Obesity rates in adolescence and young adulthood have increased in Sweden, reflecting global trends. To which extent this occurs across different socioeconomic strata has not been clarified. The aim ...of the present study was to investigate trends in social inequalities in body mass index (BMI) in young/mid-adulthood Swedish women. We obtained weight and height for all women aged 20-45 years, at their first registered pregnancy (< 12 weeks of gestation) in the Swedish Medical Birth Register 1982-2013 (1,022,330, mean age = 28.8 years), documenting education and county of residence. Trends in mean BMI and in the prevalence of BMI categories between 1982 and 2013 were estimated across education levels and geographical location. Overall, mean BMI increased from 22.7 kg/m
(SD 3.2) to 24.3 kg/m
(SD 4.4) between 1982 and 2013. Simultaneously, the prevalence of overweight and obesity (BMI ≥ 25 kg/m
) increased from 18.1 to 33.4% while that of moderate obesity (BMI ≥ 30 to < 35 kg/m
) and severe obesity (BMI ≥ 35 kg/m
) increased markedly from 3.4 and 0.4% to 7.4 and 3.1%, respectively. The prevalence of moderate and severe obesity more than doubled during the study period across all educational levels. In conclusion, BMI and moderate and severe obesity increased markedly among young/mid-adulthood Swedish women regardless of education with a widening gap between those with lower and higher education. These growing social inequalities in BMI are likely to cause a rising divide in serious health problems following early and long-lasting obesity.
It is unclear how increasing body mass index (BMI) influences risk of cancer in young women. We used data from the Medical Birth, Patient and Cause of Death registers collected between 1982 and 2014 ...to determine the risk of obesity-related cancer types, breast cancer, all cancer and cancer-related death in relation to BMI in 1,386,725 women, aged between 18 and 45 years, in Sweden. During a median follow-up of 16.3 years (IQR 7.7-23.5), 9808 women developed cancer. The hazard ratio (HR) of endometrial and ovarian cancer increased with higher BMI from 1.08 (95% CI 0.93-1.24) and 1.08 (95% CI 0.96-1.21) among women with BMI 22.5-< 25 to 2.33 (95% CI 1.92-2.83) and 1.48 (95% CI 1.24-1.77), respectively, among women with BMI ≥ 30. There were linear and positive associations between BMI and incident cancer in the ovary, colon, endometrium, pancreas, rectum, gallbladder, esophageal cancer and renal cell carcinoma, as well as death from obesity-related cancer forms. In conclusion, we found that elevated BMI in young women linearly associated with several obesity-related cancer forms, including death from these cancers.
Low weight has been associated with increased mortality risks in type 1 diabetes. We aimed to investigate the importance of weight and weight gain/loss in the Swedish population diagnosed with type 1 ...diabetes.
Patients with type 1 diabetes (
= 26,125; mean age 33.3 years; 45% women) registered in the Swedish National Diabetes Registry from 1998 to 2012 were followed from the first day of study entry. Cox regression was used to calculate risk of death from cardiovascular disease (CVD), major CVD events, hospitalizations for heart failure (HF), and total deaths.
Population mean BMI in patients with type 1 diabetes increased from 24.7 to 25.7 kg/m
from 1998 to 2012. Over a median follow-up of 10.9 years, there were 1,031 deaths (33.2% from CVD), 1,460 major CVD events, and 580 hospitalizations for HF. After exclusion of smokers, patients with poor metabolic control, and patients with a short follow-up time, there was no increased risk for mortality in those with BMI <25 kg/m
, while BMI >25 kg/m
was associated with a minor increase in risk of mortality, major CVD, and HF. In women, associations with BMI were largely absent. Weight gain implied an increased risk of mortality and HF, while weight loss was not associated with higher risk.
Risk of major CVD, HF, CVD death, and mortality increased with increasing BMI, with associations more apparent in men than in women. After exclusion of factors associated with reverse causality, there was no evidence of an obesity paradox.
Highlights • Among obese patients, bariatric surgery conferred a lower risk of heart failure. • Heart failure was less than one-half of nonsurgical obese patients. • Bariatric surgery could prevent ...heart failure in the severely obese.
Obesity is a predominant factor in development of type 2 diabetes but to which extent adolescent obesity influences adult diabetes is unclear. We investigated the association between body mass index ...(BMI) in young men and subsequent type 2 diabetes and how, in diagnosed diabetes, adolescent BMI relates to glycemic control and diabetes complications.
Baseline data from the Swedish Conscript Register for men drafted 1968–2005 was combined with data from the National Diabetes and Patient registries. Diabetes risk was estimated through Cox regression and Kaplan-Meier survival estimates. Relationships between BMI, glycemic control and diabetes complications were assessed through multiple linear and logistic regression.
