Background The World’s population is getting older, and healthy behavior such as a healthy diet may prevent the development of frailty and promote healthy ageing. In this study, we aimed to investigate the association between dietary protein intake and longitudinal changes in frailty among older, home-dwelling subjects. Method Data were obtained from 130 home-dwelling, Norwegian older adults (70+) at baseline and after 8-year follow-up. Frailty was measured by a frailty index (FI) based on an accumulation of 38 deficits, scored 0–1. Dietary protein intake was collected by 2 × 24-h recall per visit. The association between dietary intake at baseline and change in FI was analysed by linear regression modelling. Changes in diet and changes in FI between the two visits were analyzed by Spearman’s rank correlation coefficient. Results The FI score significantly increased from baseline to follow-up (0.12 vs 0.2, p < 0.001), and more subjects were categorised as frail at the follow-up visit (3% vs 33%, p < 0.001). Overall, there was no significant association between dietary protein intake at baseline or change in dietary intake and change in FI score. We did, however, observe a decreased intake of protein (E %) and meat (g) after 8-year follow-up. Conclusions Our findings suggest that frailty accelerates with age, independent of dietary protein intake. A healthy diet may delay the rate of frailty, however, even if the dietary intake of protein remains stable after 8-year follow-up, it could not prevent the frailty process in our study population. Thus, more studies are needed to describe what factors that might accelerate or prevent the accumulation of frailty deficits with advancing years.

Alcohol consumption is one of the major risk factors of colorectal cancer (CRC), yet the mechanisms underlying this relationship, particularly the role of gut microbes, are not fully understood. To study associations of alcohol intake with the gut microbiome and colorectal lesions among CRC screening participants. Of particular interest was the potential role of gut microbes in mediating the association between alcohol intake and colorectal lesions. Screening participants with a positive faecal immunochemical test at ages 55–77 were eligible for the CRCbiome study. Alcohol intake was assessed using a validated, semi-quantitative food frequency questionnaire and linked with shotgun metagenome based gut microbial profiles to study associations with screen-detected colorectal lesions. The potential role of alcohol-associated gut microbes in mediating the association between alcohol intake and colorectal lesions was examined using causal mediation analysis. Of 1468 participants with dietary data, 414 were diagnosed with advanced lesions. Alcohol intake was positively associated with advanced lesions in a dose-dependent manner (ptrend = 0.008), with odds ratio of 1.09 (95

The gut microbiome has been linked to colorectal cancer (CRC) development, with microbe-based classifiers distinguishing between CRC patients and healthy controls. However, there is a lack of studies addressing the utility of the microbiome in screening-relevant settings, including both precancers and CRC. In this Norwegian population-based study, we used fecal immunochemical test (FIT) leftovers from 1034 FIT-positive (i.e. positive for occult blood) screening participants for gut metagenome profiling using shotgun sequencing. Using comprehensive clinical, demographic, and lifestyle data, we modeled gut microbiome associations with CRC screening outcomes. Combining microbial profiles with quantitative FIT values improved detection of premalignant lesions beyond optimizing the FIT value alone, even after incorporating established CRC risk factors. Still, the FIT value maintained superior discriminative ability for CRC. We confirmed enrichment of bacteria such as Fusobacterium nucleatum and Peptostreptococcus stomatis in CRC. In contrast, other bacteria previously associated with the presence of CRC, including Hungatella hathewayi and Clostridium symbiosum, as well as pks-negative Escherichia coli, were enriched in those with no neoplastic findings, suggesting that in a FIT-positive population their presence may reflect other conditions causing intestinal bleeding rather than underlying neoplasia. Microbial profiles were predominantly associated with distal rather than proximal lesions. Together, our findings highlight the potential for microbial markers to improve FIT-based CRC screening, especially by differentiating those with premalignant lesions from those who test FIT-positive for other reasons.

