Afsaneh Koochek - Profile on Academia.edu (original) (raw)

Papers by Afsaneh Koochek

Perceptions and experiences of eating alone among community-living retired Swedes: Loss, routine and independence

Appetite, Jul 1, 2023

Perceptions and experiences of eating alone among community-living retired Swedes: Loss, routine and independence

Appetite

Diet quality and cardiovascular outcomes: A systematic review and meta‐analysis of cohort studies

Nutrition & Dietetics, Dec 20, 2023

An adequate documentation in medical records

RESEARCH ARTICLE Open Access Dietary differences between elderly Iranians living

study

The Journal of Nutrition Health and Aging, 2008

Background: Nutritional problems are common in frail elderly individuals receiving municipal care... more Background: Nutritional problems are common in frail elderly individuals receiving municipal care. Objective: To evaluate if an additional evening meal could improve total daily food intake, nutritional status, and health-related quality of life (HRQOL) in frail elderly service flat (SF) residents. Design: Out of 122 residents in two SF complexes, 60 subjects agreed to participate, of which 49 subjects (median 84 (79-90) years, (25th-75th percentile)) completed the study. For six months 23 residents in one SF complex were served 530 kcal in addition to their regular meals, i.e. intervention group (I-group). Twenty-six residents in the other SF building were controls (C-group). Nutritional status, energy and nutrient intake, length of night time fast, cognitive function and HRQOL was assessed before and after the intervention. Results: At the start, the Mini Nutritional Assessment classified 27% as malnourished and 63% as at risk for malnutrition, with no difference between the groups. After six months the median body weight was unchanged in the I-group, +0.6 (-1.7 -+1.6) kg (p=0.72) and the Cgroup -0.6 (-2.0 -+0.5) kg (p=0.15). Weight change ranged from -13% to +15%. The evening meal improved the protein and carbohydrate intake (p<0.01) but the energy intake increased by only 180 kcal/day (p=0.15). The night time fast decreased in the I-group from 15.0 (13.0-16.0) to 13.0 (12.0-14.0) hours (p<0.05). There was no significant difference in cognitive function or HRQOL between the groups. Conclusion: Nine out of ten frail elderly SF residents had nutritional problems. Serving an additional evening meal increased the protein and carbohydrate intake, but the meal had no significant effect on energy intake, body weight or HRQOL. The variation in outcome within each study group was large.

Health and Quality of Life Outcomes, 2007

Background: Although elderly Iranian immigrants in Sweden are the largest elderly group born outs... more Background: Although elderly Iranian immigrants in Sweden are the largest elderly group born outside Europe, little is known about their health-related quality of life (HRQL). The aim of this study was to examine the association between migration status and HRQL in a comparison of elderly Iranians in Iran, elderly Iranian immigrants in Sweden, and elderly Swedes in Sweden. The Short Form Health Survey (SF-36) was administered to a total of 625 men and women aged 60-84 years to collect HRQL information on elderly Iranians in Sweden (n = 176) and elderly Iranians in Iran (n = 298). A Swedish control group (n = 151) was also randomly selected from the general population. Multiple linear regression procedures were applied to analyze data while adjusting for age, which was categorized into 60-69, and 70-84 years, and education. Results: Iranian women in Sweden with shorter times of residence scored lower on vitality (βcoefficient = -7.9, 95% CI = -14.3 to -1.5) compared with other women in this study. The lower vitality dimension score remained nearly unchanged in the main model (β-coefficient = -7.3, 95% CI = -13.7 to -0.9). A longer period of residence in Sweden had a positive association with social functioning (β-coefficient = 14.1, 95% CI = 3.1-25.1) and role limitation due to emotional problems (β-coefficient = 18.3, 95% CI = 1.4-35.2) among elderly Iranian women. In general, the Swedish subsample scores higher on all dimensions of the SF-36 among women and in six out of eight among men in relation to the rest of the subsamples. The HRQL of elderly Iranians in Sweden was more like that of their countrymen in Iran than that of Swedes, who reported a better HRQL than Iranians in this study. However, length of time since migration to Sweden is not associated with poorer HRQL among elderly Iranians. The association varied, however, with sex. Elderly Iranian women showed an increase in two of eight dimensions of the SF-36 with additional years in Sweden, whereas, among elderly Iranian men, additional years in Sweden were not associated with HRQL.

