BACKGROUND: A healthy Nordic diet (ND), a diet based on foods originating from the Nordic countries, improves blood lipid profile and insulin sensitivity and lowers blood pressure and body weight in hypercholesterolemic subjects.

OBJECTIVE: To describe and compare food and nutrient composition of the ND in relation to the intake of a Swedish reference population (SRP) and the recommended intake (RI) and average requirement (AR), as described by the Nordic nutrition recommendations (NNR).

DESIGN: The analyses were based on an estimate of actual food and nutrient intake of 44 men and women (mean age 53±8 years, BMI 26±3), representing an intervention arm receiving ND for 6 weeks.

RESULTS: The main difference between ND and SRP was the higher intake of plant foods, fish, egg and vegetable fat and a lower intake of meat products, dairy products, sweets and desserts and alcoholic beverages during ND (p<0.001 for all food groups). Intake of cereals and seeds was similar between ND and SRP (p>0.3). The relative intake of protein, fat and carbohydrates during ND was in accordance with RI. Intake of all vitamins and minerals was above AR, whereas sodium intake was below RI.

CONCLUSIONS: When compared with the food intake of an SRP, ND is primarily a plant-based diet. ND represents a balanced food intake that meets the current RI and AR of NNR 2004 and has a dietary pattern that is associated with decreased morbidity and mortality.

© 2012 Viola Adamsson et al.

Objective:

The aim of this study was to investigate the effects of a healthy Nordic diet (ND) on cardiovascular risk factors.

Design and subjects:

In a randomizedcontrolled trial (NORDIET) conducted in Sweden, 88 mildly hypercholesterolaemic subjects were randomly assigned to an ad libitum ND or control diet (subjects' usual Western diet) for 6 weeks. Participants in the ND group were provided with all meals and foods. Primary outcome measurements were low-density lipoprotein (LDL) cholesterol, and secondary outcomes were blood pressure (BP) and insulin sensitivity (fasting insulin and homeostatic model assessment-insulin resistance). The ND was rich in high-fibre plant foods, fruits, berries, vegetables, whole grains, rapeseed oil, nuts, fish and low-fat milk products, but low in salt, added sugars and saturated fats.

Results:

The ND contained 27%, 52%, 19% and 2% of energy from fat, carbohydrate, protein and alcohol, respectively. In total, 86 of 88 subjects randomly assigned to diet completed the study. Compared with controls, there was a decrease in plasma cholesterol (-16%, P < 0.001), LDL cholesterol (-21%, P < 0.001), high-density lipoprotein (HDL) cholesterol (-5%, P < 0.01), LDL/HDL (-14%, P < 0.01) and apolipoprotein (apo)B/apoA1 (-1%, P < 0.05) in the ND group. The ND reduced insulin (-9%, P = 0.01) and systolic BP by -6.6 ± 13.2 mmHg (-5%, P < 0.05) compared with the control diet. Despite the ad libitum nature of the ND, body weight decreased after 6 weeks in the ND compared with the control group (-4%, P < 0.001). After adjustment for weight change, the significant differences between groups remained for blood lipids, but not for insulin sensitivity or BP. There were no significant differences in diastolic BP or triglyceride or glucose concentrations.

Conclusions:

A healthy ND improves blood lipid profile and insulin sensitivity and lowers blood pressure at clinically relevant levels in hypercholesterolaemic subjects. © 2010 The Association for the Publication of the Journal of Internal Medicine.

Background: Apart from lipid-lowering drugs, dietary changes can also reduce plasma LDL-C concentrations. No studies have been conducted to investigate the clinical effects of a diet with traditional foods originating from the Nordic countries. Method: In a randomised, controlled parallel-group intervention study 88 mildly hypercholesterolemic men and women were randomized to either an ad libitum Nordic diet (ND) or a control diet (CD) for 6 weeks. All meals and foods were provided to the participants in the ND group. Primary outcome measure was LDL-cholesterol, and secondary outcomes were blood pressure, plasma insulin and glucose concentrations. The ND was a high-fibre diet rich in plant foods (fruit, berries, vegetables, root vegetables, whole grain cereals and legumes), vegetable fats (rapeseed oil and nuts) and fatty fish, low-fat milk products, but low in salt, added sugars, saturated fats and red meats. Result: 86 subjects completed the study. Distribution of carbohydrates, fat and protein (E%) in ND was 54, 27, 19, respectively. ND lowered plasma total cholesterol 0.98±0.75 mmol/l (-16%), LDL-C by 0.83±0.67 mmol/l (-21%), HDL-C 0.08±0.23 mmol/l (-5%), including reduced LDL/HDL ratio by -0.42±0.57 (-14%) (all p<0.01 versus controls). Insulin concentrations decreased by 0.51± 2.25 (-9%, p=0.01) and systolic blood pressure by 7±13 mmHg (-5%, P<0.01) compared to controls. Despite diets were eaten ad libitum, body weight decreased by 3.0 kg in the ND (P<0.001). No significant differences were found for diastolic blood pressure, triglycerides or plasma glucose. Conclusion: A Nordic diet improves blood lipid profile, and insulin sensitivity as well as lowering blood pressure to a clinically significant extent in hypercholesterolemic subjects.

