Lauren Lissner

Different osteocalcin forms, markers of metabolic syndrome and anthropometric measures in children within the IDEFICS cohort

OBJECTIVE Osteocalcin (OC), an aboundant non-collagenous bone protein, is inversely associated with parameters of glucose metabolism. Interactions between bone tissue and energy metabolism have not been thoroughly investigated during childhood. This study investigated OC, metabolic parameters and anthropometric characteristics in normal weight and overweight/obese children. METHODS This study comprised 108 (46 normal weight/62 overweight/obese) Swedish 2-9year old children. Anthropometric data, insulin, glucose, glycosylated haemoglobin (HbA1c), HOMA index, vitamin D, adiponectin, total OC, carboxylated OC (cOC) and undercarboxylated OC (ucOC) were analysed. RESULTS No difference was found for total OC between the normal and overweight/obese groups, with a mean (±SD) value of 82.6 (±2.8) ng/mL and 77.0 (±2.4) ng/mL, (P=0.11), respectively. Overweight children had lower cOC levels, mean 69.1 (±2.2) ng/mL, vs. normal weight children, mean 75.6 (±2.5) ng/mL (P=0.03). The mean ucOC levels of 7.9 (±0.4) ng/mL in overweight children did not differ vs. normal weight children, mean level 7.0 (±0.4) ng/mL, (P=0.067). None of the three OC forms correlated with any of the measured parameters. CONCLUSIONS The cOC levels were lower in overweight children. There was no correlation between the three OC forms and any of the measured anthropometric or metabolic parameters. OC has been suggested to have a possible metabolic role, but in general the current study in prepubertal children does not support the hypothesis of an association between OC and a positive metabolic profile.

Serum 25-hydroxy vitamin D levels in middle-aged women in relationship to adiposity and height trajectories over three decades

Background/Objectives:The long-term chronology of the association between low serum concentrations of 25-hydroxy vitamin D (25(OH)D) and weight status is unclear. We examined whether lower 25(OH)D in middle-aged women drives upwards the weight, body mass index (BMI) and waist–hip ratio (WHR) over the next 32 years, and whether higher 25(OH)D might predict less decline in the mid- to late-life height trajectory.Subjects/Methods:The Population Study of Women in Gothenburg started in 1968–1969 (the baseline) in 38–60-year-old women residing in Gothenburg, Sweden. Anthropometric measures were taken at baseline and 4 re-examinations until 2000–2003. Levels of 25(OH)D were analyzed in serum stored since baseline in 1227 (84%) women. Repeated measures analyses were used to model associations between 25(OH)D (dichotomized, cut point 51.45 nmol/l) at baseline and anthropometric trajectories, adjusting for fixed and time-dependent covariates.Results:At baseline, mean BMI was 25.2 kg/m2 in women with low 25(OH)D and 23.8 kg/m2 in the remaining women (P<0.001), but this difference did not increase over 32 years and longitudinal differences were explained by the baseline BMI. Similar results were observed for weight and WHR. In contrast, no association was seen for height at baseline or longitudinally.Conclusions:No relationship was observed between 25(OH)D height trajectory, but lower 25(OH)D was associated with higher BMI, weight and WHR differences that were maintained over three decades. This provides no evidence for the direction of causality, but for a life-long difference in adiposity-related measures according to the 25D level in middle-aged women.

Evaluating the predictive ability of childhood body mass index classification systems for overweight and obesity at 18 years

Aim: To evaluate the performance of three childhood body mass index classification systems defining weight status at age 10, for predicting overweight and obesity at 18 years, according to the World Health Organization adult body mass index classification. Methods: Weight and height of 4235 Swedish girls and boys were measured both at around ages 10 and 18 years. Predictive ability of the extended International Obesity Task Force body mass index cut-offs (2012), the World Health Organization body mass index-for-age (2007) and a Swedish body mass index reference (2001) were assessed for sensitivity and specificity. Results: For predicting overweight including obesity at 18 years, the World Health Organization 2007 and the Swedish body mass index reference 2001 had similar sensitivity, 68% and 71%. The International Obesity Task Force 2012 had a significantly lower sensitivity, 53%. Specificity was 82–91% and highest for International Obesity Task Force 2012. For predicting obesity, the sensitivity for International Obesity Task Force 2012 was 29%, significantly lower than for the other two, 63% and 70%. Specificity was 94–100%, and highest for International Obesity Task Force 2012. Conclusions: In situations when optimal screening sensitivity is required for identifying as many high-risk children as possible, the World Health Organization 2007 and the Swedish body mass index reference 2001 performed better than the International Obesity Task Force 2012. However, it is important to keep in mind that the International Obesity Task Force 2012 will identify the fewest false positives.

Quality Assessment of 25(OH)D, Insulin, Total Cholesterol, Triglycerides, and Potassium in 40-Year-Old Frozen Serum

Background. Many longitudinal epidemiological studies collect specimens into biobanks to investigate how biomarkers predict future disease. In 1968-1969, the Population Study of Women in Gothenburg (PSWG) established a biobank of serum samples. Objective. To examine the validity of 25-hydroxyvitamin D (25(OH)D), total cholesterol, triglycerides, insulin, and potassium after 40 years of storage at −20°C in terms of relative and absolute agreement. The quality of these markers under such condition has not been previously investigated. Methods. Baseline and remeasured levels were compared in selected samples through percentage change, correlation, and regression. 25(OH)D levels, not assessed at baseline, were compared by season, by BMI, and longitudinally over six years. Results. Despite some lack of absolute agreement, Spearman correlations were >0.7 and statistically significant for all biomarkers. The 1968-1969 25(OH)D correlated with BMI and with levels six years later . Summer 25(OH)D was higher than winter 25(OH)D . Conclusion. For all markers, baseline and remeasured levels exhibited high relative agreement. 25(OH)D was comparable with expected levels on fresh blood and varied with season. In future studies, PSWG individuals will be ranked according to these markers in order to predict incidence of disease.