European Journal of Clinical Nutrition, 2004

Objective: To investigate nutritional status and its relationship to cognition, well-being, funct... more Objective: To investigate nutritional status and its relationship to cognition, well-being, functional ability and energy intake in frail elderly service flat residents. Design: Cross-sectional and prospective study. Setting: Two municipal service flat complexes. Subjects: A total of 80 residents (median age 85.5 (79-90) y) with regular home care assistance participated. A subgroup of 35 residents took part in a re-examination 1 y later. Methods: Mini Nutritional Assessment (MNA), Short Portable Mental Status Questionnaire, Barthel Index and Health Index were used for the evaluation of nutritional, cognitive and ADL function and well-being, respectively. Results: In all, 30% of the frail and chronically ill service flat residents were assessed as malnourished and 59% were at risk of malnutrition. The malnourished residents had worse cognitive conditions (Po0.001) and well-being (Po0.05), lower functional ability (Po0.01) and they had a greater need for daily assistance (Po0.05) than the other residents. The median night fast period was 14.0 (12.5-15.0) h. Five subjects classified as malnourished at baseline had lost a median of À9.6 kg (range À11.0 to þ 7.3 kg) (Po0.05) in body weight at the 1-y follow-up, which contrasted significantly from the weight stability in residents classified as at risk for malnutrition or well-nourished. Conclusion: Out of 10 residents, nine were assessed to have impending nutritional problems that related to impaired wellbeing, cognition, and functional ability. Malnourished residents had a significant weight loss over one year. Studies are needed to determine whether weight loss and nutrition-related dysfunction in service flat residents are preventable or treatable.

European Journal of Clinical Nutrition, 2007

Objectives: Prevention of cardiovascular diseases by paleolithic or hunterer-gatherer diets has b... more Objectives: Prevention of cardiovascular diseases by paleolithic or hunterer-gatherer diets has been discussed during recent years. Methods: Our aim was to assess the effect of a paleolithic diet in a pilot study on healthy volunteers during 3 weeks. The intention was to include 20 subjects, of whom 14 fulfilled the study. Complete dietary assessment was available for six subjects. Results: Mean weight decreased by 2.3 kg (Po0.001), body mass index by 0.8 (Po0.001), waist circumference by 0.5 cm (P ¼ 0.001), systolic blood pressure by 3 mm Hg (P ¼ 0.03) and plasminogen activator inhibitor-1 by 72% (P ¼ 0.020). Regarding nutrient intake, intake of energy decreased by 36%, and other effects were also observed, both favourable (fat composition, antioxidants, potassium-sodium rate) and unfavourable (calcium). Conclusion: This short-term intervention showed some favourable effects by the diet, but further studies, including control group, are needed.

European Journal of Clinical Nutrition, 2007

Background/Objectives: To analyze whether elderly Iranians in Sweden have a higher mean body mass... more Background/Objectives: To analyze whether elderly Iranians in Sweden have a higher mean body mass index (BMI) and are less physically active than elderly Swedes after adjustment for possible confounders. Subjects/Methods: A total of 402 men and women (167 Iranian-born and 235 Swedish-born) aged 60-84 years residing in Stockholm, Sweden, were included in this population-based survey. Iranian participants were weighed and their height was measured. BMI values from the Swedish participants were based on self-reported data adjusted for the known discrepancy between objectively measured and self-reported weight and height. The outcome variables, BMI and self-reported leisure-time physical activity, were analyzed by linear regression and unconditional logistic regression. Results: Overall, Iranian women had the highest mean BMI (29.2) of all subgroups. The model that included an interaction between sex and length of time in Sweden showed that there was no significant difference in BMI between Swedish men (reference) and Swedish women or Iranian men. In contrast, Iranian women had significantly higher BMI than the reference group after adjustment for age, education and marital status. The largest difference in BMI compared to the reference group was found among Iranian women who immigrated to Sweden in 1989 or later (b-coefficient ¼ 3.41, 95% CI ¼ 1.99-4.83). Iranians and Swedes had almost the same odds of X once-weekly leisure-time physical activity. Conclusions: Elderly Iranian immigrants and especially women who immigrated to Sweden in 1989 or later must be targeted in order to decrease their burden of risk factors for cardiovascular disease.

Is migration to Sweden associated with increased prevalence of risk factors for cardiovascular disease?

European Journal of Cardiovascular Prevention & Rehabilitation, 2008

[corrected] The proportion of elderly immigrants in Sweden is increasing. This is an important is... more [corrected] The proportion of elderly immigrants in Sweden is increasing. This is an important issue considering that the prevalence of cardiovascular disease (CVD) is a global health problem and that CVD is one of the main causes of morbidity among the elderly. The aim of this study is to analyze whether there is an association between migration status, that is being an elderly Iranian immigrant in Sweden, as compared with being an elderly Iranian in Iran, and the prevalence of risk factors for CVD. Population-based cross-sectional study with face-to-face interviews. A total of 176 Iranians in Stockholm and 300 Iranians in Tehran, aged 60-84 years. The prevalence of general obesity, abdominal obesity, hypertension, smoking, and diabetes was determined. Unconditional logistic regression analysis was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes. The age-adjusted risk of hypertension and smoking was higher in Iranian women and men in Sweden. OR for hypertension was 1.9 (95% CI: 1.1-3.2) for women and 3.1 (95% CI: 1.5-6.3) for men and OR for smoking was 6.9 (95% CI: 2.2-21.6) for women and 4.7 (95% CI: 2.0-11.0) for men. The higher risk for hypertension and smoking remained significant after accounting for age, socioeconomic status, and marital status. Abdominal obesity was found in nearly 80% of the women in both groups. The findings show a strong association between migration status and the prevalence of hypertension and smoking. Major recommendation for public health is increased awareness of CVD risk factors among elderly immigrants.