Among 1,647,826 men, 63,957 (3·88%) developed type 2 diabetes over a median follow-up of 29.0 years (IQR21.0–37.0). The risk of diabetes within 40 years after conscription was nearly 40% in individuals with adolescent BMI ≥35 kg/m2. Compared to BMI 18·5–<20 kg/m2 (reference), diabetes risk increased in a linear fashion from HR 1·18(95%CI 1·15–1·21) for BMI 20–<22·5 kg/m2 to HR 15·93(95%CI 14·88–17·05) for BMI ≥35 kg/m2, and a difference in age at onset of 11·4 years was seen. Among men who developed diabetes, higher adolescent BMI was associated with higher HbA1c levels and albuminuria rates.
Rising adolescent BMI was associated with increased risk of type 2 diabetes diagnosed at a younger age, with poorer metabolic control, and a greater prevalence of albuminuria, all suggestive of worse prognosis.
This work was supported by grants from the Swedish state under the agreement concerning research and education of doctors (ALFGBG-717,211, ALFGBG-881381); the Swedish Heart and Lung Foundation Grant No. 2018-0366, the Swedish Diabetes Foundation; and the Swedish Research Council (2018-02527, VRREG 2019-00193).
Stroke is a common and severe disease that requires prompt care. Symptom expressions as one-sided weakness and speech difficulties are common and included in public stroke campaigns. For some ...patients stroke can present with subtle and less common symptoms, difficult to interpret. The symptom severity assessed by the National Institutes of Health Stroke Scale has decreased, and symptoms at onset may have changed. Therefore, we aimed to investigate how patients describe their symptoms at the onset of a first-time stroke.
The study used a qualitative descriptive design and conventional content analysis. Data were collected through recorded interviews with 27 patients aged 18 years and older hospitalised with a first-time stroke between October 2018 and April 2020. Data were analysed on a manifest level.
Symptoms at stroke onset were presented in two themes: Altered Reality and Discomfort and Changed Body Functions and described in five categories. Various types of symptoms were found. All symptoms were perceived as sudden, persistent, and never experienced before and this appear as a "red thread" in the result. Regardless of symptom expressions, no specific symptom was described as more severe than another.
Stroke symptoms were described with a variety of expressions. Many described complex symptoms not typical of stroke, which can make it difficult to recognise the symptoms as a stroke and delay medical care. Public stroke campaigns should emphasize the importance of seeking medical care at the slightest suspicion of stroke and could be designed to help achieve this.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The individual physical activity level is an independent risk factor for cardiovascular disease and death, as well as a possible target for improving health outcome. However, today's widely adopted ...risk score charts, typically do not include the level of physical activity. There is a need for a simple risk assessment tool, which includes a reliable assessment of the level of physical activity. The aim of this study was therefore, to analyse the association between the self-reported levels of physical activity, according to the Saltin-Grimby Physical Activity Level Scale (SGPALS) question, and cardiovascular risk factors, specifically focusing on the group of individuals with the lowest level of self-reported PA.
We used cross sectional data from the Intergene study, a random sample of inhabitants from the western part of Sweden, totalling 3588 (1685 men and 1903 women, mean age 52 and 51). Metabolic measurements, including serum-cholesterol, serum-triglycerides, fasting plasma-glucose, waist circumference, blood pressure and resting heart rate, as well as smoking and self-reported stress were related to the self-reported physical activity level, according to the modernized version of the SGPALS 4-level scale.
There was a strong negative association between the self-reported physical activity level, and smoking, weight, waist circumference, resting heart rate, as well as to the levels of fasting plasma-glucose, serum-triglycerides, low-density lipoproteins (LDL), and self-reported stress and a positive association with the levels of high-density lipoproteins (HDL). The individuals reporting the lowest level of PA (SGPALS, level 1) had the highest odds-ratios (OR) for having pre-defined levels of abnormal risk factors, such as being overweight (men OR 2.19, 95% CI: 1.51-3.19; women OR 2.57, 95 % CI: 1.78-3.73), having an increased waist circumference (men OR 3.76, 95 % CI: 2.61-5.43; women OR 2.91, 95% CI: 1.94-4.35) and for reporting stress (men OR 3.59, 95 % CI: 2.34-5.49; women OR 1.25, 95% CI: 0.79-1.98), compared to the most active individuals, but also showed increased OR for most other risk factors analyzed above.
The self-reported PA-level according to the modernized Saltin-Grimby Physical Activity Level Scale, SGPALS, is associated with the presence of many cardiovascular risk factors, with the most inactive individuals having the highest risk factor profile, including self-reported stress. We propose that the present SGPALS may be used as an additional, simple tool in a routine risk assessment in e.g. primary care, to identify inactive individuals, with a higher risk profile.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Experimental and epidemiological studies have reported associations between air pollution exposure, in particular related to vehicle exhaust, and cardiovascular disease. A potential ...pathophysiological pathway is pollution-induced pulmonary oxidative stress, with secondary systemic inflammation. Genetic polymorphisms in genes implicated in oxidative stress, such as GSTP1, GSTT1 and GSTCD, may contribute to determining individual susceptibility to air pollution as a promoter of coronary vulnerability.
