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Aims/hypothesis Nordic dietary patterns that are high in healthy traditional Nordic foods may have a role in the prevention and management of diabetes. To inform the update of the EASD clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of Nordic dietary patterns and cardiometabolic outcomes. Methods We searched MEDLINE, EMBASE and The Cochrane Library from inception to 9 March 2021. We included prospective cohort studies and RCTs with a follow-up of ≥1 year and ≥3 weeks, respectively. Two independent reviewers extracted relevant data and assessed the risk of bias (Newcastle–Ottawa Scale and Cochrane risk of bias tool). The primary outcome was total CVD incidence in the prospective cohort studies and LDL-cholesterol in the RCTs. Secondary outcomes in the prospective cohort studies were CVD mortality, CHD incidence and mortality, stroke incidence and mortality, and type 2 diabetes incidence; in the RCTs, secondary outcomes were other established lipid targets (non-HDL-cholesterol, apolipoprotein B, HDL-cholesterol, triglycerides), markers of glycaemic control (HbA1c, fasting glucose, fasting insulin), adiposity (body weight, BMI, waist circumference) and inflammation (C-reactive protein), and blood pressure (systolic and diastolic blood pressure). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence. Results We included 15 unique prospective cohort studies (n=1,057,176, with 41,708 cardiovascular events and 13,121 diabetes cases) of people with diabetes for the assessment of cardiovascular outcomes or people without diabetes for the assessment of diabetes incidence, and six RCTs (n=717) in people with one or more risk factor for diabetes. In the prospective cohort studies, higher adherence to Nordic dietary patterns was associated with ‘small important’ reductions in the primary outcome, total CVD incidence (RR for highest vs lowest adherence: 0.93 [95% CI 0.88, 0.99], p=0.01; substantial heterogeneity: I2=88%, pQpp<0.05). No studies assessed CHD or stroke mortality. In the RCTs, there were small important reductions in LDL-cholesterol (mean difference [MD] −0.26 mmol/l [95% CI −0.52, −0.00], pMD=0.05; substantial heterogeneity: I2=89%, pQp<0.05). For the other outcomes there were ‘trivial’ reductions or no effect. The certainty of the evidence was low for total CVD incidence and LDL-cholesterol; moderate to high for CVD mortality, established lipid targets, adiposity markers, glycaemic control, blood pressure and inflammation; and low for all other outcomes, with evidence being downgraded mainly because of imprecision and inconsistency. Conclusions/interpretation Adherence to Nordic dietary patterns is associated with generally small important reductions in the risk of major CVD outcomes and diabetes, which are supported by similar reductions in LDL-cholesterol and other intermediate cardiometabolic risk factors. The available evidence provides a generally good indication of the likely benefits of Nordic dietary patterns in people with or at risk for diabetes. Registration ClinicalTrials.gov NCT04094194. Funding Diabetes and Nutrition Study Group of the EASD Clinical Practice. Graphical abstract

Background. Poor physical function is associated with disability and mortality in old people. Objectives. The aim was to find determinants of physical function in old people. Design. Secondary, cross-sectional analysis.Setting. Community in the Reykjavik, Iceland.Participants. 236 old people (73.7 ± 5.7 years, 58.2% female).Measurements. Timed-up-and-go (TUG), six-minute-walk-for-distance (6MWD), anthropometrics, quadriceps strength, dietary intake, mini-mental-state-examination (MMSE), leisure-time physical activity (LTPA) and blood variables were assessed. Descriptive, bivariate and multivariate statistical analyses were used.Results. There were differences between men and women in energy intake, body composition and muscular strength, but physical function did not differ between men and women. In bivariate analysis, most of the assessed variables correlated with 6MWD and TUG. Stepwise linear models showed that age, body composition, strength, medication, LTPA and MMSE were predictors of physical function but not hematological variables. The association between MMSE and function disappeared when corrected for strength/body weight. Results were similar for both 6MWD and TUG and the strongest predictors in the final models were age and quadriceps strength/body weight. Conclusions. In community dwelling old people, physical function decreases with age. However, it is of clinical relevance that there are modifiable determinants of physical function, in particular strength for a given body weight, LTPA and number of medications, which represent potential targets to maintain physical function in this age group. Our results also indicate that neither cognitive function, nor dietary intake nor blood chemical variables were independently associated with physical function.

Background & aims: Intake assessment in multicenter trials is challenging, yet important for accurate outcome evaluation. The present study aimed to characterize a multicenter randomized controlled trial with a healthy Nordic diet (HND) compared to a Control diet (CD) by plasma and urine metabolic profilesand to associate them with cardiometabolic markers. Methods: During 18e24 weeks of intervention, 200 participants with metabolic syndrome were advised at six centres to eat either HND (e.g. whole-grain products, berries, rapeseed oil, fish and low-fat dairy) or CD while being weight stable. Of these 166/159 completers delivered blood/urine samples. Metabolicprofiles of fasting plasma and 24 h pooled urine were analysed to identify characteristic diet-related patterns. Principal components analysis (PCA) scores (i.e. PC1 and PC2 scores) were used to test their combined effect on blood glucose response (primary endpoint), serum lipoproteins, triglycerides, andinflammatory markers.Results: The profiles distinguished HND and CD with AUC of 0.96 ± 0.03 and 0.93 ± 0.02 for plasma and urine, respectively, with limited heterogeneity between centers, reflecting markers of key foods. Markers of fish, whole grain and polyunsaturated lipids characterized HND, while CD was reflected by lipidscontaining palmitoleic acid. The PC1 scores of plasma metabolites characterizing the intervention is associated with HDL (β = 0.05; 95% CI: 0.02, 0.08; P = 0.001) and triglycerides (β = 0.06; 95% CI: -0.09, -0.03; P < 0.001). PC2 scores were related with glucose metabolism (2 h Glucose, β = 0.1; 95% CI: 0.05, 0.15; P < 0.001), LDL (β = 0.06; 95% CI: 0.01, 0.1; P = 0.02) and triglycerides (β 0.11; 95% CI: 0.06, 0.15; P < 0.001). For urine, the scores were related with LDL cholesterol. Conclusions: Plasma and urine metabolite profiles from SYSDIET reflected good compliance with dietary recommendations across the region. The scores of metabolites characterizing the diets associated with outcomes related with cardio-metabolic risk. Our analysis therefore offers a novel way to approach a per protocol analysis with a balanced compliance assessment in larger multicentre dietary trials.The study was registered at clinicaltrials.gov with NCT00992641.

