Background/Objectives: This systematic review aimed to investigate the relationship between birth size, a marker of prenatal undernutrition, and both physical and cognitive function in individuals aged 60 years and older. Methods: We searched the PubMed and Scopus databases up to November 2024 for prospective cohort studies that included data on birth size and physical or cognitive function in individuals aged 60 or older, excluding studies focused on preterm individuals. The Risk Of Bias In Non-randomized Studies—of Exposure (ROBINS-E) tool was used to evaluate the bias of each included study. Fixed-effects meta-analysis was performed using Review Manager. This systematic review was registered with PROSPERO, CRD42023360823. Results: Twenty-four articles met the eligibility criteria, with participant numbers ranging from 52 to 4000 (about 50% women) and an average age range of 60.9 to 78.4 years. Eight articles had a high risk of bias, while the remaining 16 presented some concerns. Three meta-analyses were conducted: two for grip strength and one for word fluency. Grip strength was positively associated with birth weight, both in an unadjusted analysis, which showed an increase of 1.88 kg (95% CI 1.19, 2.56), and in an analysis adjusted for age, sex, and height/body mass index, which showed an increase of 1.15 kg (95% CI 0.71, 1.59). Word fluency also displayed a positive association with birth weight, with an increase of 0.62 words per minute (95% CI 0.15, 1.10). Conclusions: Smaller birth size, indicative of prenatal undernutrition, is associated with diminished physical and cognitive function in later life. These results highlight the importance of identifying individuals born small as a vulnerable group and implementing lifelong strategies to promote healthy aging.

Physical function is an important domain of healthy ageing and previous studies have suggested socioeconomic status, including education to be influential. Also, lifestyle factors such as physical activity can play a crucial role in maintaining physical function. Furthermore, birth size as an indicator of nutritional status during gestation can add insight into the interplay between factors that influence physical functioning. Thus, examining healthy ageing from a life course perspective can broaden our scope for possible preventive measures for maintaining independence and quality of life at late-life. Our objective was to investigate the longitudinal association between midlife education and late-life physical function, over the mean time-period of 25 years, and to investigate whether birth size modifies the association. Participants were 1604 men and women from the Age Gene/Environment Susceptibility (AGES) - Reykjavik Study who had measures from birth, midlife and late-life. Multivariate linear regression included gait speed (GS) and timed up and go test (TUG) at late-life as outcomes and midlife educational level as exposure. To examine effect modification, data was stratified by birth size as ponderal index (PI) in three groups. Participants with primary education had slower GS of 0.05 m/s (p < 0.001) and longer TUG time of 0.66 s (p = 0.006) compared to college/university (reference). Birth size modified the association, with the low PI group having a slower GS of 0.1 m/s (p < 0.001) and taking 1.35s longer to complete TUG between educational groups (primary education vs. reference). There was no association between GS nor TUG with education in the high PI group. Our results imply that for those born small, having lower educational level is associated with having worse physical function at late-life, partly through less physical activity throughout the life-course.

OBJECTIVES:Examine different sources of social support/network depending on depressive symptoms among older adults. METHODS:Data were obtained from two waves of the Age, Gene/Environment Susceptibility - Reykjavik Study (AGES-Reykjavik): Wave I (2002-2006, N = 5.764) and Wave II (2007-2011, N = 3.316). Seven questions (meet with friends/children feeling close to family/friends telephone children/friends living alone were used as: single question (social support)/social network score (SNS). The Geriatric Depression Scale (GDS) screened for depressive symptoms, recoded as: low score (GDS score < 6) and high score (GDS score ≥6). Longitudinal linear regression assessed associations between social questions and GDS score at follow-up among low and high depressive symptoms. RESULTS:Among low depressive symptoms (mean age 77) decrease in depressive symptoms was found for those meeting with children (β: -0.439, p = .007); friends (β: -0.288, p = .002); feeling close to family (β: -0.232, p ≤ .001) and friends (β: -0.217, p = .009). Among high depressive symptoms (mean age 78) decrease in depressive symptoms was when telephoning children (β: -4.679, p = .002); meeting with children (β: -2.725, p = .018). CONCLUSIONS:In older community-dwelling adults regular social support decreases depressive symptoms with most meaningful support arriving from children and friends. CLINICAL IMPLICATIONS:Incorporating social network assessments into routine geriatric evaluations could help identify individuals at higher risk of developing or sustaining depressive symptoms.

