Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality, and physical activity (PA) is central to secondary prevention. However, factors associated with PA among individuals with CVDs remain poorly understood, with few studies using accelerometer-based methods. This cross-sectional study examined the associations between accelerometer-measured PA and demographic, socioeconomic, lifestyle factors, and comorbidity in a large Swedish cohort of individuals with CVDs. Participants aged between 50 and 64 years with a confirmed diagnosis of angina pectoris, myocardial infarction, atrial fibrillation and flutter, heart failure, or stroke were included. Moderate-to-vigorous physical activity was measured using hip-worn triaxial accelerometers over seven consecutive days and categorized into tertiles of low, medium and high PA level. Demographic, socioeconomic, lifestyle factors, and comorbidities were assessed through questionnaires and registry data. Associations with PA levels were analyzed using multiple ordinal logistic regression. A total of 1,484 participants (32% women; median age 60.2 years) were included. Being in the oldest age group was significantly associated with lower odds of having a higher PA level (OR = 0.59; 95% CI [0.44, 0.77]), as well as female sex (OR = 0.73; 95% CI [0.59, 0.91]), regular/occasional smoking (OR = 0.37; 95% CI [0.26, 0.52]), and having one (OR = 0.61; 95% CI [0.48, 0.77]) or more comorbidities (OR = 0.45; 95% CI [0.30, 0.68]). A healthy diet was significantly associated with higher PA levels (OR = 1.84; 95% CI [1.46, 2.31]). Financial strain, level of education and alcohol consumption had no association with PA. Using data from a representative sample of middle-aged adults, the findings indicate that engagement in PA is primarily associated with lifestyle factors, demographic characteristics, and comorbidity. These identified characteristics may inform future research aimed at CVD populations with low PA. Further research should investigate mediating and moderating pathways to clarify how these factors influence PA.

Abstract Introduction Gastrointestinal (GI) bleeding is a common reason for emergency hospital admission, with an in-hospital mortality of 3.9–14%. Less is known about long-term mortality after a bleeding event and the factors influencing it. Methods A cohort of consecutive adult patients admitted for GI bleeding at Skåne University Hospital from January 1, 2018 to June 30, 2019 was validated using medical records. Mortality data were collected from the Swedish National Cause of Death Register for 3 years after the index bleeding event. Long-term mortality was estimated using Cox proportional hazards regression. Results A total of 582 patients were included, 58% male, with a median age of 76 years. During follow-up, 228 (39.2%) patients died, with a median time to death of 263 days. Patients who died of GI bleeding had a shorter median time to death (47 days, IQR 10.5–272, n = 31) compared to those dying from GI tumors (192 days, IQR 63–679, n = 29) or cardiovascular causes (260 days, IQR 94–639, n = 62). Antithrombotic treatment at admission did not significantly affect 3-year mortality (HR 1.09, 95% c.i. 0.09–1.01, P = 0.31), even after adjustment for Charlson Comorbidity Index and sex. No difference in 3-year mortality was found between upper and lower GI bleeding (HR 0.94, 95% c.i. 0.75–1.19, P = 0.61). Discussion Long-term mortality after GI bleeding is high. Patients dying from new bleeding events have shorter survival than those dying from tumors or cardiovascular causes. Further studies are needed to identify patients at risk and factors influencing rebleeding and mortality.

Abstract Introduction The Detailed Characteristics of a first-time Acute Pancreatitis cohort during 10 years (DeCAP) was established to study both short- and long-term outcomes following acute pancreatitis. It also provides the possibility to study risk factors associated with the development of acute pancreatitis and the severity of the disease. Methods DeCAP is an unselected cohort of consecutive patients with first-time acute pancreatitis at Skåne University hospital, Sweden (2009–2018). It contains 2188 patients with pancreatitis and 10 938 pancreatitis-free individuals matched on sex and age using registry linkage. Medical records were reviewed from index admission to 31 December 2024. Recurrent episodes of acute pancreatitis, including treatment, severity, etiology and development of chronic pancreatitis or diabetes was recorded until death, emigration or end of study. Results The proportion of patients with moderately severe or severe disease differs by etiologies. Patients who experienced moderately severe or severe pancreatitis during their first episode had a fivefold higher likelihood of developing moderately severe or severe disease during a subsequent episode compared with patients whose initial event was mild. Discussion DeCAP combined with the unique national registers in Sweden will be used to to identify risk factors present at the index admission that may influence individual patient trajectories. Improved risk stratification is essential to enable more individualized follow-up strategies aimed at optimizing long-term outcomes while minimizing unnecessary resource utilization. More specifically, we plan to study short- and long-term morbidity, mortality, and recurrence related to individual risk factors. Further, the impact of socio-economic factors and ethnicity on these outcomes will be analyzed.