Background: As part of the process of updating national dietary reference values (DRVs) and food-based dietary guidelines (FBDGs), the Nordic Nutrition Recommendations 2022 project (NNR2022) will select a limited number of topics for systematic reviews (SRs). Objective: To develop and transparently describe the results of a procedure for prioritisation of topics that may be submitted for SRs in the NNR2022 project. Design: In an open call, scientists, health professionals, national food and health authorities, food manufacturers, other stakeholders and the general population in the Nordic and Baltic countries were invited to suggest SR topics. The NNR2022 Committee developed scoping reviews (ScRs) for 51 nutrients and food groups aimed at identifying potential SR topics. These ScRs included the relevant nominations from the open call. SR topics were categorised, ranked and prioritised by the NNR2022 Committee in a modified Delphi process. Existing qualified SRs were identified to omit duplication. Results: A total of 45 nominations with suggestion for more than 200 exposure-outcome pairs were received in the public call. A number of additional topics were identified in ScRs. In order to omit duplication with recently qualified SRs, we defined criteria and identified 76 qualified SRs. The NNR2022 Committee subsequently shortlisted 52 PI/ECOTSS statements, none of which overlapped with the qualified SRs. The PI/ ECOTSS statements were then graded 'High' (n = 21), 'Medium' (n = 9) or 'Low' (n = 22) importance, and the PI/ECOTSS statements with 'High' were ranked in a Delphi process. The nine top prioritised PI/ECOTSS included the following exposure-outcome pairs: 1) plant protein intake in children and body growth, 2) pulses/ legumes intake, and cardiovascular disease and type 2 diabetes, 3) plant protein intake in adults, and atherosclerotic/cardiovascular disease and type 2 diabetes, 4) fat quality and mental health, 5) vitamin B12 and vitamin B12 status, 6) intake of white meat (no consumption vs. high consumption and white meat replaced with red meat), and all-cause mortality, type 2 diabetes and risk factors, 7) intake of n-3 LPUFAs from supplements during pregnancy, and asthma and allergies in the offspring, 8) nuts intake and cardiovascular disease (CVD) and type 2 diabetes in adults, 9) dietary fibre intake (high vs. low) in children and bowel function. Discussion: The selection of topics for de novo SRs is central in the NNR2022 project, as the results of these SRs may cause adjustment of existing DRVs and FBDGs. That is why we have developed this extensive process for the prioritisation of SR topics. For transparency, the results of the process are reported in this publication. Conclusion: The principles and methodologies developed in the NNR2022 project may serve as a framework for national health authorities or organisations when developing national DRVs and FBDGs. This collaboration between the food and health authorities in Denmark, Estonia, Finland, Iceland, Latvia, Lithuania, Norway and Sweden represents an international effort for harmonisation and sharing of resources and competence when developing national DRVs and FBDGs.

Obesity has been associated with low 25-hydroxy-vitamin D (25OHD). The causes of hypovitaminosis D in obese individuals are not known. The present work aimed to investigate 25OHD in obese and normal-/overweight subjects with consideration of leisure-time physical activity (LTPA).Community-dwelling old adults (N = 229, 73.7 ± 5.7yrs, 58.2% female) from the Reykjavik capital area in Iceland participated in this cross-sectional study. LTPA, vitamin D intake, body composition and background variables were assessed. 25OHD was measured in fasting blood samples.Mean LTPA was 5.7 ± 5.6 h/week and the common activities were walking and gardening. Mean 25OHD was 66.7 ± 28.1 nmol/L and 8.5/21.2% were below 30 and 50 nmol/L, respectively. Obese participants (n = 84) had lower 25OHD (-11.0 ± 3.8 nmol/L,P 0.001) and lower LTPA (-2.5 + 0.8 h/week,P = 0.001) than normal-/overweight subjects (n = 145). Linear models showed that LTPA (h/week) was associated with higher 25OHD in normal-/overweight participants only (1.3 nmol/L, P 0.001) but not in obese (-0.7 nmol, P = 0.245). Fish oil intake was associated with higher 25OHD both in normal-/overweight (19.2 ± 4.5 nmol/L, P = 0.001) and obese subjects (13.4 ± 5.3 nmol/L, P = 0.013).Obese community-dwelling old adults in Iceland have lower 25OHD than their normal-/overweight counterparts. LTPA was associated with a higher 25OHD in normal-/overweight, but not in obese participants. However, fish oil was associated with higher 25OHD independently from obesity status. Thus, vitamin D supplementation is important for obese old adults to maintain vitamin D levels.

Women who are obese before pregnancy have a higher risk of caesarean section than normal weight women. We investigated the combined effect of pre-pregnancy weight and gestational weight gain on pre-labour and intrapartum caesarean section risk. We collected data on 22,763 singleton, term, live deliveries in 2003–2014 from the Icelandic Maternal and Child Health Study (ICE-MCH), based on Icelandic registries. These were the Icelandic Medical Birth Registry and the Saga Maternal and Child Health Database. Pre-pregnancy body mass index was categorised into underweight, normal weight, overweight and obese. Gestational weight gain was classified according to the Institute of Medicine´s recommendation into below, within and above the recommended range. Logistic regression models, adjusted for maternal and gestational characteristics, were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the risk of caesarean section. Obese women had a higher risk of pre-labour (AOR 1.56, 95% CI 1.34–1.81) and intrapartum caesarean section (AOR 1.92, 95% CI 1.70–2.17) than normal weight women in all categories of gestational weight gain. Gestational weight gain above the recommended range, compared to within the range, increased the risk of intrapartum caesarean section among normal weight (AOR 1.46, 95% CI 1.23–1.73) and overweight women (AOR 1.291, 95% CI 1.04–1.60). Gestational weight gain below the recommended range, compared to within the range, increased the risk of pre-labour caesarean section (AOR 1.64, 95% CI 1.20–2.25), but only among overweight women. Women who are obese before pregnancy have a high risk of caesarean section regardless of gestational weight gain. However, women who are normal weight or overweight before pregnancy and gain weight above the recommended range during pregnancy may also have an increased risk of caesarean section.