Background. Depression is related to incident type 2 diabetes (T2D). However, little is known on this topic in older people from the Nordic countries and how health and lifestyle characteristics of participants affect this relationship. Thus, the aim of the present study was to investigate whether baseline depressive symptoms predict incident T2D in Icelandic older people and whether health and lifestyle characteristics of participants, can explain the relation between depression and diabetes. Methods. We used data from the Age-Gene/Environment-Susceptibility-Reykjavik-Study (65-96 years). From the original sample of 3316 participants who finished follow-up, 2823 non-diabetic participants with a complete dataset on depressive symptoms and incident T2D at endpoint were included in this analysis. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS). Results. During a mean follow-up of 5.2 years, 103 (3.6%) of the 2823 participants developed T2D. According to the fully adjusted logistic regression model, baseline depressive symptoms in the highest category predicted incident T2D when compared to the lowest category (OR: 3.2; 95%CI: 1.3-8.2; p = 0.014). Statistical adjustment did only marginally alter the results. Subgroup analysis revealed that GDS was a significant predictor of incident T2D in most subgroups. Conclusions. In older Icelandic people, having high depressive symptoms is a predictor of incident T2D during a follow-up period of 5.2 years. These associations are independent from health and lifestyle related covariates and are observed in most subgroups of our study population.

This study examined whether participants with poor activities of daily living (ADLs) at hospital discharge had increased weight loss after 6 months of follow-up and whether nutrition therapy can prevent this weight loss. This dietary randomized controlled trial (N=104) examined community-dwelling older adults (66-95 years) discharged from hospital and at risk for malnutrition, receiving either 6 months of nutrition therapy (intervention) or only standard care (control). ADL was assessed using seven questions on self-care based on the Katz et al.'s method. At discharge, 45 (43%), 36 (35%), and 23 (22%) had high, medium, and poor ADL, respectively, with no differences between the control and intervention groups according to chi-square test. Participants in the control group with poor ADL had significantly higher weight loss than participants with high ADL (ageand sex-adjusted analysis of covariance: 3.6 kg; 95% confidence interval [1.0, 6.1] kg, p = .007). No such difference was observed in the intervention group. Participants with poor ADL at hospital discharge develop lower body weight by around 3.5 kg 6 months later when compared with participants with high ADL. Receiving nutrition therapy could help older adults with poor ADL to maintain body weight after hospital discharge.

Objectives This study aimed to systematically review the evidence for associations between consumption of legumes and cardiovascular disease (CVD), type 2 diabetes (T2D) and their risk factors among healthy adults. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus up to 16 May 2022 for ≥4 weeks long randomized (RCT) and non-randomized controlled trials and prospective cohort studies with follow-up ≥12 months, assessing legume intake (beans/lentils/peas/soybeans, excluding peanuts and legume-products/protein/powder/flour) as the intervention or exposure. Outcomes were CVD, coronary heart disease (CHD), stroke, T2D and in intervention trials only: changes in blood lipids, glycemic markers, and blood pressure. Risk of bias (RoB) was evaluated with Cochrane’s RoB2, ROBINS-I, and US Department of Agriculture (USDA)’s RoB-NObS. Effect sizes were pooled using random-effects meta-analyses and expressed as relative risk or weighed mean differences with 95% confidence intervals, heterogeneity quantified as I2. The evidence was appraised according to World Cancer Research Fund’s criteria. Results Of the 181 full-text articles assessed for eligibility, 47 were included: 31 cohort studies (2,081,432 participants with generally low legume consumption), 14 crossover RCTs (448 participants), one parallel RCT and one non-randomized trial. Meta-analyses of cohort studies were suggestive of null associations for CVD, CHD, stroke and T2D. Meta-analyses of RCTs suggested a protective effect on total cholesterol (mean difference −0.22 mmol/L), low density lipoprotein (LDL)-cholesterol (−0.19 mmol/L), fasting glucose (−0.19 mmol/L), and HOMA-IR (−0.30). Heterogeneity was high (I2 = 52% for LDL-cholesterol, >75% for others). The overall evidence for associations between consumption of legumes and risk of CVD and T2D was considered limited – no conclusion. Conclusion Legume consumption was not found to influence risk of CVD and T2D in healthy adult populations with generally low legume consumption. However, protective effects on risk factors, seen in RCTs, lend some support for recommending legume consumption as part of diverse and healthy dietary patterns for prevention of CVD and T2D.