Abstract Background Polygenic risk scores (PRSs) strongly discriminate for prostate cancer risk at the population level. The role of these genetic scores in determining prostate cancer survival is unclear, potentially due to methodological issues. Methods We included 19,607 men from the Malmö Diet and Cancer Study (MDCS) and the Health Professionals Follow-up Study (HPFS) and analyzed 20-year incidence and mortality (from full cohort analyses) and survival (from case-only analyses) according to a 451-variant PRS. For most of the men included, early access to prostate-specific antigen (PSA) testing was limited. Results In full cohort analyses, a PRS at or above the median (vs. below the median) shows a strong association with prostate cancer incidence (hazard ratio (HR) 3.02, 95% CI 2.78-3.28) and, somewhat stronger, with prostate cancer mortality (HR 3.26, 95% CI 2.63-4.04). As expected, case-only survival analyses of prostate cancer death show a similar direction (HR 1.21, 95% CI 0.98-1.50), which becomes stronger when excluding variants linked to PSA (HR 1.25, 95% CI, 1.01-1.54), in particular in the age group 65-74 years at diagnosis (HR 1.72, 95% CI 1.21-2.45). In the other age groups, HRs are close to or below 1. This indicates that standard case-only survival estimates may not accurately reflect risk across age, consistent with age-dependent selection mechanisms, and further points to an influence from disease detection. Conclusions Overall, these findings support that inherited genetic risk captured by the 451-variant PRS may have an influence on prostate cancer survival.

IMPORTANCE: Adherence to the Mediterranean Diet (MedDiet) has been associated with a lower incidence of cancer and reduced weight gain. These associations suggest a potential role for the MedDiet in lowering the risk of obesity-related cancers (ORCs). Obesity is a known risk factor for various cancers and shows an inverse association with MedDiet adherence. OBJECTIVE: To examine the association between adherence to the MedDiet and the risk of ORCs, considering the possible mediating role of adiposity. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study analyzed data from the European Prospective Investigation Into Cancer and Nutrition (EPIC) study, which enrolled participants aged 35 to 70 years from 1992 to 2000 across 23 centers in 10 countries. The data analysis was conducted from March 1 to May 31, 2023. EXPOSURES: Dietary intake before baseline was evaluated using country-specific, validated questionnaires administered at recruitment. Adherence to the MedDiet was scored on a 9-point scale and categorized as low (0-3 points), medium (4-6 points), or high (7-9 points). MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of ORCs, classified according to the 2015 International Agency for Research on Cancer criteria. Multivariable Cox proportional hazards regression models were used to assess the association between MedDiet adherence and ORC incidence. Mediation analyses were conducted to evaluate the role of waist to hip ratio and body mass index in this association. RESULTS: A total of 450 111 participants were included in the study (mean [SD] age, 51.1 [9.8] years; 70.8% women) and followed up during a median (IQR) time of 14.9 (4.1) years. Among participants, 4.9% experienced an ORC (rates, 0.053, 0.049, and 0.043 per person-year in the low, medium, and high MedDiet adherence groups, respectively). Participants with high adherence to the MedDiet (7-9 points) had a lower risk of ORC compared with those with low adherence (0-3 points) (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98). A similar inverse association was observed for participants with medium adherence (4-6 points vs 0-3 points). However, mediation analyses did not show associations of waist to hip ratio or body mass index between MedDiet adherence and ORC risk. CONCLUSIONS AND RELEVANCE: These findings indicate that higher adherence to the MedDiet is associated with a modest reduction in the risk of ORCs, independent of adiposity measures. Further research is needed to clarify the mechanisms by which the MedDiet may contribute to cancer prevention.