BMC Public Health, 2011

Background: During the last decades, global migration has increased and many immigrant groups hav... more Background: During the last decades, global migration has increased and many immigrant groups have a higher prevalence than the native born population of several cardiovascular disease risk factors, including poor dietary habits. However, it is uncertain if dietary habits in immigrant populations reflect dietary habits in their country of origin or if the current diet is a consequence of the migration and possible change of dietary habits. The aim of this study was to examine possible dietary differences between elderly Iranians living in Stockholm, Sweden with elderly Iranians living in Tehran, Iran, taking into account sex, age, marital status, and education. Methods: Dietary intakes were assessed by semi-quantitative food frequency questionnaire in a cross-sectional study of 121 Iranians living in Stockholm and 52 Iranians living in Tehran, aged 60-80. Differences in dietary habits between the two groups was analysed by bootstrapped regression analyses with 1000 replications. Results: Iranians living in Sweden had significantly higher intake of protein, total fat, fiber than Iranians living in Iran, but lower consumption of carbohydrates. The observed differences in intake of macronutrients were reflected in consumed amount of all food items, which were higher among Iranians living in Iran with the exception of bread and grain consumption which was lower. Conclusions: There are general differences in dietary habits between Iranians living in Iran and Iranians living in Sweden. Parts of observed differences in dietary habits may reflect a favourable adoption process to the Swedish dietary habits after migration. Meanwhile other differences are point of concern in light of the high prevalence of overweight, among Iranians living in Sweden and can have unfavourable impact in particular in the context of cardiovascular health.

Aim: To analyze determinants of and differences in risk factors for cardiovascular disease (CVD) ... more Aim: To analyze determinants of and differences in risk factors for cardiovascular disease (CVD) among elderly Iranians in Sweden, elderly Swedes, and elderly Iranians in Iran. Method: A total of 1212 men and women aged 60-84 were studied. Study I included 167 Iranianborn and 235 Swedish-born residing in Stockholm, Sweden. The outcome variables, body mass index (BMI) and self-reported leisure-time physical activity were analyzed by linear regression and unconditional logistic regression. Study II included 176 Iranians in Stockholm and 300 Iranians in Tehran and was designed to determine the prevalence of general obesity, abdominal obesity, hypertension, smoking, and diabetes. Unconditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for outcome variables. In Study III, the Short Form Health Survey (SF-36) was administered to collect information about health-related quality of life in elderly Iranians in Sweden (n=176), elderly Iranians in Iran (n=298), and an elderly Swedish control group (n = 151) randomly selected from the general population. Multiple linear regression procedures were applied to analyze data while adjusting for age and education. In Study IV, dietary intakes were assessed by administering a semi-quantitative food frequency questionnaire to 121 Iranians living in Stockholm and 52 Iranians living in Tehran. Differences in dietary habits between the two groups and association of dietary habits with prevalence of overweight, general obesity, and central obesity were analyzed by linear and unconditional logistic regression. Results: In Study I, Iranian women had the highest mean BMI (29.2) of all subgroups. The model that included an interaction between sex and length of time in Sweden showed that there was no significant difference in BMI between Swedish men (reference group) and Swedish women or Iranian men. In contrast, Iranian women had significantly higher average BMI than the reference group after adjustment for age, education, and marital status. The largest difference in BMI compared to the reference group was found among Iranian women who immigrated to Sweden in 1989 or later. Iranians and Swedes had almost the same odds of once-weekly leisure-time physical activity. In Study II, the risks of hypertension and smoking were higher in Iranian women and men in Sweden than in Iran in the age-adjusted model and remained significant after adjusting for all other independent variables. Abdominal obesity was found in nearly 80% of the women in both groups. In Study III, Iranian women in Sweden with shorter times of residence scored lower vitality than other women in this study. Among elderly Iranian women, more than 15 years of residence in Sweden was positively associated with social functioning and role limitation due to emotional problems. In general, the Swedish women scored higher in all dimensions of the SF-36 than the women in the other two subsamples. The Swedish men scored higher in six of eight dimensions than the men in the other two subsamples. Study IV, Iranians living in Sweden consumed more protein, total fat, fiber, and all food groups than Iranians living in Iran, with the exception of bread and grain. The only association found between diet and prevalence of overweight, general obesity, and central obesity was an inverse association between fruit consumption and central obesity in Iranians who had lived in Sweden >15 years. Conclusions: There is a strong association between migration status and the prevalence of cardiovascular disease among elderly Iranians living in Sweden. However, length of time since migration to Sweden is not associated with poorer health-related quality of life among elderly Iranians. In fact, the partial adoption of favorable dietary habits may be associated with increasing number of years in Sweden. The adoption of such favorable habits may lead to increased healthrelated quality of life, decreased CVD risk factors, and increased life expectancy. Health promotion in the public health care system and interventions aimed at the prevention and treatment of overweight and obesity should include a special focus on recent elderly female immigrants, who exhibited the largest difference in BMI and lowest score of health-related quality of life compared to the reference groups. Such resources could empower individuals to achieve a lifestyle that includes more physical activity and healthier dietary habits. This could increase health-related quality of life and decrease risk of obesity and CVD, especially as regular physical activity clearly attenuates many of the health risks associated with overweight or obesity. Treatments and prevention programs that focus on lifestyle changes, carried out by dieticians, physiotherapists, district nurses and physicians in primary health care are therefore recommended.

