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.

Academic performance in children is associated with a range of health-related factors, including physical fitness, mental well-being, sleep, and behavioral patterns. While previous studies have examined these factors individually, fewer have assessed their independent associations with academic achievement while accounting for other relevant health indicators. This study uses data from the I.Family study to explore how physical, mental, sleep-related, and behavioral health indicators relate to academic achievement among European adolescents, considering each factor’s contribution while adjusting for the others. We used data from the 2013–2014 wave of the I.Family study to investigate eight health indicators: health related quality of life (HRQoL), body mass index (BMI), diet, media use, physical activity, sleep duration and quality, and stressful life events. Their associations with self-reported academic performance in mathematics and language were analyzed using binary logistic regression models, adjusting for confounders such as parents’ education, income, survey country and child’s age. We conducted separate analyses for girls and boys to capture associations that are specific to academic subject and sex. A number of significant associations were found between several health indicators and academic performance. Higher HRQoL scores, reduced media time, and increased physical activity were linked to better academic performance in both mathematics and language for both boys and girls. Variation by sex and academic subjects were observed, with lower BMI, higher healthy diet scores and better sleep quality associated with better academic performance in language among girls. For mathematics, emotional, self-esteem, and family-related HRQoL were all significantly associated with higher performance for both boys and girls. In contrast, for language achievement, only family-related HRQoL was significant for both sexes. Our study underscores the need to consider both the importance of accounting for heterogeneity in sex and the differences between math and language academic subjects when investigating determinants of academic performance, setting the stage for further research on this topic to explore potential competing, synergistic, or time-dependent effects among these different health dimensions.

Objective We assessed whether early-life diet quality and food intake frequencies were associated with subsequent IBD. Design Prospectively recorded 1-year and 3-year questionnaires in children from the All Babies in Southeast Sweden and The Norwegian Mother, Father and Child Cohort Study were used to assess diet quality using a Healthy Eating Index and intake frequency of food groups. IBD was defined as >2 diagnoses in national patient registers. Cox regression yielded HRs adjusted (aHRs) for child’s sex, parental IBD, origin, education level and maternal comorbidities. Cohort-specific results were pooled using a random-effects model. Results During 1 304 433 person-years of follow-up, we followed 81 280 participants from birth through childhood and adolescence, whereof 307 were diagnosed with IBD. Compared with low diet quality, medium and high diet quality at 1 year of age were associated with a reduced risk of IBD (pooled aHR 0.75 (95% CI=0.58 to 0.98) and 0.75 (95% CI=0.56 to 1.00)). The pooled aHR per increase of category was 0.86 (0.74 to 0.99). Pooled aHR for children 1 year old with high versus low fish intake was 0.70 (95% CI=0.49 to 1.00) for IBD, and showed association with reduced risk of UC (pooled aHR=0.46; 95% CI=0.21, 0.99). Higher vegetable intake at 1 year was associated with a risk reduction in IBD. Intake of sugar-sweetened beverages was associated with an increased risk of IBD. Diet quality at 3 years was not associated with IBD. Conclusion In this Scandinavian birth cohort, high diet quality and fish intake in early life were associated with a reduced risk of IBD.