Introduction:Acute lower limb ischemia (ALI) is a life and limb threatening event often affecting patients with type 2 diabetes mellitus (T2DM). Little is known about how T2DM affects the risk of adverse events in patients revascularized for ALI. This study aimed to investigate if there were differences in major outcomes between ALI patients with and without T2DM. Methods:Between 2010 and 2014, 615 patients underwent revascularization for ALI, according to the Swedish Vascular Registry (SWEDVASC). Using the National Diabetes Registry (NDR), 245 (39.8%) of the patients were identified as having T2DM. Uni- and multivariable Cox or logistic regression analyses were performed to evaluate risk differences for major amputation, mortality, major adverse cardiovascular events (MACE), and fasciotomy between patients with and without T2DM. Results:The rates of major amputation and mortality at one year were 32.7% and 21.6% in the T2DM group, compared to 21.9% and 31.9% in the non-DM group, respectively, resulting in a hazard ratio (HR) of 1.52 (95% confidence interval [CI] 1.12-2.07) for major amputation and HR of 0.64 (95% CI 0.46-0.88) for mortality. At one year, the HR for major amputation was 1.45 (95% CI 0.99-2.11), HR for mortality 0.92 (95% CI 0.61-1.39), HR for combined major amputation/mortality 1.27 (95% CI 0.94-1.72), and HR for MACE 1.24 (95% CI 0.92-1.67) for those with T2DM compared to those without in the multivariable Cox-regression analyses. The multivariable logistic regression analysis showed significantly lower odds of fasciotomy, OR 0.1 (95% CI 0.01-0.51) in the T2DM-group. Conclusion:T2DM was not significantly associated with higher hazard of major amputation, mortality, combined major amputation/mortality, or MACE after revascularization for ALI, compared to patients without T2DM. Patients with T2DM had significantly lower odds of fasciotomy.

AIMS:Diet is a determinant of cardiovascular diseases (CVD) with coronary disease as predominant cause of pre-mature death. To analyse how diet was associated with coronary atherosclerosis, including plaque features. METHODS AND RESULTS:The cross-sectional population-based study using data from the Swedish CArdioPulmonary BioImage Study (SCAPIS) included 24 079 adults aged 50-64 years, recruited in 2013 to 2018 who were free of clinical cardiovascular disease. The recruitment and comprehensive examinations were conducted at six locations in Sweden. A dietary index (DI) based on a previously published anti-inflammatory DI including high proportion of plant-based foods, and low in red or processed meat and sugar-sweetened beverages was constructed. The reference group was within lowest DI tertile. Coronary atherosclerosis assessed by coronary computed tomography angiography, including any-, significant-, and adverse or high-risk coronary plaque, which is non-calcified with a significant stenosis ≥50%. Lowest, compared to highest DI tertile was associated with younger age, more often men (62.2% vs. 32.9%), higher high-sensitive C-reactive protein, more cardiometabolic risk and smokers, higher alcohol-, and higher energy-intake. In the highest and lowest tertile, coronary plaques were present in 36.3% and 44.3%, respectively, stenosis ≥ 50% in 3.7% and 6.0%. Non-calcified coronary plaques with stenosis ≥50% were present in 0.9% and 1.5% in highest and lowest tertiles. In multivariable analyses, the lowest tertile of DI was associated with high-risk plaque features after adjusting for age, sex, smoking, with waist circumference, triglycerides (TGs), and hypertension as possible mediators. CONCLUSION:A low-fibre diet with high red meat content was associated with high-risk plaques features, increased coronary calcification and significant stenosis. Waist circumference, TGs, and hypertension emerged as potential mediators of these associations, underscoring the role of metabolic and hemodynamic factors in the dietary impact on coronary atherosclerosis. Our findings strengthen the importance of cardioprotective dietary recommendations.

BACKGROUND:This study compared levels of physical activity (PA) and sedentary behavior (SB) in adults with and without chronic diseases or multimorbidity, acknowledging sociodemographic factors. METHODS:A cross-sectional analysis was conducted with data from 27,890 participants (52% women), aged 50-64, from the Swedish CArdioPulmonary bioImage Study cohort. Over 1500 chronic diseases were included and categorized into chronic disease and multimorbidity groups. Chronic diseases were retrieved from national registries, using International Classification of Disease codes. PA and SB were measured with a triaxial hip-worn accelerometer, over 7 consecutive days. General linear models were used to calculate estimated means for daily time spent in light-intensity PA (LIPA), moderate- to vigorous-intensity PA and SB. RESULTS:Time spent in LIPA, moderate- to vigorous-intensity PA, and SB did not differ between individuals in a chronic disease group and individuals without chronic diseases. Individuals living with any multimorbidity spent less time in moderate- to vigorous-intensity PA than participants without chronic diseases. Individuals living with 4 or more chronic diseases spent more time sedentary than individuals without chronic diseases. Women spent more time in LIPA and less time in SB than men, regardless of chronic disease or multimorbidity. Individuals with less education spent more time in LIPA and less time in SB than individuals with more education, regardless of chronic disease or multimorbidity. CONCLUSIONS:When using an extensive set of chronic diseases, marginal differences in PA and SB were seen between individuals living with and without chronic diseases. PA and SB seem to significantly differ by sex and education, rather than living with chronic disease.