The struggle to balance system and lifeworld : Swedish dietitians’ experiences of the Nutrition Care Process and standardized terminology

The aim of this thesis was to explore dietetic notes in Swedish patient records regarding content... more The aim of this thesis was to explore dietetic notes in Swedish patient records regarding content, language and the meaning of standardization.Firstly, an audit instrument for dietetic notes in patient records, Diet-NCP-Audit, was elaborated and tested. The instrument, a 14-item scoring questionnaire based on the four steps of the Nutrition Care Process (NCP), proved to have high content validity and moderate to high inter- and intra-rater reliability. The instrument was then used in an evaluation of the content, language and structure of 147 Swedish dietetic notes. Although the nutrition intervention and some information about the evaluation were well documented, the overall result showed a need for improvement in several aspects of documentation, such as nutrition prescriptions, goals and the connection between problem-etiology-symptom.After this, 30 of the audited dietetic notes were also included in a critical linguistic study exploring how the patients and dietitians were refer...

Effect of nutritional supplementation and structured physical activity on physical function in mobility-limited older adults : results from the VIVE2 study

Effect of nutritional supplementation and structured physical activity on physical function in mo... more Effect of nutritional supplementation and structured physical activity on physical function in mobility-limited older adults : results from the VIVE2 study

Serum 25-hydroxy vitamin D and physical performance in community-dwelling old mobility limited adults in Sweden and USA

Serum 25-hydroxy vitamin D and physical performance in community-dwelling old mobility limited ad... more Serum 25-hydroxy vitamin D and physical performance in community-dwelling old mobility limited adults in Sweden and USA

Functional improvements to 6 months of physical activity are not related to changes in size or density of multiple lower-extremity muscles in mobility-limited older individuals

Experimental Gerontology

International Journal of Environmental Research and Public Health

Research on healthy aging commonly concerns problems related to loneliness and food intake. These... more Research on healthy aging commonly concerns problems related to loneliness and food intake. These are not independent aspects of health since eating, beyond its biological necessity, is a central part of social life. This scoping review aimed to map scientific articles on eating alone or together among community-living older people, and to identify relevant research gaps. Four databases were searched, 989 articles were identified and 98 fulfilled the inclusion criteria. In the first theme, eating alone or together are treated as central topics of interest, isolated from adjoining, broader concepts such as social participation. In the second, eating alone or together are one aspect of the findings, e.g., one of several risk factors for malnutrition. Findings confirm the significance of commensality in older peoples’ life. We recommend future research designs allowing identification of causal relationships, using refined ways of measuring meals alone or together, and qualitative metho...

Background: The combined effect of sarcopenia and obesity, i.e., sarcopenic obesity, has been ass... more Background: The combined effect of sarcopenia and obesity, i.e., sarcopenic obesity, has been associated with disability and worse outcomes in older adults, but results are conflicting. The objectives of this study were to describe the prevalence of sarcopenic obesity (SO) in older adults, and to examine how the risk of mortality is associated with SO and its various components.Methods: Data were obtained from two Swedish population studies, the Gothenburg H70 Birth Cohort Studies of 521 women and men at the age of 75, and the Uppsala Longitudinal Study of Adult Men (ULSAM), which included 288 men aged 87 years. Sarcopenia was defined using the recently updated EWGSOP2 definition. Obesity was defined by any of three established definitions: body mass index ≥30 kg/m2, fat mass >30%/ >42% or waist circumference ≥88 cm/≥102 cm for women and men, respectively. The Kaplan-Meier survival curve and the Cox proportional hazard model were used for 10-year and 4-year survival analyses i...

