not associated with body fatness in infants, but possibly with their length2014In: Pediatric Obesity, ISSN 2047-6302, E-ISSN 2047-6310, Vol. 9, no 5, p. E112-E115Article in journal (Refereed)
    Abstract [en]

    BackgroundData relating variation at the fat mass and obesity-related (FTO) locus (rs9939609) to fat mass in infancy are inconclusive. ObjectiveTo study relationships between FTO genotype and infant size (at 1 and 12 weeks and at 1 year of age) and body composition (at 1 and 12 weeks). MethodsBody composition was assessed using air displacement plethysmography in 207 infants. FTO was genotyped using the TaqMan assay. ResultsThe number of risk alleles was related to length at 1 and 12 weeks (P=0.007-0.033) but not to fat mass. The relationship to length was stronger in boys than in girls. ConclusionsOur results suggest that the FTO genotype is not related during infancy to fat mass but is related to length in boys but not in girls.

  • 33.
    Henriksson, Pontus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Lof, Marie
    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.
    Glucose Homeostasis Variables in Pregnancy versus Maternal and Infant Body Composition2015In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 7, no 7, p. 5615-5627Article in journal (Refereed)
    Abstract [en]

    Intrauterine factors influence infant size and body composition but the mechanisms involved are to a large extent unknown. We studied relationships between the body composition of pregnant women and variables related to their glucose homeostasis, i.e., glucose, HOMA-IR (homeostasis model assessment-insulin resistance), hemoglobin A(1c) and IGFBP-1 (insulin-like growth factor binding protein-1), and related these variables to the body composition of their infants. Body composition of 209 women in gestational week 32 and of their healthy, singleton and full-term one-week-old infants was measured using air displacement plethysmography. Glucose homeostasis variables were assessed in gestational week 32. HOMA-IR was positively related to fat mass index and fat mass (r(2) = 0.32, p less than 0.001) of the women. Maternal glucose and HOMA-IR values were positively (p 0.006) associated, while IGFBP-1was negatively (p = 0.001) associated, with infant fat mass. HOMA-IR was positively associated with fat mass of daughters (p less than 0.001), but not of sons (p = 0.65) (Sex-interaction: p = 0.042). In conclusion, glucose homeostasis variables of pregnant women are related to their own body composition and to that of their infants. The results suggest that a previously identified relationship between fat mass of mothers and daughters is mediated by maternal insulin resistance.

  • 34.
    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.

  • 35.
    Henriksson, Pontus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Department of Biosciences and Nutrition, Karolinska Institute, NOVUM, Huddinge, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Glucose, insulin, and the insulin-like growth factor binding protein 1 in the circulation of pregnant women in relation to their own body composition and to that of their infants2015Manuscript (preprint) (Other academic)
    Abstract [en]

    Aim: Intrauterine factors influence infant size and body composition but the mechanisms involved are incompletely known. We studied relationships between the body composition of pregnant women and variables related to their glucose homeostasis, i.e. glucose, insulin, HOMA-IR (homeostasis model assessment-insulin resistance), haemoglobin A1c and IGFBP-1 (insulin-like growth factor binding protein 1), in their circulation and related these variables to the body composition of their infants.

    Methods: Body composition of 209 women in gestational week 32 and of their healthy, singleton and full-term one-week-old infants was measured using air displacement plethysmography. Glucose homeostasis variables were assessed in gestational week 32.

    Results: Insulin/HOMA-IR were positively related to body mass index, fat mass index and fat mass (r2=0.32-0.36, P<0.001) of the women. Their glucose, insulin and HOMA-IR values were positively (P≤0.009) associated, while IGFBP-1was negatively (P=0.001) associated, with infant fat mass. Insulin and HOMA-IR were positively associated with fat mass of daughters (P<0.001), but not of sons (P≥0.65) (Sex-interaction: P≤ 0.042).

    Conclusion: Glucose homeostasis variables of pregnant women are related to their own body composition and to that of their infants. The results suggested that a previously identified relationship between fat mass of mothers and daughters is mediated by insulin resistance.