Objective To examine height changes in middle-aged northern European women in relation to overall and cardiovascular mortality.Design Population-based cohort studies with longitudinally measured heights and register-based mortality.Setting Sweden and Denmark.Participants Population-based samples of 2406 Swedish and Danish women born on selected years in 1908–1952, recruited to baseline examinations at ages 30–60, and re-examined 10–13 years later.Main outcome measure Total and cardiovascular disease (CVD) specific mortality during 17–19 years of follow-up after last height measure.Results For each 1 cm height loss during 10–13 years, the HR (95% CI) for total mortality was 1.14 (1.05 to 1.23) in Swedish women and 1.21 (1.09 to 1.35) in Danish women, independent of key covariates. Low height and high leisure time physical activity at baseline were protective of height loss, independent of age. Considering total mortality, the HR for major height loss, defined as height loss greater than 2 cm, were 1.74 (1.32 to 2.29) in Swedish women and 1.80 (1.27 to 2.54) in Danish women. Pooled analyses indicated that height loss was monotonically associated with an increased mortality, confirming a significant effect above 2 cm height loss. For cause-specific mortality, major height loss was associated with a HR of 2.31 (1.09 to 4.87) for stroke mortality, 2.14 (1.47 to 3.12) for total CVD mortality and 1.71 (1.28 to 2.29) for mortality due to causes other than CVD.Conclusion Height loss is a marker for excess mortality in northern European women. Specifically the hazard of CVD mortality is increased in women with height loss during middle age, and the results suggest that the strongest cause-specific endpoint may be stroke mortality. The present findings suggest attention to height loss in early and mid-adulthood to identify women at high risk of CVD, and that regular physical activity may prevent early onset height loss.

Background: Few studies have evaluated educational nutrition activities in undergraduate nursing, and none have published how the established food assessment method, the food diary, can be used as a pedagogical method in this context. Objective: To describe undergraduate nursing students' learning outcomes of basic nutrition and important elements for their learning after conducting a one-day food record with a subsequent seminar (henceforth: "the food diary method"). Design: Cross-sectional. Setting: Undergraduate nursing program in Sweden. Participants: 161 students. Methods: Participants conducted a one-day food record by documenting their food intake and calculating the nutritional values. After completion, students participated in a seminar, and an evaluative questionnaire was distributed at the end. The questionnaires contained both numerical and free-text questions. Results: Of 162 students attending the seminar, all but one completed the questionnaire (response rate: 99%). The highest rated learning outcome, on the 5-point Likert scale, was an increased understanding for the nutritional recommendations (Median, M = 5). The highest rated educational aspects were that they compared their records with the nutritional recommendations (M = 5), and the calculations of nutritional values of their records (M = 5). Participants also indicated that they gained information that would be useful for them as practicing nurses (M = 5). Conclusions: Overall, the food diary method appeared to be a feasible method in educating and engaging undergraduate nursing students in the field of basic nutrition. These findings support results from previous studies in this area, such that educational nutrition activities that utilize active, experiential, and social learning strategies were appreciated by the students.

Objective: This study examines secular changes in diet-related greenhouse gas emissions (GHGE) in younger and older Swedish adults, since the turn of this century. Design: Two cross-sectional health examination surveys were conducted in 2001-2004 (T (1)) and 2014-2018 (T (2)). At both times, an eighty-six-item FFQ was embedded in the survey. From the food frequencies and age-standardised portion sizes, GHGE estimates (kg CO(2)e/year) were calculated. GHGE was modelled as a function of time period and covariates, for five distinct age groups. Setting: The municipality of Gothenburg, in western Sweden. Participants: Women and men aged 25-34, 35-44, 45-54, 55-64 and 65-75 years were randomly selected from the population registry and recruited for examinations. After exclusion of participants with incomplete dietary data, the analytic sample consisted of 2569 individuals at T (1) and 2119 at T (2). Results: Lower dietary GHGE scores were observed at T (2) compared with T (1), in each age group, adjusting for sex, BMI and education. The largest differences in GHGE were observed in the youngest age group (approximately 30 % reduction). Decreasing trends in GHGE from animal-based foods were observed at all ages and were accompanied by smaller increases from plant-based sources in younger groups only. At all ages, GHGE from discretionary foods decreased, and prevalence of overweight remained stable. Conclusions: Optimal dietary trends should support both human health and planetary health. Our results suggest that Swedish adults have moved in this direction, e.g. through less intake of red meat products and stable weight status.