Perceptions and experiences of eating alone among community-living retired Swedes: Loss, routine and independence

Appetite, Jul 1, 2023

Perceptions and experiences of eating alone among community-living retired Swedes: Loss, routine and independence

Appetite

Diet quality and cardiovascular outcomes: A systematic review and meta‐analysis of cohort studies

Nutrition & Dietetics, Dec 20, 2023

An adequate documentation in medical records

RESEARCH ARTICLE Open Access Dietary differences between elderly Iranians living

study

The Journal of Nutrition Health and Aging, 2008

Background: Nutritional problems are common in frail elderly individuals receiving municipal care... more Background: Nutritional problems are common in frail elderly individuals receiving municipal care. Objective: To evaluate if an additional evening meal could improve total daily food intake, nutritional status, and health-related quality of life (HRQOL) in frail elderly service flat (SF) residents. Design: Out of 122 residents in two SF complexes, 60 subjects agreed to participate, of which 49 subjects (median 84 (79-90) years, (25th-75th percentile)) completed the study. For six months 23 residents in one SF complex were served 530 kcal in addition to their regular meals, i.e. intervention group (I-group). Twenty-six residents in the other SF building were controls (C-group). Nutritional status, energy and nutrient intake, length of night time fast, cognitive function and HRQOL was assessed before and after the intervention. Results: At the start, the Mini Nutritional Assessment classified 27% as malnourished and 63% as at risk for malnutrition, with no difference between the groups. After six months the median body weight was unchanged in the I-group, +0.6 (-1.7 -+1.6) kg (p=0.72) and the Cgroup -0.6 (-2.0 -+0.5) kg (p=0.15). Weight change ranged from -13% to +15%. The evening meal improved the protein and carbohydrate intake (p<0.01) but the energy intake increased by only 180 kcal/day (p=0.15). The night time fast decreased in the I-group from 15.0 (13.0-16.0) to 13.0 (12.0-14.0) hours (p<0.05). There was no significant difference in cognitive function or HRQOL between the groups. Conclusion: Nine out of ten frail elderly SF residents had nutritional problems. Serving an additional evening meal increased the protein and carbohydrate intake, but the meal had no significant effect on energy intake, body weight or HRQOL. The variation in outcome within each study group was large.

Health and Quality of Life Outcomes, 2007

Background: Although elderly Iranian immigrants in Sweden are the largest elderly group born outs... more Background: Although elderly Iranian immigrants in Sweden are the largest elderly group born outside Europe, little is known about their health-related quality of life (HRQL). The aim of this study was to examine the association between migration status and HRQL in a comparison of elderly Iranians in Iran, elderly Iranian immigrants in Sweden, and elderly Swedes in Sweden. The Short Form Health Survey (SF-36) was administered to a total of 625 men and women aged 60-84 years to collect HRQL information on elderly Iranians in Sweden (n = 176) and elderly Iranians in Iran (n = 298). A Swedish control group (n = 151) was also randomly selected from the general population. Multiple linear regression procedures were applied to analyze data while adjusting for age, which was categorized into 60-69, and 70-84 years, and education. Results: Iranian women in Sweden with shorter times of residence scored lower on vitality (βcoefficient = -7.9, 95% CI = -14.3 to -1.5) compared with other women in this study. The lower vitality dimension score remained nearly unchanged in the main model (β-coefficient = -7.3, 95% CI = -13.7 to -0.9). A longer period of residence in Sweden had a positive association with social functioning (β-coefficient = 14.1, 95% CI = 3.1-25.1) and role limitation due to emotional problems (β-coefficient = 18.3, 95% CI = 1.4-35.2) among elderly Iranian women. In general, the Swedish subsample scores higher on all dimensions of the SF-36 among women and in six out of eight among men in relation to the rest of the subsamples. The HRQL of elderly Iranians in Sweden was more like that of their countrymen in Iran than that of Swedes, who reported a better HRQL than Iranians in this study. However, length of time since migration to Sweden is not associated with poorer HRQL among elderly Iranians. The association varied, however, with sex. Elderly Iranian women showed an increase in two of eight dimensions of the SF-36 with additional years in Sweden, whereas, among elderly Iranian men, additional years in Sweden were not associated with HRQL.