BACKGROUND:Weight retention postpartum can increase long-term risk of maternal overweight and obesity. In theory, breastfeeding may facilitate postpartum weight loss, but its association with maternal weight change, especially long-term, remains uncertain. OBJECTIVES:The aim of this study was to investigate the association between breastfeeding duration and maternal weight change through adulthood emphasizing possible variations based on early adulthood BMI and the time of childbirth during the 1940s through the 1990s. METHODS:Women (n = 172,472) in the Norwegian Women and Health Study, born 1927 to 1965, completed ≤3 questionnaires (Q1-Q3) between 1991 and 2014. A linear mixed model was applied to assess the association between BMI change from age 18 y in relation to mean breastfeeding duration per child (0, >0 to <3, 3 to <6, 6 to <9, 9 to <12, 12 to <15, ≥15 mo), including a 3-way interaction with categories of BMI at age 18 y and time period of first birth. RESULTS:We found a significant interaction between breastfeeding duration per child, BMI at age 18 y, and year of first birth in relation to BMI change from age 18 y. Longer breastfeeding duration per child was associated with a lower increase in BMI among both mothers who either had overweight or obesity or had normal weight at age 18 y (P-trend < 0.001), irrespective of time of first birth. Among mothers with overweight or obesity at age 18 y who had their first child ≥1980, breastfeeding for ≥3 mo per child was significantly associated with lower increase in BMI from age 18 y, ranging from -1.26 kg/m2 [95% confidence interval (CI): -2.19, -0.32] to -2.11 kg/m2 (95% CI: -2.93, -1.30), compared with >0 to <3 mo. CONCLUSIONS:We found a significant association between longer breastfeeding duration per child and lower maternal weight gain through adulthood, which was particularly pronounced among mothers with overweight or obesity at age 18 y and among mothers who had their first child ≥1980.

Importance:The current recommendation for a 10-year rescreening interval after a negative colonoscopy screening (NCS) result has been questioned, with some studies showing a persistently lower risk of colorectal cancer (CRC) after NCS results. Objective:To examine long-term CRC incidence and mortality after NCS results (ie, no presence of CRC or polyps) and according to a risk score based on major demographic and lifestyle risk factors. Design, Setting, and Participants:In this cohort study, 3 prospective US population-based cohorts from the Nurses' Health Study, Nurses' Health Study II, and Health Professionals Follow-up Study were followed up from 1988 and 1991 to 2020. Data from the National Health and Nutrition Examination Survey (NHANES) from the January 1, 2017, to December 31, 2018, cycle were used to compare the risk profile distribution with that of the general US population. Data analysis was performed from October 2023 to August 2024. Exposures:Time-varying status of NCS results and risk score. Main Outcomes and Measures:Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% CIs for incidence and mortality of CRC. Results:A total of 195 453 participants (median [IQR] age, 44 [37-56] years at baseline; 81% female) were followed up for a median (IQR) of 12 (6-20) years. Among 81 151 individuals with NCS results and 114 302 without endoscopy, 394 and 2229 CRC cases and 167 and 637 CRC deaths, respectively, were documented. Negative colonoscopy screening results were consistently associated with lower CRC incidence (HR, 0.51; 95% CI, 0.44-0.58) and mortality (HR, 0.56; 95% CI, 0.46-0.70) for 20 years. Among individuals with NCS results, those with an intermediate risk (scores, 6-7) and low risk (scores, 0-5) did not reach the 10-year cumulative incidence of CRC (0.78%) of the high-risk individuals (scores, 8-12) until 16 and 25 years after initial screening, respectively. Conclusion and Relevance:These findings provide evidence for shared decision-making between patients and physicians to consider extending the rescreening intervals after an NCS result beyond the currently recommended 10 years, particularly for individuals with a low-risk profile. These results showed, as a proof of concepts, the importance of considering known CRC risk factors when making decisions for colonoscopy rescreening.

INTRODUCTION:The impact of lifestyle changes after colorectal cancer (CRC) screening on risk of CRC and major chronic diseases remains unknown. METHODS:Leveraging the repeatedly collected dietary, lifestyle, and screening data in the Nurses' Health Study (1988-2018), Nurses' Health Study II (1993-2019) and Health Professionals Follow-up Study (1988-2016), we assessed changes after initial colonoscopy screening in a healthy lifestyle score (0-5) based on smoking, body mass index, physical activity, alcohol intake, and diet. We used time-varying multivariable Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incidence of CRC and major chronic diseases (including cancer, cardiovascular disease, and type 2 diabetes), among 118,396 and 88,558 individuals, respectively. RESULTS:During a median follow-up of 10.0 years (interquartile range 6.2-12.6) and 9.6 years (interquartile range 6.0-12.3 years), we documented 537 CRC and 14,165 major chronic disease cases, respectively. Forty-eight percent of participants changed their lifestyle score with at least 1 point. One-unit increase in the lifestyle score was associated with 14% lower risk of CRC (HR 0.86, 95% CI 0.77-0.95) and 11% lower risk of major chronic diseases (HR 0.89, 95% CI 0.88-0.91). Similar associations were observed for proximal and distal CRC and individual chronic diseases. Changes in smoking and physical activity were associated with CRC and chronic diseases, whereas changes in weight, alcohol intake, and diet were associated with chronic diseases only. DISCUSSION:Adopting a healthier lifestyle after initial colonoscopy screening may reduce risk of CRC and chronic diseases, suggesting colonoscopy screening could be a teachable moment for health promotion.