Objectives To examine the relationship between adherence to dietary guidelines and the risk of developing RA. Methods Participants in the Malmo Diet and Cancer Study (MDCS) cohort diagnosed with RA were identified through register linkage and validated in a structured review. Four controls per case were selected, matched for sex, year of birth, and year of inclusion in the MDCS. Diet was assessed at baseline (1991-1996) using a validated diet history method. A Diet Quality Index (DQI) based on adherence to the Swedish dietary guidelines including intakes of fibre, vegetables and fruits, fish and shellfish, saturated fat, polyunsaturated fat, and sucrose, was used. The associations between the DQI and its components and the risk of RA were assessed using conditional logistic regression analysis, adjusting for total energy intake, smoking, leisure time physical activity and alcohol consumption. Results We identified 172 validated cases of incident RA in the cohort. Overall adherence to the dietary guidelines was not associated with the risk of RA. Adherence to recommended fibre intake was associated with decreased risk of RA in crude and multivariable-adjusted analyses, with odds ratios (ORs) 0.60 (95% CI 0.39, 0.93) and 0.51 (95% CI 0.29, 0.90), respectively, compared with subjects with non-adherence. Conclusions Reaching the recommended intake level of dietary fibre, but not overall diet quality, was independently associated with decreased risk of RA. Further studies are needed to assess the role of different food sources of dietary fibre in relation to risk of RA and the underlying mechanisms.

Importance Numerous prospective cohort studies have reported a J-shaped association of urinary sodium excretion with cardiovascular events and mortality. Objective To study the association between sodium intake and incident atrial fibrillation (AF). Design, Setting, and Participants This cohort study included participants in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomised Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease (TRANSCEND) multicenter, randomized clinical trials comparing the effect of ramipril 10 mg daily with telmisartan 80 mg daily, or their combination (ONTARGET) or 80 mg telmisartan daily with placebo (TRANSCEND) for the outcome of death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. ONTARGET and TRANSCEND included 31 546 participants with vascular disease or high-risk diabetes, and this study excluded participants without a urine sample for sodium measurement, missing data for key covariates, a history of AF, or AF detected in the first year after enrollment. Analyses were performed in July 2023 to May 2024. Exposure Estimated sodium intake from a morning fasting urine sample (Kawasaki formula). Main Outcomes and Measures The main outcome was incident AF. The association between estimated sodium intake and incident AF was modeled using multivariable adjusted Cox regression and cubic splines. Results A total of 27 391 participants (mean [SD] age, 66.3 [7.2] years; 19 310 [70.5%] male) were included. Mean (SD) estimated sodium intake was 4.8 (1.6) g/d. During a mean (SD) follow-up of 4.6 (1.0) years, 1562 participants (5.7%) had incident AF. After multivariable adjustment, a J-shaped association between sodium intake and AF risk was observed (P for nonlinearity = .03). Sodium intake of 8 g/d or greater (3% of participants) was associated with incident AF (hazard ratio, 1.32; 95% CI, 1.01-1.74) compared with sodium intake of 4 to 5.99 g/d. Cubic splines showed that sodium intake greater than 6 g/d (19% of participants) was associated with a 10% increased AF risk per additional 1-g/d sodium intake (hazard ratio, 1.10; 95% CI, 1.03-1.18), but with no further lowering of AF risk at lower levels of sodium intake. Conclusions and Relevance In this cohort study of sodium intake and AF risk, there was a J-shaped association between sodium intakes and AF risk in patients with cardiovascular disease or diabetes. Lowering sodium intake for AF prevention is best targeted at individuals who consume high sodium diets.