Abstract The aim was to investigate effects of six-month nutrition therapy on hospital readmissions, LOS, mortality and need for long-term care residence up to 18-months post-discharge in older Icelandic adults. Participants (>65 years) were randomised into intervention (n=53) and control (n=53) before discharge from a geriatric unit. The intervention group received nutrition therapy based on the Nutrition Care Process, including home visits, phone calls, freely delivered energy- and protein-rich foods and supplements for six months after hospital discharge. The Icelandic electronic hospital registry was accessed to gain information on emergency room visits (ER), hospital readmissions, LOS, mortality and need for long-term care residence. One subject from each arm dropped out during the intervention period. The intervention increased body weight (+5.2kg, 95%CI: 3.9-6.5kg) and energy intake (1696kcal, 95%CI: 1557-1834kcal) compared to control. The intervention group had a lower proportion of participants with at least one readmission compared to control (1 month: 1.9% vs 15.8%, P=0.033; 6 months: 25.0% vs 46.2%, P=0.021; 12 months: 38.5% vs 55.8%, P=0.051; and 18 months: 51.9% vs 65.4%, P=0.107). There was also a lower total number of readmissions (significant at 1, 6 and 12 months) and a shorter LOS (significant at all time points) in the intervention group. However, there were no differences between groups in ER visits, mortality and need for long-term care residence. It is of great clinical relevance that a six-month nutrition therapy in older Icelandic adults discharged from hospital reduced hospital readmissions and shortens LOS at the hospital up to 18-months post-discharge.

Objective: To systematically review the evidence for whether habitual or different levels of experimental intake of vitamin B12 from diet and supplements is sufficient to ensure adequate B12 status in groups most susceptible to vitamin B12 deficiency. Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Scopus up to 21 May 2021, for intervention studies, prospective cohort studies and case-control studies assessing B12 intake from diet and/or supplements in relation to B12 status (s/p-B12, holotranscobalamin, methylmalonic acid, homocysteine or breastmilk B12). Cross-sectional studies were eligible for studies conducted during pregnancy and lactation. Included populations were children (0–18 years), young adults (18–35 years), pregnant or lactating women, older adults (≥65 years) and vegans or vegetarians. Study selection, data extraction and risk of bias assessment were conducted by two assessors independently. The evidence was synthesized qualitatively and classified according to the World Cancer Research Fund. Results: The searches yielded 4855 articles of which 89 were assessed in full text and 18 included. Three studies were conducted during pregnancy and three during lactation or infancy – all observational. Eight studies were conducted among older adults; most were interventions among B12-deficient participants. Four studies were eligible for vegetarian and vegans, all interventions. The strength of evidence that habitual B12 intake or an intake in line with the current Nordic recommended intake (RI) is sufficient to ensure adequate status was considered Limited – no conclusion for all included populations. Conclusion: Evidence is insufficient to assess if or which level of B12 intake is sufficient to maintain adequate status for all included populations. Population-based cohort studies and low-to-moderate dose interventions that address this question are highly warranted.

