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  • 451. Xu, Hong
    et al.
    Evans, Marie
    Gasparini, Alessandro
    Szummer, Karolina
    Spaak, Jonas
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala universitet.
    Lindholm, Bengt
    Jernberg, Tomas
    Carrero, Juan Jesús
    Outcomes associated to serum phosphate levels in patients with suspected acute coronary syndrome2017Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 245, s. 20-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: We investigated the association between phosphate and the risk of adverse clinical outcomes in patients with manifest cardiovascular disease (CVD).

    METHODS: Observational study of patients hospitalized during 2006-2011 in Stockholm, Sweden, because of suspected acute coronary syndrome (ACS). The exposure was serum phosphate during the hospitalization. We modeled the association between phosphate and in-hospital death or in-hospital events (composite of myocardial infarction, cardiogenic shock, resuscitated cardiac arrest, atrial fibrillation, or atrioventricular block) as well as the one-year post-discharge risk of death or cardiovascular event (composite of myocardial re-infarction, heart failure and stroke). Confounders included demographics, comorbidities, kidney function, diagnoses, in-hospital procedures and therapies.

    RESULTS: Included were 2547 patients (68% men, mean age 67±14years) with median phosphate of 1.10 (range 0.14-4.20) mmol/L. During hospitalization, 198 patients died and 328 suffered an adverse event. Within one year post-discharge, further 381 deaths and 632 CVD events occurred. The associations of phosphate with mortality and CVD were J-shaped, with highest risk magnitudes at higher phosphate levels. For instance, compared to patients in the 50th percentile of phosphate distribution, those above the 75th percentile (1.3mmol/L, normal range) had significantly higher odds for in-hospital death [odds ratio 1.36, 95% confidence interval (CI) (1.08-1.71)] and of CVD post-discharge [sub-hazard ratios 1.17 (1.03-1.33)].

    CONCLUSIONS: In patients with suspected ACS, both higher and lower phosphate levels associated with increased risk of adverse outcomes during the index hospitalization and within one year post-discharge. The risk association was present already within normal-range serum phosphate values.

  • 452. Xu, Hong
    et al.
    Gasparini, Alessandro
    Ishigami, Junichi
    Mzayen, Khaled
    Su, Guobin
    Barany, Peter
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala universitet.
    Lindholm, Bengt
    Elinder, Carl Gustaf
    Carrero, Juan Jesús
    eGFR and the risk of community-acquired infections2017Inngår i: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905X, Vol. 12, nr 9, s. 1399-1408Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Community-acquired infections are common, contributing to adverse outcomes and increased health care costs. We hypothesized that, with lower eGFR, the incidence of community-acquired infections increases, whereas the pattern of site-specific infections varies.

    DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Among 1,139,470 health care users (mean age =52±18 years old, 53% women) from the Stockholm CREAtinine Measurements Project, we quantified the associations of eGFR with the risk of infections, overall and major types, over 12 months.

    RESULTS: A total of 106,807 counts of infections were recorded throughout 1,128,313 person-years. The incidence rate of all infections increased with lower eGFR from 74/1000 person-years for individuals with eGFR=90-104 ml/min per 1.73 m(2) to 419/1000 person-years for individuals with eGFR<30 ml/min per 1.73 m(2). Compared with eGFR of 90-104 ml/min per 1.73 m(2), the adjusted incidence rate ratios of community-acquired infections were 1.08 (95% confidence interval, 1.01 to 1.14) for eGFR of 30-59 ml/min per 1.73 m(2) and 1.53 (95% confidence interval, 1.39 to 1.69) for eGFR<30 ml/min per 1.73 m(2). The relative proportions of lower respiratory tract infection, urinary tract infection, and sepsis became increasingly higher along with lower eGFR strata (e.g., low respiratory tract infection accounting for 25% versus 15% of community-acquired infections in eGFR<30 versus 90-104 ml/min per 1.73 m(2), respectively). Differences in incidence associated with eGFR were in general consistent for most infection types, except for nervous system and upper respiratory tract infections, for which no association was observed.

    CONCLUSIONS: This region-representative health care study finds an excess community-acquired infections incidence in individuals with mild to severe CKD. Lower respiratory tract infection, urinary tract infection, and sepsis are major infections in CKD.

  • 453.
    Xu, Hong
    et al.
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden ; Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.
    Huang, Xiaoyan
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden ; Division of Nephrology, Peking University Shenzhen Hospital, Peking University, Shenzhen, China.
    Risérus, Ulf
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Cederholm, Tommy
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Lindholm, Bengt
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Department of Public Health and Caring Sciences, Section of Geriatrics, Uppsala University, Uppsala, Sweden.
    Carrero, Juan Jesús
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden ; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden ; Center for Gender Medicine, Karolinska Institutet, Stockholm, Sweden.
    Urinary albumin excretion, blood pressure changes and hypertension incidence in the community: effect modification by kidney function2014Inngår i: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 29, nr 8, s. 1538-1545Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Both increased albuminuria and reduced kidney function may predict blood pressure (BP) progression in the community, while they exacerbate each other's effects. We investigated associations and interactions between these two risk factors, BP changes and hypertension incidence in community-dwelling elderly men.

    METHODS: Observational study from the Uppsala Longitudinal Study of Adult Men, which included 1051 men (all aged 71 years) with assessments on urinary albumin excretion rate (UAER), 24-hour ambulatory BP monitoring (ABPM) and cystatin-C estimated glomerular filtration rate (eGFR). Of these, 574 men attended re-examination after 6 years, and ABPM measurements were again recorded to assess blood pressure changes and hypertension incidence.

    RESULTS: UAER was found to be associated with ABPM measurements both at baseline and longitudinally. In longitudinal analysis, there were significant interactions between UAER and kidney function in its association with the changes of systolic BP, mean arterial pressure and pulse pressure. After stratification for renal function state, UAER independently predicted BP changes only in those who had eGFR <60 mL/min/1.73 m(2). At re-examination, 71 new cases of hypertension were recorded. In multivariable logistic models, similar interactions were observed on hypertension incidence: UAER was an independent predictor of incident hypertension only in those with reduced renal function. These associations were evident also in the subpopulation of non-diabetics and in participants with normal range UAER (<20 µg/min).