  • 36.
    Henriksson, Pontus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Löf, Marie
    Department of Biosciences and Nutrition, Karolinska Institute, NOVUM, Huddinge, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Parental fat-free mass is related to the fat-free mass of infants and maternal fat mass is related to the fat mass of infant girls2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 5, p. 491-497Article in journal (Refereed)
    Abstract [en]

    Aim: Existing studies suggest that weight and body composition of parents influence the size and body composition of their offspring, but are often inconclusive and conducted by means of inappropriate body composition methodology. Our aim was to study infant size and body composition variables in relation to body composition variables of their mothers and fathers in a well-nourished population using an accurate methodology.

    Methods: Between 2008 and 2011, we used air displacement plethysmography to measure the body composition of 209 parent–infant units. Parents were measured when women were in gestational week 32. Their healthy, singleton, full-term infants were measured at 1 week.

    Results: Infant fat-free mass in grams was positively related (p ≤ 0.007) to the fat-free mass in kilograms of the mothers (15.6 g/kg) and the fathers (9.1 g/kg). Furthermore, the fat mass of the daughters, but not of the sons, was positively related to the fat mass of the mothers (5.8 g/kg, p = 0.007).

    Conclusion: This study found associations between the fat-free mass of parents and infants and an association between the fat mass of mothers and their infant girls. These findings may help to understand early life factors behind overweight and obesity.

  • 37.
    Lachat, Carl
    et al.
    University of Ghent, Belgium; Institute Trop Med, Belgium.
    Hawwash, Dana
    University of Ghent, Belgium.
    Ocke, Marga C.
    National Institute Public Health and Environm, Netherlands.
    Berg, Christina
    University of Gothenburg, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Hornell, Agneta
    Umeå University, Sweden.
    Larsson, Christel
    University of Gothenburg, Sweden.
    Sonestedt, Emily
    Lund University, Sweden.
    Wirfalt, Elisabet
    Lund University, Sweden.
    Åkesson, Agneta
    Karolinska Institute, Sweden.
    Kolsteren, Patrick
    University of Ghent, Belgium; Institute Trop Med, Belgium.
    Byrnes, Graham
    Int Agency Research Canc, France.
    De Keyzer, Willem
    University of Coll Ghent, Belgium.
    Van Camp, John
    University of Ghent, Belgium.
    Cade, Janet E.
    University of Leeds, England.
    Slimani, Nadia
    Int Agency Research Canc, France.
    Cevallos, Myriam
    University of Bern, Switzerland; University of Bern, Switzerland.
    Egger, Matthias
    University of Bern, Switzerland.
    Huybrechts, Inge
    Int Agency Research Canc, France.
    Strengthening the Reporting of Observational Studies in Epidemiology-Nutritional Epidemiology (STROBE-nut): An Extension of the STROBE Statement2016In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 13, no 6, p. e1002036-Article, review/survey (Refereed)
    Abstract [en]

    Background Concerns have been raised about the quality of reporting in nutritional epidemiology. Research reporting guidelines such as the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement can improve quality of reporting in observational studies. Herein, we propose recommendations for reporting nutritional epidemiology and dietary assessment research by extending the STROBE statement into Strengthening the Reporting of Observational Studies in Epidemiology-Nutritional Epidemiology (STROBE-nut). Methods and Findings Recommendations for the reporting of nutritional epidemiology and dietary assessment research were developed following a systematic and consultative process, coordinated by a multidisciplinary group of 21 experts. Consensus on reporting guidelines was reached through a three-round Delphi consultation process with 53 external experts. In total, 24 recommendations for nutritional epidemiology were added to the STROBE checklist. Conclusion When used appropriately, reporting guidelines for nutritional epidemiology can contribute to improve reporting of observational studies with a focus on diet and health.

  • 38.
    Löf, Marie
    et al.
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Activity pattern and energy expenditure due to physical activity before and during pregnancy in healthy Swedish women2006In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 95, no 2, p. 296-302Article in journal (Refereed)
    Abstract [en]

    Human pregnancy is associated with increased requirements for dietary energy and this increase may be partly offset by reductions in physical activity during gestation. Studies in well-nourished women have shown that the physical activity level (PAL), obtained as the total energy expenditure (TEE) divided by the BMR, decreases in late pregnancy. However, it is not known if this decrease is really caused by reductions in physical activity or if it is the result of decreases in energy expenditure/BMR (the so-called metabolic equivalent, MET) for many activities in late pregnancy. In the present study activity pattern, TEE and BMR were assessed in twenty-three healthy Swedish women before pregnancy as well as in gestational weeks 14 and 32. Activity pattern was assessed using a questionnaire and heart rate recording. TEE was assessed using the doubly labelled water method and BMR was measured by means of indirect calorimetry. When compared to the pre-pregnant value, there was little change in the PAL in gestational week 14 but it was significantly reduced in gestational week 32. Results obtained by means of the questionnaire and by heart rate recording showed that the activity pattern was largely unaffected by pregnancy. The findings support the following conclusion: in a population of well-nourished women where the activity pattern is maintained during pregnancy, the increase in BMR represents approximately the main part of the pregnancy-induced increase in TEE, at least until gestational week 32.