Europe is dependent on protein-rich crop imports to meet domestic food demand. This has moved the topic of sustainable protein self-sufficiency up the policy agenda. The current study assesses the feasibility of protein self-sufficiency in Iceland, and its capacity to meet Northern Europe's demand, based on industrial-scale cultivation of Spirulina in novel production units. Production units currently operating in Iceland, and laboratory-derived nutritional profile for the Spirulina cultivated, provide the basis for a theoretical protein self-sufficiency model. Integrating installed and potentially installed energy generation data, the model elaborates six production scale-up scenarios. Annual biomass produced is compared with recommended dietary allowance figures for protein and essential amino acids to determine whether Northern Europe's population demands can be met in 2030. Results show that Iceland could be protein self-sufficient under the most conservative scenario, with 20,925 tonnes of Spirulina produced using 15% of currently installed capacity. In a greater allocation of energy capacity used by heavy industry, Iceland could additionally meet the needs of Lithuania, or Latvia, Estonia, Jersey, Isle of Man, Guernsey, and Faroe Islands. Under the most ambitious scenario utilizing planned energy projects, Iceland could support itself plus Denmark, or Finland, or Norway, or Ireland with up to 242,366 tonnes of biomass. On a protein-per-protein basis, each kilogram of Spirulina consumed instead of beef could save 0.315 tonnes CO2-eq. Under the most ambitious scenario, this yields annual savings of 75.1 million tonnes CO2-eq or 7.3% of quarterly European greenhouse gas emissions. Finally, practicalities of production scale-up are discussed.

Background Malnutrition is frequently observed in older adults and is associated with hospital readmissions, length of stay (LOS), and mortality in discharged patients. Objective The aim of this study was to investigate effects of six-month nutrition therapy on hospital readmissions, LOS, mortality and need for long-term care residence 1-, 6-, 12- and 18-months post-discharge in older Icelandic adults. Design Secondary analysis of a randomized controlled trial. Paarticipants Participants (>65 years) were randomised into intervention (n=53) and control (n=53) before discharge from a geriatric unit. Intervention The intervention group received nutrition therapy based on the Nutrition Care Process, including home visits, phone calls, freely delivered energy- and protein-rich foods and supplements for six months after hospital discharge. Measurements The Icelandic electronic hospital registry was accessed to gain information on emergency room visits (ER), hospital readmissions, LOS, mortality and need for long-term care residence. Results The intervention group had a lower proportion of participants with at least one readmission compared to control (1 month: 1.9% vs 15.8%, P=0.033; 6 months: 25.0% vs 46.2%, P=0.021; 12 months: 38.5% vs 55.8%, P=0.051; and 18 months: 51.9% vs 65.4%, P=0.107). There was also a lower total number of readmissions per participant (1 month: 0.02 vs 0.19, P=0.015; 6 month: 0.33 vs 0.77, P=0.014; 0.62 vs 1.12, P=0.044) and a shorter LOS (1 month: 0.02 vs 0.92, P=0.013; 6 months: 2.44 vs 13.21; P=0.006; 12 months: 5.83 vs 19.40, P=0.034; 18 months: 10.42 vs 26.00, P=0.033) in the intervention group. However, there were no differences between groups in ER visits, mortality and need for long-term care residence. Conclusion A six-month nutrition therapy in older Icelandic adults discharged from hospital reduced hospital readmissions and shortens LOS at the hospital up to 18-months post-discharge. However, it did neither affect mortality, ER, nor need of long-term care residence in this group.

Background: While dietary fiber intake is low in many children, the current trend to plant-based diets is associated with higher fiber intake in children raised on these diets. As older reports indicate that diets providing high fiber intake in children 0–5 years may affect growth, iron status and bowel function, we summarized the available evidence in this systematic review. Objective: To identify, critically appraise, and synthesize evidence on the effect of high fiber intake on growth, iron and bowel function in children 0–5 years, with relevance to the Nordic and Baltic countries. Methods: Following a pre-registered protocol, we searched MEDLINE, EMBASE, Cochrane Central of Controlled Trials, and Scopus for clinical trials and prospective cohort studies published until November 2021. Two reviewers independently screened retrieved literature, extracted relevant data, and performed risk of bias assessment. Outcomes were growth, iron metabolism and bowel function in children 0–5 years. We narratively described findings from studies that met inclusion criteria. Results: From 5,644 identified records, five articles met the inclusion criteria. Two RCTs had an overall moderate risk of bias, while the three observational studies had serious risk. Overall, we found no robust association between high intake of dietary fiber and growth. In the RCTs, higher intake of fiber had a positive effect on bowel movements and constipation. No studies on fiber intake and iron status were identified. The certainty of the overall evidence was inconclusive for growth and bowel function, while no assessment was made for iron status. Conclusion: We found no clear association between high intake of dietary fiber and growth or bowel function in young children living in affluent countries, albeit with only a limited number of studies. There is a lack of studies investigating health effects of high fiber intake in small children.