Background Insulin resistance is a hypothesised biological mechanism linking obesity with prostate cancer (PCa) death. Data in support of this hypothesis is limited. Methods We included 259,884 men from eight European cohorts, with 11,760 incident PCa’s and 1784 PCa deaths during follow-up. We used the triglyceride-glucose (TyG) index as indicator of insulin resistance. We analysed PCa cases with follow-up from PCa diagnosis, and the full cohort with follow-up from the baseline cancer-free state, thus incorporating both PCa incidence and death. We calculated hazard ratios (HR) and the proportion of the total effect of body mass index (BMI) on PCa death mediated through TyG index. Results In the PCa-case-only analysis, baseline TyG index was positively associated with PCa death (HR per 1-standard deviation: 1.11, 95% confidence interval (CI); 1.01–1.22), and mediated a substantial proportion of the baseline BMI effect on PCa death (HR total effect per 5-kg/m 2 BMI: 1.24; 1.14–1.35, of which 28%; 4%–52%, mediated). In contrast, in the full cohort, the TyG index was not associated with PCa death (HR: 1.03; 0.94-1.13), hence did not substantially mediate the effect of BMI on PCa death. Conclusions Insulin resistance could be an important pathway through which obesity accelerates PCa progression to death.

Background & AimsIt is unclear to what extent lifestyle and genetic factors affect incidence of chronic liver disease (CLD) in a general population and if lifestyle affects CLD independently of underlying cardiometabolic perturbations and genetic predisposition.MethodsWe examined 27,991 men and women aged 44-73 years from the Malmö Diet and Cancer Study recruited between 1991-1996 and followed until end of 2020 using registry-linkage (median follow-up time 25.1 years; 382 incident first-time CLD events). Associations between cardiometabolic factors, polygenic risk scores (PRSs), and lifestyle factors in relation to CLD were examined using multivariable Cox proportional hazards regression models.ResultsIncidence of CLD increased with number of cardiometabolic risk factors (the hazard ratio (HR) per each additional cardiometabolic risk factor was 1.33 (95% CI: 1.21-1.45; p= 5.1 x 10-10). Two novel polygenic risk scores (PRS) for metabolic dysfunction-associated steatotic liver disease (MASLD) and a PRS for liver cirrhosis associated with higher risk of CLD but provided marginal predictive utility on top of other risk factors and compared to the PNPLA3 rs738409 genetic variant. An unhealthy lifestyle (high alcohol intake, current smoking, physical inactivity and unhealthy diet) markedly increased risk of CLD (HR=3.97, 95% CI: 2.59-6.10). Observed associations between examined lifestyle factors and CLD were largely independent of cardiometabolic perturbations and polygenic risk.ConclusionsWe confirmed the importance of cardiometabolic dysfunction in relation to risk of CLD in a general population. Lifestyle risk factors were shown to independently associate with CLD and added predictive information on top of cardiometabolic risk factors. Information on the polygenic risk of liver disease does not currently add to prediction of CLD in a general population.Lay summaryIn this large longitudinal study of a general population, we found that cardiometabolic, genetic and lifestyle risk factors all contribute to the development of chronic liver disease (CLD). Our results suggest that an unhealthy lifestyle, including alcohol consumption, smoking, physical inactivity, and an unhealthy diet, substantially increase risk of CLD independently of underlying genetic risk or cardiometabolic health. This suggest that a large proportion of CLD cases are potentially preventable through adoption of healthy lifestyle changes.Impact and implicationsThis large population-based prospective study suggests largely independent roles of cardiometabolic, lifestyle, and genetic risk factors in the development of chronic liver disease. Findings strengthen the evidence base for a beneficial effect of modification of high-risk lifestyle behaviors in the primary prevention of chronic liver disease in the general population.