  • 39.
    Löf, Marie
    et al.
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Evaluation of bioimpedance spectroscopy for measurements of body water distribution in healthy women before, during, and after pregnancy2004In: Journal of applied physiology, ISSN 8750-7587, E-ISSN 1522-1601, Vol. 96, no 3, p. 967-973Article in journal (Refereed)
    Abstract [en]

    Bioimpedance spectroscopy (BIS) is a technique of interest in the study of human pregnancy because it can assess extracellular (ECW), intracellular (ICW), and total body water (TBW) as ECW plus ICW. The technique requires appropriate resistivity coefficients and has not been sufficiently evaluated during the reproductive cycle. Therefore, in a methodological study, we estimated ECW, ICW, and TBW, by means of BIS, and compared the results with the corresponding estimates obtained by using reference methods. Furthermore, results obtained by means of population-specific resistivity coefficients were compared with results obtained by means of general resistivity coefficients. These comparisons were made before pregnancy, in gestational weeks 14 and 32, as well as 2 wk postpartum in 21 healthy women. The reference methods were isotope and bromide dilution. Average ICW, ECW, and TBW, estimated by means of BIS, were in agreement with reference data before pregnancy, in gestational week 14, and postpartum. The corresponding comparison in gestational week 32 showed good agreement for ICW, whereas estimates by means of BIS were significantly (P < 0.001) lower than the corresponding reference values for ECW and TBW. Thus the BIS technique, which was based on a model developed for the nonpregnant body, estimated increases in ICW accurately, whereas increases in ECW and TBW tended to be underestimated. Estimates obtained by using population-specific and general resistivity coefficients were very similar. In conclusion, the results indicated that BIS is potentially useful for studies during pregnancy but that further work is needed before it can be generally applied in such studies.

  • 40.
    Löf, Marie
    et al.
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Hydration of fat-free mass in healthy women with special reference to the effect of pregnancy2004In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 80, no 4, p. 960-965Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge of the biological variability of the hydration factor (HF), ie, the ratio between total body water and fat-free mass, is important when calculating total body fat by means of the commonly used two-component model, which is based on estimates of body weight and total body water. The effect of pregnancy on the biological variability of HF, and consequently on the precision of the two-component model, is unknown.

    Objective: Our goal was to assess the effect of pregnancy on HF and its biological variability.

    Design: HF was assessed in 33 women planning pregnancy and in 17 of these women during gestational weeks 14 and 32 and 2 wk postpartum. HF was calculated by using estimates of body weight, total body water obtained by means of deuterium dilution, and body volume measured by using underwater weighing.

    Results: In the 17 women who became pregnant, HF was 0.718 ± 0.023, 0.723 ± 0.031, 0.747 ± 0.017, and 0.734 ± 0.020 before pregnancy, in gestational week 14, in gestational week 32, and 2 wk postpartum, respectively. The biological variability represented ≈2% of average HF in the nonpregnant state. The corresponding figure was >3% in gestational week 14 but ≤1.7% in gestational week 32.

    Conclusion: The two-component model for assessing body fat is as appropriate during late gestation as it is in the nonpregnant state, although its precision may be impaired when applied during the first part of pregnancy.