Objectives: To systematically review the evidence on the effect of replacing the intake of animal protein with plant protein on cardiovascular disease (CVD) and type 2 diabetes (T2D) and their intermediate risk factors. Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus up to 12th May 2022 for randomized controlled trials (RCTs) or prospective cohort studies that investigated replacement of animal protein with plant protein from foods. Outcomes were CVDs, T2D, and in RCTs also the effects on blood lipids, glycemic markers, and blood pressure. Risk of bias was evaluated with the Cochrane's RoB2, ROBINS-I, and USDA's RoB-NObS tools. Random-effects meta-analyses assessed the effects of plant vs. animal proteins on blood lipids in RCTs. The evidence was appraised according to the World Cancer Research Fund's criteria. Results: After screening 15,090 titles/abstracts, full text of 124 papers was scrutinized in detail, from which 13 RCTs and seven cohort studies were included. Eight of the RCTs had either some concern or high risk of bias, while the corresponding evaluation of cohort studies resulted in moderate risk of bias for all seven. Meta-analyses of RCTs suggested a protective effect on total cholesterol (mean difference-0.11 mmol/L; 95% CI-0.22,-0.01) and low-density lipoprotein cholesterol (-0.14 mmol/L; 95% CI-0.25,-0.02) by replacing ani-mal protein with plant protein. The substitution of animal protein with plant protein (percentage of energy intake) in cohort studies was associated with lower CVD mortality (n = 4) and lower T2D incidence (n = 2). The evidence was considered limited-suggestive for both outcomes. Conclusion: Evidence that the substitution of animal protein with plant protein reduces risk of both CVD mortality and T2D incidence is limited-suggestive. Replacing animal protein with plant protein for aspects of sustainability may also be a public health strategy to lower the risk of CVD mortality and T2D.

Conventions for assessing human health risks for contaminants, food additives, and other regulated products have largely centered around using animal experiments. Under this framework, epidemiological studies in humans, particularly observational studies, are often considered a secondary source of evidence. In this chapter, it is argued that the major strength of both observational and experimental studies in humans lies in their high external validity. That is if properly used and integrated with other lines of evidence the uncertainty of the animal to human extrapolation can be reduced or even eliminated. The limitations of assessing evidence by study design are explained with different examples. Areas of uncertainty associated with characterizing risk based on a few selected studies, judged to be of high quality, are also discussed. It is concluded that to allow for better integration of human epidemiology in risk assessment further development of evidence-based medicine should provide more room for expert judgment and mechanistic understanding.

Milk and milk products have been known as important for bone health. Can ingestion of milk and milk products lower hip fracture risk for older adults? In this study, older Icelandic adults who were ingesting higher milk had a lower risk of hip fractures. This study describes associations between milk intake and hip fracture risk in older Icelanders. The data indicate that no/low milk consumption is related to greater hip fracture risk. Hip fracture can have a severe effect on the life of older adults. Health authorities recommend milk intake for better bone health. However, previous studies addressing this association have been divergent. This prospective study included 4614 subjects (mean age 76 years) recruited between 2002 and 2006 into the Age, Gene/Environment Susceptibility-Reykjavik (AGES-Reykjavik) study. Information on hip fractures occurring between recruitment and end of follow-up in 2012 was extracted from hospital records. A total of 14