Growth rate is regulated by hormonal pathways that might affect early cancer development. We explored the association between rate of growth in height from ages 8 to 13 years (childhood) and from age 13 to attainment of adult height (adolescence), as measured at study entry, and the risk of breast or prostate cancer. Participants were 2,037 Icelanders born during 1915–1935, who took part in the Reykjavik Study, established in 1967. Height measurements were obtained from school records and at study entry. We used multivariable Cox regression models to calculate hazard ratios with 95% confidence intervals of breast and prostate cancer by rates of growth in tertiles. During a mean follow-up of 66 years (women) and 64 years (men), 117 women were diagnosed with breast cancer and 118 men with prostate cancer (45 with advanced disease). Women in the highest growth-rate tertile in adolescence had a higher risk of breast cancer (hazard ratio = 2.4, 95% confidence interval: 1.3, 4.3) compared with women in the lowest tertile. A suggestive inverse association was observed for highest adolescent growth rate in men and advanced prostate cancer: hazard ratio = 0.4, 95% confidence interval: 0.2, 1.0. Rapid growth, particularly in adolescence may affect cancer risk later in life.

Publisher's version (útgefin grein), Iodine is an essential nutrient for growth and development during infancy. Data on iodine status of exclusively (EBF) and partially breastfed (PBF) infants as well as breast milk iodine concentration (BMIC) are scarce. We aimed to assess (a) infant iodine nutrition at the age of 5.5 months by measuring urinary iodine concentration (UIC) in EBF (n = 32) and PBF (n = 28) infants and (b) mothers' breast milk iodine concentration (n = 57). Sixty mother–infant pairs from three primary health care centres in Reykjavik and vicinities provided urine and breast milk samples for iodine analysis and information on mothers' habitual diet. The mother–infant pairs were participants of the IceAge2 study, which focuses on factors contributing to infant growth and development, including body composition and breast-milk energy content. The median (25th–75th percentiles) UIC was 152 (79–239) μg/L, with no significant difference between EBF and PBF infants. The estimated median iodine intake ranged from 52 to 86 μg/day, based on urinary data (assuming an average urine volume of 300–500 ml/day and UIC from the present study). The median (25th–75th percentiles) BMIC was 84 (48–114) μg/L. It is difficult to conclude whether iodine status is adequate in the present study, as no ranges for median UIC reflecting optimal iodine nutrition exist for infants. However, the results add important information to the relatively sparse literature on UIC, BMIC, and iodine intake of breastfed infants., We would like to thank all the infants and their mothers for participat-ing in the study. Furthermore, we are grateful to the primary healthcare centres for their part in the recruitment process. The Iceage2study (Growth and Body Composition in Breastfed Infants: Study onAge of Introduction of Complementary Foods in Iceland, clinicaltrials.gov identifier NCT02586571) was funded by the University of Iceland Research fund. Analysis of UIC and BMIC was funded by NordicWorking Group for Diet, Food & Toxicology (NKMT), and EUthyroidproject (funded by the Horizon 2020 Framework Programme forResearch and Innovation) with Grant agreement 634453.

BACKGROUND: Recently, a group of betainized compounds have been suggested to play a role in health effects in relation to a whole-grain-rich diet.OBJECTIVES: The aims of this study were to develop a quantitative mass spectrometric method for selected betainized compounds in human plasma, and to investigate their association with nutrient intake and measures of metabolic health in participants of the SYSDIET study.METHODS: The SYSDIET study was a controlled randomized intervention including individuals with metabolic syndrome, where the healthy Nordic diet (HND) group increased intakes of whole grains, canola oil, berries, and fish, whereas the control diet (CD) group consumed low-fiber cereal products, milk fat, and restricted amounts of fish and berries. A quantitative LC combined with triple quadrupole MS method for betainized compounds was developed and applied to fasting plasma samples from baseline (week 0) and the end of the intervention (week 18 or 24). Concentrations of betainized compounds were correlated with intakes of selected nutrients and fiber and measures of metabolic health.RESULTS: Pipecolic acid betaine (PAB) concentrations were significantly higher in the HND group than in the CD group (P = 0.00032) at the end of the intervention and correlated directly (P < 0.0001) with intakes of dietary fiber (r = 0.376) and a biomarker related to whole-grain rye intake, namely the ratio of alkylresorcinol C17:0 to C21:0 (r = 0.442). PAB was associated inversely with fasting plasma insulin consistently at the beginning and at the end of the intervention (P < 0.001, r = -0.300; P < 0.01, r = -0.250, respectively), as well as IL-1 receptor antagonist (P < 0.01, r = -0.232 at the beginning; P < 0.01, r = -0.236 at the end) and serum LDL/HDL cholesterol (P < 0.01, r = -0.239 at the beginning; P < 0.01, r = -0.241 at the end).CONCLUSIONS: Among adults with the metabolic syndrome, PAB plasma concentrations were associated with fasting insulin, inflammation, and lipids and were significantly increased with adoption of the HND. Further studies are needed to clarify the biological functions of betainized compounds. This trial was registered at clinicaltrials.gov as NCT00992641.

Nordic Nutrition Recommendations (NNR) recommend exclusive breastfeeding until 6 months, partial breastfeeding until 1 year or longer and irrespective of breastfeeding, avoiding solid foods before 4 months. Strong evidence was found for benefits of breastfeeding regarding growth and infections but limited/inconclusive evidence regarding atopic disease and asthma. Vitamin D is of special interest in the Nordic diet. The aim of this prospective study was to compare infant feeding and vitamin D between immunoglobulin E (IgE) sensitized (n = 14) and non-sensitized (n = 130) children at 6 years. Information on diet and vitamin D supplement use were collected with dietary recall (&lt, 5 months), 1-d food records (5 and 6 months) and 3-d weighed food records (12 months and 6 years). Serum-specific IgE-antibodies against milk, egg, cod, wheat, soy and peanut (cut-off specific IgE &ge, 0.35 kUA/L) were measured at 6 years and serum 25-hydroxyvitamin D at 12 months and 6 years. At 4 months, 57% of IgE sensitized vs. 23% of non-sensitized children (p &lt, 0.01) had received solid food. At 12 months, IgE sensitized children had a lower intake of vitamin D (median (25th, 75th percentiles): 3.9 &mu, g/d (3.2, 7.2) vs. 8.1 &mu, g/d (4.4, 12.3), p = 0.03) and at 6 years, fewer used vitamin D supplements regularly (23% vs. 56%, p = 0.03). Introduction of solid foods prior to 4 months increased the odds of IgE-sensitization, OR = 4.9 (95%, CI = 1.4&ndash, 16.6) and vitamin D supplement at 6 years decreased the odds of IgE-sensitization, OR = 0.2 (95%, CI = 0.1&ndash, 0.98), adjusting for maternal smoking. These observations support the NNR in their recommendation against introducing complementary solid foods before the age of 4 months. Furthermore, they support encouraging vitamin D intake for young children at northern latitudes.