Importance Prostate cancer, a leading cause of cancer death among men, urgently requires new prevention strategies, which may involve targeting men with an underlying genetic susceptibility. Objective To explore differences in risk of early prostate cancer death among men with higher vs lower genetic risk to inform prevention efforts. Design, Setting, and Participants This cohort study used a combined analysis of genotyped men without prostate cancer at inclusion and with lifestyle data in 2 prospective cohort studies in Sweden and the US, the Malm & ouml; Diet and Cancer Study (MDCS) and the Health Professionals Follow-Up Study (HPFS), followed up from 1991 to 2019. Data were analyzed between April 2023 and April 2024. Exposures Men were categorized according to modifiable lifestyle behaviors and genetic risk. A polygenic risk score above the median or a family history of cancer defined men at higher genetic risk (67% of the study population); the remaining men were categorized as being at lower genetic risk. Main Outcomes and Measures Prostate cancer death analyzed using time-to-event analysis estimating hazard ratios (HR), absolute risks, and preventable deaths by age. Results Among the 19 607 men included for analysis, the median (IQR) age at inclusion was 59.0 (53.0-64.7) years (MDCS) and 65.1 (58.0-71.8) years (HPFS). During follow-up, 107 early (by age 75 years) and 337 late (after age 75 years) prostate cancer deaths were observed. Compared with men at lower genetic risk, men at higher genetic risk had increased rates of both early (HR, 3.26; 95% CI, 1.82-5.84) and late (HR, 2.26; 95% CI, 1.70-3.01) prostate cancer death, and higher lifetime risks of prostate cancer death (3.1% vs 1.3% [MDCS] and 2.3% vs 0.6% [HPFS]). Men at higher genetic risk accounted for 94 of 107 early prostate cancer deaths (88%), of which 36% (95% CI, 12%-60%) were estimated to be preventable through adherence to behaviors associated with a healthy lifestyle (not smoking, healthy weight, high physical activity, and a healthy diet). Conclusions and Relevance In this 20-year follow-up study, men with a genetic predisposition accounted for the vast majority of early prostate cancer deaths, of which one-third were estimated to be preventable. This suggests that men at increased genetic risk should be targeted in prostate cancer prevention strategies.

PDF - 65K, Correlation coefficients between plasma DHBA and DHPPA, energy-adjusted dietary variables and body composition among 1817 male controls of a nested case-control study in the Malmoe Diet and Cancer cohort (1991-1996).

OBJECTIVES:Diet has received attention as a factor possibly contributing to the development of Rheumatoid arthritis (RA). Several dietary exposures have been examined in various populations using different diet assessment methods. The aim of this study was to systematically assess the literature on the relation between dietary patterns, different food and food groups, macronutrients, non-alcoholic beverages and the risk of developing RA. METHODS:A systematic literature search was performed to identify relevant articles on diet and the risk of developing RA. The selection of articles and overall quality assessment of all included studies were performed independently by two examiners. Overall study quality was evaluated using the Newcastle-Ottawa Scales. We excluded all articles where the temporal relation between dietary data collection and time of RA diagnosis was not presented. Main findings were summarized for cohort-based studies and case-control studies separately. RESULTS:A total of 984 articles were screened. Nineteen relevant cohort-based studies, and eight case-control studies, were included in our review. Two articles were excluded due to lacking data on the relation between RA diagnosis and time of dietary data collection and one due to incorrect outcome. Identified studies suggested protective effects of fish, vegetables and Mediterranean-style diets, although study results and methods were heterogenous. An issue in some case-control studies was that unvalidated diet assessment methods were used. A vast majority of the cohort-based studies used validated diet assessment methods, although the definitions of exposures studied varied. CONCLUSION:There is lack of consistent evidence on the role of diet in the development of RA, partly due to differences in study quality and methodology Limited evidence suggests that some healthy eating habits may reduce the risk of RA. More high-quality studies in the area are needed for a deeper understanding of the effect of diet, and to enable strategies to prevent RA.

PDF - 56K, Baseline characteristics of a nested case-control study in the Malmoe Diet and Cancer cohort (1991-1996) by quintiles of plasma alkylresorcinol concentrations.

PDF - 51K, Partial correlations between plasma alkylresorcinol metabolites (DHBA+DHPPA) and various dietary variables among men of a nested case-control study in the Malmoe Diet and Cancer cohort (1991-1996).

