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Objective: To examine if long-term constant low vitamin D status in the sunny season has a greater impact on bone mineral density (BMD) over time than long-term constant low vitamin D status in the dark season.

Patients and Methods: In a longitudinal cohort study conducted from November 3, 2003 to May 22, 2019, 1802 Swedish women living in Uppsala County (latitude 58°N) (mean baseline age of 65 years and average follow-up of 12 years) had vitamin D status measured by serum 25-hydroxyvitamin D concentration (S-25OHD). Participants were stratified by season of blood draw (dark [November-April] vs sunny [May-October]). We examined the association of long-term stable season-specific S-25OHD with 12-year changes in total hip BMD, measured by dual-energy x-ray absorptiometry, and investigated if increasing S-25OHD during follow-up influenced changes in BMD by baseline S-25OHD levels and season.

Results: Compared with longitudinally sunny season constant S-25OHD>70 nmol/L, women with sunny season constant S-25OHD<40 nmol/L displayed 10.0% (95% CI,3.8%-16.1%) lower total hip BMD at follow-up. No difference in BMD was observed by dark season S-25OHD. Among women with baseline sunny season S-25OHD<45 nmol/L, each 20 nmol/L increase in S-25OHD during follow-up was associated with a 2.5% increase in hip BMD (95% CI,0.5-4.6). This estimate was attenuated when increasing the low S-25OHD cut-off and was not observed with dark season samples.

Conclusion: Women with sunny season S-25OHD<40-50 nmol/L are a likely target group for vitamin D interventions to improve BMD. Blood samples taken during the dark season are less informative for determining future bone health. 

Purpose

Although recent studies suggest associations between temporal meal patterns, diet quality, and health outcomes such as obesity and cardiometabolic risk, the evidence remains inconclusive, highlighting the need for further investigation. This study aimed to evaluate meal patterns, including meal frequency, breakfast skipping and timing of energy intake (late or early), and their associations with diet quality and body mass index.

Methods

The study was completed as a secondary analysis of two cross-sectional, national dietary surveys, Riksmaten Adults 2010-11 (n = 1796) and Riksmaten Adolescents 2016-17(n = 2967). Meal patterns were reported for 3-4 days using two different web-based methods. Among adolescents, weight was measured using standardised methods, whereas adults provided self-reported weight. Diet quality was evaluated with the Swedish Healthy Eating Index 2025.

Results

Meal patterns differed according to weight status, where adults with obesity or adolescents with overweight or obesity reported a lower meal frequency and more often skipped breakfast. A low eating frequency, breakfast skipping, and a late energy distribution were negatively associated with diet quality. A high meal frequency (OR 0.44 CI 0.28-0.68) and a late energy distribution (OR 0.70 CI 0.57-0.85) were associated with a decreased risk for overweight or obesity in adolescents.

Conclusion

Our study suggests that there may be a benefit in having a higher eating frequency and consuming breakfast, with regard to diet quality and weight.

Background

Detailed knowledge about the disease burden from unhealthy diet in Nordic and Baltic countries is lacking. This study quantifies and compares deaths and disability-adjusted life-years (DALYs) from dietary risks in these countries

Methods

Data from the Global Burden of Disease study 2023 (GBD 2023) was used. Attributable disease burden from 15 dietary risks was analysed using the comparative risk assessment framework. Steps included: (1) estimating dietary intake; (2) assessing relative risks of dietary factors on disease endpoints; (3) determining theoretical minimum risk exposure levels (TMREL); and (4) estimating dietary risk-attributable disease burden as numbers and age-standardised rates (ASR) of deaths and DALYs.

Findings

Across the Nordic and Baltic countries (total population = 34,064,020), dietary risks resulted in 38,450 attributed deaths (95% uncertainty interval 10,749–59,386) and 735,284 DALYs (242,417–1,06,638) in 2023. Leading dietary risks included high intake of processed meat and low intake of fruits and whole grains. Dietary risks accounted for 24.9% of cardiovascular disease burden (5.0–37.6), 29.6% of diabetes and kidney disease burden (18.6–40.0), and 7.8% of neoplasm burden (2.9–12.1), with higher burden in the Baltic countries and Greenland than in the Nordic countries.