Scope. To explore the effect of a healthy Nordic diet on the global transcriptome profile in peripheral blood mononuclear cells (PBMCs) of subjects with metabolic syndrome. Methods and results. Subjects with metabolic syndrome undergo a 18/24 week randomized intervention study comparing an isocaloric healthy Nordic diet with an average habitual Nordic diet served as control (SYSDIET study). Altogether, 68 participants are included. PBMCs are obtained before and after intervention and total RNA is subjected to global transcriptome analysis. 1302 probe sets are differentially expressed between the diet groups (p‐value < 0.05). Twenty‐five of these are significantly regulated (FDR q‐value < 0.25) and are mainly involved in mitochondrial function, cell growth, and cell adhesion. The list of 1302 regulated probe sets is subjected to functional analyses. Pathways and processes involved in the mitochondrial electron transport chain, immune response, and cell cycle are downregulated in the healthy Nordic diet group. In addition, gene transcripts with common motifs for 42 transcription factors, including NFR1, NFR2, and NF‐κB, are downregulated in the healthy Nordic diet group. Conclusion. These results suggest that benefits of a healthy diet may be mediated by improved mitochondrial function and reduced inflammation. The project was funded by NordForsk Nordic Centre of Excellencein Food, Nutrition and Health project 070014 (SYSDIET [Systems Biologyin Controlled Dietary Interventions and Cohort Studies]) and further, OsloMetropolitan University-OsloMet (Norway), University of Oslo (Norway),Throne Holst Foundation (Norway), Academy of Finland, SwedishResearch Council, Svenska Diabetesf ̈orbundet, SRP Diabetes, FinnishDiabetes Research Foundation, Finnish Foundation for CardiovascularResearch, the Sigrid Juselius Foundation, EVO funding from KuopioUniversity Hospital (Finland), the Druvan Foundation, Sk ̊ane UniversityHospital, the Heart-Lung Foundation, Diabetesfonden and FoundationCerealia (Sweden), the Danish Obesity Research Centre (DanORC,www.danorc.dk), the Danish Council for Strategic Research (DairyHealth,BioFunCarb) (Denmark), the Agricultural Productivity Fund, and theResearch Fund of the University of Iceland (Iceland).

Background: A previous randomized dietary intervention in pregnant women from the 1970s, the Harlem Trial, reported retarded fetal growth and excesses of very early preterm births and neonatal deaths among those receiving high-protein supplementation. Due to ethical challenges, these findings have not been addressed in intervention settings. Exploring these findings in an observational setting requires large statistical power due to the low prevalence of these outcomes. The aim of this study was to investigate if the findings on high protein intake could be replicated in an observational setting by combining data from two large birth cohorts. Methods: Individual participant data on singleton pregnancies from the Danish National Birth Cohort (DNBC) (n = 60,141) and the Norwegian Mother, Father and Child Cohort Study (MoBa) (n = 66,302) were merged after a thorough harmonization process. Diet was recorded in mid-pregnancy and information on birth outcomes was extracted from national birth registries. Results: The prevalence of preterm delivery, low birth weight and fetal and neonatal deaths was 4.77%, 2.93%, 0.28% and 0.17%, respectively. Mean protein intake (standard deviation) was 89 g/day (23). Overall high protein intake (&gt, 100 g/day) was neither associated with low birth weight nor fetal or neonatal death. Mean birth weight was essentially unchanged at high protein intakes. A modest increased risk of preterm delivery [odds ratio (OR): 1.10 (95% confidence interval (CI): 1.01, 1.19)] was observed for high (&gt, 100 g/day) compared to moderate protein intake (80&ndash, 90 g/day). This estimate was driven by late preterm deliveries (weeks 34 to &lt, 37) and greater risk was not observed at more extreme intakes. Very low (&lt, 60 g/day) compared to moderate protein intake was associated with higher risk of having low-birth weight infants [OR: 1.59 (95%CI: 1.25, 2.03)]. Conclusions: High protein intake was weakly associated with preterm delivery. Contrary to the results from the Harlem Trial, no indications of deleterious effects on fetal growth or perinatal mortality were observed.

Background: Quality of life (QOL) is a multidimensional concept which is often used as an evaluation of a person‘s health and psychological status. Increasing longevity can be associated with better QOL as long as older adults are independent in daily life. The aim of the study was to examine the associations of QOL with muscle strength and physical function among community-dwelling older adults. Methods: The current cross-sectional study had 225 participants (73.7±5.7yrs, 58.2% female) living in Reykjavik, Iceland. QOL measured using the 36-item short-form survey (SF-36). Covariates were anthropometrics, muscle strength, physical function including timed up and go test (TUG), and 6-minute walking distance (6MWD), physical activity per week (PA). Linear regression analysis was used to examine the association of QOL with physical function. Results: The mean QOL score for the study population was 54.9±6.13. The analysis was adjusted for age and gender, body mass index, height, and PA. We found that QOL was associated with better grip strength (B=1.4, P

Publisher's version (útgefin grein), Objectives. Obesity-related physiological changes can limit improvements of obese subjects after training. The aim was to investigate obesity, muscular strength, and physical function in community-dwelling nonsarcopenic old adults. Methods. Nonsarcopenic subjects (N=229, 73.7 ± 5.7 years; 21% normal weight, 42% overweight, and 37% obese based on body mass index (BMI)) participated in a 12-week resistance exercise program. Leisure time physical activity (LTPA), body composition (dual-energy X-ray absorptiometry), quadriceps strength (maximum voluntary isometric contraction; absolute and relative to body weight), and physical function in terms of 6-minutes-walk-for-distance (6MWD) and timed up and go (TUG) were measured baseline and endpoint. Results. At baseline, normal weight participants had lower absolute quadriceps strength (-43 ± 22 N, P=0.015) than obese, but better quadriceps strength relative to body weight (1.4 ± 0.7 N/kg, P, This study was part of the IceProQualita project, which was funded by the Icelandic Technology Development Fund (no 071323008), Research Fund of the University of Iceland, a grant from Landspitali University Hospital Research Fund, and the Helga Jonsdottir and Sigurlidi Kristjansson Geriatric Research Fund.