  • 41.
    Löf, Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery.
    Forsum, Elisabet
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery.
    Validation of energy intake by dietary recall against different methods to assess energy expenditure2004In: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 17, no 5, p. 471-480Article in journal (Refereed)
    Abstract [en]

    Objectives. To compare the validity of dietary recalls and physical activity recalls and investigate some factors influencing this validity. To provide an example showing how procedures based on recalls of physical activity can assess the validity of dietary recalls and identify subjects constantly underreporting their energy intake (EI). Design and subjects. Thirty-seven women were studied using three 24-h dietary recalls, two kinds of physical activity recalls, indirect calorimetry and the doubly labelled water method. Results. The EI obtained using dietary recalls were biased with respect to body mass index (BMI) and attitudes towards body weight and dieting, whereas results obtained using a physical activity recall were not. Eighteen women produced underreports (UR), i.e. their average EI was below 76% of total energy expenditure (TEE), whereas 24 women reported an EI that was lower than TEE on all three recall days, i.e. constantly underreporting subjects. A physical activity recall identified 13 URs and 20 of the constantly underreporting subjects. Conclusions. In contrast to estimates of EI, TEE assessed using physical activity recalls was not biased with respect to BMI or attitudes towards body weight and dieting. Recalls of physical activity represent potentially useful procedures for identifying URs and constantly underreporting subjects but are not accurate enough for individuals.

  • 42.
    Löf, Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Nutrition.
    Hannestad, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry.
    Forsum, Elisabet
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Nutrition.
    Assessing physical activity of women of childbearing age. Ongoing work to develop and evaluate simple methods2002In: Food and Nutrition Bulletin, ISSN 0379-5721, E-ISSN 1564-8265, Vol. 23, no 3 SUPP, p. 30-33Article in journal (Refereed)
    Abstract [en]

    Simple methods were developed and evaluated to assess total energy expenditure in 24 healthy, Swedish women planning pregnancy. Total energy expenditure was measured by the doubly-labeled water method (reference method) and three simple methods: heart rate recording, movement registration by an accelerometer, and a questionnaire. Mean total energy expenditure obtained by the four methods varied between 2,530 kcal per 24 hours (10,570 kJ/24 hours) and 2,730 kcal per 24 hours (11,420 kJ/24 hours). No significant difference between the results obtained by the different methods was found. The mean difference between the simple method and the reference method was for the questionnaire 204 +/- 508 kcal per 24 hours (853 +/- 2,124 kJ/24 hours), for the heart rate recorder 58 +/- 338 kcal per 24 hours (241 +/- 1,416 kJ/24 hours) and for the accelerometer 6 +/- 325 kcal per 24 hours (25 +/- 1,360 kJ/24 hours). The heart rate recorder and the questionnaire overestimated high and underestimated low energy expenditures. The accelerometer and the heart rate recorder were able to assess mean total energy expenditure of groups. No systematic bias was found when the accelerometer was used.

  • 43.
    Löf, Marie
    et al.
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Hannestad, Ulf
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Comparison of commonly used procedures, including the doubly-labelled water technique, in the estimation of total energy expenditure of women with special reference to the significance of body fatness2003In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 90, no 5, p. 961-968Article in journal (Refereed)
    Abstract [en]

    According to the report of the World Health Organization (1985), total energy expenditure (TEE) in human subjects can be calculated as BMR × physical activity level (PAL). However, other reports have pointed out limitations in the suggested procedure related to the % body fat of the subjects. The purpose of the present study was to evaluate the World Health Organization (1985) procedure in thirty-four healthy women with BMI 18-39 kg/m2. BMR and TEE were measured using indirect calorimetry (BMRmeas) and the doubly-labelled water method (TEEref) respectively. When assessed using the doubly-labelled water and skinfold-thickness methods, the women had 34 (SD 8) and 33 (SD 6) % body fat respectively. On the basis of guidelines provided by the World Health Organization (1985), 1.64 was selected to represent the average PAL of the women. Furthermore, PAL was also assessed by means of an accelerometer (PALacc), heart-rate recordings (PALHR) and a questionnaire (PALq). These estimates were: PALacc 1.71 (SD 0.17), PALHR 1.76 (SD 0.24), PALq 1.86 (SD 0.27). These values were lower than TEEref/BMRref, which was 1.98 (SD 0.21). BMR assessed using equations recommended by the World Health Organization (1985) (BMRpredicted) overestimated BMR by 594 (SD 431) kj/24 h. However, when TEE was calculated as BMRpredicted × PALacc, BMRpredicted × PALHR and BMRpredicted × PALq respectively, average results were in agreement with TEEref. Furthermore, TEE values based on BMRpredicted and PALacc, PALHR, PALq as well as on PAL = 1.64, minus TEEref, were significantly correlated with body fatness. When the same PAL value (1.64) was used for all subjects, this correlation was particularly strong. Thus, the World Health Organization (1985) procedure may give TEE results that are biased with respect to the body fatness of subjects.