European Journal of Clinical Nutrition, 2004

Objective: To investigate nutritional status and its relationship to cognition, well-being, funct... more Objective: To investigate nutritional status and its relationship to cognition, well-being, functional ability and energy intake in frail elderly service flat residents. Design: Cross-sectional and prospective study. Setting: Two municipal service flat complexes. Subjects: A total of 80 residents (median age 85.5 (79-90) y) with regular home care assistance participated. A subgroup of 35 residents took part in a re-examination 1 y later. Methods: Mini Nutritional Assessment (MNA), Short Portable Mental Status Questionnaire, Barthel Index and Health Index were used for the evaluation of nutritional, cognitive and ADL function and well-being, respectively. Results: In all, 30% of the frail and chronically ill service flat residents were assessed as malnourished and 59% were at risk of malnutrition. The malnourished residents had worse cognitive conditions (Po0.001) and well-being (Po0.05), lower functional ability (Po0.01) and they had a greater need for daily assistance (Po0.05) than the other residents. The median night fast period was 14.0 (12.5-15.0) h. Five subjects classified as malnourished at baseline had lost a median of À9.6 kg (range À11.0 to þ 7.3 kg) (Po0.05) in body weight at the 1-y follow-up, which contrasted significantly from the weight stability in residents classified as at risk for malnutrition or well-nourished. Conclusion: Out of 10 residents, nine were assessed to have impending nutritional problems that related to impaired wellbeing, cognition, and functional ability. Malnourished residents had a significant weight loss over one year. Studies are needed to determine whether weight loss and nutrition-related dysfunction in service flat residents are preventable or treatable.

European Journal of Clinical Nutrition, 2007

Objectives: Prevention of cardiovascular diseases by paleolithic or hunterer-gatherer diets has b... more Objectives: Prevention of cardiovascular diseases by paleolithic or hunterer-gatherer diets has been discussed during recent years. Methods: Our aim was to assess the effect of a paleolithic diet in a pilot study on healthy volunteers during 3 weeks. The intention was to include 20 subjects, of whom 14 fulfilled the study. Complete dietary assessment was available for six subjects. Results: Mean weight decreased by 2.3 kg (Po0.001), body mass index by 0.8 (Po0.001), waist circumference by 0.5 cm (P ¼ 0.001), systolic blood pressure by 3 mm Hg (P ¼ 0.03) and plasminogen activator inhibitor-1 by 72% (P ¼ 0.020). Regarding nutrient intake, intake of energy decreased by 36%, and other effects were also observed, both favourable (fat composition, antioxidants, potassium-sodium rate) and unfavourable (calcium). Conclusion: This short-term intervention showed some favourable effects by the diet, but further studies, including control group, are needed.

European Journal of Clinical Nutrition, 2007

Background/Objectives: To analyze whether elderly Iranians in Sweden have a higher mean body mass... more Background/Objectives: To analyze whether elderly Iranians in Sweden have a higher mean body mass index (BMI) and are less physically active than elderly Swedes after adjustment for possible confounders. Subjects/Methods: A total of 402 men and women (167 Iranian-born and 235 Swedish-born) aged 60-84 years residing in Stockholm, Sweden, were included in this population-based survey. Iranian participants were weighed and their height was measured. BMI values from the Swedish participants were based on self-reported data adjusted for the known discrepancy between objectively measured and self-reported weight and height. The outcome variables, BMI and self-reported leisure-time physical activity, were analyzed by linear regression and unconditional logistic regression. Results: Overall, Iranian women had the highest mean BMI (29.2) of all subgroups. The model that included an interaction between sex and length of time in Sweden showed that there was no significant difference in BMI between Swedish men (reference) and Swedish women or Iranian men. In contrast, Iranian women had significantly higher BMI than the reference group after adjustment for age, education and marital status. The largest difference in BMI compared to the reference group was found among Iranian women who immigrated to Sweden in 1989 or later (b-coefficient ¼ 3.41, 95% CI ¼ 1.99-4.83). Iranians and Swedes had almost the same odds of X once-weekly leisure-time physical activity. Conclusions: Elderly Iranian immigrants and especially women who immigrated to Sweden in 1989 or later must be targeted in order to decrease their burden of risk factors for cardiovascular disease.

Is migration to Sweden associated with increased prevalence of risk factors for cardiovascular disease?

European Journal of Cardiovascular Prevention & Rehabilitation, 2008

[corrected] The proportion of elderly immigrants in Sweden is increasing. This is an important is... more [corrected] The proportion of elderly immigrants in Sweden is increasing. This is an important issue considering that the prevalence of cardiovascular disease (CVD) is a global health problem and that CVD is one of the main causes of morbidity among the elderly. The aim of this study is to analyze whether there is an association between migration status, that is being an elderly Iranian immigrant in Sweden, as compared with being an elderly Iranian in Iran, and the prevalence of risk factors for CVD. Population-based cross-sectional study with face-to-face interviews. A total of 176 Iranians in Stockholm and 300 Iranians in Tehran, aged 60-84 years. The prevalence of general obesity, abdominal obesity, hypertension, smoking, and diabetes was determined. Unconditional logistic regression analysis was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes. The age-adjusted risk of hypertension and smoking was higher in Iranian women and men in Sweden. OR for hypertension was 1.9 (95% CI: 1.1-3.2) for women and 3.1 (95% CI: 1.5-6.3) for men and OR for smoking was 6.9 (95% CI: 2.2-21.6) for women and 4.7 (95% CI: 2.0-11.0) for men. The higher risk for hypertension and smoking remained significant after accounting for age, socioeconomic status, and marital status. Abdominal obesity was found in nearly 80% of the women in both groups. The findings show a strong association between migration status and the prevalence of hypertension and smoking. Major recommendation for public health is increased awareness of CVD risk factors among elderly immigrants.