Aims and objectives: To describe overweight persons' experiences with weight reduction and participation in the dietary advice on prescription.

Background: Approximately 20% of overweight individuals are able to successfully lose weight. Experiences from earlier weight reduction programmes indicate that those who succeed typically manage to avoid overeating to handle stress and have high motivation to lose weight. Those who fail have low self-control and engage in negative health behaviours such as eating when experiencing negative emotions and stress.

Design: The study used adescriptive qualitative design and was conducted at a Primary Health Care Centre in south-west Sweden.

Methods: The first nineteen study participants who completed the weight reduction programme in two years responded in writing to five open questions about their experiences with the programme. Data were analysed using inductive content analysis.

Results: The participants appreciated the face-to-face meetings with the nurse because they felt seen and listened to during these sessions. They also felt their life situations and self-discipline had an impact on how well they were able to follow the programme. Dietary advice on prescription advice was considered to be helpful for achieving behavioural changes and losing weight. People who succeeded in sustainably losing weight described the importance of support from partners or close friends.

Conclusions: To achieve sustainable weight reduction, it is important to individualise the programme in order to address each person's life situation and the unique difficulties they may encounter.

Relevance to clinical practice: Motivational interviewing appears to be a good technique for developing a successful relationship between the nurse and the patient. The dietary advice on prescription advice was perceived to be a good way to improve food habits and can easily be used at many Primary Health Care Centres. Patient's partners should also be offered the opportunity to participate in the programme.

© 2016 John Wiley & Sons Ltd.

BACKGROUND: We have previously reported that rheumatoid arthritis patients, who adopted a modified Cretan Mediterranean diet, obtained a reduction in disease activity and an improvement in physical function and vitality. This shift in diet is likely to result in an altered intake of fatty acids. Therefore, the objective of the present study was to examine the dietary intake of fatty acids, as well as the fatty acid profile in serum phospholipids, during the dietary intervention study presented earlier. RESULTS: From baseline to the end of the study, changes in the reported consumption of various food groups were observed in the Mediterranean diet group. The change in diet resulted in a number of differences between the Mediterranean diet group and the control diet group regarding the fatty acid intake. For instance, a lower ratio of n-6 to n-3 fatty acids was observed in the Mediterranean diet group, both assessed by diet history interviews (dietary intake) and measured in serum phospholipids. Moreover, the patients in the Mediterranean diet group that showed a moderate or better clinical improvement during the study (diet responders), had a higher reported intake of n-3 fatty acids and a lower ratio of n-6 to n-3 fatty acids compared to the patients with minor or no improvement. Also the fatty acid profile in serum phospholipids differed in part between the diet responders and the diet non-responders. CONCLUSION: The changes in the fatty acid profile, indicated both by dietary assessments and through fatty acids in s-phospholipids may, at least in part, explain the beneficial effects of the Cretan Mediterranean diet that we have presented earlier.

Objectives: The aim of the study was to validate a diet history interview (DHI) method and a 3-day activity registration (AR) with biological markers. Subjects and study design: The reported dietary intake of 33 rheumatoid arthritis patients (17 patients on a Mediterranean-type diet and 16 patients on a control diet) participating in a dietary intervention study was assessed using the DHI method. The total energy expenditure (TEE), estimated by a 3-day AR, was used to validate the energy intake (EI). For nine subjects the activity registration was also validated by means of the doubly labelled water (DLW) method. The excretion of nitrogen, sodium and potassium in 24-h urine samples was used to validate the intake of protein, sodium and potassium. Results: There was no significant difference between the EI and the TEE estimated by the activity registration or between the intake of protein, sodium and potassium and their respective biological markers. However, in general, the AR underestimated the TEE compared to the DLW method. No significant differences were found between the subjects in the Mediterranean diet group and the control diet group regarding the relationship between the reported intakes and the biological markers. Conclusion: The DHI could capture the dietary intake fairly well, and the dietary assessment was not biased by the dietary intervention. The AR showed a bias towards underestimation when compared to the DLW method. This illustrates the importance of valid biological markers. © 2005 Nature Publishing Group. All rights reserved.

Objective

The objective of this study was to examine the predictive ability of perceived talent development environment (TDE) on the well-being of youth elite football players.

Design

A field-based longitudinal design was employed.