  • 44.
    Löf, Marie
    et al.
    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.
    Boström, Karin
    Lust och Hälsa (Pleasure and Health) Clinic, Linköping, Sweden.
    Janerot-Sjöberg, Birgitta
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Sohlström, Annica
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Changes in basal metabolic rate during pregnancy in relation to changes in body weight and composition, cardiac output, insulin-like growth factor I, and thyroid hormones and in relation to fetal growth2005In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 81, no 3, p. 678-685Article in journal (Refereed)
    Abstract [en]

    Background: The total energy cost of pregnancy is largely due to an elevated basal metabolic rate (BMR). Large variations in the BMR response to pregnancy have been reported, but the factors associated with this variability are incompletely known.

    Objective: The objective was to identify factors associated with variability in the BMR response to pregnancy.

    Design: In 22 healthy women, BMR, body weight (BW), total body fat (TBF), fat-free mass (FFM), circulatory variables, serum concentrations of insulin-like growth factor I (IGF-I), and thyroid hormones were measured before pregnancy and in gestational weeks 14 and 32. BMR and BW were also measured in gestational weeks 8, 20, and 35. Fetal weight was estimated in gestational week 31.

    Results: In gestational week 14, the increase in BMR correlated significantly with the corresponding increase in BW and with the prepregnancy percentage of TBF. Together these variables explained ≈40% of the variability in the BMR response. In gestational week 32, the increase in BMR correlated significantly with the corresponding changes in BW, TBF, FFM, IGF-I, cardiac output, and free triiodothyronine. The increase in BW in combination with fetal weight or with the elevated concentration of IGF-I in serum explained ≈60% of the variability in the increase in BMR.

    Conclusions: Weight gain and the prepregnancy percentage of TBF—ie, factors related to the maternal nutritional situation—are important factors with regard to the variability in the BMR response to pregnancy. Thus, it is important to consider the nutritional situation before and during gestation when assessing pregnancy energy requirements.

  • 45.
    Olausson, Hanna
    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.
    Brismar, K.
    Unit for Endocrinology and Diabetes, Karolinska Institutet, Department of Molecular Medicine, Karolinska Hospital, Stockholm, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Sohlström, Annica
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Maternal serum levels of insulin-like growth factor (IGF)-I and IGF binding protein-1 before and during pregnancy in relation to body weight and composition of mother and infantManuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: To investigate the following relationships: 1) maternal body weight and composition versus insulin-like growth factor (IGF)-I and IGF binding protein (IGFBP)-1 in maternal serum before and during pregnancy, and 2) IGF-I and IGFBP-1 in maternal serum during pregnancy versus infant birth weight, body composition and ponderal index.

    Study design: Serum was collected from 23 healthy women before pregnancy, and in weeks 14, 32 and 35 of pregnancy. On these occasions maternal body weight and composition were assessed. Weight, length and body composition of the newborn were measured. Linear and multiple linear regression analyses were applied.

    Results: Women with the lowest body weight and body fat content had the largest decreases in IGF-I in early pregnancy. During pregnancy maternal fat-free body weight was positively related to IGF-I, whereas body fat was inversely related to IGFBP-1. Maternal body weight before pregnancy and IGF-I in week 14 of gestation explained 47 % of the variation in birth weight.

    Conclusion: The maternal IGF-system may be a mediator of the effect of maternal nutritional status on fetal growth.

  • 46.
    Olausson, Hanna
    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.
    Brismar, K.
    Unit for Endocrinology and Diabetes, Karolinska Institutet, Department of Molecular Medicine, Karolinska Hospital, Stockholm, Sweden.
    Lewitt, M.
    Unit for Endocrinology and Diabetes, Karolinska Institutet, Department of Molecular Medicine, Karolinska Hospital, Stockholm, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Sohlström, Annica
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    A longitudinal study of the insulin-like growth factor system before, during and after pregnancy in healthy womenManuscript (preprint) (Other academic)
    Abstract [en]