    CONCLUSIONS: In community-dwelling elderly men, UAER associates with BP progression and hypertension incidence, even within the normal range. Concurrent reduction of renal function modifies and exacerbates these associations.

  • 454.
    Xu, Hong
    et al.
    Karolinska institutet .
    Huang, Xiaoyan
    Karolinska institutet; Peking University Shenzhen Hospital.
    Risérus, Ulf
    Uppsala universitet.
    Cederholm, Tommy
    Uppsala universitet.
    Sjögren, Per
    Uppsala universitet.
    Lindholm, Bengt
    Karolinska institutet .
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Carrero, Juan Jesús
    Karolinska institutet .
    Albuminuria, renal dysfunction and circadian blood pressure rhythm in older men: a population-based longitudinal cohort study2015Inngår i: Clinical Kidney Journal, ISSN 2048-8505, E-ISSN 2048-8513, Vol. 8, nr 5, s. 560-6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Both albuminuria and kidney dysfunction may affect circadian blood pressure (BP) rhythm, while exacerbating each other's effects. We investigated associations and interactions of these two risk factors with circadian BP rhythm variation and non-dipper pattern progression in community-dwelling older men.

    METHODS: This was a cross-sectional and longitudinal analyses in the third and fourth cycles of the Uppsala Longitudinal Study of Adult Men, including 1051 men (age 71 years) with assessments on urinary albumin excretion rate (UAER), 24-h ambulatory BP monitoring (ABPM) and cystatin-C-estimated glomerular filtration rate (eGFR). Of these, 574 men attended re-examination after 6 years. Study outcomes were ABMP changes and non-dipping BP pattern (prevalence and progression).

    RESULTS: UAER associated with circadian BP rhythm both cross-sectionally and longitudinally. Longitudinally, significant interactions were observed between UAER and kidney dysfunction (eGFR < 60 mL/min/1.73 m(2)) in its association with the changes of both night-time systolic BP (SBP) and night-day SBP ratio. After stratification, UAER strongly predicted night-day SBP ratio change only in those with concurrent kidney dysfunction. At re-examination, 221 new cases of non-dipper were identified. In multivariable logistic models, high UAER associated with increased likelihood of non-dipper progression, but more strongly so among individuals with concurrent kidney dysfunction. These associations were evident also in the subpopulation of non-diabetics and in participants with normal range UAER.

    CONCLUSIONS: UAER associates with circadian BP rhythm variation and non-dipper progression in elderly men. Concurrent renal dysfunction modifies and exacerbates these associations.

  • 455. Xu, Hong
    et al.
    Huang, Xiaoyan
    Risérus, Ulf
    Krishnamurthy, Vidya M
    Cederholm, Tommy
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala universitet.
    Lindholm, Bengt
    Sjögren, Per
    Carrero, Juan Jesús
    Dietary fiber, kidney function, inflammation, and mortality risk2014Inngår i: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905X, Vol. 9, nr 12, s. 2104-2110Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: In the United States population, high dietary fiber intake has been associated with a lower risk of inflammation and mortality in individuals with kidney dysfunction. This study aimed to expand such findings to a Northern European population.

    DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Dietary fiber intake was calculated from 7-day dietary records in 1110 participants aged 70-71 years from the Uppsala Longitudinal Study of Adult Men (examinations performed during 1991-1995). Dietary fiber was adjusted for total energy intake by the residual method. Renal function was estimated from the concentration of serum cystatin C, and deaths were registered prospectively during a median follow-up of 10.0 years.

    RESULTS: Dietary fiber independently and directly associated with eGFR (adjusted difference, 2.6 ml/min per 1.73 m(2) per 10 g/d higher; 95% confidence interval [95% CI], 0.3 to 4.9). The odds of C-reactive protein >3 mg/L were lower (linear trend, P=0.002) with higher fiber quartiles. During follow-up, 300 participants died (incidence rate of 2.87 per 100 person-years at risk). Multiplicative interactions were observed between dietary fiber intake and kidney dysfunction in the prediction of mortality. Higher dietary fiber was associated with lower mortality in unadjusted analysis. These associations were stronger in participants with kidney dysfunction (eGFR<60 ml/min per 1.73 m(2)) (hazard ratio [HR], 0.58; 95% CI, 0.35 to 0.98) than in those without (HR, 1.30; 95% CI, 0.76 to 2.22; P value for interaction, P=0.04), and were mainly explained by a lower incidence of cancer-related deaths (0.25; 95% CI, 0.10 to 0.65) in individuals with kidney dysfunction versus individuals with an eGFR≥60 ml/min per 1.73 m(2) (1.61; 95% CI, 0.69 to 3.74; P value for interaction, P=0.01).

    CONCLUSIONS: High dietary fiber was associated with better kidney function and lower inflammation in community-dwelling elderly men from Sweden. High dietary fiber was also associated with lower (cancer) mortality risk, especially in individuals with kidney dysfunction.

  • 456.
    Xu, Hong
    et al.
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China;.
    Huang, Xiaoyan
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Nephrology, Peking University Shenzhen Hospital, Peking University, Shenzhen, China;.
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Department of Public Health and Caring Sciences, Section of Geriatrics, and Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Cederholm, Tommy
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden;.
    Stenvinkel, Peter
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Lindholm, Bengt
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Risérus, Ulf
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden;.
    Carrero, Juan Jesús
    Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;.
    Clinical correlates of insulin sensitivity and its association with mortality among men with CKD stages 3 and 42014Inngår i: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905X, Vol. 9, nr 4, s. 690-697Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Insulin resistance participates in the pathogenesis of multiple metabolic and cardiovascular diseases. CKD patients have impaired insulin sensitivity, but the clinical correlates and outcome associations of impaired insulin sensitivity in this vulnerable population are not well defined.

    DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The prospective cohort study was from the third examination cycle of the Uppsala Longitudinal Study of Adult Men, a population-based survey of elderly men ages 70-71 years; insulin sensitivity was assessed by glucose disposal rate as measured with euglycemic clamps. Inclusion criterion was eGFR<60 ml/min per 1.73 m(2) (n=543). Exclusion criteria were incomplete data on euglycemic clamp and diabetes (n=97), leaving 446 men with CKD stages 3 and 4 (eGFR median=51.9 ml/min per 1.73 m(2); range=20.2-59.5 ml/min per 1.73 m(2)).

    RESULTS: The mean of glucose disposal rate was 5.4 ± 1.9 mg/kg per minute. In multivariable analysis, the independent clinical correlates of glucose disposal rate were eGFR (slope, 0.02; 95% confidence interval, 0.01 to 0.04), hypertension (-0.48; 95% confidence interval, -0.86 to -0.11), hyperlipidemia (-0.51; 95% confidence interval, -0.84 to -0.18), and body mass index (-0.32; 95% confidence interval, -0.37 to -0.27). During follow-up (median=10.0 years; interquartile range=8.7-11.0 years), 149 participants died. In Cox regression models, glucose disposal rate was not associated with all-cause or cardiovascular mortality. Multiplicative interactions (P<0.05) were observed between glucose disposal rate and physical activity or smoking in total mortality association. After subsequent stratification, glucose disposal rate was an independent correlate of all-cause mortality in smokers (adjusted hazard ratio, 0.72; 95% confidence interval, 0.54 to 0.96 per 1 mg/kg per minute glucose disposal rate increase) and physically inactive individuals (hazard ratio, 0.77; 95% confidence interval, 0.61 to 0.97) but not their counterparts.

    CONCLUSION: eGFR, together with various components of the metabolic syndrome, contributed to explain the variance of insulin sensitivity in men with CKD stages 3 and 4. Insulin sensitivity was associated with a lower mortality risk in individuals who smoked and individuals who were physically inactive.

  • 457.
    Xu, Hong
    et al.
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital K56, Karolinska Institutet, 14186, Stockholm, Sweden ; Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.
    Jia, Ting
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital K56, Karolinska Institutet, 14186, Stockholm, Sweden.
    Huang, Xiaoyan
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital K56, Karolinska Institutet, 14186, Stockholm, Sweden ; Division of Nephrology, Peking University Shenzhen Hospital, Peking University, Shenzhen, China.
    Risérus, Ulf
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Cederholm, Tommy
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Department of Public Health and Caring Sciences, Section of Geriatrics, Uppsala University, Uppsala, Sweden .
    Sjögren, Per
    Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Lindholm, Bengt
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital K56, Karolinska Institutet, 14186, Stockholm, Sweden.
    Carrero, Juan-Jesús
    Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital K56, Karolinska Institutet, 14186, Stockholm, Sweden ; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dietary acid load, insulin sensitivity and risk of type 2 diabetes in community-dwelling older men2014Inngår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 57, nr 8, s. 1561-1568Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS/HYPOTHESIS: We tested the hypothesis that dietary acid load may increase the risk of type 2 diabetes, and studied the association between acid load and insulin sensitivity as a possible mechanism involved.

    METHODS: An observational survey with prospective follow-up including 911 non-diabetic Swedish men aged 70-71 years was carried out. The gold standard euglycaemic-hyperinsulinaemic clamp technique and the OGTT were used to determine insulin sensitivity and beta cell function, respectively. Diabetes incidence was assessed during 18 years of follow-up. Renal function was estimated from serum cystatin C concentrations. Dietary acid load was calculated as potential renal acid load (PRAL) and net endogenous acid production (NEAP) algorithms from 7 day food records. Adequate dietary reporters were identified by Goldberg cut-offs.

    RESULTS: PRAL and NEAP were not associated with insulin sensitivity or beta cell function. Underlying kidney function or consideration of dietary adequate reporters did not modify these null findings. During follow-up, 115 new cases of diabetes were validated. Neither PRAL nor NEAP was associated with diabetes incidence.

    CONCLUSIONS/INTERPRETATION: Our results do not support the hypothesis that dietary acid load influences insulin sensitivity, beta cell function or diabetes risk. Interventional studies modifying acid-base dietary intake are needed to further elucidate a possible role of acid load in the development of type 2 diabetes.

  • 458. Xu, Hong
    et al.
    Matsushita, Kunihiro
    Su, Guobin
    Trevisan, Marco
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Karolinska Institutet.
    Barany, Peter
    Lindholm, Bengt
    Elinder, Carl-Gustaf
    Lambe, Mats
    Carrero, Juan-Jesus
    Estimated glomerular filtration rate and the risk of cancer2019Inngår i: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905XArtikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Community-based reports regarding eGFR and the risk of cancer are conflicting. We here explore plausible links between kidney function and cancer incidence in a large Scandinavian population-based cohort.

    DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In the Stockholm Creatinine Measurements project, we quantified the associations of baseline eGFR with the incidence of cancer among 719,033 Swedes ages ≥40 years old with no prior history of cancer. Study outcomes were any type and site-specific cancer incidence rates on the basis of International Classification of Diseases-10 codes over a median follow-up of 5 years. To explore the possibility of detection bias and reverse causation, we divided the follow-up time into different time periods (≤12 and >12 months) and estimated risks for each of these intervals.