Method

The participants were 195 Swedish youth elite football players between 13 and 16 years of age enrolled at Swedish football academies. The players responded to questionnaires regarding their perceptions of their TDE, perceived stress, and well-being in the beginning of the competitive season 2012 (T1). On two more occasions, six and 12 months later, the players completed the stress and well-being questionnaires.

Results

A latent class analysis, based on the TDEQ sub-scale scores at T1, revealed three classes of players with different perceptions of their TDE (one high quality, one moderate quality, and one poor quality class). A second-order multivariate latent growth curve model (factor-of-curves model) showed that the class of players perceiving the lowest TDE quality, experienced higher initial level of stress and lower initial level of well-being at T1 compared to the other two classes. Moreover, there were no significant differences in slopes for neither stress nor well-being between classes (the initial difference between the three groups, in well-being, remained stable over time).

Conclusion

The results indicate that players perceiving their TDE as supporting and focusing on long-term development seem to be less stressed and experience higher well-being than other players. Hence, in addition to facilitate sport-specific development and performance among youth athletes, high quality TDEs may be important for youth elite athletes' general well-being.

Aim:

The objective of the study was to compare nutritional intake results obtained from the 4 x 4-day weighed records with those obtained from a food frequency questionnaire, repeated 24-hour recalls, a seven-day food record and a seven-day checklist in elederly men.

Methods:

Seventy-five healthy men aged 55-88 years and living at home in Cambridge, UK, took part in the study. Energy and nutrients had means and standard deviations calculated. Misreporting was based on an evaluation of food intake level, calculated as reported energy divided by predicted basal metabolic rate. This was in relation to a plausible physical activity level, calculated as the ratio of energy expenditure divided by predicted basal metabolic rate. Statistical significance was assessed via one-way ANOVA.

Results:

The nutrient density was higher for protein and potassium for the group with low food intake level values in all dietary assessment methods. For some methods, this was also true for calciumm, carotene, iron and vitamin C. All methods yielded similar results.

Conclusions:

The present study indicates that selective underreporting exists. Surprisingly, The simplest method, the simplified 24-hour recall, performed as well as more complicated methods.

This article describes a novel approach to giving dietary advice, which is called "Dietary Advice on Prescription" (DAP; Matordning på Recept [MoR] in Swedish). It is the same principle as prescription on medicine and "Physical Activity on Prescription" (PAP; Fysisk aktivitet på Recept [FaR] in Swedish). The main idea is that a written prescription will strengthen the oral advice and emphasize certain aspects of the dietary recommendation. The DAP is on the brink of being tested in a planned study.

Bakgrund Ett flertal studier visar att "Fysisk aktivitet på Recept" (FaR) är en underutnyttjad metod i vården för behandling och prevention av sjukdomar. Metod Data över antal förskrivna recept på fysisk aktivitet (FaR) åren 2005-2009 erhölls från Hallands läns landsting. Resultat Vid tjugotre vårdcentraler (33 %) skrevs det inte ut ett enda FaR-recept. Vid 42 vårdcentraler (61 %) skrevs det ut 1-9 recept. Vid två vårdcentraler skrevs det ut mer än 100 recept. I medeltal skrevs det ut fem recept per läkare år 2008. Det var en oförändrad trend 2005-2009 över antal förskrivna recept. Sammanfattning Denna rapport visar att FaR är en underutnyttjad metod för behandling och prevention av sjukdomar och att majoriteten av vårdpersonalen inte använder FaR. Det fanns inga tecken på att förskrivningen av FaR-recept ökade under femårsperioden 2005 till 2009.

OBJECTIVE:

The number of overweight and obese persons increased through the 1980s and 1990s in Sweden, for instance for men from 35% in 1980 to 52% in 2007. This study investigated whether this trend continued over the past 5 years, including trends for diet and physical activity.

MATERIALS AND METHODS:

The sampling frame in these surveys was established from the Swedish National Registry where all people registered in Sweden between 18 and 84 years in 2004 and 16-84 years in 2005-08 were included.

RESULTS:

There were no changes in the number of overweight (approximately 42% for men and 27% for women) and obese (approximately 11% for both men and women) persons between 2004 and 2008. Approximately 65% of the men and 64% of the women were physically active for an average of 30 minutes per day in 2008. Thirteen percent of women and 5% of men reported consuming at least five servings of fruit and vegetables per day during the 5-year period.

CONCLUSIONS:

Sweden seems to have reached a steady state regarding overweight and obesity. It would probably be fruitful to further discuss life-style issues, such as diet and physical activity, in the Swedish healthcare system and how to deal with the social gradient.

Background: The objective of this study was to compare the interchangeability of spot urine samples and 24-hour urine samples in assessing dietary intake of electrolytes.