Interpretation

A substantial disease burden can be attributed to dietary risks in the Nordic and Baltic countries. Knowledge about the impact from unhealthy diet can inform targeted public health policies.

Funding

Gates Foundation and Norwegian Institute of Public Health.

Background

How cardiovascular diseases (CVD) predispose to a higher risk of fragility fractures is not well understood. Both contribute to significant components of disease burden and health expenditure. Poor bone quality, central obesity, sarcopenia, falls, and low grip strength are independent risk factors for hip and other fragility fractures and also for CVD and early death.

Methods

We used proteomics and a cohort design combined with Mendelian randomisation analysis to understand shared mechanisms for developing CVD and fragility fractures, two significant sources of disease burden and health expenditure. We primarily aimed to discover and replicate the association of 274 cardio-metabolic-related proteins with future rates of hip and any fracture in two separate population-based cohorts, with a total of 12,314 women and men.

Findings

The average age at baseline was 68 years in the discovery cohort of women and 74 years in the mixed-sex replication cohort. During 100,619 person-years of follow-up, 2168 had any fracture, and 538 had a hip fracture. Our analysis resulted in 24 cardiometabolic proteins associated with fracture risk: 20 with hip fracture, 9 with any fracture, and 5 with both. The associations remained even if protein concentrations were measured from specimens taken during preclinical stages of cardio-metabolic diseases, and 19 associations remained after adjustment for bone mineral density. Twenty-two of the proteins were associated with total body fat mass or lean body mass. Mendelian randomisation (MR) analysis supported causality since genetically predicted levels of SOST (Sclerostin), CCDC80 (Coiled-coil domain-containing protein 80), NT-proBNP (N-terminal prohormone brain natriuretic peptide), and BNP (Brain natriuretic peptide) were associated with risk of hip fracture. MR analysis also revealed a possible negative impact on bone mineral density (BMD) by genetically predicted higher levels of SOST, CCDC80, and TIMP4 (Metalloproteinase inhibitor 4). The MR association with BMD was positive for PTX3 (Pentraxin-related protein) and SPP1 (Osteopontin). Genetically predicted higher concentrations of SOST and lower concentrations of SPP1 also conferred a higher risk of falls and lowered grip strength. The genetically determined concentration of nine proteins influenced fat mass, and one influenced lean body mass.

Interpretation

These data reveal biological links between cardiovascular diseases and fragility fractures. The proteins should be further evaluated as shared targets for developing pharmacological interventions to prevent fractures and cardiovascular disease.

Diet is considered a key research priority for juvenile idiopathic arthritis (JIA), garnering considerable interest from affected families. Despite this, research studies focusing on dietary interventions remain scarce. The specific carbohydrate diet (SCD) has shown potential, however, its nutritional consequences and risks are not well understood. This study aims to describe and evaluate food and nutrient intakes in children with JIA adhering to the SCD and contextualize the results relative to recommendations and intakes in the general population. In a secondary analysis, food and nutrient intakes from three-day dietary records of ten children, following a four-week SCD intervention, were evaluated against the Nordic Nutrition Recommendations 2023 and Riksmaten Adolescents data (RMA) (n = 1282). All children following the SCD met the recommended minimum intake of fruit and vegetables of 500g/day, a stark contrast to the 6% in RMA. Median dietary fibre intake for the SCD was 26g/d, (IQR 21-33), compared to 16g/d (IQR 12-22) in RMA. Elevated saturated fatty acid (SFA) intake was observed in both groups, with the SCD group also consuming high amounts of red meat. Calcium was the sole nutrient for which the standard diet surpassed the SCD, as 9 out of 10 participants had inadequate intake. While children on the SCD showed a lower likelihood of nutrient inadequacy compared to the general population, inadequate calcium intake and elevated SFA and red meat consumption are concerning given known comorbidities in JIA. These results highlight the importance of disease-specific dietary guidance to ensure optimal support for patients and parents.