Summary Background Although controversial, lower maternal intake of n‐3 polyunsaturated fatty acid (PUFA) during pregnancy and lower levels of omega‐3 PUFA in serum phospholipids during childhood have been related to obesity. The main source of omega‐3 PUFA is fatty fish in the diet. Objectives To assess the relationship between overweight/obesity and the intake of fatty fish in maternal diet during pregnancy and in children up to 8 years of age. Methods The prospective cohort All Children in South‐East Sweden (ABIS) followed babies from birth to 8 years of age. A total of 6749 children at 5 years of age (boys 52.6%) and 3017 children at 8 years (boys 52.3%) participated. A “fatty‐fish index” was constructed on the basis of self‐reports of nutritional habits. Results The prevalence of overweight and obesity in children at 5 years were 12.9% and 4.2%, respectively. At 8 years, 12.2% of the children presented overweight and 2.3% obesity. Girls were more affected than boys by overweight/obesity. A higher fish index during pregnancy was not related to overweight/obesity in the children, whereas a higher fish index in the children during the first years of life was related to obesity at 5 and 8 years of age. This relationship disappeared in a multivariable analysis. Maternal body mass index (BMI), maternal education, maternal smoking during pregnancy, birth weight, and physical activity all remained related to overweight/obesity at both 5 and 8 years of age. Conclusion No relationships were found between a lower intake of fatty fish in the diet, neither in mothers during pregnancy nor in early childhood, and increased risk of overweight/obesity.

The etiology of asthma includes lifestyle factors. Breastfeeding and introduction of complementary foods have been suggested to affect asthma risk, but the scientific foundation is not solid. Children from the birth cohort All Babies In Southeast Sweden study were included (n = 9727). Breastfeeding duration and timing of introduction of infant formula and food were collected prospectively during the first year. Through linkage to the Swedish Patient Register, 948 children were identified with any asthma until age 15–17 years, of which 450 cases were atopic. Breastfeeding duration was not associated to risk of asthma. Introduction of infant formula earlier than at 14 weeks of age was associated with higher risk of non-atopic asthma. Introduction of fish before 43 weeks of age, as compared to later, was associated with a lower risk of asthma, irrespective of atopic classification. Reverse causation was accounted for but did not explain the results.

Occupational stress and obesity are both increasing in prevalence, but prospective findings relating these conditions are inconsistent. We investigated if baseline as well as prolonged exposure to high job demands and low decision latitude were associated with major weight gain (≥ 10% of baseline weight) in 3872 Swedish women and men examined three times over 20 years in the population-based Västerbotten Intervention Program.

In women, a large hip circumference (HC) related to lower hip fracture risk, independent of age and regardless if HC was measured long before or closer to the fracture. In older women, body mass index (BMI) explained the protection.

AbstractObjectiveTo describe the introduction of complementary foods in a population-based cohort in relation to recommendations and explore the possible impact of maternal education on infant feeding practices.DesignProspective data from the All Babies in Southeast Sweden (ABIS) cohort study were used. The ABIS study invited all infants born in south-east Sweden during October 1997–October 1999 (n 21 700) to participate. A questionnaire was completed for 16 022 infants. During the infants’ first year parents continuously filed in a diary covering introduction of foods.SettingSweden.SubjectsInfants (n 9727) with completed food diaries.ResultsPotatoes, vegetables, fruits/berries and porridge were the foods first introduced, with a median introduction between 19 and 22 weeks, followed by introduction of meat, cow’s milk, follow-on formula and sour milk/yoghurt between 24 and 27 weeks. Early introduction of any food, before 16 weeks, occurred for 27 % of the infants and was more common in infants of mothers with low education. Overall, potatoes (14·7 %), vegetables (11·1 %), fruits/berries (8·5 %), porridge (7·4 %) and follow-on formula (2·7 %) were the foods most frequently introduced early. The majority of infants (≥70 %) were introduced to potatoes, vegetables, fruits/berries and porridge during concurrent breast-feeding, but introduction during concurrent breast-feeding was less common in infants of mothers with low education.ConclusionsMost infants were introduced to complementary foods timely in relation to recommendations. Low maternal education was associated with earlier introduction of complementary foods and less introduction during concurrent breast-feeding. Still, the results indicated exposure to fewer foods at 12 months in infants of mothers with low education.