Method: Eighty-six healthy men between the ages of 55 and 88 and living at home in Cambridge, UK took part in the study. The volunteers were given three 80 mg tablets of para-aminobenzoic acid (PABA) to take with morning, midday and evening meals. One overnight (approximately eight hours) and one 24-h urine collection were used for comparison against each other. The study was approved by the Ethics Committee of the Dunn Clinical Nutrition Unit, Cambridge, UK.

Result: The regression line did not near x=y but was instead nearly parallel with the x-axis, illustrating that as 24-hour samples increased there was no increase in overnight samples of electrolytes. Fifty-five percent of the 24-h urine samples were complete.

Conclusion: Overnight urine samples cannot replace 24-hour urine samples. Many 24-h urine collections were not complete, which partly may explain the poor predictive value of overnight samples in this study and also other studies.

Meta-analyser formar våra kostråd och de är därför viktiga att analysera. Artikeln diskuterar rimligheten i att relatera en kostkomponent, i detta fall fettsyror, och relatera dessa till sjukdom och död. Reduktionismen och nutritionismen ifrågasätts. Ett komplement till detta synsätt bör finnas med där man studerar mat, livsmedel och kostmönster istället för att relatera sjukdom och död till en kostkomponent. En helhetssyn på livet där hela kosten finns som en del av andra levnadsvanor bör finnas med när man analyserar livsstilsrelaterade och multifaktoriella sjukdomar.

Objective:

Valid dietary information is difficult to obtain and there is no consensus on the best method to use. The objective of the study was to compare nutritional intake results obtained from 16-day weighed records with those obtained from a food frequency questionnaire, repeated 24 h recalls, a 7-day food record, and a 7-day checklist.

Methods:

Seventy-five healthy men aged 55 to 88 years and living at home took part in the study. Means and standard deviations were calculated and distributions were ranked and then divided into quartiles. Statistical significance was assessed via one-way ANOVA.

Results:

The nutrient density was higher for protein and potassium for the group with low FIL values (energy intake/basal metabolic rate) in all dietary assessment method. For some methods this was also true for calcium, carotene, iron and vitamin C. All methods yielded similar results.

Conclusions:

This study indicates that selective underreporting exists, with socially desirable food items as the least underreported foods. Surprisingly, the simplest method, the simplified 24-h recall, performed as well as more complicated method. The existing conservative approach to dietary surveys needs to be abandoned and a more behaviourally intuitive approach should be adopted.

Several studies indicate that promotion of physical activity in health care settings is an underused method for promoting health in the population as well as for preventing and treating diseases. Physical activity referral schemes have been used as a method for activating patients. The aim of this study was to describe the development of prescribing physical activity in the county of Halland, Sweden from the start in 2001 until 2009. Data were obtained from the health authorities in the county of Halland on how many written prescriptions on physical activity were administered per clinic from 2005 until 2009. During 2008, the year when most prescriptions were written, data on how many doctors were employed in the primary health care were obtained. A mean value of five prescriptions per doctor was administered per year. There was no indication of a change in the number of prescriptions between 2005 and 2009. This study indicates that the overwhelming evidence for physical activity in prevention and treatment of diseases does not seem to be sufficient to convince health professionals to use physical activity referral schemes. It is thus vital that further research is performed on the barriers against prescribing physical activity and how to overcome these barriers.

Bakgrund: The aim of the study was to investigate whether a shift from a mixed diet to a lacto-vegetarian diet would lead to a decreased risk for coronary heart diseases indicated by surrogate markers.

Metod: Twenty volunteers participated in the study (4 men and 16 women, mean age 44 years, range 27-61). Clinical examinations were performed, blood samples were drawn and dietary survey, i.e. repeated 24-h recalls were carried out before (0 months) and 3, 6 and 12 months after the dietary change.

Resultat: The dietary shift lead to an increase in the intake of total carbohydrates and fiber and a decrease in fat, protein and sucrose. The coronary heart disease risk markers body mass index, systolic and diastolic blood pressure, total cholesterol and low-density lipoptrotein cholesterol decreased statistically significantly.

Sammanfattning: There was a decrease in low-density lipoprotein cholesterol and other disease risk markers even though the ratio polyunsaturated to saturated fatty acids was unchanged indicating that a decreased energy intake is more important than a change in the distribution of fat, carbohydrates and protein. The main finding in this study is that there was a weight loss, sustained for one year, without any recommendation to decrease the energy intake. Thus, this may be the most important effect of choosing a vegetarian diet.

Background:

There is convincing evidence that vegetarians have lower incidence of coronary heart disease, but there is a debate as to why this is the case.

Objective:

The aim of the study was to investigate whether a shift from a mixed diet to a lacto-vegetarian diet would lead to a decrease in risk for coronary heart diseases indicated by surrogate markers.