    RESULTS: In total, 64,319 cases of cancer (affecting 9% of participants) were detected throughout 3,338,226 person-years. The relationship between eGFR and cancer incidence was U shaped. Compared with eGFR of 90-104 ml/min, lower eGFR strata associated with higher cancer risk (adjusted hazard ratio, 1.08; 95% confidence interval, 1.05 to 1.11 for eGFR=30-59 ml/min and adjusted hazard ratio, 1.24; 95% confidence interval, 1.15 to 1.35 for eGFR<30 ml/min). Lower eGFR strata were significantly associated with higher risk of skin, urogenital, prostate, and hematologic cancers. Any cancer risk as well as skin (nonmelanoma) and urogenital cancer risks were significantly elevated throughout follow-up time, but they were higher in the first 12 months postregistration. Associations with hematologic and prostate cancers abrogated after the first 12 months of observation, suggesting the presence of detection bias and/or reverse causation.

    CONCLUSIONS: There is a modestly higher cancer risk in individuals with mild to severe CKD driven primarily by skin and urogenital cancers, and this is only partially explained by bias.

  • 459. Xu, Hong
    et al.
    Sjogren, Per
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Banerjee, Tanushree
    Cederholm, Tommy
    Riserus, Ulf
    Lindholm, Bengt
    Lind, Lars
    Carrero, Juan Jesus
    A proinflammatory diet is associated with systemic inflammation and reduced kidney function in elderly adults2015Inngår i: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 145, nr 4, s. 729-735Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Diet can affect kidney health through its effects on inflammation. Objective: We tested whether the Adapted Dietary Inflammatory Index (ADII) is associated with kidney function and whether effects of diet on chronic low-grade inflammation explain this association. Methods: This was an observational analysis in 1942 elderly community-dwelling participants aged 70-71 y from 2 independent cohorts: the Uppsala Longitudinal Study of Adult Men (n = 1097 men) and the Prospective Investigation of Vasculature in Uppsala Seniors (n = 845 men and women). The ADII was calculated from 7-d food records, combining putatively proinflammatory and anti-inflammatory effects of nutrients, vitamins, and trace elements. The ADII was validated against serum C-reactive protein (CRP) concentrations. The estimated glomerular filtration rate (eGFR) was assessed from serum cystatin C (cys) and creatinine (crea). Associations between the ADII and eGFR were investigated, and CRP was considered to be a mediator. Results: In adjusted analysis, a 1-SD higher ADII was associated with higher CRP (beta: 6%, 95% Cl: 1%, 10%; P= 0.01) and lower eGFR [Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)(cys): -2.1%, 95% Cl: -3.2%, -1.1%; CKD-EPi(cys+crea): -1.8%; 95% Cl: -2.7%, -0.9%; both P < 0.001]. CRP was also inversely associated with eGFR. Mediation analyses showed that of the total effect of the ADII on kidney function, 15% and 17% (for CKD-EPIcys+crea and CKD-EPIcys equations, respectively) were explained/mediated by serum CRP. Findings were similar when each cohort was analyzed separately. Conclusions: A proinflammatory diet was associated with systemic inflammation as well as with reduced kidney function in a combined analysis of 2 community-based cohorts of elderly individuals. Our results also suggest systemic inflammation to be one potential pathway through which this dietary pattern is linked to kidney function.

  • 460. Xu, Hong
    et al.
    Xiong, Zibo
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala university.
    Qureshi, Abdul Rashid
    Cederholm, Tommy
    Sjögren, Per
    Lindholm, Bengt
    Risérus, Ulf
    Carrero, Juan Jesus
    Circulating alpha-tocopherol and insulin sensitivity among older men with chronic kidney disease2016Inngår i: Journal of renal nutrition (Print), ISSN 1051-2276, E-ISSN 1532-8503, Vol. 26, nr 3, s. 177-182Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Insulin resistance is common in individuals with chronic kidney disease (CKD) and may be partly explained by modifiable risk factors. In the general population, vitamin E supplementation has been suggested to improve both insulin sensitivity and secretion. We here explore the potential role of vitamin E as a modifiable risk factor for insulin resistance among individuals with CKD.

    Design: Observational study.

    Setting: A total of 273 nondiabetic men aged 70 to 71 years with CKD defined as either cystatin C estimated glomerular filtration rate &lt; 60 mL/minute/1.73 m2 or urinary albumin excretion rate ≥ 20 mg/minute from the third examination cycle of Uppsala Longitudinal Study of Adult Men.

    Subjects: A total of 273 nondiabetic men aged 70 to 71 years with CKD defined as either cystatin C estimated glomerular filtration rate &lt; 60 mL/minute/1.73 m2 or urinary albumin excretion rate ≥ 20 μg/minute.

    Methods: Serum α-, β-, and γ-tocopherol concentrations were measured by high-performance liquid chromatography and expressed as μmol/total serum cholesterol and triglycerides (in mmol). Dietary vitamin E intake was estimated from 7-day food records.

    Main Outcome Measure: Insulin sensitivity index (M/I ratio) was measured by hyperinsulinemic-euglycemic glucose clamps. Univariate and multivariate regression models were fitted to assess the association between M/I and circulating concentrations of tocopherols.

    Results: The mean serum concentration of α-, β-, and γ- was 37.4 ± 6.58, 0.89 ± 0.23, and 4.32 ± 1.69 μmol/mmol, respectively. Median dietary vitamin E intake was 6.14 (interquartile range, 5.48-6.82) mg/day. In crude and fully-adjusted multivariate regression analyses, serum α-tocopherol levels were directly and strongly associated with M/I (standard β = 0.17, P = .003). No such association was observed for dietary vitamin E, serum β-, and γ-tocopherol concentrations.

    Conclusions: Serum α-tocopherol concentration associates with insulin sensitivity in nondiabetic older men with CKD. 

