Sofia Björkman - Academia.edu (original) (raw)

Papers by Sofia Björkman

Additional file 1: Suppl Table 1. Parameters associated with the metabolic syndrome at baseline (... more Additional file 1: Suppl Table 1. Parameters associated with the metabolic syndrome at baseline (BL) and after weight loss at 6 months (M6) and 12 months (M12) in controls with obesity. Values are median and inter-quartile range (IQR).

Clinical Endocrinology, 2019

Objective: Existing data are contradictory on the prevalence of polycystic ovary syndrome (PCOS) ... more Objective: Existing data are contradictory on the prevalence of polycystic ovary syndrome (PCOS) and metabolic syndrome (MetS) in women with severe obesity (body mass index [BMI] ≥ 35 kg/m 2), and there are few studies investigating the effect of weight reduction in women with severe obesity and PCOS. The aim was to study the prevalence of PCOS and MetS among women with severe obesity and to evaluate the effect of a 12-months weight loss programme on the prevalence of PCOS and MetS. Design/Participants: In total, 298 women with severe obesity were enrolled whereof 246 women had complete screening data for PCOS and MetS before commencing treatment. Weight loss intervention included very low energy diet. At 12-months follow-up, 72 women with complete data remained and were reexamined with baseline parameters. Results: At baseline, the prevalence of PCOS was 25.6% and in this group, the prevalence of MetS was 43.4% in PCOS vs 43.3% in controls (ns). At 12-months follow-up, weight loss in women with PCOS was 12.3 ± 10.7 kg (P < .001) and in non-PCOS 13.9 ± 13.4 kg (P < .001) with no between group difference. Women without PCOS decreased in total bone mass. Conclusions: Polycystic ovary syndrome occurs in one out of four women with severe obesity. The prevalence of MetS does not differ between women with or without PCOS with severe obesity. There was a significant weight loss in both groups but no difference between groups regarding change in metabolic parameters.

Oral Presentations, 2019

Background: The link between obesity and disease activity in PsA is unclear. Obesity has been ass... more Background: The link between obesity and disease activity in PsA is unclear. Obesity has been associated with a poorer therapeutic response and higher treatment discontinuation rates in patients with PsA being treated with tumour necrosis factor inhibitors (TNFi). Recent data confirm the favourable effect of weight reduction on these factors. There are no data available for other biologics. Objectives: To investigate the relationship between baseline overweight/obesity and disease activity, patient-reported outcomes and disability, in a large realworld cohort of patients with PsA starting biologic treatment with either ustekinumab (UST) or TNFi. Methods: The PsABio study (ClinicalTrials.gov: NCT02627768) is an ongoing observational study evaluating efficacy, tolerability and persistence of 1 st , 2 nd-and 3 rd-line UST or TNFi in PsA in 8 European countries 1 when introduced as part of standard clinical care. Baseline data of the study population were collected and analysed for BMI, disease activity (cDAPSA, psoriasis BSA), patient-perceived impact (PsAID-12), disability (HAQ-DI) and presence or history of CVD/MET. Descriptive statistics on available data and 3 exploratory multiple regression models are shown, to investigate the relationship of cDAPSA, PsAID-12 and HAQ-DI (dependent variables) with BMI, adjusted for age, sex, smoking, BSA, CRP, disease duration and biologic treatment. Results: In all, 917 patients were included, starting either UST (n=450) or TNFi (n=467): mean (SD) age 49.7 (12.5) years, 55.5% female. The mean (SD) baseline BMI (N=827) was 28.1 (5.8) kg/m 2 , with 40.0% and 30.4% in BMI categories overweight (>25-30) and obese (>30), respectively. In univariate analyses, obesity was linked to worse outcomes (Table 1). More severe disease was associated with higher BMI (Table 2). In multiple regression modelling, higher BMI was independently linked to higher cDAPSA (BMI: b=0.09 p=0.026); to higher patient-perceived disease impact measured by PsAID-12 (BMI: b=0.16, p<0.0001) and to higher disability measured by HAQ-DI (BMI: b=0.21, p<0.0001). Conclusion: This multi-country routine-care PsA cohort of patients in need of biologic treatment confirms the high prevalence of overweight/obesity and indicates an independent association between high BMI and disease activity as well as patient-reported impact of disease and disability. These results emphasize the need for lifestyle-directed approaches in PsA, such as overweight management in parallel with joint-and skin-focused treatment.