Design:

Twenty volunteers participated in the study (4 men and 16 women, mean age 44 years, range 27 - 61) from a town in western Sweden. Clinical examinations were performed, blood samples were drawn and dietary survey, i.e. repeated 24-h recalls were carried out before (0 months) and 3, 6 and 12 months after the change from a mixed diet to a lacto-vegetarian diet. A dietician educated the volunteers with regard to the vegetarian dietary regimen, organized and taught the vegetarian cooking courses.

Results:

The dietary shift lead to an increase in the intake of total carbohydrates and fibre and a decrease in fat, protein and sucrose. The coronary heart disease risk markers body weight, body mass index, systolic and diastolic blood pressure, total cholesterol and low-density lipoptrotein cholesterol decreased significantly.

Conclusions:

There was a decrease in disease risk markers even though the ratio polyunsaturated to saturated fatty acids was unchanged. The main finding in this study is that there was a weight loss, sustained for one year, without any recommendation to decrease the energy intake or any focus on weight reduction.

Aim: To describe the self assessed dental health and utilization of dental care during the period 2004- 2008 and study patterns of prediction.

Material and Methods: To describe the self assessed dental health and utilization of dental care during the period 2004-2008 and study patterns of prediction.

Results: Very good and rather good dental health was on average reported by 73% of the responders. Variation over the period and between genders was small, but with a significant increase over time. Proportion with visit to a dentist or dental hygienist during the last two years was 88%, with small change over the studied period. The lowest proportion was obser- ved in age group 25-44, 80%. Seventeen percent had not visited a dentist/hygienist during the last three months although they reported need for treatment. This proportion decreased significantly over time independent of age and gender. Twelve percent of the participants reported that they had experienced need for dental care but had abstained for economic reasons, a change from 13% to 10%, with a most marked trend in the youngest group, 14% to 8%. Impaired dental health and low utilization of dental care was associated with low social and economic levels, life style factors as smoking, low physical ac- tivity, unfavourable dietary habits and prevalence of chronic disease and experience of lower well-being.

Conclusion: A large majority of the population report good dental health and high utilization of dental care, but approximately one in ten claims to have abstained from seeking dental care due to economic reasons. A comparison of the areas of explanatory factors, show that impaired dental health is equally well predicted by all. For models with utilization as dependent, the socio-economic factors had best predictive ability. Highest odds ratios were found in models for abstaining from needed dental care, with socio-economic factors as best predictors, and with better prediction among people above 45 years of age.

Objective: To validate  a two-question questionnaire on physical activity with the doubly labeled water (DLW) method.

Design: Cross-sectional study.

Subjects: Nine volunteers, age 33-75 years, with a mean body mass index (BMI) of 27.4.

Measurements: A questionnaire with one question on physical activity at work and one question on physical activity during leisure time. The answers were converted into a PAL (physical activity level=energy expenditure/basal metabolic rate) value, which was validated with the DLW method.

Results: The mean values (s.d.) of PAL for the questionnaire and DLW measurements were 1.7 (0.1) and 1.7 (0.1), respectively, with a mean difference of 0.004 (0.172).

Conclusions: The results were promising to the extent that they could be used in large-scale epidemiological studies.

The aim of this study was to identify sources of nutrients in diets of young Swedish vegans and omnivores. Three months of dietary intakes were investigated by diet history interviews. Volunteers were recruited through advertising and visits to schools in the city of Umeå, Sweden. Thirty vegans, 15 female and 15 male, aged 17.5±1.0 years, were compared with 30 sex-, age-, and height-matched omnivores. Vegans had different sources of nutrients than young omnivores and relied to a great extent on dietary supplements as a source of vitamin B-12, vitamin D, calcium, and selenium. Dietary intake of vegetables, fruits, and berries exceeded 500 g/day for 21 of the 30 vegans, whereas the same held true for only 1 of the 30 omnivores. Instead of animal products, young vegans rely on dietary supplements, legumes, vegetables, fruits, and berries as sources of nutrients. Copyright © 2005 by the American Dietetic Association.

The relative contents of the fatty acids 14 : 0, 15 : 0 and 17 : 0 in serum and adipose tissue may be used as biological markers of dairy fat intake. However, the determinants of these fatty acids are not fully understood. This study investigates the relationship between these fatty acids and the intake of macronutrients and physical activity in a cross-sectional study of 301 healthy men aged 61-64 years. Dietary intake was assessed using a pre-coded 7 d food record, and physical activity during the previous year was recorded in an interview. Under-reporters of energy intake were identified by the Goldberg cut-off. Fatty acid composition was determined in serum phospholipids (PL) and subcutaneous adipose tissue (AT) from the upper buttock. The relative content of each of 14 : 0, 15 : 0 and 17 : 0 in PL and AT was positively associated with the intake of dairy fat. In addition, all three fatty acids were inversely correlated with alcohol intake, R ranging from -0.28 to -0.53 (P<0.001). The results were not markedly affected when under-reporters n>88) were excluded from the analyses. In both PL and AT, the relative content of the fatty acids was approximately 5% higher in a group of high physical activity compared with a group of low physical activity, although significant trends were only seen for 14 : 0 in PL and 17 : 0 in AT. The findings suggest that adjustments should be made for alcohol intake when the fatty acids 14 : 0, 15 : 0 and 17 : 0 are applied as markers for dairy fat intake.