  • 461. Yohannes, Ambachew M.
    et al.
    Teklehaimanot, Awash
    Bergqvist, Yngve
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Ringwald, Pascal
    Confirmed vivax resistance to chloroquine and effectiveness of artemether-lumefantrine for the treatment of vivax malaria in Ethiopia2011Inngår i: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645, Vol. 84, nr 1, s. 137-140Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Chloroquine (CQ) is still the drug of choice for the treatment of vivax malaria in Ethiopia, whereas artemether-lumefantrine (AL) is for falciparum malaria In this setting, clinical malaria cases are treated with AL This necessitated the need to assess the effectiveness of AL for the treatment of Plasmodium vivax with CQ as a comparator A total of 57 (80 3%) and 75 (85 2%) cases treated with CQ or AL, respectively, completed the study in an outpatient setting At the end of the follow-up period of 28 days a cumulative incidence of treatment failure of 7 5% (95% confidence interval [CI] = 2 9-18 9%) for CQ and 19% (95% CI = 11-31 6%) for AL was detected CQ resistance was confirmed in three of five CQ treatment failures cases The effectiveness of AL seems lower than CQ, however the findings were not conclusive, because the AL evening doses were not supervised

  • 462. Yuan, Lu
    et al.
    Hajifathalian, Kaveh
    Ezzati, Majid
    Woodward, Mark
    Rimm, Eric B
    Selmer, Randi
    Strand, Björn
    Fang, X
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala universitet.
    Goodarz, Danaei
    Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1·8 million participants2014Inngår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 383, nr 9921, s. 970-983Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Body-mass index (BMI) and diabetes have increased worldwide, whereas global average blood pressure and cholesterol have decreased or remained unchanged in the past three decades. We quantified how much of the effects of BMI on coronary heart disease and stroke are mediated through blood pressure, cholesterol, and glucose, and how much is independent of these factors.

    METHODS: We pooled data from 97 prospective cohort studies that collectively enrolled 1·8 million participants between 1948 and 2005, and that included 57 161 coronary heart disease and 31 093 stroke events. For each cohort we excluded participants who were younger than 18 years, had a BMI of lower than 20 kg/m(2), or who had a history of coronary heart disease or stroke. We estimated the hazard ratio (HR) of BMI on coronary heart disease and stroke with and without adjustment for all possible combinations of blood pressure, cholesterol, and glucose. We pooled HRs with a random-effects model and calculated the attenuation of excess risk after adjustment for mediators.

    FINDINGS: The HR for each 5 kg/m(2) higher BMI was 1·27 (95% CI 1·23-1·31) for coronary heart disease and 1·18 (1·14-1·22) for stroke after adjustment for confounders. Additional adjustment for the three metabolic risk factors reduced the HRs to 1·15 (1·12-1·18) for coronary heart disease and 1·04 (1·01-1·08) for stroke, suggesting that 46% (95% CI 42-50) of the excess risk of BMI for coronary heart disease and 76% (65-91) for stroke is mediated by these factors. Blood pressure was the most important mediator, accounting for 31% (28-35) of the excess risk for coronary heart disease and 65% (56-75) for stroke. The percentage excess risks mediated by these three mediators did not differ significantly between Asian and western cohorts (North America, western Europe, Australia, and New Zealand). Both overweight (BMI ≥25 to <30 kg/m(2)) and obesity (BMI ≥30 kg/m(2)) were associated with a significantly increased risk of coronary heart disease and stroke, compared with normal weight (BMI ≥20 to <25 kg/m(2)), with 50% (44-58) of the excess risk of overweight and 44% (41-48) of the excess risk of obesity for coronary heart disease mediated by the selected three mediators. The percentages for stroke were 98% (69-155) for overweight and 69% (64-77) for obesity.

    INTERPRETATION: Interventions that reduce high blood pressure, cholesterol, and glucose might address about half of excess risk of coronary heart disease and three-quarters of excess risk of stroke associated with high BMI. Maintenance of optimum bodyweight is needed for the full benefits.

    FUNDING: US National Institute of Health, UK Medical Research Council, National Institute for Health Research Comprehensive Biomedical Research Centre at Imperial College Healthcare NHS Trust, Lown Scholars in Residence Program on cardiovascular disease prevention, and Harvard Global Health Institute Doctoral Research Grant.

  • 463. Zethelius, B
    et al.
    Berglund, L
    Sundström, J
    Ingelsson, e
    Basu, S
    Larsson, A
    Venge, P
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Use of multiple biomarkers to improve the prediction of death from cardiovascular causes2008Inngår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 358, nr 20, s. 2107-16Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background The incremental usefulness of adding multiple biomarkers from different disease pathways for predicting the risk of death from cardiovascular causes has not, to our knowledge, been evaluated among the elderly. Methods We used data from the Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based cohort of elderly men, to investigate whether a combination of biomarkers that reflect myocardial cell damage, left ventricular dysfunction, renal failure, and inflammation (troponin I, N-terminal pro–brain natriuretic peptide, cystatin C, and C-reactive protein, respectively) improved the risk stratification of a person beyond an assessment that was based on the established risk factors for cardiovascular disease (age, systolic blood pressure, use or nonuse of antihypertensive treatment, total cholesterol, high-density lipoprotein cholesterol, use or nonuse of lipid-lowering treatment, presence or absence of diabetes, smoking status, and body-mass index). Results During follow-up (median, 10.0 years), 315 of the 1135 participants in our study (mean age, 71 years at baseline) died; 136 deaths were the result of cardiovascular disease. In Cox proportional-hazards models adjusted for established risk factors, all of the biomarkers significantly predicted the risk of death from cardiovascular causes. The C statistic increased significantly when the four biomarkers were incorporated into a model with established risk factors, both in the whole cohort (C statistic with biomarkers vs. without biomarkers, 0.766 vs. 0.664; P<0.001) and in the group of 661 participants who did not have cardiovascular disease at baseline (0.748 vs. 0.688, P=0.03). The improvement in risk assessment remained strong when it was estimated by other statistical measures of model discrimination, calibration, and global fit. Conclusions Our data suggest that in elderly men with or without prevalent cardiovascular disease, the simultaneous addition of several biomarkers of cardiovascular and renal abnormalities substantially improves the risk stratification for death from cardiovascular causes beyond that of a model that is based only on established risk factors.