BMC Public Health, 2011

Background: During the last decades, global migration has increased and many immigrant groups hav... more Background: During the last decades, global migration has increased and many immigrant groups have a higher prevalence than the native born population of several cardiovascular disease risk factors, including poor dietary habits. However, it is uncertain if dietary habits in immigrant populations reflect dietary habits in their country of origin or if the current diet is a consequence of the migration and possible change of dietary habits. The aim of this study was to examine possible dietary differences between elderly Iranians living in Stockholm, Sweden with elderly Iranians living in Tehran, Iran, taking into account sex, age, marital status, and education. Methods: Dietary intakes were assessed by semi-quantitative food frequency questionnaire in a cross-sectional study of 121 Iranians living in Stockholm and 52 Iranians living in Tehran, aged 60-80. Differences in dietary habits between the two groups was analysed by bootstrapped regression analyses with 1000 replications. Results: Iranians living in Sweden had significantly higher intake of protein, total fat, fiber than Iranians living in Iran, but lower consumption of carbohydrates. The observed differences in intake of macronutrients were reflected in consumed amount of all food items, which were higher among Iranians living in Iran with the exception of bread and grain consumption which was lower. Conclusions: There are general differences in dietary habits between Iranians living in Iran and Iranians living in Sweden. Parts of observed differences in dietary habits may reflect a favourable adoption process to the Swedish dietary habits after migration. Meanwhile other differences are point of concern in light of the high prevalence of overweight, among Iranians living in Sweden and can have unfavourable impact in particular in the context of cardiovascular health.

Aim: To analyze determinants of and differences in risk factors for cardiovascular disease (CVD) ... more Aim: To analyze determinants of and differences in risk factors for cardiovascular disease (CVD) among elderly Iranians in Sweden, elderly Swedes, and elderly Iranians in Iran. Method: A total of 1212 men and women aged 60-84 were studied. Study I included 167 Iranianborn and 235 Swedish-born residing in Stockholm, Sweden. The outcome variables, body mass index (BMI) and self-reported leisure-time physical activity were analyzed by linear regression and unconditional logistic regression. Study II included 176 Iranians in Stockholm and 300 Iranians in Tehran and was designed to determine the prevalence of general obesity, abdominal obesity, hypertension, smoking, and diabetes. Unconditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for outcome variables. In Study III, the Short Form Health Survey (SF-36) was administered to collect information about health-related quality of life in elderly Iranians in Sweden (n=176), elderly Iranians in Iran (n=298), and an elderly Swedish control group (n = 151) randomly selected from the general population. Multiple linear regression procedures were applied to analyze data while adjusting for age and education. In Study IV, dietary intakes were assessed by administering a semi-quantitative food frequency questionnaire to 121 Iranians living in Stockholm and 52 Iranians living in Tehran. Differences in dietary habits between the two groups and association of dietary habits with prevalence of overweight, general obesity, and central obesity were analyzed by linear and unconditional logistic regression. Results: In Study I, Iranian women had the highest mean BMI (29.2) of all subgroups. The model that included an interaction between sex and length of time in Sweden showed that there was no significant difference in BMI between Swedish men (reference group) and Swedish women or Iranian men. In contrast, Iranian women had significantly higher average BMI than the reference group after adjustment for age, education, and marital status. The largest difference in BMI compared to the reference group was found among Iranian women who immigrated to Sweden in 1989 or later. Iranians and Swedes had almost the same odds of once-weekly leisure-time physical activity. In Study II, the risks of hypertension and smoking were higher in Iranian women and men in Sweden than in Iran in the age-adjusted model and remained significant after adjusting for all other independent variables. Abdominal obesity was found in nearly 80% of the women in both groups. In Study III, Iranian women in Sweden with shorter times of residence scored lower vitality than other women in this study. Among elderly Iranian women, more than 15 years of residence in Sweden was positively associated with social functioning and role limitation due to emotional problems. In general, the Swedish women scored higher in all dimensions of the SF-36 than the women in the other two subsamples. The Swedish men scored higher in six of eight dimensions than the men in the other two subsamples. Study IV, Iranians living in Sweden consumed more protein, total fat, fiber, and all food groups than Iranians living in Iran, with the exception of bread and grain. The only association found between diet and prevalence of overweight, general obesity, and central obesity was an inverse association between fruit consumption and central obesity in Iranians who had lived in Sweden >15 years. Conclusions: There is a strong association between migration status and the prevalence of cardiovascular disease among elderly Iranians living in Sweden. However, length of time since migration to Sweden is not associated with poorer health-related quality of life among elderly Iranians. In fact, the partial adoption of favorable dietary habits may be associated with increasing number of years in Sweden. The adoption of such favorable habits may lead to increased healthrelated quality of life, decreased CVD risk factors, and increased life expectancy. Health promotion in the public health care system and interventions aimed at the prevention and treatment of overweight and obesity should include a special focus on recent elderly female immigrants, who exhibited the largest difference in BMI and lowest score of health-related quality of life compared to the reference groups. Such resources could empower individuals to achieve a lifestyle that includes more physical activity and healthier dietary habits. This could increase health-related quality of life and decrease risk of obesity and CVD, especially as regular physical activity clearly attenuates many of the health risks associated with overweight or obesity. Treatments and prevention programs that focus on lifestyle changes, carried out by dieticians, physiotherapists, district nurses and physicians in primary health care are therefore recommended.