Objectives: Several investigators have reported that clinical improvements of patients with rheumatoid arthritis (RA), from participating in therapeutic diet intervention studies, have been accompanied by loss of body weight. This has raised the question whether weight reduction per se can improve RA. In order to test this hypothesis, three previously conducted diet intervention studies, comprising 95 patients with RA, were pooled. Together with Age, Gender, and Disease Duration, change during the test period in body weight, characterised dichotomously as reduction or no reduction (dichoΔBody Weight), as well as Diet (dichotomously as ordinary diet or test diet), were the independent variables. Dependent variables were the difference (Δ) from baseline to conclusion of the study in five different disease outcome measures. ΔESR and ΔPain Score were both characterised numerically and dichotomously (improvement or no improvement). ΔAcute Phase Response, ΔPhysical Function, and ΔTender Joint Count were characterised dichotomously only. Multiple logistic regression was used to analyse associations between the independent and the disease outcome variables. Results: Statistically significant correlations were found between Diet and three disease outcome variables i.e. ΔAcute-Phase Response, ΔPain Score, and ΔPhysical Function. Δ Body Weight was univariately only correlated to ΔAcute-Phase Response but not significant when diet was taken into account. Conclusion: Body weight reduction did not significantly contribute to the improvement in rheumatoid arthritis when eating lacto-vegetarian, vegan or Mediterranean diets. © 2005 Sköldstam et al; licensee BioMed Central Ltd.

Bakgrund

Hos patienter med ankyloserande spondylit (AS) har man sett en ökad förekomst av kardiovaskulära sjukdomar och det är inte klarlagt vad som orsakar denna ökning. Syftet med studien var därför att utvärdera om kost och andra kardiovaskulära riskfaktorer hos patienter med AS skiljer sig åt i jämförelse med normalbefolkningen.

Metod Åttionio patienter med AS, diagnosticerade enligt de modifierade New York kriterierna, identifierades i databaserna till ett hälsoundersökningsprojekt, det så kallade Västerbotten Intervention Project (VIP). Patienterna jämfördes med 356 kontroller matchade för ålder, kön och undersökningsperiod. Inom VIP har deltagarna fyllt i enkäter om kost, fysisk aktivitet och rökning. Blodtryck, längd och vikt, har mätts och blodprover har analyserats för kolesterol, triglycerider och blodsockernivåer.

Resultat Vi fann inga signifikanta skillnader mellan patienter och kontroller avseende kost, fysisk aktivitet, träningsvanor, rökvanor, BMI, vikt eller blodtryck. Däremot hade patienterna signifikant lägre nivåer av serumtriglycerider (p <0,001) och -kolesterol (p <0,01). Hos patienterna var triglyceridvärdet omvänt korrelerat till totala intaget av fett (rs = -0,25, p <0,05) liksom intaget av enkelomättade fetter (rs = -0,29, p <0,05) och positivt korrelerat till intaget av kolhydrater (rs = 0,26, p <0,05). Kolesterolvärdet visade också en positiv korrelation till intag av kolhydrater (rs = 0,26, p <0,05) och negativ korrelation till intaget av enkelomättade fetter (rs = -0,28, p <0,05). Dessa samband sågs inte hos kontrollerna.

Sammanfattning Patienterna uppvisade signifikant lägre nivåer av kolesterol och triglycerider jämfört med kontrollgruppen. Det fanns samband mellan kost och aterogena blodfetter hos patienter som inte fanns i kontrollgruppen. Resultaten antyder att det kan finnas skillnader i fettmetabolismen hos patienter med AS i jämförelse med normalbefolkningen.

Background:

An increased risk of cardiovascular diseases (CVD) has been reported among patients with Ankylosing Spondylitis (AS). As of today, little is known what causes this increase.

Objectives: The aim of this study was to evaluate whether traditional CVD risk factors, such as smoking, diet, physical activity and atherogenic blood lipids, differ among AS patients in comparison to the general population.

Methods: Eighty-nine patients diagnosed with AS by fulfilling the modified New York criteria were identified in the databases of a community intervention programme, the Västerbotten Intervention Programme (VIP). The patients were compared with 356 controls matched for age, sex and study period. As part of the VIP, participants have completed questionnaires regarding diet, physical activity and smoking. Additionally, the VIP included measurement of blood pressure, height and weight, and blood samples analysed for cholesterol, serum triglycerides and blood glucose.