  • 464. Zethelius, B
    et al.
    Venge, P
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Multiple biomarkers and cardiovascular risk2008Inngår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 359, nr 7, s. 760-761Artikkel i tidsskrift (Annet vitenskapelig)
  • 465.
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Cathepsin S as a biomarker: where are we now and what are the future challenges2012Inngår i: Biomarkers in Medicine, ISSN 1752-0363, Vol. 6, nr 1, s. 9-11Artikkel, forskningsoversikt (Fagfellevurdert)
  • 466.
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Diminished renal function and the incidence of heart failure2009Inngår i: Current Cardiology Reviews, ISSN 1573-403X, Vol. 5, nr 3, s. 223-227Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Heart failure is one of the most common, costly, disabling and deadly diseases. During the last decade, several different indices reflecting renal function such as creatinine-based glomerular filtration rate, circulating levels of cystatin C and low-grade albuminuria have been demonstrated to be independent risk factors for heart failure. This review summarizes our current knowledge of the relationship between diminished renal function and the incidence of heart failure in the community, and also in individuals with increased risk of heart failure such as patients with overt cardiovascular disease, hypertension or diabetes. This review will also put forward important areas of future research in this field.

  • 467.
    Ärnlöv, Johan
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Carlsson, Axel C
    Sundström, Johan
    Ingelsson, Erik
    Larsson, Anders
    Lind, Lars
    Larsson, Tobias E
    Higher fibroblast growth factor-23 increases the risk of all-cause and cardiovascular mortality in the community2013Inngår i: Kidney International, ISSN 0085-2538, E-ISSN 1523-1755, Vol. 83, s. 160-166Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Fibroblast growth factor-23 (FGF23), a regulator of mineral metabolism, has been linked to cardiovascular disease in chronic kidney disease. As community-based data of the longitudinal association between FGF23 and cardiovascular events are lacking, we investigated a possible relationship in 727 men of the Uppsala Longitudinal Study of Adult Men population-based cohort (mean age 77 years). During a median follow-up of 9.7 years, 110 participants died of cardiovascular causes. In Cox regression models adjusted for age and established cardiovascular risk factors, higher serum FGF23 was associated with a significantly increased risk for cardiovascular mortality (hazard ratio (HR) per increased s.d. of 1.36). This relationship remained significant, albeit attenuated, after adjustment for glomerular filtration rate (GFR) (HR 1.21). FGF23 was also associated with all-cause mortality, although the association was weaker than that with cardiovascular mortality, and it was nonsignificant in fully adjusted multivariate models. Spline analysis suggested a log-linear relationship between FGF23 and outcome. Participants with a combination of high FGF23 (>60 pg/ml), low GFR (<60 ml/min), and micro-/macro-albuminuria (albumin/creatinine ratio above 3 mg/ml) had an almost eightfold increased risk compared with participants without these abnormalities. Thus, a higher FGF23 level is associated with an increased cardiovascular mortality risk in the community. Clinical trials are needed to determine whether FGF23 is a modifiable risk factor.Kidney International advance online publication, 5 September 2012; doi:10.1038/ki.2012.327.

  • 468.
    Ärnlöv, Johan
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala Univ, Dept Publ Hlth & Caring Sci, Sect Geriatr, Uppsala, Sweden.
    Carlsson, Axel C.
    Sundström, Johan
    Ingelsson, Erik
    Larsson, Anders
    Lind, Lars
    Larsson, Tobias E.
    Serum FGF23 and risk of cardiovascular events in relation to mineral metabolism and cardiovascular pathology2013Inngår i: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905X, Vol. 8, nr 5, s. 781-786Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and objectives Circulating fibroblast growth factor-23 is associated with adverse cardiovascular outcomes in CKD and non-CKD individuals, but the underlying mechanism remains unclear. This study tested whether this association is independent of mineral metabolism and indices of subclinical cardiovascular pathology. Design, setting, participants, & measurements The prospective association between fibroblast growth factor-23 and major cardiovascular events (a composite of hospital-treated myocardial infarction, hospital-treated stroke, or all-cause mortality) was investigated in the community-based Prospective Investigation of the Vasculature in Uppsala Seniors (n=973; mean age=70 years, 50% women) using multivariate logistic regression. Subjects were recruited between January of 2001 and June of 2004. Results During follow-up (median=5.1 years), 112 participants suffered a major cardiovascular event. In logistic regression models adjusted for age, sex, and estimated GFR, higher fibroblast growth factor-23 was associated with increased risk for major cardiovascular events (odds ratio for tertiles 2 and 3 versus tertile 1=1.92, 95% confidence interval=1.19-3.09, P<0.01). After additional adjustments in the model, adding established cardiovascular risk factors, confounders of mineral metabolism (calcium, phosphate, parathyroid hormone, and 25 (OH)-vitamin D), and indices of subclinical pathology (flow-mediated vasodilation, endothelial-dependent and -independent vasodilation, arterial stiffness, and atherosclerosis and left ventricular mass) attenuated this relationship, but it remained significant (odds ratio for tertiles 2 and 3 versus tertile 1=1.69, 95% confidence interval=1.01-2.82, P<0.05). Conclusions Fibroblast growth factor-23 is an independent predictor of cardiovascular events in the community, even after accounting for mineral metabolism abnormalities and subclinical cardiovascular damage. Circulating fibroblast growth factor-23 may reflect novel and important aspects of cardiovascular risk yet to be unraveled. Clin J Am Soc Nephrol 8: 781-786, 2013. doi: 10.2215/CJN.09570912