Introduction: Fathers are underrepresented in studies on young children’s eating, a gap that may mask their potential influence and involvement. This study aimed to explore how fathers experience feeding and mealtime situations.

Methods: Semi-structured interviews were conducted with 21 first-time fathers (90 % university degree, 19 % foreign background) that were or had been on paternity leave with their child (57 % girls) aged 10-24 months (mean 15 months). Transcribed interviews were analyzed thematically.

Results: Two themes were identified: Between uncertainty and reassurance and Balancing responsiveness and control. Several fathers could find it challenging to handle feeding and mealtime situations, express uncertainty regarding how to act, and worry about their child’s food intake. Others were more reassured in feeding situations and about the child’s health and growth. They could also experience insufficient and conflicting information about food and nutrition and felt that this information was mostly targeted at mothers. The fathers struggled to balance between supporting their child’s autonomy in eating and the desire to exert control, particularly when they perceived the child’s intake as insufficient. Some encouraged eating to ensure the child ate enough, while others avoided pressure out of concern it might create negative associations with food.

Conclusion: Swedish first-time fathers experience mealtimesas challenging, alternate between responsive and controlling feeding practices, and experience a lack of clear guidance and support. Our findings show that men care for and may struggle with the feeding of their children, suggesting that child health care services need to strengthen food-related support towards fathers.

Conflict of Interest: None Disclosed

Purpose This observational study examined the relationship between self-reported dietary patterns-omnivore, pescatarian, vegetarian, and vegan-and iron status among Swedish teenage girls. Additionally, we compared the consumption of various food groups in relation to iron status. Methods Data were collected from 475 female high school students in Malm & ouml; and Lund, Sweden, using questionnaires on dietary habits, iron supplementation, and demographic factors. Participants were classified into dietary groups: 347 omnivores, 38 pescatarians, 27 non-consumers of red meat, 60 vegetarians and 3 vegans. Blood samples were analysed for ferritin and haemoglobin levels to determine iron status. Iron deficiency was defined as ferritin < 15 <mu>g/L, and anaemia as haemoglobin < 110 g/L if < 19 years and < 117 g/L if >= 19 years. ANOVA and logistic regression were used to compare biomarker levels and the prevalence of iron deficiency and anaemia across dietary groups. Results Omnivores had the highest estimated ferritin levels (19.6 <mu>g/L), which was significantly higher than pescatarians (14.7 mu g/L, p = 0.03), and vegans/vegetarians (10.9 mu g/L, p < 0.001). Overall 38.1% of participants were iron deficient. Vegetarians/vegans and pescatarians were significantly more likely to be iron deficient (69.4%, p < 0.001 and 49.4%, p-value 0.016, respectively) compared to omnivores (30.5%). Lower red meat consumption and higher intake of vegetarian patties and legumes were linked to an increased risk of iron deficiency. Anaemia prevalence (haemoglobin < 110 g/L if < 19 years and < 117 g/L if >= 19 years) was 3% across all dietary groups. Conclusion This study highlights a higher prevalence of iron deficiency among Swedish teenage girls adhering to plant-based diets. Public health strategies should promote balanced diets that ensure adequate iron intake and absorption while considering environmental sustainability. Regular screening and targeted dietary recommendations are essential for supporting the health of this population.

Timing of food intake seems to impact metabolism and circadian rhythms, and eating in synchronisation with the rhythms has been suggested to be favourable for health. This study aims to evaluate temporal meal patterns in the Swedish population and explore differences between population groups. Further, to investigate whether temporal meal patterns are associated with energy and nutrient intake, data were sourced from two national dietary surveys Riksmaten Adolescents 2016–2017 and Riksmaten Adults 2010–2011, with a total of 4763 participants. Food intake and temporal meal patterns were measured with 3- to 4-day food diaries and/or 24-hour recalls. The average meal frequency was 4·2 eating occasions (sd 0·9) per day for adolescents with an eating window of 11·9 h (sd 1·7). For adults, it was 4·6 (sd 1·1) eating occasions and an eating window of 12·0 h (sd 1·9) Meal frequency was positively associated with energy intake in both adolescents (r = 0·47) and adults (r = 0·51). Meal frequency was higher with age, and adolescents skipped breakfast more often, and had a later energy distribution than adults. A higher eating frequency and eating breakfast are associated with a higher absolute intake of whole grains, as well as Vitamin D and folate. A higher eating frequency makes it more likely to reach nutrient requirements. However, a higher eating frequency was also associated with a higher intake of free sugars. The findings can serve as reference data for temporal meal patterns in the Swedish context and also show differences within a population, which can be valuable insights for public health nutrition.

