Timing of eating across ten European countries - results from the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study

Objective To examine timing of eating across ten European countries. Design Cross-sectional analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study using standardized 24 h diet recalls collected during 1995-2000. Eleven predefined food consumption occasions were assessed during the recall interview. We present time of consumption of meals and snacks as well as the later:earlier energy intake ratio, with earlier and later intakes defined as 06.00-14.00 and 15.00-24.00 hours, respectively. Type III tests were used to examine associations of sociodemographic, lifestyle and health variables with timing of energy intake. Setting Ten Western European countries. Subjects In total, 22 985 women and 13 035 men aged 35-74 years (n 36 020). Results A south-north gradient was observed for timing of eating, with later consumption of meals and snacks in Mediterranean countries compared with Central and Northern European countries. However, the energy load was reversed, with the later:earlier energy intake ratio ranging from 0 center dot 68 (France) to 1 center dot 39 (Norway) among women, and from 0 center dot 71 (Greece) to 1 center dot 35 (the Netherlands) among men. Among women, country, age, education, marital status, smoking, day of recall and season were all independently associated with timing of energy intake (all PPeer reviewe

Nutritional quality of food as represented by the FSAm-NPS nutrient profiling system underlying the Nutri-Score label and cancer risk in Europe : Results from the EPIC prospective cohort study

Background Helping consumers make healthier food choices is a key issue for the prevention of cancer and other diseases. In many countries, political authorities are considering the implementation of a simplified labelling system to reflect the nutritional quality of food products. The Nutri-Score, a five-colour nutrition label, is derived from the Nutrient Profiling System of the British Food Standards Agency (modified version) (FSAm-NPS). How the consumption of foods with high/low FSAm-NPS relates to cancer risk has been studied in national/regional cohorts but has not been characterized in diverse European populations. Methods and findings This prospective analysis included 471,495 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC, 1992-2014, median follow-up: 15.3 y), among whom there were 49,794 incident cancer cases (main locations: breast, n = 12,063; prostate, n = 6,745; colon-rectum, n = 5,806). Usual food intakes were assessed with standardized country-specific diet assessment methods. The FSAm-NPS was calculated for each food/beverage using their 100-g content in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. The FSAm-NPS scores of all food items usually consumed by a participant were averaged to obtain the individual FSAm-NPS Dietary Index (DI) scores. Multi-adjusted Cox proportional hazards models were computed. A higher FSAm-NPS DI score, reflecting a lower nutritional quality of the food consumed, was associated with a higher risk of total cancer (HRQ5 versus (Q1) = 1.07; 95% CI 1.03-1.10, P-trend <0.001). Absolute cancer rates in those with high and low (quintiles 5 and 1) FSAm-NPS DI scores were 81.4 and 69.5 cases/10,000 person-years, respectively. Higher FSAm-NPS DI scores were specifically associated with higher risks of cancers of the colon-rectum, upper aerodigestive tract and stomach, lung for men, and liver and postmenopausal breast for women (all P <0.05). The main study limitation is that it was based on an observational cohort using self-reported dietary data obtained through a single baseline food frequency questionnaire; thus, exposure misclassification and residual confounding cannot be ruled out. Conclusions In this large multinational European cohort, the consumption of food products with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of cancer. This supports the relevance of the FSAm-NPS as underlying nutrient profiling system for front-of-pack nutrition labels, as well as for other public health nutritional measures.Peer reviewe

From efficacy to effectiveness: Two randomized controlled trials of lifestyle intervention postpartum