Health literacy in a complex digital media landscape: Pediatric obesity patients’ experiences with online weight, food, and health information:

This study aimed to explore experiences with online information regarding food, weight management, and health in a group of adolescents in treatment for obesity. Individual semi-structured interviews with 20 adolescents were conducted. Participants used a screen-recorded laptop to demonstrate their search procedures and online information sources. The transcribed interviews were categorized using qualitative content analysis. The adolescents described both encouraging and discouraging experiences. On one hand, they said that online forums could provide nutritious meal ideas and inspiration as well as social support for behavior change. On the other hand, they mentioned that there was a confusing amount of misleading commercial content online and also experiences of peer-facilitated food marketing in online networks. An overarching theme was generated: social media might be a resource for health inspiration, health information, and social support, but requires awareness and competencies. Implications for clinical practice are discussed in light of these findings.

Dairy product intake and mortality in a cohort of 70-year-old Swedes: a contribution to the Nordic diet discussion

IntroductionConflicting results in the literature exist on the role of dairy products in the context of a Nordic Healthy Diet (NHD). Two recent Swedish studies indicate both negative and positive associations with total mortality when comparing key dairy products. There is no consensus about how to include these foods into the NHD.PurposeTo study consumption of cheese and milk products (milk, sour milk and unsweetened yoghurt) by 70-year-old Swedes in relation to all-cause mortality.MethodsCox proportional hazard models, adjusted for potential confounders and stratified by follow-up duration, were used to assess the prediction of all-cause mortality by the above foods. The associations of fat from cheese and milk products with mortality were tested in separate models.ResultsCheese intake inversely predicted total mortality, particularly at high protein intakes, and this association decreased in strength with increasing follow-up time. Milk products predicted increased mortality with stable HRs over follow-up. The association between milk products and mortality was strongly influenced by the group with the highest consumption. Fat from cheese mirrored the protective association of cheese intake with mortality, whereas fat from milk products predicted excess mortality, but only in an energy-adjusted model.ConclusionBased on our results, it may be argued that the role of dairy products in the context of a Nordic healthy diet should be more clearly defined by disaggregating cheese and milk products and not necessarily focusing on dairy fat content. Future epidemiological research should consider dairy products as disaggregated food items due to their great diversity in health properties.

Evaluation of clinical and radiographic indices as predictors of osteoporotic fractures: a 10-year longitudinal study

OBJECTIVES The aim of the study was to evaluate 2 radiographic and 3 clinical indices as predictors of future osteoporotic fractures. STUDY DESIGN In a prospective, longitudinal study with a 10-year fracture follow-up, the 2 radiographic indices mandibular cortical erosion (normal, mild/moderate erosion, and severe erosion of the inferior cortex) and cortex thickness were assessed using panoramic radiographs of 411 women, age 62 to 78 years. The clinical indices were the fracture assessment tool FRAX, the osteoporosis index of risk (OSIRIS), and the osteoporosis self-assessment tool (OST). RESULTS The relative risks (RRs) for future fracture were significant for FRAX greater than 15%, 4.1 (95% confidence interval [CI] 2.4-7.2), and for severely eroded cortices, 1.7 (95% CI 1.1-2.8). Cortical thickness less than 3 mm, OSIRIS, and OST were not significant fracture predictors (RR 1.1, 1.4, and 1.5, respectively). For the 5 tested fracture predictors, Fishers exact test gave the following P values for differences between fracture and nonfracture groups: FRAX <.001, cortical erosion 0.023, OST 0.078, OSIRIS 0.206, and cortical thickness 0.678. The area under the curve was 0.69 for FRAX less than 15%, 0.58 for cortical erosion, and 0.52 for cortical thickness. Adding OSIRIS and OST did not change the area under the curve significantly. CONCLUSIONS FRAX and severely eroded cortices predicted fracture but cortical thickness, OSIRIS, and OST did not.

The Health Equilibrium Initiative-Is it Possible to Prevent Intervention- Generated Inequality?

Introduction: Obesity is unequally distributed between socio-economic Groups. Public health interventions may, unintentionally, contribute to widen health gaps. The approach Community based participatory research (CBPR) offers potential to narrow such gaps. CBPR needs to be adapted to the Nordic context and thus tested in appropriate settings. The aim was to examine the potential for a CBPR intervention to decrease childhood obesity in an underserved community in a major Swedish city. Methods: Activities were planned together with target groups, using Social Cognitive Theory. Activities were documented by structured reports aiming at developing knowledge and minimizing risk of harm. From determinants for healthy behavior (reciprocal determination, self-efficacy, learning by observation, facilitation and expectations of outcome) strategies for health promotion were formed. Viewpoints from collaborators were collected. Families in schools in areas where many had low education, low income and where many were recent immigrants, were invited to examinations that were discussed in the context of the participatory intervention. Examinations included anthropometric measurements, interviews on life style habits and neuropsychological assessments. Data were analyzed by independent sample t-test, Chi-square tests, one way Anova, content analysis and the CANTAB protocols, respectively. Results: Changes on structural levels were initiated during the intervention. Guidelines to remove sweets from schools were difficult to implement. 35% (n=119) of the initially invited sample participated at follow-up. At follow-up there was no difference between children in control and intervention schools. There was no evidence for links between weight and cognitive development in children. Conclusion: For participatory public health interventions time must be allocated to develop them in concert with target groups. To justify efforts and costs all steps should be thoroughly documented, transparent and evaluated. Policies to minimize sweets in schools need increased support from management levels. Participatory interventions can provide insights that cannot be obtained by traditional methods.