The struggle to balance system and lifeworld : Swedish dietitians’ experiences of the Nutrition Care Process and standardized terminology

The aim of this thesis was to explore dietetic notes in Swedish patient records regarding content... more The aim of this thesis was to explore dietetic notes in Swedish patient records regarding content, language and the meaning of standardization.Firstly, an audit instrument for dietetic notes in patient records, Diet-NCP-Audit, was elaborated and tested. The instrument, a 14-item scoring questionnaire based on the four steps of the Nutrition Care Process (NCP), proved to have high content validity and moderate to high inter- and intra-rater reliability. The instrument was then used in an evaluation of the content, language and structure of 147 Swedish dietetic notes. Although the nutrition intervention and some information about the evaluation were well documented, the overall result showed a need for improvement in several aspects of documentation, such as nutrition prescriptions, goals and the connection between problem-etiology-symptom.After this, 30 of the audited dietetic notes were also included in a critical linguistic study exploring how the patients and dietitians were refer...

Effect of nutritional supplementation and structured physical activity on physical function in mobility-limited older adults : results from the VIVE2 study

Effect of nutritional supplementation and structured physical activity on physical function in mo... more Effect of nutritional supplementation and structured physical activity on physical function in mobility-limited older adults : results from the VIVE2 study

Serum 25-hydroxy vitamin D and physical performance in community-dwelling old mobility limited adults in Sweden and USA

Serum 25-hydroxy vitamin D and physical performance in community-dwelling old mobility limited ad... more Serum 25-hydroxy vitamin D and physical performance in community-dwelling old mobility limited adults in Sweden and USA

Functional improvements to 6 months of physical activity are not related to changes in size or density of multiple lower-extremity muscles in mobility-limited older individuals

Experimental Gerontology

International Journal of Environmental Research and Public Health

Research on healthy aging commonly concerns problems related to loneliness and food intake. These... more Research on healthy aging commonly concerns problems related to loneliness and food intake. These are not independent aspects of health since eating, beyond its biological necessity, is a central part of social life. This scoping review aimed to map scientific articles on eating alone or together among community-living older people, and to identify relevant research gaps. Four databases were searched, 989 articles were identified and 98 fulfilled the inclusion criteria. In the first theme, eating alone or together are treated as central topics of interest, isolated from adjoining, broader concepts such as social participation. In the second, eating alone or together are one aspect of the findings, e.g., one of several risk factors for malnutrition. Findings confirm the significance of commensality in older peoples’ life. We recommend future research designs allowing identification of causal relationships, using refined ways of measuring meals alone or together, and qualitative metho...

Background: The combined effect of sarcopenia and obesity, i.e., sarcopenic obesity, has been ass... more Background: The combined effect of sarcopenia and obesity, i.e., sarcopenic obesity, has been associated with disability and worse outcomes in older adults, but results are conflicting. The objectives of this study were to describe the prevalence of sarcopenic obesity (SO) in older adults, and to examine how the risk of mortality is associated with SO and its various components.Methods: Data were obtained from two Swedish population studies, the Gothenburg H70 Birth Cohort Studies of 521 women and men at the age of 75, and the Uppsala Longitudinal Study of Adult Men (ULSAM), which included 288 men aged 87 years. Sarcopenia was defined using the recently updated EWGSOP2 definition. Obesity was defined by any of three established definitions: body mass index ≥30 kg/m2, fat mass >30%/ >42% or waist circumference ≥88 cm/≥102 cm for women and men, respectively. The Kaplan-Meier survival curve and the Cox proportional hazard model were used for 10-year and 4-year survival analyses i...