    The maternal insulin-like growth factor (IGF)-system is considered to influence fetal growth. In this longitudinal study of 23 healthy women we aimed 1) to assess maternal serum levels of IGF-I, IGF-II, IGF binding protein (IGFBP)-1, IGFBP-3 and protease activity against IGFBP-3 before, during and after pregnancy, and 2) to relate these levels in early and late pregnancy to fetal and birth weight. Serum was collected before pregnancy, in weeks 8, 14, 20, 32 and 35 of pregnancy and 2 weeks postpartum. IGF-I, IGF-II, IGFBP-1, and IGFBP-3 were analyzed with radioimmuno/radiometric assays and protease activity with Western blot. Fetal weight was measured by means of ultrasound (week 31 of pregnancy) and birth weight was recorded. IGF-I was initially decreased during pregnancy, compared to before conception. This early decrease was not correlated with fetal or birth weight. In late pregnancy, IGF-I and protease activity were positively related to fetal weight, whereas from week 20 of pregnancy IGFBP-1 showed an inverse association with birth weight. We suggest that in healthy pregnant women there is a fine-tuned balance within the maternal IGF-system, with components With either promoting or restricting influences on fetal growth. The results indicate that maternal IGFBP-1 cguld be used from mid-pregnancy as a marker for birth weight.

  • 47.
    Olausson, Hanna
    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.
    Brismar, K.
    Unit for Endocrinology and Diabetes, Karolinska Institutet, Department of Molecular Medicine, Karolinska Hospital, Stockholm, Sweden.
    Lewitt, M.
    Unit for Endocrinology and Diabetes, Karolinska Institutet, Department of Molecular Medicine, Karolinska Hospital, Stockholm, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Sohlström, Annica
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Longitudinal study of the maternal insulin-like growth factor system before, during and after pregnancy in relation to fetal and infant weight2008In: Hormone Research, ISSN 0301-0163, E-ISSN 1423-0046, Vol. 69, no 2, p. 99-106Article in journal (Refereed)
    Abstract [en]

    Background: The maternal insulin-like growth factor (IGF) system is considered to be involved in fetal growth regulation. However, available data linking this system to fetal growth are contradictory and incomplete.

    Aims: To measure components of the IGF system before, during and after pregnancy in healthy women and to relate these results, and their changes during pregnancy, to fetal weight (gestational week 31) and birth weight.

    Methods: Serum concentrations of IGF-I, IGF-II, IGF-binding protein (IGFBP)-1, IGFBP-3 and IGFBP-3 protease activity were assessed in 23 women before conception, at weeks 8, 14, 20, 32 and 35 of pregnancy and 2 weeks postpartum. The data were analyzed using simple and multiple linear regression.

    Results: One third of the variability in fetal weight was explained by IGF-I in combination with IGFBP-3 protease activity, both assessed at gestational week 32 (p = 0.013). Birth weight was negatively correlated (r = –0.43 to –0.59) with IGFBP-1 at gestational week 20 (p = 0.041), 32 (p = 0.012) and 35 (p = 0.003).

    Conclusion: We propose there is a finely tuned balance among the components of the IGF system, providing a means for fetal growth regulation.

  • 48.
    Olausson, Hanna
    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.
    Brismar, Kerstin
    Unit of Endocrinology and Diabetology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Rolf Luft Center for Diabetes Research, Karolinska University Hospital, Stockholm, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Sohlström, Annica
    Linköping University, Department of Clinical and Experimental Medicine, Nutrition. Linköping University, Faculty of Health Sciences.
    Maternal serum concentrations of insulin-like growth factor (IGF)-I and IGF binding protein-1 before and during pregnancy in relation to maternal body weight and composition and infant birth weight2010In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 104, no 6, p. 842-848Article in journal (Refereed)
    Abstract [en]

    Maternal nutritional status, e.g. body weight and composition, is associated with fetal growth. It has been suggested that the insulin-like growth factor (IGF) system may be a mediator of this relationship. In twenty-three healthy Swedish women, we studied (1) the relationships before and during pregnancy between maternal serum concentrations of IGF-I and IGF binding protein-1 (IGFBP-1) and maternal body weight and composition; (2) interactions between serum concentrations of IGF-I (before and in early pregnancy) and maternal nutritional status in relation to infant birth weight. We found that serum IGF-I during pregnancy was positively correlated with maternal body weight (r 0·47–0·56) and fat-free body weight (r 0·61–0·65), whereas serum IGFBP-1 was negatively correlated with maternal body weight (r − 0·44 to − 0·69) and body fat (r − 0·64 to − 0·76) before and during pregnancy. Women with a lower body fat content (%) before pregnancy had greater increases in serum IGFBP-1 during pregnancy than women with a higher prepregnant body fat content (%). In addition, significant fractions of the variation in corrected infant birth weight were explained by variables related to the maternal nutritional status when these were combined with serum concentrations of IGF-I in gestational week 14 (adjusted r2 0·25–0·44, P = 0·001–0·021), but not when they were combined with such concentrations before pregnancy (adjusted r2 0·11–0·12, P = 0·105–0·121). These results suggest mechanisms by which the IGF system may be a mediator between maternal nutritional status and fetal growth.