BACKGROUND: High parity has been suggested to increase risk of maternal cardiovascular disease independent of body mass index measured after childbearing. Pregnancy is, however, associated with persistent weight gain and metabolic changes that, independent of parity, increase the risk of cardiovascular disease. It could therefore be questioned if high parity independently increases the risk of cardiovascular disease or if this association may be confounded, mediated, or modified by other parity-related factors.OBJECTIVE: We sought to investigate the association between parity and risk of cardiovascular disease, and secondary outcomes in terms of myocardial infarction and cerebral infarction, with particular focus on potential mediation by anthropometric measures and effect modification by lactation.STUDY DESIGN: We used data from 16,515 female participants (age 44.5-73.6 years) of the population-based Malmo " Diet and Cancer Study with baseline examination from 1991 through 1996. The Malmo " Diet and Cancer Study was followed up throughout 2010, with a median follow-up of 15.8 years. We used Cox proportional hazards model to examine the association between parity and cardiovascular disease.RESULTS: Adjusted for age and other potential confounders, grand multiparous women (<= 5 children) had an increased risk of cardiovascular disease (hazard ratio, 1.60; 95% confidence interval, 1.20-2.14), myocardial infarction (hazard ratio, 1.68; 95% confidence interval, 1.15-2.45), and cerebral infarction (hazard ratio, 1.74; 95% confidence interval, 1.18-2.58) compared to women with 2 children. Additional adjustment for baseline body mass index and weight change since age 20 years attenuated the risk, but the increased risk for cardiovascular disease (hazard ratio, 1.38; 95% confidence interval, 1.02-1.87) and myocardial infarction (hazard ratio, 1.53; 95% confidence interval, 1.04-2.26) in grand multiparous women remained significant. Models stratified by lactation time showed that risk was only raised in grand multiparous women who had a mean lactation time of <4 mo/child. In sensitivity analyses excluding women with a history of diabetes at baseline, risk estimates for grand multiparous women became nonsignificant in the full model.CONCLUSION: Part of the increased risk of cardiovascular disease and myocardial infarction in grand multiparous women seems to be mediated by weight gain and potentially by higher likelihood of type 2 diabetes mellitus. Lactation may modify the increased risk of grand multiparity in that longer duration might offset the cardiovascular disease risk.

Dietary risks today constitute the largest proportion of disability-adjusted life years (DALYs) globally and in Sweden. An increasing number of people today consume highly processed foods high in saturated fat, refined sugar and salt and low in dietary fiber, vitamins and minerals. It is important that dietary trends over time are monitored to predict changes in disease risk.

ObjectiveDespite solid evidence of an association between centralized body fatness and subsequent disease risk, little is known about the consequences of changes in body fat distribution. Recently it was shown that large hip circumference (HC), measured once, was protective against total and cardiovascular disease (CVD) mortality in women but that gain or loss in HC was unrelated to these outcomes. This study examines whether a 6-year change in waist circumference (WC) predicts mortality and CVD in the same study sample.MethodsBaseline WC and 6-year change in WC as predictors of mortality and CVD were analyzed in 2,492 women from the Danish MONICA study and the Prospective Population Study of Women in Gothenburg, Sweden.ResultsIncrease in WC was significantly associated with increased subsequent mortality and CVD adjusting for BMI and other covariates, with some evidence of a J-shaped association. Associations between increase in WC and outcomes were restricted to women with normal weight at baseline and to ever-smokers.ConclusionsIn contrast to changes in HC which did not predict mortality and CVD, a 6-year increase in WC is strongly predictive, particularly among initially lean women and ever-smokers. This implies the importance of developing strategies to prevent central fat deposition.