BackgroundValid assessment tools are needed when investigating adherence to national dietary and lifestyle guidelines. ObjectiveThe relative validity of the new digital food frequency questionnaire, the DIGIKOST-FFQ, against 7-day weighed food records and activity sensors was investigated. MethodsIn total, 77 participants were included in the validation study and completed the DIGIKOST-FFQ and the weighed food record, and of these, 56 (73%) also used the activity sensors. The DIGIKOST-FFQ estimates the intake of foods according to the Norwegian food–based dietary guidelines (FBDGs) in addition to lifestyle factors. ResultsAt the group level, the DIGIKOST-FFQ showed good validity in estimating intakes according to the Norwegian FBDG. The median differences were small and well below portion sizes for all foods except “water” (median difference 230 g/day). The DIGIKOST-FFQ was able to rank individual intakes for all foods (r=0.2-0.7). However, ranking estimates of vegetable intakes should be interpreted with caution. Between 69% and 88% of the participants were classified into the same or adjacent quartile for foods and between 71% and 82% for different activity intensities. The Bland-Altman plots showed acceptable agreements between DIGIKOST-FFQ and the reference methods. The absolute amount of time in “moderate to vigorous intensity” was underestimated with the DIGIKOST-FFQ. However, estimated time in “moderate to vigorous intensity,” “vigorous intensity,” and “sedentary time” showed acceptable correlations and good agreement between the methods. The DIGIKOST-FFQ was able to identify adherence to the Norwegian FBDG and physical activity recommendations. ConclusionsThe DIGIKOST-FFQ gave valid estimates of dietary intakes and was able to identify individuals with different degrees of adherence to the Norwegian FBDG and physical activity recommendations. Moderate physical activity was underreported, water was overreported, and vegetables showed poor correlation, which are important to consider when interpreting the data. Good agreement was observed between the methods in estimating dietary intakes and time in “moderate to vigorous physical activity,” “sedentary time,” and “sleep.”

Background: We have developed a digital semi-quantitative food frequency and lifestyle questionnaire, the DIGIKOST-FFQ, based on the validated paper-based NORDIET-FFQ. Objective: The study aims to investigate the reproducibility of the DIGIKOST-FFQ and to compare the DIGIKOST-FFQ against the NORDIET-FFQ for the adjusted questions for intakes of fruits, vegetables, whole grains, fish, meat, and dairy products. Design: Participants were recruited from May to September 2021 through a random sample from the National Population Register and advertisements on Facebook in Norway. In the reproducibility study, the DIGIKOSTFFQ was completed twice by the participants, 1-2 months apart. In the comparison study, the DIGIKOSTFFQ was completed 1-2 months prior to the NORDIET-FFQ. Results: In the reproducibility study, 317 individuals were included. For 12 out of 16 food groups there were no significant differences in intake estimations between the first and second DIGIKOST-FFQ administrations. A small but significant median difference was observed for fruits (6 g/day) and vegetables (24 g/day). Correlations were satisfactory for all items (r = 0.60-1.00), and in the cross-classification 85% of the participants were classified into the same or adjacent quartile for all items. The comparison study included 81 individuals. Compared to the NORDIET-FFQ a significant median difference was observed for fruits 29 g/ day, vegetables 36 g/day, whole grains -10 g/day, and red meat -11 g/day, but not for fish, processed meat, or dairy products. Conclusion: The DIGIKOST-FFQ was able to reproduce diet and lifestyle at the group level. An intended difference for the food groups where questions had been adjusted, was observed between DIGIKOST-FFQ and NORDIET-FFQ in the comparison study.