The overall aim of this thesis was to evaluate if, and how, weight loss can be achieved in women with overweight and obesity after pregnancy by combining results from two randomized controlled trials; LEVA and LEVA in Real Life. In the LEVA trial, a 12-wk diet intervention based on the Nordic Nutrition Recommendations produced a weight loss of 9%, which was sustained at 10% after 1 y, among 68 lactating women. However, important aspects of the dietary changes contributing to this weight loss remained to be examined. Therefore, in the first two papers, eating frequency and food choice in the LEVA trial are reported. In the following two papers, effectiveness of the diet treatment to produce weight loss among 110 postpartum women within a primary health care setting was examined through the LEVA in Real Life trial. At baseline, LEVA women reported an eating frequency of 5.9 intake occasions/d (paper I). During the intervention, a positive association was found between change in eating frequency and change in energy intake. Also, women who received diet treatment reduced their eating frequency more during the intervention than did women not receiving it. Furthermore, results from paper II show that LEVA women had a high intake of sweets and salty snacks and an intake of fruit and vegetables below the recommendations at baseline. During the intervention, women receiving diet treatment reduced their intake of sweets, salty snacks and caloric drinks, and increased their intake of vegetables, more than did women not receiving it. At 1 y, only the difference in increased vegetable intake remained between the groups. Thus, findings from papers I and II suggest that dietary changes in line with current dietary guidelines can help women with overweight and obesity to achieve weight loss after pregnancy. In the LEVA in Real Life trial, women randomized to the diet group achieved greater weight loss after 12 wk (6.7% vs 2.0%) and 1 y (11.6% vs 5.1%) compared to the control group (paper III). Preliminary data after 2 y show that the diet group has had a greater weight regain from 1-2 y compared to the control group such that the observed difference in weight loss at 1 y was not maintained at 2 y (7.5% vs 5.8%). In sum, the combined results from papers III and IV provide evidence that diet treatment delivered within a primary health care setting can produce clinically relevant weight loss among postpartum women with overweight and obesity. However, the results also highlight the difficulty of maintaining weight lost during the first year postpartum

Selenium and diabetes – can selenium protect against the development of diabetes mellitus type 2?

Bakgrund: I dag har 220 miljoner människor diabetes världen över och 90 % av dessa har typ 2 diabetes. Sjukdomen föregås alltid av en insulinresistens och eftersom den har en koppling till oxidativ stress är en teori att spårämnet selen kan spela en viktig roll. Det är känt att selen har antioxidativa effekter i kroppen och tidigare djurstudier har visat att selen skulle kunna härma insulinets effekter samt öka insulinkänsligheten. Syfte: Att ta reda på om selen kan skydda mot utvecklingen av typ 2 diabetes. De frågeställningar som användes var om selensupplementering, selenintag via kosten eller selenstatus i blod kan påverka risken att utveckla typ 2 diabetes hos friska individer. Sökväg: Datainsamlingen genomfördes i den medicinska databasen PubMed med sökorden ”selenium AND diabetes mellitus type 2”. Andra sökord som kombinerades var diabetes, blood glucose, hyperglycemia, serum selenium och selenium supplementation. Urvalskriterier: De inklusionskriterier som antogs var RCT eller longitudinella epidemiologiska studier, studier som haft insjuknande i typ 2 diabetes som effektmått, populationer friska från typ 2 diabetes vid baseline och studier som undersökt kostintag av selen, selensupplementering eller selenstatus i blod. De exklusionskriterier som antogs var reviews, tvärsnitts- och fallkontrollstudier, andra typer av diabetes än typ 2, studier som undersökt selen ihop med andra antioxidanter och andra bifaktorer, studier som endast undersökt samband mellan selen och blodglukosnivåer, haft otillräcklig uppföljning eller varit skrivna på andra språk än engelska och svenska. Datainsamling och analys: Totalt tre studier valdes ut för analys, en RCT och två kohortstudier. Dessa granskades enligt granskningsmall för respektive studiedesign hämtade från SBU och Avdelningen för klinisk näringslära vid Göteborgs Universitet. Detta resulterade i ett bevisvärde för varje studie. Effektmåttets evidensstyrka bestämdes enligt GRADEs sammanfattande evidensformulär. Resultat: Studien som undersökte effekten av selensupplementering jämfört med placebo visade ett ökat insjuknande i typ 2 diabetes i interventionsgruppen. Studien som undersökt selenintag via kosten visade att de med högt selenintag vid baseline hade ett ökat insjuknande i typ 2 diabetes efter 16 år. Den tredje studien undersökte selenstatus i blod och fann att lågt selenvärde var en riskfaktor för att insjukna i typ 2 diabetes. Evidensstyrkan för effektmåttet i de tre studier som analyserats bedömdes vara mycket låg (+). Slutsats: I dagsläget finns det otillräckligt med underlag för att säga att selen skyddar mot utvecklingen av typ 2 diabetes