BackgroundDiet has received much attention as a factor that may contribute to the development of rheumatoid arthritis (RA). Several different nutrients, food components and dietary patterns have been studied in different populations. There is limited information on the importance of compliance with diet recommendations in this context.ObjectivesThe aim of this study was to investigate the relation between overall dietary quality, diet components, and the risk of RA.MethodsParticipants in a population-based survey conducted in 1991-1996 who were subsequently diagnosed with RA (from inclusion until December 2004) were identified through register linkage and validated in a structured process. Four controls for each case, matched for sex, year of birth, and year of inclusion, were selected from the study cohort. The controls were alive and RA-free when the index person was diagnosed with RA. At inclusion, diet was assessed using a modified diet history method, consisting of a seven-day food record, a food questionnaire, and a supplementary interview.The New Diet Score (NDS) reflects the recommendations in the Swedish dietary guidelines (SDG) from 2015, produced developed by the Swedish Food Agency, which in turn are based on the Nordic Nutrition Recommendations from 2012. According to the SDG, it is recommended to eat more fiber, vegetables and fruits and fish, and less red meat and added sugars. The mentioned dietary components are all included in the NDS, with a range 0-5. A score of 1 was assigned to each component where the individual complied with the recommendation. Non-compliance was assigned a score of 0. The cutoff values for the recommendations are based on a previously validated Diet Quality Index, except for red meat (based on SDG) and added sugars (based on World Health Organization guidelines from 2015 for sugar intake).We used conditional logistic regression analysis to study the relation between NDS, its components, and RA. The NDS was divided into categories, defined as low (0–1), moderate (2–3) and high (4-5), with “low” as reference, and also assessed as a continuous variable. All models were adjusted for reported total energy intake, and potential misreporters of total energy intake were excluded.We designed multivariable-adjusted models in which we included covariates that had been associated with diet and RA (smoking, alcohol and leisure time physical activity).ResultsIn the study population, 172 RA cases were identified. Low red meat intake (<500 g/week) was significantly associated with a decreased risk of RA (Table 1). Compliance with the recommendations for intake of fiber and vegetables and fruit were inversely associated with RA, with a similar trend for the total NDS (Table). In additional multivariable analysis, including both variables and relevant confounders, compliance with recommendations for red meat intake (odds ratio (OR) 0.43; 95% CI 0.22-0.85) and for fiber intake (OR 0.53; 95% CI 0.30-0.94) were both associated with a reduced risk of RA.Table 1.Multivariable-adjusted odds ratios (ORs) describing the relation between New Diet Score (NDS) and its components and the risk of developing rheumatoid arthritisAdjusted for reported energy intake, smoking, alcohol, leisure time physical activityNDS componentsRecommendationOR95% CI Fibre≥2.4 g/MJ0.510.29–0.90 Vegetables and fruits≥400 g/day0.550.32–0.95 Fish≥300 g/week1.250.76–2.05 Added sugar≤10 E%1.100.68–1.78 Red meat<500 g/week0.420.22–0.81NDS 0–11.00(Ref) 2–30.650.38–1.10 4–50.670.30–1.46 Per point increment0.820.67–1.00ConclusionThese preliminary results indicate that low intake of red meat and higher fiber intake, in line with current recommendations, are independently associated with reduced risk of developing RA, suggesting that components found in meat and fiber-rich foods may affect very early disease mechanisms.Disclosure of InterestsNone declared.

The present study aims to describe accelerometer-assessed physical activity (PA) patterns and fulfillment of PA recommendations in a large sample of middle-aged men and women, and to study differences between subgroups of socio-demographic, socio-economic, and lifestyle-related variables. A total of 27 890 (92.5% of total participants, 52% women, aged 50-64 years) middle-aged men and women with at least four days of valid hip-worn accelerometer data (Actigraph GT3X+, wGT3X+ and wGT3X-BT) from the Swedish CArdioPulmonary bioImage Study, SCAPIS, were included. In total, 54.5% of daily wear time was spent sedentary, 39.1% in low, 5.4% in moderate, and only 0.1% in vigorous PA. Male sex, higher education, low financial strain, born in Sweden, and sedentary/light working situation were related to higher sedentary time, but also higher levels of vigorous PA. High BMI and having multiple chronic diseases associated strongly with higher sedentary time and less time in all three PA intensities. All-year physically active commuters had an overall more active PA pattern. The proportion fulfilling current PA recommendations varied substantially (1.4% to 92.2%) depending on data handling procedures and definition used. Twenty-eight percent was defined as having an "at-risk" behavior, which included both high sedentary time and low vigorous PA. In this large population-based sample, a majority of time was spent sedentary and only a fraction in vigorous PA, with clinically important variations between subgroups. This study provides important reference material and emphasizes the importance of a comprehensive assessment of all aspects of the individual PA pattern in future research and clinical practice.