Publisher's version (útgefin grein)., A healthy dietary pattern is associated with a lower risk of metabolic syndrome (MetS) and reduced inflammation. To explore this at the molecular level, we investigated the effect of a Nordic diet (ND) on changes in the gene expression profiles of inflammatory and lipid-related genes in peripheral blood mononuclear cells (PBMCs) of individuals with MetS. We hypothesized that the intake of an ND compared to a control diet (CD) would alter the expression of inflammatory genes and genes involved in lipid metabolism. The individuals with MetS underwent an 18/24-week randomized intervention to compare a ND with a CD. Eighty-eight participants (66% women) were included in this sub-study of the larger SYSDIET study. Fasting PBMCs were collected before and after the intervention and changes in gene expression levels were measured using TaqMan Array Micro Fluidic Cards. Forty-eight pre-determined inflammatory and lipid related gene transcripts were analyzed. The expression level of the gene tumor necrosis factor (TNF) receptor superfamily member 1A (TNFRSF1A) was down-regulated (p = 0.004), whereas the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) subunit, RELA proto-oncogene, was up-regulated (p = 0.016) in the ND group compared to the CD group. In conclusion, intake of an ND in individuals with the MetS may affect immune function., Funding: This research was funded by the NordForsk Nordic Centre of Excellence in Food, Nutrition and Health project 070014 [SYSDIET (Systems Biology in Controlled Dietary Interventions and Cohort Studies)] and further, the University of Oslo (Norway), Throne Holst Foundation (Norway), Academy of Finland, Swedish Research council, Svenska Diabetesförbundet, SRP Diabetes, Finnish Diabetes Research Foundation, Finnish Foundation for Cardiovascular Research, the Sigrid Juselius Foundation, EVO funding from Kuopio University Hospital (Finland), the Druvan Foundation, Skåne University Hospital, the Heart-Lung Foundation, Diabetesfonden and Foundation Cerealia (Sweden), the Agricultural Productivity Fund, and the Research Fund of the University of Iceland (Iceland). Acknowledgments: We thank Maritta Siloaho for their excellent expertise and advice for biochemical measurements and Marika Rönnholm for their excellent technical assistance.

Background: Hemoglobin transports oxygen in blood yet its concentrations generally decrease with age. The aim of the study was to examine whether hemoglobin is connected with physical function in older age people. Design: Intervention study. Setting: Community. Participants: Older adults (N=236, 73.7±5.7 years, 58.2% female). Intervention: A 12-week resistance exercise program (3 times/week; 3 sets, 6-8 repetitions at 75-80% of the 1-repetition maximum) was conducted to increase strength and muscle mass of major muscle groups. Measurements: Anthropometrics, muscle strength, timed up and go (TUG in sec), six-minute walking distance (6MWD in m) and blood chemical variables were measured at baseline, endpoint and after 10.7 months followup. The linear regression model was used to examine the association between baseline hemoglobin and physical function outcome. Results: Only about 4% of the participants were anemic. According to calculations baseline hemoglobin was associated with TUG (0.14 to 0.36 sec improvement by 10 g/L increase of hemoglobin) at all-time points, even though this was of borderline significance for baseline (p=0.57) and endpoint (p=0.062). Hemoglobin also predicted endpoint 6 MWD (4.88m), but not at baseline (follow up 6 MWD was not available). Statistical correction for compliance did not influences results. Conclusion: Hemoglobin is positively associated to physical function in community dwelling old aged people. Additionally, we found that baseline hemoglobin is associated to adaptions to 12-week resistance exercise training and changes in physical function during the follow-up., Rannís (No 071323008), Rannsóknarsjóður Háskóla Íslands, Styrkur frá Landspítala Hákólasjúkrahúsi Helga Jonsdottir and Sigurlidi Kristjansson Geriatric Research Fund.

Background: The association between obesity and vitamin D level has been reported in community-dwelling healthy adults as well as in hospitalized patients. A deficit of 25 hydroxyvitamin D (25OHD) is also associated with various negative health consequences in older adults. The aim of the current study was to compare 25OHD in different BMI status (obese, normal, overweight) with particular consideration of physical activity, season and fish oil intake, the most important dietary source of vitamin D in Iceland. Methods: Total of 236 Subjects (73.7 ± 5.7 years) participated in the cross-sectional study. Anthropometrics, health screening questionnaire, physical & cognitive function, physical activity, dietary intake, parathyroid hormone, and quality of life (QoL) were measured. Results: Mean concentrations of 25OHD were 66.7 ± 28.1 nmol/L in our participants. Obese participants had lower 25OHD, higher parathyroid hormone, exercised less and were less likely to take fish oil compared with normal and overweight participants. The results indicate that physical activity was associated with higher 25OHD among people with normal- and overweight BMI but not in people with obese BMI. Fish oil intake was associated with higher 25OHD independently from BMI status. Conclusions: Our study shows that obese community-dwelling older adults in Iceland have lower 25OHD than their normal-/overweight counterparts. We also found that the level of leisure time physical activity was associated with higher 25OHD in normal-/overweight, but not in obese participants. On the other hand, vitamin D supplementation in the form of fish oil was associated with higher 25OHD regardless of BMI status.

Background: In 2004 a publication in Science by Hites et al. reported a 10 to 100-fold higher concentrations of persistent organochlorine pollutants (POPs) in farmed Atlantic salmon compared to wil...

This report summarizes a Nordic symposium on the current use and challenges in applying a dual risk assessment approach in the setting of nutrition recommendations. The symposium is timed with resp ...