Changes in food intake patterns during 2000–2007 and 2008–2016 in the population-based Northern Sweden Diet Database

Background: Food intake patterns provide a summary of dietary intake. Few studies have examined trends in food intake patterns over time in large, population-based studies. We examined food intake patterns and related sociodemographic and individual characteristics in the large Northern Sweden Diet Database during the two time windows 2000–2007 and 2008–2016. Methods: In total, 100 507 participants (51% women) who had filled in a 64-item food frequency questionnaire and provided background and sociodemographic data between 2000 and 2016 were included. Food intake patterns were evaluated for women and men separately for the two time windows 2000–2007 and 2008–2016, respectively. Latent class analysis was used to identify distinct, latent clusters based on 40 food groups. Results: Among both women and men, a greater proportion of participants were classified into food intake patterns characterized by high-fat spread and high-fat dairy during 2008–2016 compared to 2000–2007. In the earlier time window, these high-fat clusters were related to lower educational level and smoking. Simultaneously, the proportion of women and men classified into a cluster characterized by high intake of fruit, vegetables, and fibre decreased from the earlier to the later time window. Conclusion: From a public health perspective, the increase in clusters with a high conditional mean for high-fat spread and high-fat dairy and decrease in clusters with a high conditional mean for fruit and vegetables, during the time period 2008–2016 compared to 2000–2007, is worrisome as it indicates a shift away from the recommended food habits. Subgroups of women and men with less healthy dietary patterns in the time window 2008–2016 with lower education, lower age, higher body mass index, lower levels of physical activity and more smoking were identified and future interventions may be targeted towards these groups

Cost-effectiveness and quality of life of a diet intervention postpartum: 2-year results from a randomized controlled trial

Background Pregnancy has been identified as a contributor to obesity. We have shown that a diet intervention postpartum produced a 2-y weight loss of 8%. Here, we present the impact of the diet intervention on cost-effectiveness and explore changes in quality of life (QOL). Methods A total of 110 postpartum women with overweight/obesity were randomly assigned to diet (D-group) or control (C-group). D-group received a 12-wk diet intervention within primary health care followed by monthly emails up to the 1-y follow-up. C-group received a brochure. Changes in QOL were measured using the 36-item Short Form Health Survey and EQ-5D. The analysis of cost-effectiveness was a cost-utility analysis with a health care perspective and included costs of intervention for stakeholder, quality-adjusted life-years (QALYs) gained and savings in health care. The likelihood of cost-effectiveness was examined using the net monetary benefit method. Results The D-group increased their QOL more than the C-group at 12 wk. and 1 y, with pronounced differences for the dimensions general health and mental health, and the mental component summary score (all p < 0.05). Cost per gained QALY was 1704–7889 USD. The likelihood for cost-effectiveness, based on a willingness to pay 50,000 USD per QALY, was 0.77–1.00. Conclusions A diet intervention that produced clinically relevant postpartum weight loss also resulted in increased QOL and was cost-effective. Trial registration Clinical trials, NCT01949558, 2013-09-2

Changes in dietary carbon footprint over ten years relative to individual characteristics and food intake in the Västerbotten Intervention Programme