  • 469.
    Ärnlöv, Johan
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Ingelsson, E
    Sundström, J
    Lind, L
    The impact of body mass index and the metabolic syndrome on the risk of cardiovascular disease and mortality in middle-aged men2010Inngår i: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 121, nr 2, s. 230-236Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background— The purpose of this study was to investigate associations between combinations of body mass index (BMI) categories and metabolic syndrome (MetS) and the risk of cardiovascular disease and death in middle-aged men. Methods and Results— At age 50 years, cardiovascular risk factors were assessed in 1758 participants without diabetes in the community-based Uppsala Longitudinal Study of Adult Men (ULSAM). According to BMI-MetS status, they were categorized as normal weight (BMI <25 kg/m2) without MetS (National Cholesterol Education Program criteria; n=891), normal weight with MetS (n=64), overweight (BMI 25 to 30 kg/m2) without MetS (n=582), overweight with MetS (n=125), obese (BMI >30 kg/m2) without MetS (n=30), or obese with MetS (n=66). During follow-up (median 30 years), 788 participants died, and 681 developed cardiovascular disease (composite of cardiovascular death or hospitalization for myocardial infarction, stroke, or heart failure). In Cox proportional-hazards models that adjusted for age, smoking, and low-density lipoprotein cholesterol, an increased risk for cardiovascular disease was observed in normal-weight participants with MetS (hazard ratio 1.63, 95% confidence interval 1.11 to 2.37), overweight participants without MetS (hazard ratio 1.52, 95% confidence interval 1.28 to 1.80), overweight participants with MetS (hazard ratio 1.74, 95% confidence interval 1.32 to 2.30), obese participants without MetS (hazard ratio 1.95, 95% confidence interval 1.14 to 3.34), and obese participants with MetS (hazard ratio 2.55, 95% confidence interval 1.81 to 3.58) compared with normal-weight individuals without MetS. These BMI-MetS categories significantly predicted total mortality rate in a similar pattern. Conclusions— Middle-aged men with MetS had increased risk for cardiovascular events and total death regardless of BMI status during more than 30 years of follow-up. In contrast to previous reports, overweight and obese individuals without MetS also had an increased risk. The present data refute the notion that overweight and obesity without MetS are benign conditions.

  • 470.
    Ärnlöv, Johan
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Larsson, Tobias E
    The authors reply2013Inngår i: Kidney International, ISSN 0085-2538, E-ISSN 1523-1755, Vol. 84, nr 3, s. 621-Artikkel i tidsskrift (Fagfellevurdert)
  • 471.
    Ärnlöv, Johan
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Ruge, Toralph
    Ingelsson, Erik
    Larsson, Anders
    Sundström, Johan
    Lind, Lars
    Serum endostatin and risk of mortality in the elderly: findings from 2 community-based cohorts2013Inngår i: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 33, nr 11, s. 2689-2695Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Experimental data imply that endostatin, a proteolytically cleaved fragment of collagen XVIII, could be involved in the development of cardiovascular disease and cancer. Prospective data concerning the relation between circulating endostatin and mortality are lacking. Accordingly, we aimed to study associations between circulating endostatin and mortality risk.

    APPROACH AND RESULTS: Serum endostatin was analyzed in 2 community-based cohorts: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; women 50%, n=931; mean age, 70 years; median follow-up, 7.9 years) and the Uppsala Longitudinal Study of Adult Men (ULSAM; n=748; mean age, 77 years; median follow-up, 9.7 years). During follow-up, 90 participants died in PIVUS (1.28/100 person-years at risk), and 417 participants died in ULSAM (6.7/100 person-years at risk). In multivariable Cox regression models adjusted for age and established cardiovascular risk factors, 1 SD higher ln(serum endostatin level) was associated with a hazard ratio of mortality of 1.39 and 95% confidence interval, 1.26 to 1.53, on average in both cohorts. In the ULSAM cohort, serum endostatin was also associated with cardiovascular mortality (177 deaths; hazard ratio per SD of ln[endostatin] 1.45, 95% confidence interval [1.25-1.71]) and cancer mortality (115 deaths; hazard ratio per SD of ln[endostatin] 1.35, 95% confidence interval [1.10-1.66]).

    CONCLUSIONS: High serum endostatin was associated with increased mortality risk in 2 independent community-based cohorts of the elderly. Our observational data support the importance of extracellular matrix remodeling in the underlying pathophysiology of cardiovascular disease and cancer.

  • 472.
    Ärnlöv, Johan
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Sundström, J
    Ingelsson, E
    Lind, L
    The impact of body mass index and the metabolic syndrome on the risk of diabetes in middle-aged men2011Inngår i: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 34, nr 1, s. 61-65Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The existence of an obese subgroup with a healthy metabolic profile and low diabetes risk has been proposed; yet long-term data are lacking. We aimed to investigate associations between combinations of BMI categories and metabolic syndrome and risk of type 2 diabetes in middle-aged men.

    Research design and methods: At age 50, cardiovascular risk factors were assessed in 1,675 participants without diabetes in the community-based Uppsala Longitudinal Study of Adult Men (ULSAM) study. According to BMI/metabolic syndrome status, they were categorized as normal weight (BMI <25 kg/m2) without metabolic syndrome (National Cholesterol Education Program criteria, n = 853), normal weight with metabolic syndrome (n = 60), overweight (BMI 25–30 kg/m2) without metabolic syndrome (n = 557), overweight with metabolic syndrome (n = 117), obese (BMI >30 kg/m2) without metabolic syndrome (n = 28), and obese with metabolic syndrome (n = 60). We investigated the associations between BMI/metabolic syndrome categories at baseline and diabetes incidence.

    Results: After 20 years, 160 participants had developed diabetes. In logistic regression models adjusting for age, smoking, and physical activity, increased risks for diabetes were observed in the normal weight with metabolic syndrome (odds ratio 3.28 [95% CI] 1.38–7.81; P = 0.007), overweight without metabolic syndrome (3.49 [2.26–5.42]; P < 0.001), overweight with metabolic syndrome (7.77 [4.44–13.62]; P < 0.001), obese without metabolic syndrome (11.72 [4.88–28.16]; P < 0.001), and obese with metabolic syndrome (10.06 [5.19–19.51]; P < 0.001) categories compared with the normal weight without metabolic syndrome category.