Background: Decline in both physical function and cognition among older adults has been associated with increased risk of dementia. Physical activity (PA) is beneficial for the improvement of both physical and cognitive function. The purpose of the study was to investigate the association between baseline physical function and cognitive function after 12 weeks of resistance training among older adults. Methods: Two hundred and thirty-seven community-dwelling older adults (N=237, 73.7±5.7 years, 58.2% female) participated in a 12-week resistance exercise program (3 times/week; 3 sets, 6-8 repetitions at 75-80% of the 1-repetition maximum), designed to increase strength and muscle mass of major muscle groups. Body composition, physical activity status, grip strength, cardiovascular risk factors, 6 minutes walking distance (6MWD), and Mini-Mental State Examination (MMSE) were measured at baseline and endpoint. The linear regression model was used to examine the association. Results: Mean MMSE score was 27.5±2.1 at baseline and 28.1±2.2 after the exercise intervention. After the intervention, 57 declined, 55 remained the same, and 120 have improved in MMSE scores. We found that the MMSE score after the intervention was significantly associated with baseline grip strength (beta=.03, P

BACKGROUND: A healthy Nordic diet is associated with improvements in cardiometabolic risk factors, but the effect on lipidomic profile is not known.OBJECTIVE: The aim was to investigate how a healthy Nordic diet affects the fasting plasma lipidomic profile in subjects with metabolic syndrome.METHODS: Men and women (n = 200) with features of metabolic syndrome [mean age: 55 y; body mass index (in kg/m(2)): 31.6] were randomly assigned to either a healthy Nordic (n = 104) or a control (n = 96) diet for 18 or 24 wk at 6 centers. Of the participants, 156 completed the study with plasma lipidomic measurements. The healthy Nordic diet consisted of whole grains, fruits, vegetables, berries, vegetable oils and margarines, fish, low-fat milk products, and low-fat meat. An average Nordic diet served as the control diet and included low-fiber cereal products, dairy fat-based spreads, regular-fat milk products, and a limited amount of fruits, vegetables, and berries. Lipidomic profiles were measured at baseline, week 12, and the end of the intervention (18 or 24 wk) by using ultraperformance liquid chromatography mass spectrometry. The effects of the diets on the lipid variables were analyzed with linear mixed-effects models. Data from centers with 18- or 24-wk duration were also analyzed separately.RESULTS: Changes in 21 plasma lipids differed significantly between the groups at week 12 (false discovery rate P < 0.05), including increases in plasmalogens and decreases in ceramides in the healthy Nordic diet group compared with the control group. At the end of the study, changes in lipidomic profiles did not differ between the groups. However, when the intervention lasted 24 wk, changes in 8 plasma lipids that had been identified at 12 wk, including plasmalogens, were sustained. There were no differences in changes in plasma lipids between groups with an intervention of 18 wk. By the dietary biomarker score, adherence to diet did not explain the difference in the results related to the duration of the study.CONCLUSIONS: A healthy Nordic diet transiently modified the plasma lipidomic profile, specifically by increasing the concentrations of antioxidative plasmalogens and decreasing insulin resistance-inducing ceramides. This trial was registered at clinicaltrials.gov as NCT00992641.

Cod liver oil is a traditional source of vitamin D in Iceland, and regular intake is recommended partly for the sake of bone health. However, the association between lifelong consumption of cod liver oil and bone mineral density (BMD) in old age is unclear. The present study attempted to assess the associations between intake of cod liver oil in adolescence, midlife, and old age, and hip BMD in old age, as well as associations between cod liver oil intake in old age and serum 25-hydroxyvitamin D (25(OH)D) concentration. Participants of the Age, Gene/Environment Susceptibility–Reykjavik Study (age 66–96 years; n 4798), reported retrospectively cod liver oil intake during adolescence and midlife, as well as the one now in old age, using a validated FFQ. BMD of femoral neck and trochanteric region was measured by volumetric quantitative computed tomography, and serum 25(OH)D concentration was measured by means of a direct, competitive chemiluminescence immunoassay. Associations were assessed using linear regression models. No significant association was seen between retrospective cod liver oil intake and hip BMD in old age. Current intake of aged men was also not associated with hip BMD, while aged women with daily intakes had z-scores on average 0·1 higher, compared with those with an intake of P for trend

Background: Deficits in n-3 fatty acids may be associated with depression. However, data are scarce from older adults who are at greater risk of poor dietary intake and of developing depression. Objective: To investigate proportion of plasma phospholipid fatty acids with respect to depressive symptoms and major depressive disorder in community dwelling older adults. Methods: Cross-sectional analyses of 1571 participants in the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study aged 67-93 years. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS-15). Major depressive disorder was assessed according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria using the Mini-International Neuropsychiatric Interview (MINI). Results: Depressive symptoms were observed in 195 (12.4%) subjects and there were 27 (1.7%) cases of major depressive disorder. Participants with depressive symptoms were less educated, more likely to be smokers, less physically active and consumed cod liver oil less frequently. Difference in GDS-15 scores by tertiles of n-3 fatty acid proportion was not significant. Proportion of long chain n-3 fatty acids (Eicosapentaenoic- + Docosahexaenoic acid) were inversely related to major depressive disorder, (tertile 2 vs. tertile 1) OR: 0.31 (95% CI: 0.11, 0.86); tertile 3 vs. tertile 1, OR: 0.45 (95% CI: 0.17, 1.21). Conclusion: In our cross sectional analyses low proportions of long chain n-3 fatty acids in plasma phospholipids appear to be associated with increased risk of major depressive disorder. However, the results from this study warrant further investigation in prospective setting with sufficiently long follow-up.