The objective was to examine 10-year changes in dietary carbon footprint relative to individual characteristics and food intake in the unique longitudinal Västerbotten Intervention Programme, Sweden. Here, 14 591 women and 13 347 men had been followed over time. Food intake was assessed via multiple two study visits 1996–2016, using a 64-item food frequency questionnaire. Greenhouse gas emissions (GHGE) related to food intake, expressed as kg carbon dioxide equivalents/1000 kcal and day, were estimated. Participants were classified into GHGE quintiles within sex and 10-year age group strata at both visits. Women and men changing from lowest to highest GHGE quintile exhibited highest body mass index within their quintiles at first visit, and the largest increase in intake of meat, minced meat, chicken, fish and butter and the largest decrease in intake of potatoes, rice and pasta. Women and men changing from highest to lowest GHGE quintile exhibited basically lowest rates of university degree and marriage and highest rates of smoking within their quintiles at first visit. Among these, both sexes reported the largest decrease in intake of meat, minced meat and milk, and the largest increase in intake of snacks and, for women, sweets. More research is needed on how to motivate dietary modifications to reduce climate impact and support public health. © 2020, The Author(s).Funding details: Forskningsrådet om Hälsa, Arbetsliv och Välfärd, FORTE; Funding details: Västerbotten Läns Landsting; Funding details: Vetenskapsrådet, VR; Funding text 1: The authors want to acknowledge teams at Västerbotten County Council for collecting data and organizing Västerbotten Intervention Programme, and the personnel at the Department of Biobank Research, Umeå University for data maintenance and administrative support. The Northern Sweden Diet Database was supported by the Swedish Research Council for Health, Working Life and Welfare and the Swedish Research Council. The funders had no role in the design, analysis or writing of this article.</p

Comparison of meal patterns across five European countries using standardized 24-h recall (GloboDiet) data from the EFCOVAL project

Purpose: To examine meal patterns in terms of frequency and circadian timing of eating in five European countries participating in the EFCOVAL project. Methods: In this cross-sectional study, 559 men and women, aged 44–65 years, were recruited in Belgium, the Czech Republic, France (Southern part), The Netherlands, and Norway. Dietary data were collected by trained interviewers using standardized computerised 24-h recalls (GloboDiet). Means ± SE of (1) eating frequency, (2) overnight fasting, and (3) time between eating occasions were estimated by country using means from 2 days of 24-h recalls. We also estimated the frequency of eating occasions per hour by country as well as the proportional energy intake of meals/snacks by country compared to the mean energy intake of all countries. Results: Mean eating frequency ranged from 4.3 times/day in France to 7.1 times/day in The Netherlands (p <0.05). Mean overnight fasting was shortest in the Netherlands (9.2 h) and longest in Czech Republic (10.9 h) (p <0.05). Mean time between single eating occasions was shortest in The Netherlands (2.4 h) and longest in France (4.3 h) (p <0.05). Different patterns of energy intake by meals and snacks throughout the day were observed across the five countries. Conclusions: We observed distinct differences in meal patterns across the five European countries included in the current study in terms of frequency and circadian timing of eating, and the proportion of energy intake from eating occasions

Climate impact from diet in relation to background and sociodemographic characteristics in the Västerbotten Intervention Programme

Objective:The objective of this study was to examine climate impact from diet across background and sociodemographic characteristics in a population-based cohort in northern Sweden.Design:A cross-sectional study within the Västerbotten Intervention Programme. Dietary data from a 64-item food frequency questionnaire collected during 1996-2016 were used. Energy-adjusted greenhouse gas emissions (GHGE) for all participants, expressed as kg carbon dioxide equivalents/day and 4184 kJ (1000 kcal), were estimated using data from life cycle analyses. Differences in background and sociodemographic characteristics were examined between participants with low and high GHGE from diet, respectively. The variables evaluated were age, BMI, physical activity, marital status, level of education, smoking, and residence.Setting:Västerbotten county in northern Sweden.Participants:In total, 46 893 women and 45 766 men aged 29-65 years.Results:Differences in GHGE from diet were found across the majority of examined variables. The strongest associations were found between GHGE from diet and age, BMI, education, and residence (all P &lt; 0·001), with the highest GHGE from diet found among women and men who were younger, had a higher BMI, higher educational level, and lived in urban areas.Conclusions:This study is one of the first to examine climate impact from diet across background and sociodemographic characteristics. The results show that climate impact from diet is associated with age, BMI, residence and educational level amongst men and women in Västerbotten, Sweden. These results define potential target populations where public health interventions addressing a move towards more climate-friendly food choices and reduced climate impact from diet could be most effective.