    Conclusions: Overweight or obese men without metabolic syndrome were at increased risk for diabetes. Our data provide further evidence that overweight and obesity in the absence of the metabolic syndrome should not be considered a harmless condition.

  • 473.
    Ärnlöv, Johan
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Zethelius, B
    Ny kombination av markörer kan förbättra riskbedömningen vid hjärt-kärlsjukdom.2008Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, nr 30Artikkel i tidsskrift (Annet vitenskapelig)
  • 474.
    Ärnlöv, Johan
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Zethelius, B
    Risérus, U
    Basu, S
    Berne, C
    Vessby, B
    Alfthan, G
    Helmersson, J
    Serum and dietary beta-carotene and alpha-tocopherol and incidence of diabetes in a community based study of Swedish men2009Inngår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 52, nr 1, s. 97-105Artikkel i tidsskrift (Fagfellevurdert)
  • 475.
    Åberg, Anna Cristina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala universitet.
    Aktuell geriatrisk forskning i Uppsala2018Inngår i: Svensk geriatrik, ISSN 2001-2047, nr 2, s. 9-12Artikkel, forskningsoversikt (Annet vitenskapelig)
  • 476.
    Åberg, Anna Cristina
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala universitet.
    Cedervall, Y
    Giedraitis, V
    Berglund, L
    Lennhed, B
    Rosendahl, E
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Kilander, L
    Can Timed Up-and-GO (TUG) Dual Task Performance Aid Diagnosis of Dementia?2017Konferansepaper (Fagfellevurdert)
  • 477.
    Åberg, Anna Cristina
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Cedervall, Y
    Lundberg, C
    Giedraitis, V
    Berglund, L
    Kilander, L
    Ingelsson, M
    Rosendahl, E
    McKee, Kevin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Socialt arbete.
    Timed Up-and-Go dual-task performance in people with cognitive impairment2018Konferansepaper (Fagfellevurdert)
  • 478.
    Åberg, Anna Cristina
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala universitet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Örebro universitet.
    Inpatient geriatric care in Sweden: Important factors from an inter-disciplinary team perspective2017Inngår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 172, s. 113-120Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this study was to describe factors of importance for the quality of inpatient geriatric care from an inter-disciplinary team perspective, an area that has not been previously studied to our knowledge. The study design was qualitative descriptive with data being collected from focus-group interviews with members of geriatric care teams. The data collection was conducted at a Swedish university hospital with 69 beds for geriatric care. It comprised five group interviews with a total of 32 staff members, including representatives of all the seven professions working with geriatric care. Data was analysed using qualitative content analysis and a thematic framework approach. Three main themes were identified as being perceived as characterising important factors essential for quality geriatric care:

    • Interactive assessment processes,
    • A holistic care approach, and
    • Proactive non-hierarchical interaction

    Aspects of time and goal-orientation were additionally running like common threads through these themes and informed them. Accessibility, open communication, and staff continuity were experienced as prerequisites for well-functioning teamwork. Including patients and relatives in care planning and implementation was seen as essential for good care, but was at risk due to budget cuts that imposed shortened hospital stays. To meet the care demands of the growing population of older frail people, more specialised team-based care according to the concept of Comprehensive Geriatric Assessment – which is possibly best provided by older-friendly hospitals – appears as a constructive solution for reaching high degrees of both staff and patient satisfaction in geriatric care. More research is needed in this area.

  • 479.
    Åberg, Anna Cristina
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Nordmark, S
    Lyhagen, J
    Lindberg, I
    Finch, T
    The Swedish version of the normalisation process theory measurement s-nomad: Translation, adaptation and pilot testing2018Inngår i: BMJ Evidence-Based Medicine, ISSN 2515-446X, Vol. 23, nr Suppl 1, s. A33-A33Artikkel i tidsskrift (Fagfellevurdert)
  • 480.
    Åberg, Anna Cristina
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Elf, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Nordmark, S
    Lyhagen, J
    Lindberg, I
    Finch, T
    The Swedish version of the Normalization Process Theory Measure S-NoMAD: Translation, adaptation and pilot testing2018Konferansepaper (Fagfellevurdert)
  • 481.
    Åberg, Anna Cristina
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Grundström, A
    Cedervall, Y
    Dual-task timed up and go test as part of memory assessment: a pilot study2015Konferansepaper (Fagfellevurdert)
  • 482.
    Åberg, Anna Cristina
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala University.
    Halvorsen, Kjartan
    Uppsala University.
    From, Ingrid
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Bruhn Bergman, Åsa
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Oestreicher, Lars
    Uppsala University.
    Melander-Wikman, Anita
    Luleå University of Technology.
    A study protocol for applying user participation and co-learning: lessons learned from the eBalance project2017Inngår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, nr 5, artikkel-id 512Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The eBalance project is based on the idea that serious exergames—i.e., computer gaming systems with an interface that requires physical exertion to play—that are well adapted to users, can become a substantial part of a solution to recognized problems of insufficient engagement in fall-prevention exercise and the high levels of fall-related injuries among older people. This project is carried out as a collaboration between eight older people who have an interest in balance training and met the inclusion criteria of independence in personal activities of daily living, access to and basic knowledge of a computer, four staff working with the rehabilitation of older adults, and an interdisciplinary group of six research coordinators covering the areas of geriatric care and rehabilitation, as well as information technology and computer science. This paper describes the study protocol of the project’s initial phase which aims to develop a working partnership with potential users of fall-prevention exergames, including its conceptual underpinnings. The qualitative methodology was inspired by an ethnographical approach implying combining methods that allowed the design to evolve through the study based on the participants’ reflections. A participatory and appreciative action and reflection (PAAR) approach, accompanied by inquiries inspired by the Normalization Process Theory (NPT) was used in interactive workshops, including exergame testing, and between workshop activities. Data were collected through audio recordings, photos, and different types of written documentation. The findings provide a description of the methodology thus developed and applied. They display a methodology that can be useful for the design and development of care service and innovations for older persons where user participation is in focus.

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