  • 49.
    Olhager, Elisabeth
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Flinke, Eva
    Linköping University, Department of Medicine and Care, Medical Radiology. Linköping University, Faculty of Health Sciences.
    Hannerstad, Ulf
    Linköping University, Department of Biomedicine and Surgery, Division of 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.
    Studies on human body composition during the first 4 months of life using magnetic resonance imaging and isotope dilution2003In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 54, no 6, p. 906-912Article in journal (Refereed)
    Abstract [en]

    Assessing body composition during infancy requires data for the so-called reference infant. Currently available data for this purpose need to be updated and extended using methods based on principles different from those used previously to define the reference infant. Thus, magnetic resonance imaging was applied to full-term healthy boys (n = 25) and girls (n = 21), 4-131 d old, to estimate adipose tissue volume (ATV) and the amounts of s.c. and non-s.c. adipose tissue (AT). Total body water was estimated using isotope dilution. Total body fat (TBF), fat free weight (FFW) and the degree of hydration in FFW were calculated. Increases in weight, TBF, and FFW with age agreed with current reference data, although when compared with the reference, a slightly more rapid increase in % TBF was observed for boys. The degree of hydration in FFW was 78.9 ± 4.5% (n = 45). Both sexes showed significant increases with age in s.c. ATV (14.7 and 13.0 mL/d for boys and girls, respectively) and in non-s.c. ATV (1.58 and 1.26 mL/d, respectively). Subcutaneous ATV was 90.5 ± 1.8% (boys) and 91.1 ± 1,9% (girls) of total ATV. In conclusion, a pronounced increase with age in the amount of AT was demonstrated involving a considerable gain in s.c. fat during early life. Except for % TBF in boys, changes in body composition with age agreed with current reference data.

  • 50.
    Olhager, Elisabeth
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Forsum, Elisabet
    Linköping University, Department of Biomedicine and Surgery, Nutrition. Linköping University, Faculty of Health Sciences.
    Assessment of total body fat using the skinfold technique and body water dilution in fullterm and preterm infants under four months of ageManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: To evaluate a method based on measurements of skinfold thickness (SFT) in infants under four months of age.

    Methods: Adipose tissue volume was assessed by means of magnetic resonance imaging and total body fat (TBF) by means of a method based on skinfold measurements previously developed for children under two years of age (TBF-SFT). Estimates of TBF obtained by means of body water dilution (TBF-BWD) represented reference values. The subjects were 45 fullterm infants, 4-131 days old, and eight premature infants born in gestational weeks 30-33 and studied at a postnatal age of 63 ± 10 days.

    Results: In fullterm infants TBF-SFT and TBF-BWD were 23.3 ± 3.4 and 21.8 ± 7.0 %, respectively, and the difference between the two methods was non-significant. However TBF-SFT minus TBF-BWD (%, y) was significantly con-elated (p<0.0001) with the average TBF-SFT and TBF-BWD (%, x), showing that the skinfold method overstimated TBF in lean infants while it underestimated TBF in infants with a high body fat content. In fullterm infants adipose tissue (AT) contained 0.68 ± 0.14 g fat/ml. Significant correlations were found between the AT fat content (g/ml, y) and TBF-BWD (%, x) (p<0.0001 ), as well as between the AT fat content (g/ml, x) and TBF-SFT minus TBF-BWD (%, y) (p<0.0001). In premature infants TBF-SFT (%), TBF-BWD (%) and the AT fat content were similar to the corresponding figures for nine fullterm newborns.

    Conclusion: In fullterm infants the skinfold method produced biased estimates of TBF, which to a large extent can be explained by a variation in the AT fat content. However, the method has the potential to provide meaningful results in groups of infants with similar AT fat content.

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