Body mass index (BMI) does not necessarily predict cardiovascular disease in old populations which has been called obesity paradox. The aims of the present study were to investigate 1) the associations between BMI and body fat in old adults, and 2) whether more sophisticated measures of body fat are stronger associated with cardiovascular risk than BMI. In the current cross-sectional analysis, the participants‘(N=232, 65-92 years) body fatness was estimated using BMI, waist-circumference, DXA (fat mass, visceral fat mass) and cardiovascular risk factors (blood lipids, glucose metabolism, blood pressure) were assessed. BMI correlated highly with fat mass measured by DXA independently from age tertiles and in both genders. In general, body fatness was positively related to several cardiovascular risk factors and this was persistently observed for all the different measures of body fatness. However, fat measures were not associated with total cholesterol or LDL. Sensitivity analysis indicated that BMI ≥ 25 identifies 70-100% of participants with the above mentioned cardiovascular risk factors outside normal range. We conclude in BMI is highly correlated with body fatness in old Icelandic adults. DXA measurement of body fatness is not better in estimating cardiovascular risk in old adults compared to simple BMI.

inngangur: Niðurstoður fyrri rannsokna benda til þess að offita se algengari meðal kvenna utan hofuðborgarsvaeðis en innan, en engar sam - baerilegar upplýsingar eru til fyrir karla. Tilgangur þessarar rannsoknar var að kanna holdafar og mataraeði islenskra kvenna og karla eftir busetu. Efniviður og aðferðir: Þatttakendur voru 1312 konur og karlar, 18-80 ara, valin með slembiurtaki ur þjoðskra, heildarsvorun 68,6%. Mataraeði var kannað arin 2010 til 2011 með tvitekinni solarhringsupprifjun og jafn - framt var spurt um haeð og þyngd, auk bakgrunnsspurninga. Reiknað var likindahlutfall (oR) þess að vera yfir kjorþyngd (likamsþyngdarstuðull ≥ kg/m2) ut fra busetu og menntun. niðurstoður: Konur ≥46 ara innan hofuðborgarsvaeðis voru með laegri likamsþyngdarstuðul en konur utan hofuðborgarsvaeðis (25,7 kg/m 2 a moti 28,4 kg/m 2 p=0,007) og likindahlutfall fyrir likamsþyngdarstuðul ≥25 kg/ m 2 var laegra samanborið við konur i sama aldurshopi utan hofuðborgar - svaeðis, oR=0,64 (95% oryggisbil 0,41;1,0). Enginn munur var meðal karla eða yngri kvenna. Faeði folks utan hofuðborgarsvaeðis var fiturikara og hlutfall mettaðra fitusýra og transfitusýra var haerra en innan svaeðis. Hlutfall mettaðra fitusýra i faeði var 15,7E% a moti 13,9E%, p

BACKGROUND: Previously, a healthy Nordic diet (ND) has been shown to have beneficial health effects close to those of Mediterranean diets.OBJECTIVE: The objective was to explore whether the ND has an impact on gene expression in abdominal subcutaneous adipose tissue (SAT) and whether changes in gene expression are associated with clinical and biochemical effects.DESIGN: Obese adults with features of the metabolic syndrome underwent an 18- to 24-wk randomized intervention study comparing the ND with the control diet (CD) (the SYSDIET study, carried out within Nordic Centre of Excellence of the Systems Biology in Controlled Dietary Interventions and Cohort Studies). The present study included participants from 3 Nordic SYSDIET centers [Kuopio (n = 20), Lund (n = 18), and Oulu (n = 18)] with a maximum weight change of ±4 kg, highly sensitive C-reactive protein concentration RESULTS: Altogether, 128 genes were differentially expressed in SAT between the ND and CD (nominal P < 0.01; false discovery rate, 25%). These genes were overrepresented in pathways related to immune response (adjusted P = 0.0076), resulting mainly from slightly decreased expression in the ND and increased expression in the CD. Immune-related pathways included leukocyte trafficking and macrophage recruitment (e.g., interferon regulatory factor 1, CD97), adaptive immune response (interleukin32, interleukin 6 receptor), and reactive oxygen species (neutrophil cytosolic factor 1). Interestingly, the regulatory region of the 128 genes was overrepresented for binding sites for the nuclear transcription factor κB.CONCLUSION: A healthy Nordic diet reduces inflammatory gene expression in SAT compared with a control diet independently of body weight change in individuals with features of the metabolic syndrome. The study was registered at clinicaltrials.gov as NCT00992641.

Background. Resistance exercise training can be effective against sarcopenia. We identified predictors of drop-out and compared physical outcomes between men and women after such training.Methods. Subjects (N=236,73.7±5.7years) participated in a 12-week resistance exercise program. Outcome variables were measured at baseline and endpoint.Results. Drop-out was 11.9% and not significantly different between genders. Drop-outs were significantly older and had poorer strength and physical function in comparison to completers. Anthropometrics, QoL, and cognitive function were not related to drop-out. According to multivariate analysis, gait speed and physical activity were the strongest predictors of drop-out. After the training, gains in lean mass or appendicular muscle were significantly higher in men than women; however relative gains in appendicular muscle as well as absolute improvements in strength and function were similar in men and women, respectively.Conclusions. Participants who drop out are older, have poorer physical function, and are less physically active. Old women do not drop out more frequently than men and show meaningful improvements in relevant outcomes similar to men after such a training program. The trial is registered at the US National Library of Medicine (NCT01074879).

The prevalence of lifestyle related diseases is higher among people with psychotic disorders than the general population. The aim was to assess dietary intake of young people with psychotic disorders for the first time in Iceland.Subjects were young people (n=48, age 18-30y) with psychotic disorders. Dietary intake was assessed by a 24-hour recall in July-August 2016, and compared with official recommendations and intake of the general public (n=250, age 18-30y). Body weight in the past eight to 12 months, was retrieved from medical records.Consumption of fruits, fish, dairy products, vegetable and fish oil was significantly lower among subjects when compared with the general public, while their soft drink and sweets consumption was higher (p0.001). Furthermore, the contribution of added sugar was higher (15E% vs. 12E%) and protein intake lower (16E% vs. 18E%). Consumption of omega-3 fatty acids and vitamin D was lower among subjects than the general public and lower than recommended (0.04±0.3% omega-3 of total energy vs. 1.2±0.6%, p0.001 and 3.1±4.2 µg vitamin D/day vs. 5.6±6.5 µg/day, p0.001). Almost 40% of the subjects had gained5% of their initial body weight in the past 8-2 months.Diet of young people with psychotic disorders is not consistent with recommendations and is worse than the diet of their peers in the general population. It is important to find ways to improve the diet and thereby nutrient intake of the group. Key words: psychotic disorders, schizophrenia, recommended dietary allowances, fatty acids, omega-3, vitamin D. Correspondence: Ingibjorg Gunnarsdottir, ingigun@landspitali.is.