Results: Levels of serum triglycerides (p<0.01) and cholesterol (p<0.01) were significantly lower in the patient group. Among the patients, the level of triglycerides was inversely correlated to the intake of total fat (r_s = -0.25, p<0.05), monounsaturated fats (r_s = -0.29, p<0.05) and positively correlated to the intake of carbohydrates (r_s =0.26, p<0.05). These correlations were not seen among the controls. No significant differences were found between patients and controls regarding diet, physical activity, exercise frequency or smoking habits nor in measurements of body mass index (BMI), weight or blood pressure.

Conclusions: The patients exhibited significantly lower levels of cholesterol and triglycerides compared with controls. There were correlations between diet and atherogenic blood lipids among the patients which were not found in the control group. The results suggest that there may be differences in fat metabolism among patients with AS in comparison with the general population.

The aim of this study was to evaluate whether modifiable cardiovascular disease (CVD) risk factors, e.g.atherogenic blood lipids, hypertension and lifestyle-related factors such as smoking, diet and physical inactivity, differ among patients with ankylosing spondylitis (AS) in comparison to the general population. Eighty-eight patients diagnosed with AS were identified by analysis of the databases of a previous community intervention programme, the Västerbotten intervention programme. The patients were compared with 351 controls matched for age, sex and study period. These databases include the results of blood samples analysed for cholesterol, triglycerides and plasma glucose, as well as data on hypertension, height, weight, smoking and dietary habits and physical activity. No significant differences were found between patients and controls regarding hypertension, body mass index, physical activity, diet or smoking. Levels of serum triglycerides (p <0.01) and cholesterol (p <0.01) were significantly lower in the patient group. Among the patients, the level of triglycerides correlated inversely with the intake of total fat (r s=−0.25, p <0.05), monounsaturated fats (r s= −0.29, p <0.05) and positively correlated to the intake of carbohydrates (r s=0.26, p <0.05). These associations were not apparent among the controls. In the cohort of AS patients studied, no differences were found regarding the modifiable risk factors for CVD compared with the general population. Hence, the increased presence of CVD in patients with AS may be caused by other factors such as differences in metabolism and medication such as NSAID or the chronic low-grade inflammation present in the disease. © 2013 Clinical Rheumatology. © 2013 Clinical Rheumatology.

OBJECTIVE: To investigate fatty acid composition in the diet, plasma phospholipids, and adipose tissue in a cohort of patients with ankylosing spondylitis (AS), and to determine their correlations to disease activity and blood lipids in a cross-sectional study. METHODS: Diet was assessed using a food frequency questionnaire in 66 patients with AS. Polyunsaturated fatty acids in plasma phospholipids and gluteal adipose tissue were measured using gas chromatography. Disease status was quantified using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein, and proinflammatory cytokines. RESULTS: Diet did not correlate with disease activity assessed by the BASDAI, but there were negative correlations between the dietary intake of long-chain omega-3 fatty acids and ESR (rs = -0.27, p < 0.05). The plasma phospholipid content of arachidonic acid correlated significantly with the BASDAI score (rs = 0.39, p < 0.01). There were correlations between the intake of long-chain omega-3 fatty acids and high-density lipoproteins and serum triglycerides (rs = 0.26 and rs = -0.25, respectively, p < 0.05). CONCLUSION: There was a positive correlation between levels of arachidonic acid in plasma phospholipids and disease activity assessed by BASDAI in patients with AS. A Western diet does not appear to influence this correlation, but seems to affect blood lipids involved in atherogenic processes.

OBJECTIVE: To study the effect of supplementation with omega-3 fatty acids on disease variables and drug consumption in patients with ankylosing spondylitis (AS).

METHODS: Twenty-four patients were randomized to either a low-dose (1.95 g omega-3/day) or a high-dose (4.55 g omega-3/day) supplement. Disease activity, functional impairment, erythrocyte sedimentation rate (ESR), and drug consumption were assessed during visits at baseline and at weeks 7, 14, and 21.

RESULTS: Eighteen patients completed the study, nine patients from each group. The patients in the high-dose group exhibited a significant decrease in disease activity according to the Bath Ankylosing Disease Activity Index (BASDAI; p = 0.038), which was not seen in the low-dose group. Significant differences were not found on drug consumption or in functional capacity in either of the groups. No significant differences were found when comparing the results between the high- and low-dose groups.

CONCLUSION: Omega-3 fatty acids in adequate doses may have the capacity to decrease the disease activity of AS. However, larger and better controlled studies are needed before any further conclusions can be made on the extent of this capacity.