Dietary intake of naturally occurring plant sterols is inversely related to serum cholesterol concentrations. Elevated serum cholesterol increases the risk of myocardial infarction (MI), but it is unknown if this can be reduced by dietary intake of naturally occurring plant sterols. Our aim was to investigate if a high intake of naturally occurring plant sterols is related to a lower risk of contracting a first MI. The analysis included 1005 prospective cases (219 women, 786 men) and 3148 matched referents (723 women, 2425 men), aged 29-73 y at baseline, from the population-based Northern Sweden Health and Disease Study. A food frequency questionnaire (FFQ) was completed at baseline. Absolute plant sterol intake was inversely related to the risk of a first MI in men (OR highest vs. lowest quartile = 0.70; 95% CI: 0.53, 0.85; P-trend = 0.006) but not in women. After adjustment for confounders, the estimated risk was somewhat attenuated (OR highest vs. lowest quartile = 0.71; 95% CI: 0.55, 0.92; P-trend = 0.067), suggesting that increasing sterol intake from 150 to 340 mg/d reduces the risk of a first MI by 29%. Energy-adjusted plant sterol intake was not related to the risk of a first MI in either men or women. In conclusion, the findings of this observational study show that a high absolute intake of naturally occurring plant sterols is significantly related to a lower risk of a first MI in men in northern Sweden, whereas no significant relation was seen for energy-adjusted plant sterol intake. In women, no significant associations were found. The results from this study show that intake of plant sterols may be important in prevention of MI.

Abstract Objective To evaluate plant sterol intake estimated with the eighty-four-item Northern Sweden FFQ against repeated 24 h dietary recalls (24-HDR) as the reference method. Design Randomly recruited participants from the Västerbotten Intervention Programme (VIP) responded to an FFQ (FFQ1). Over the subsequent 12 months, ten repeated 24-HDR were carried out. After this, a second FFQ (FFQ2) was completed. Setting Västerbotten county, northern Sweden. Subjects Ninety-six men and ninety-nine women. Results The Pearson correlation coefficient for absolute total plant sterol intake estimated with FFQ1 and 24-HDR was 0·58 and 0·55 for the men and women, respectively. Cross-classification of participants into quartiles of absolute plant sterol intake estimated with FFQ1 and 24-HDR showed that 90 % of the men and 83 % of the women were classified into the same or an adjacent quartile. For energy-adjusted plant sterol intake, 71 % of the men and 74 % of the women were classified into the same or an adjacent quartile. The agreement for cross-classification of participants into quartiles between FFQ1 and FFQ2 was good for both absolute and energy-adjusted plant sterol intake. Conclusions The FFQ is able to capture absolute plant sterol intake to the same extent as other nutrients, and to rank individuals according to both their absolute and energy-adjusted plant sterol intake. The reproducibility of the FFQ was good, suggesting that the method is reliable. This makes it possible to use plant sterol data from the FFQ in large-scale studies of the association between plant sterol intake and disease.

Objective: To measure dietary salt intake in a Swedish population.Design:A cross-sectional study with measured 24 h urinary excretion of Na and K. Completeness of urine collection was assessed using p-aminobenzoic acid. The subjects were interviewed on their habitual food intake.Setting: Sahlgrenska University Hospital, Gothenburg, Sweden.Subjects: Eighty-six young men (age 18-20 years), randomly selected from the population of Gothenburg. Seven men were excluded due to incomplete urine collection.Results: The mean excretion of Na and K over 24 h was 198 and 84 mmol, respectively (corresponding to 11.5 g NaCl and 3.3 g K). The mean 24 h excretion in the highest quartile of Na excretion was 297 mmol Na and 105 mmol K. and in the lowest quartile, 100 mmol Na and 68 mmol K. The mean Na:K ratio was 2.3, and respectively 3.2 and 1.8 in the highest and lowest Na excretion quartiles. Calculated energy intake did not differ between the highest and lowest quartiles of Na excretion, but body weight, BMI and the intake of certain foods known to be Na-rich did.Conclusions: Salt intake in young men was alarming high and even subjects in the lowest quartile of Na excretion did not meet present recommendations to limit salt intake to 5-6 g/d. At this point we can only speculate what the consequences of the high salt intake may be for CVD and stroke later in life. Regulation of the salt content in processed and fast food and in snacks is advocated, to curtail the salt burden on society imposed by the food industry.