We aimed to investigate effects of long-term traffic-related air pollution exposure, as well as variants in GSTP1, GSTT1 and GSTCD, on risk of acute myocardial infarction (AMI) and hypertension. In addition, we studied whether air pollution effects were modified by the investigated genetic variants.
Genotype data at 7 single nucleotide polymorphisms (SNPs) in the GSTP1 gene, and one in each of the GSTT1 and GSTCD genes, as well as air pollution exposure estimates, were available for 119 AMI cases and 1310 randomly selected population controls. Population control individuals with systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg or on daily antihypertensive medication were defined as hypertensive (n = 468). Individual air pollution exposure levels were modeled as annual means of NO₂ (marker of vehicle exhaust pollutants) using central monitoring data and dispersion models, linking to participants' home addresses.
Air pollution was significantly associated with risk of AMI: OR 1.78 (95%CI 1.04-3.03) per 10 µg/m³ of long-term NO₂ exposure. Three GSTP1 SNPs were significantly associated with hypertension. The effect of air pollution on risk of AMI varied by genotype strata, although the suggested interaction was not significant. We saw no obvious interaction between genetic variants in the GST genes and air pollution exposure for hypertension.
Air pollution exposure entails an increased risk of AMI, and this risk differed over genotype strata for variants in the GSTP1, GSTT1 and GSTCD genes, albeit not statistically-significantly.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The relative importance of risk factor reduction in healthy people (primary prevention) versus that in patients with coronary heart disease (secondary prevention) has been debated. We aimed to ...quantify the contribution of the two.
We used the previously validated IMPACT model to estimate contributions from primary prevention (reducing risk factors in the population, particularly smoking, cholesterol and systolic blood pressure) and from secondary prevention (reducing risk factors in coronary heart disease patients) in the Swedish population.
Between 1986 and 2002, about 8,690 fewer deaths were related to changes in the three major risk factors. Population cholesterol fell by 0.64 mmol/L, with approximately 5,210 fewer deaths attributable to diet changes (4,470 in healthy people740 in patients.) plus 810 to statin treatment (200 in healthy people, 610 in patients). Overall smoking prevalence decreased by 10.3%, resulting in 1,195 fewer deaths, attributable to smoking cessation (595 in healthy people, 600 in patients). Mean population systolic blood pressure fell by 2.6 mmHg, resulting in 900 fewer deaths (865 in healthy people, 35 in patients), plus 575 fewer deaths attributable to antihypertensive medication in healthy people. The majority of falls in deaths attributable to risk factors occurred in people without known heart disease: 6,705 fewer deaths compared with 1,985 fewer deaths in patients (secondary prevention), emphasizing the importance of promoting health interventions in the general population.
The largest effects on mortality came from primary prevention, giving markedly larger mortality reductions than secondary prevention.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Secondary prevention after an acute myocardial infarction (AMI) reduces morbidity and mortality, but suboptimal secondary prevention of cardiovascular disease is common. Therefore, the present study ...aimed to identify potential underlying factors for suboptimal secondary prevention 2 years after an AMI event.
Patients aged 18-85 years at the time of their index AMI and hospitalized between July 2010 and December 2011, were identified retrospectively and consecutively from hospital discharge records. All patients who agreed to participate underwent a structured interview, physical examinations and laboratory analysis 2 years after their index AMI. The secondary preventive goals included are; blood pressure < 140/90 mmHg, LDL < 1.8 mmol/L, HbA1c < 48 mmol/mol, regular physical activity that causes sweating at least twice a week, non-smoking and BMI < 25 kg/m
. Multivariable and univariable logistic regression models were applied to identify independent predictors of different secondary prevention achievements.
Of the 200 patients (mean age 63.3 ± 9.7 years) included in the study, 159 (80%) were men. No common determinants were found in patients who failed to achieve at least six secondary prevention guideline-directed goals. For individual secondary prevention goals, several determinants were defined. Patients born in Sweden were less likely to achieve optimal lipid control odds ratio (OR) 0.28 (95% confidence interval, CI 0.12-0.63). Younger (≤ 65 years) OR 0.24 (95% CI 0.07-0.74) and unemployed patients OR 0.23 (95% CI 0.06-0.82) were less likely to be non-smokers. Patients with diabetes mellitus OR 0.21 (95% CI 0.04-0.98) or with a walking aid OR 0.23 (95% CI 0.07-0.71) were less likely to achieve an optimal body mass index (BMI < 25). Living alone was an independent predictor of achieving regular physical activity OR 1.94 (95% CI 1.02-3.69).
Long-term secondary prevention remained suboptimal 2 years after an AMI. Causes are likely multifactorial, with no single determinant for all six guideline-recommended preventive goals. Therefore a tailored comprehensive assessment should be requested and updated and treatment of risk factors should be applied.
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