Non-steroidal anti-inflammatory drugs (NSAIDs) are the basic treatment of pain and stiffness in patients with ankylosing spon- dylitis (AS). NSAIDs act by blocking the synthesis of eicosanoids which are derived from 20-carbon long-chained polyunsaturated fatty acids (LCPUFAs). LCPUFAs in the body are obtained from the diet or from endogenous elongation of shorter dietary poly- unsaturated fatty acids.In a cross-sectional design, dietary intake of LCPUFAs, com- position of LCPUFAs in plasma and adipose tissues and disease activity were assessed among patients with AS who were not on treatment with biologics. Blood samples and gluteal fat biopsy were drawn from sixty-six patients (51 male, 15 female,mean age 48 years, range 26-65) with AS fulfilling the modified New York criteria. Dietary intake of LCPUFAs were calculated on the ba- sis of a semi-quantitative food frequency questionnaire. Plasma and adipose tissue content of LCPUFAs were assessed using gas chromatography. Disease status was measured with erythrocyte sedimentation rate (ESR, Westergren), high sensitive C-reactive protein (hiCRP) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).The phospholipid plasma level of Arachodonic Acid (AA) correlated significantly with disease activity according to both the total BASDAI score (Rs=0.39, p<0.01), and five of its six sub-scores. Levels of other long-chained fatty acids in plasma phospholipids such as dihomo gammalinolenic acid and eicosa- pentaenoic acid did not correlate with BASDAI. Neither did con- tents of LCPUFAs in gluteal adipose tissue and dietary intake correlate with BASDAI.The plasma phospholipid content of AA correlated with BAS- DAI, and may be regarded as a biomarker for disease activity. The lack of correlation between BASDAI and LCPUFAs in diet and adipose tissue, suggests that the endogenous production and incorporation of AA in phospholipids may be involved in the pathogenesis of AS.

Background: There is strong evidence today of a relation between Ankylosing Spondylitis (AS) and inflammatory changes in the bowel. Since symptoms from the bowel is not a major sign of AS, the inflammatory changes have been considered as “silent”.

Method: The aim of this study was to investigate the frequency and nature of gastric complaints among patients with AS without a diagnosis of inflammatory bowel disease (IBD) and their relation to disease activity, functional status, physical activity and diet by a cross-sectional design. One hundred sixty-five patients with verified diagnosis of AS according to the modified New York criteria, aged 18-70 years received a questionnaire regarding diet, physical activity, gastric complaints and disease status, as measured by BASDAI and BASFI. One hundred twenty-two patients (92 males, 30 females, mean age 50 ±10 years) answered the questionnaire (response rate 74%). Nine patients reported that they had been diagnosed with IBD and were excluded from further analysis, yielding 113 available patients for further analysis.

Result: Forty-Nine percent of the patients reported that they experienced loose stools or diarrhea at least twice a month and 18 % reported loose stools or diarrhea more than two times per week. Furthermore, 29 % of the patients reported gastric pain more than twice a month and 21 % reported problems with constipation or hard stools more than two times per month. Patients with reported gastric pain more often than twice a month had significantly higher disease activity and worse functional status according to BASDAI and BASFI (p=0,003 and p=0,006; respectively). Patients with reported loose stools and diarrhea more than twice a week had a trend towards higher disease activity and worse functional status according to BASDAI and BASFI (p=0,08 and p=0,09; respectively). No significant correlation could be found between medication, including consumption of NSAID and these gastric symptoms.

Conclusion: Gastric pain is common in AS and could be linked to disease activity and functional status. Loose stools and diarrhea are also common in AS, and could also be linked with disease activity or functional status, although to a lesser degree than gastric pain.

The aims of this study were to investigate, firstly, the relationship between diet and disease activity and, secondly, the presence of gastrointestinal symptoms and their relationship to diet among patients with ankylosing spondylitis (AS) using a cross-sectional design. One hundred sixty-five individuals diagnosed with AS were invited to complete a self-administered postal questionnaire regarding demographic data, diet, medication, and gastrointestinal symptoms in addition to two established disease assessment questionnaires, i.e., the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). No significant correlation between diet and disease activity was found. Overall, 27% of the patients reported aggravating gastrointestinal problems when consuming certain foodstuff(s). The 30% of patients who reported suffering from gastrointestinal pain had significantly greater disease activity and poorer functional status according to their BASDAI and BASFI scores (p < 0.01 and p = 0.01, respectively). Patients who reported gastrointestinal pain had a significantly higher consumption of vegetables (p < 0.01) and lower consumption of milk and soured milk (p = 0.04). No significant correlation was found between the use of non-steroidal anti-inflammatory drugs (NSAID) and gastrointestinal symptoms. In multiple regression models, BASDAI and the consumption of vegetables were independent and statistically significant predictors of gastrointestinal pain. To conclude, in a group of Swedish AS patients, no correlation between diet and disease activity could be detected. There were, however, correlations between diet and gastrointestinal pain. Gastrointestinal problems were also found to be prevalent in AS, independent of NSAID usage.