Background

National dietary surveys provide essential data for risk benefit assessments of foods and nutrients, for management and policy development. Physical activity measurement and biomonitoring can provide important complementary data but are less commonly included.

Objectives

This study aimed to describe the study design and methods of the cross-sectional Swedish national dietary survey Riksmaten Young Children (Riksmaten småbarn), of children aged 9 mo, 18 mo, and 4 y. Participation/dropout rates for the 2 older age groups are also presented. The impact of different recruitment strategies is discussed.

Methods

Children (N = 16,655) were randomly selected from the population register; invitations to guardians were sent by post and where possible, followed up by telephone. Food intake was assessed by a 2-d food diary and/or questionnaire. Height and weight were reported after measurement. Physical activity (accelerometery, 7 d) and stool, blood, and urine samples were assessed in subgroups.

Results

Food consumption data were collected in 1828 children (11% of the invited; 18 mo: n = 1078, and 4 y: n = 750). Of participants also in subgroups, 71% provided physical activity data (n = 1307), 60% stool samples (n = 630), and 51% blood and/or urine samples (n = 593). The study population represented all geographic regions and types of municipalities in Sweden, but participating households had both higher education level and higher income than the target population. Only minor differences were seen in participation rates between recruitment via post and telephone compared with those through post only (12% compared with 10%). Repeated contact attempts were needed for the majority of participants (65%). Despite the low-participation rate, 99% of the participants completed the study once started.

Conclusions

Although it was a challenge to recruit participants, Riksmaten Young Children provides a substantial amount of information at national level, representative in terms of sex, geography, and family structure. The underrepresentation of households with lower socioeconomic position must be considered when generalizing results.

Objectives: Hip fractures are associated with a high burden of morbidity and mortality. Diet is essential for preventing fragility fractures, but the role of dietary fatty acids on the risk of hip fracture is uncertain. The aim was to investigate how intake of different dietary fatty acids relates to the risk of hip fracture. A relative validation of the long-term intake of dietary fatty acids estimated from food frequency questionnaires (FFQs) was also performed.

Design, settings and participants: We used data collected in two population-based cohorts, the Swedish Mammography Cohort and the Cohort of Swedish men (n = 83,603, 54% men, aged 45–82 years). Data from the repeated investigations in the cohorts and cross-sectional data from their clinical sub-cohorts were used.

Measurements: Diet data was collected in FFQs. Incident hip fractures were gathered by individual linkage to national registers. We performed Cox regression analysis to investigate associations between dietary fatty acids and hip fracture. Follow-up time was between January 1st, 1998 and December 31st, 2020. The validation was performed using correlation analyses, comparing fatty acids measured in adipose tissue with estimated fatty acid intakes from FFQs.

Results: During up to 23 years of follow-up (mean 18 years) and 1,538,627 person-years at risk, 7345 participants (2840 men) experienced a hip fracture. A low linoleic acid (LA) and high intakes of long-chain n-3 fatty acids were associated with higher hip fracture risk in a non-linear way. In quartile 4 compared to quartile 1 of LA, the multivariable-adjusted hazard ratio of hip fracture was 0.89 (95% Confidence Interval: 0.81, 0.97). The study confirmed the validity of FFQs to capture the intake of the specific dietary long-chain n-3 fatty acids. The estimated intake of LA, α-linolenic acid, and myristic acid were also adequately captured by the FFQs. Validity was confirmed in both women and men.

Conclusion: A low to moderate intake of linoleic acid and a higher intake of long-chain n-3 fatty acids were associated with a higher risk of hip fractures. The results indicate that attention should be paid to dietary fatty acid composition for the optimal prevention of fragility fractures.