Tilgangur: Tíðni lífsstílssjúkdóma er hærri meðal einstaklinga með geð- rofssjúkdóma en almennings. Tilgangur rannsóknarinnar var að kanna fæðuval ungs fólks með geðrofssjúkdóma, en fæðuval þessa hóps hefur aldrei verið kannað hérlendis áður. Efniviður og aðferðir: Þátttakendur voru þjónustuþegar Laugarássins (n=48, 18-30 ára), sem sóttu þjónustu á því tímabili sem gagnaöflun fór fram (júlí- ágúst 2016). Fæðuval og næringargildi fæðu var metið með sólarhringsupprifjun á mataræði. Niðurstöður voru bornar saman við ráð- leggingar Embættis landlæknis og niðurstöður landskönnunar á mataræði 2010-2011 fyrir sama aldurshóp (n=250). Þróun líkamsþyngdar síðastliðna 8-12 mánuði var metin út frá skráðum upplýsingum í sjúkraskrá (Sögu). Niðurstöður: Neysla á ávöxtum, fiski, mjólkurvörum, jurtaolíum og lýsi var marktækt lægri meðal þjónustuþega en hjá þátttakendum í landskönnun 2010-2011, en neysla á sælgæti og gosdrykkjum hærri (p5% af upphafs- þyngd sinni á 8-12 mánaða tímabili. Ályktanir: Fæðuval ungs fólks með geðrofssjúkdóma samræmist ekki opinberum ráðleggingum um fæðuval og er lakara en fæðuval viðmiðunarhópsins. Mikilvægt er að þróa leiðir til að bæta fæðuval og þar með næringargildi fæðu hópsins., Introduction: The prevalence of lifestyle related diseases is higher among people with psychotic disorders than the general population. The aim was to assess dietary intake of young people with psychotic disorders for the first time in Iceland. Material and methods: Subjects were young people (n=48, age 18-30y) with psychotic disorders. Dietary intake was assessed by a 24-hour recall in July-August 2016, and compared with official recommendations and intake of the general public (n=250, age 18-30y). Body weight in the past eight to 12 months, was retrieved from medical records. Results: Consumption of fruits, fish, dairy products, vegetable and fish oil was significantly lower among subjects when compared with the general public, while their soft drink and sweets consumption was higher (p5% of their initial body weight in the past 8-2 months. Conclusion: Diet of young people with psychotic disorders is not consistent with recommendations and is worse than the diet of their peers in the general population. It is important to find ways to improve the diet and thereby nutrient intake of the group.

Introduction Here we compare results on food and nutrient intake from the two most recent Icelandic national nutrition surveys from 2010/11 and 2002 and compare intake of energy giving nutrients from 1990. Finally we assess associations beween a healthy diet and difficulties people have in making ends meet. Materials and methods Participants were selected by a random sample from the national register. Final sample was 1912 individuals in 2010/11 and 1934 in 2002, response rate 68.6% and 70.6% respectively. Diet was assessed by 24-hour recall. Results from the surveys were calculated using t-test and sssociations between a healthy diet and difficulties making ends meet by linear regression. Results Consumption of bread, bisquits, cakes and cookies, margarine, highly processed meat products, chips, sugared soft drinks and whole milk was lower in 2010/11 than in 2002 while consumption of whole grain bread, oat meal, fruits, vegetables, meat and cod liver oil was higher. Fish intake was unchanged. Fat intake decreased from 1990 to 2010/11, from 41E% to 35E%, saturated fatty acids from 20.0E% to 14.5E% and trans-fatty acids from 2.0E% to 0.8E%. Most of the changes occurred between 1990 and 2002. People having difficulties making ends meet consumed less fruits, vegetables and whole grain bread but more soft drinks in 2010/11 than those not having difficulties. Conclusion Dietary changes in Iceland from 2002 have mostly been toward recommended intake. Between 1990 and 2002 fat consumption decreased considerably, while less significant changes occurred from 2002 til 2010/11. Economic status is associated with healthy diet in Iceland.

Little is known about the mediating effects of the determinants of fruit and vegetable (FV) intake in school-based interventions that promote FV intake, and few studies have examined the impact of the degree of implementation on the effects of an intervention. The present study examined whether the degree of implementation of an intervention had an effect on children's fruit or vegetable intake and determined possible mediators of this effect. The study is part of the European PRO GREENS intervention study which aimed to develop effective strategies to promote consumption of fruit and vegetables in schoolchildren across Europe. Data from 727 Finnish children aged 11 years were used. The baseline study was conducted in spring 2009 and the follow-up study 12 months later. The intervention was conducted during the school year 2009–2010. The effects were examined using multilevel mediation analyses. A high degree of implementation of the intervention had an effect on children's fruit intake. Knowledge of recommendations for FV intake and liking mediated the association between a high degree of implementation of the intervention and an increase in the frequency of fruit intake. Knowledge of recommendations for FV intake and bringing fruits to school as a snack mediated the association between a low degree of implementation of the intervention and an increase in the frequency of fruit intake. Overall, the model accounted for 34 % of the variance in the change in fruit intake frequency. Knowledge of recommendations acted as a mediator between the degree of implementation of the intervention and the change in vegetable intake frequency. In conclusion, the degree of implementation had an effect on fruit intake, and thus in future intervention studies the actual degree of implementation of interventions should be assessed when considering the effects of interventions.

Breastfeeding has several advantages for both mother and child. Lactation consultants may promote prolonged breastfeeding, but little is known about their impact on the initiation of complementary feeding.Dietary intake during the initial complementary feeding period from 5 to 6 months was collected on mother-infant pairs who had unlimited access to lactation consultants along with those mother-infant pairs who received routine care at the well-baby clinics. The total duration of breastfeeding in each study population was also recorded, and total breastfeeding durations of infants receiving complementary foods from 4 months and those exclusively breastfed for 6 months in each of the two study populations were compared.Higher proportion of infants of mothers with unlimited access to lactation consultants were fed vegetable and vegetable purées (p=0.05) and more than one food type (p=0.05) at 5 months. Furthermore, a lower percentage of them had three meals per day at 6 months (p=0.001) compared with those receiving routine care at the well-baby clinics. Infants exclusively breastfed for 6 months all had similar duration of total breastfeeding.Mother-infant pairs with unlimited access to lactation consultant had slower introduction of complementary foods at the initial complementary feeding period, according to number of infant's meals at 6 months of age. Furthermore, those exclusively breastfed for 6 months had more prolonged breastfeeding compared with mothers who began complementary feeding at 4 months regardless of exposure to lactation consultants.