•In the treatment era nutritional care remain important in pediatric patients with SMA.•Regular assessment of iron status was indicated in both SMA II and SMA III.•Adequate intake of iron and vitamin D was dependent on use of supplementation.•Feeding difficulties were associated with reduced intake of protein.

To investigate the association between five dietary trajectories over 21 years and frailty in Norwegian older adults. This study used data from three surveys of the Tromsø Study. Diet was measured using food frequency questionnaires at baseline (Tromsø4, 1994–95), after 7 years (Tromsø5, 2001) and at the end of follow-up (Tromsø7, 2015–16). Survey-specific diet scores were constructed based on the Nordic Nutrition Recommendations 2023 and group-based trajectory modelling was used to derive dietary trajectories. At follow-up, frailty was assessed with a 41-item frailty index. Linear regression analysis was performed to assess the associations between dietary trajectories and frailty, adjusted for baseline variables. Among the 715 participants, 55

Abstract Introduction Pre-frailty provides an ideal opportunity to prevent physical frailty and promote healthy ageing. Excess adiposity has been associated with an increased risk of pre-frailty, but limited studies have explored whether the association between adiposity measures and pre-frailty varies by social position. Methods We used data from the seventh survey of the Tromsø Study (Tromsø7) conducted in 2015–2016. Our primary sample consisted of 2,945 women and 2,794 men aged ≥ 65 years. Pre-frailty was defined as the presence of one or two of the five frailty components: low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity. Adiposity was defined by body mass index (BMI), waist circumference (WC), fat mass index (FMI) and visceral adipose tissue (VAT) mass. Education and subjective social position were used as measures of social position. Poisson regression with robust variance was used to assess the association between adiposity measures and pre-frailty, and the interaction term between adiposity measures and social position measures were utilised to explore whether the association varied by social position. Results In our sample, 28.7% of women and 25.5% of men were pre-frail. We found sub-multiplicative interaction of BMI-defined obesity with education in women and subjective social position in men with respect to development of pre-frailty. No other adiposity measures showed significant variation by education or subjective social position. Regardless of the levels of education or subjective social position, participants with excess adiposity (high BMI, high WC, high FMI and high VAT mass) had a higher risk of pre-frailty compared to those with low adiposity. Conclusion We consistently observed that women and men with excess adiposity had a greater risk of pre-frailty than those with low adiposity, with only slight variation by social position. These results emphasize the importance of preventing excess adiposity to promote healthy ageing and prevent frailty among all older adults across social strata.

Objective This study investigated the association between obesity, assessed using body mass index (BMI) and waist circumference (WC), and pre-frailty/frailty among older adults over 21 years of follow-up. Design Prospective cohort study. Setting Population-based study among community-dwelling adults in Tromsø municipality, Norway. Participants 2340 women and 2169 men aged ≥45 years attending the Tromsø study in 1994–1995 (Tromsø4) and 2015–2016 (Tromsø7), with additional BMI and WC measurements in 2001 (Tromsø5) and 2007–2008 (Tromsø6). Primary outcome measure Physical frailty was defined as the presence of three or more and pre-frailty as the presence of one to two of the five frailty components suggested by Fried et al : low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity. Results Participants with baseline obesity (adjusted OR 2.41, 95% CI 1.93 to 3.02), assessed by BMI, were more likely to be pre-frail/frail than those with normal BMI. Participants with high (OR 2.14, 95% CI 1.59 to 2.87) or moderately high (OR 1.57, 95% CI 1.21 to 2.03) baseline WC were more likely to be pre-frail/frail than those with normal WC. Those at baseline with normal BMI but moderately high/high WC or overweight with normal WC had no significantly increased odds for pre-frailty/frailty. However, those with both obesity and moderately high/high WC had increased odds of pre-frailty/frailty. Higher odds of pre-frailty/frailty were observed among those in ‘overweight to obesity’ or ‘increasing obesity’ trajectories than those with stable normal BMI. Compared with participants in a stable normal WC trajectory, those with high WC throughout follow-up were more likely to be pre-frail/frail. Conclusion Both general and abdominal obesity, especially over time during adulthood, is associated with an increased risk of pre-frailty/frailty in later years. Thus maintaining normal BMI and WC throughout adult life is important.