Arthritis Research & Therapy, 2019

Background: Obesity is over-represented in patients with psoriatic arthritis (PsA) and associated... more Background: Obesity is over-represented in patients with psoriatic arthritis (PsA) and associated with higher disease activity, poorer effect of treatment and increased cardiovascular morbidity. Studies on the effects of weight loss are however needed. This study aimed to prospectively study the effects of weight loss treatment with very low energy diet (VLED) on disease activity in patients with PsA (CASPAR criteria) and obesity (body mass index BMI ≥ 33 kg/m 2). Methods: VLED (640 kcal/day) was taken during 12-16 weeks, depending on pre-treatment BMI. Afterwards, an energy-restricted diet was gradually reintroduced. Weight loss treatment was given within a structured framework for support and medical follow-up. Treatment with conventional synthetic and/or biologic disease-modifying anti-rheumatic drugs was held constant from 3 months before, until 6 months after baseline. Patients were assessed with BMI, 66/68 joints count, Leeds enthesitis index, psoriasis body surface area (BSA), questionnaires and CRP at baseline, 3 and 6 months. Primary outcome was the percentage of patients reaching minimal disease activity (MDA) and secondary outcomes were reaching Psoriatic Arthritis Response Criteria (PsARC) and American College of Rheumatology (ACR) response criteria. Results: Totally 41/46 patients completed the study, 63% women, median age 54 years (IQR 48-62). At baseline increased BMI was associated with higher disease activity and poorer function. The median weight loss was 18.7 kg (IQR 14.6-26.5) or 18.6% (IQR 14.7-26.3) of the baseline weight. A majority of the disease activity parameters improved significantly after weight loss, including 68/66 tender/swollen joints count, CRP, BSA, Leeds enthesitis index, HAQ and patient VAS for global health, pain and fatigue. A larger weight loss resulted in more improvement in a dose-response manner. The percentage of patients with MDA increased from 29 to 54%, (p = 0.002). PsARC was reached by 46.3%. The ACR 20, 50 and 70 responses were 51.2%, 34.1% and 7.3% respectively. Conclusions: Short-term weight loss treatment with VLED was associated with significant positive effects on disease activity in joints, entheses and skin in patients with PsA and obesity. The study supports the hypothesis of obesity as a promotor of disease activity in PsA.

Surgery for Obesity and Related Diseases, 2013

Background: Duodenal switch provides greater weight loss than gastric bypass in severely obese pa... more Background: Duodenal switch provides greater weight loss than gastric bypass in severely obese patients; however, comparative data on the changes in gastrointestinal symptoms, bowel function, eating behavior, dietary intake, and psychosocial functioning are limited. Methods: The setting for the present study was 2 university hospitals in Norway and Sweden. Participants with a body mass index of 50-60 kg/m 2 were randomly assigned to gastric bypass (n ϭ 31) or duodenal switch (n ϭ 29) and followed up for 2 years. Of the 60 patients, 97% completed the study. Their mean weight decreased by 31.2% after gastric bypass and 44.8% after duodenal switch. At inclusion and 1 and 2 years of follow-up, the participants completed the Gastrointestinal Symptom Rating Scale, a bowel function questionnaire, the Three-Factor Eating Questionnaire-R21, a 4-day food record, and the Obesity-related Problems scale. Results: Compared with the gastric bypass group, the duodenal switch group reported more symptoms of diarrhea (P ϭ .0002), a greater mean number of daytime defecations (P ϭ .007), and more anal leakage of stool (50% versus 18% of participants, respectively; P ϭ .015) after 2 years. The scores for uncontrolled and emotional eating were significantly and similarly reduced after both operations. The mean total caloric intake and intake of fat and carbohydrates were significantly reduced in both groups. Protein intake was significantly reduced only after gastric bypass (P ϭ .008, between-group comparison). Psychosocial function was significantly improved after both operations (P ϭ .23, between the 2 groups). Conclusion: Gastrointestinal side effects and anal leakage of stool were more pronounced after duodenal switch than after gastric bypass. Both procedures led to reduced uncontrolled and emotional eating, reduced caloric intake, and improved psychosocial functioning.

Annals of Surgery, 2006

Objective: To assess body composition, eating pattern, and basal metabolic rate in patients under... more Objective: To assess body composition, eating pattern, and basal metabolic rate in patients undergoing obesity surgery in a randomized trial. Introduction: There is limited knowledge regarding how different bariatric surgical techniques function in terms of altering body composition, dietary intake, and basic metabolic rate. Methods: Non-superobese patients were randomized to laparoscopic Roux-en-Y gastric bypass (LGBP, n ϭ 37) or laparoscopic vertical banded gastroplasty (LVBG, n ϭ 46). Anthropometry, dual-energy x-ray absorptiometry (DEXA), computed tomography (CT), indirect calorimetry, and reported dietary intake were registered prior to and 1 year after surgery. Results: Follow-up rate was 97.6%. LGBP patients had significantly greater reduction of waist circumference and sagittal diameter compared with LVBG. DEXA demonstrated a larger reduction of body fat in all compartments after LGBP, especially at the trunk (P Ͻ 0.001). CT demonstrated more reduction of the visceral fat (P ϭ 0.016). Patients were able to eat all types of food after LGBP, although about 30% claimed they avoided fats. LGBP patients decreased their proportion of dietary fat significantly more than those operated on with LVBG (P ϭ 0.005), who consumed more sweet foods and avoided whole meat and vegetables. Lean tissue mass (LTM) was proportionally less reduced, especially in men, after LGBP. The decreases in BMR postoperatively reflected the lower body mass in a pattern that did not differ among the groups. Conclusion: LGBP patients demonstrated better outcomes compared with LVBG patients in terms of body composition. Energy expenditure developed as expected postoperatively. A "steering" away from fatty foods after LGBP may be an important mechanism of action in gastric bypass.

Annals of Internal Medicine, 2011

Background: Gastric bypass and duodenal switch are currently performed bariatric surgical procedu... more Background: Gastric bypass and duodenal switch are currently performed bariatric surgical procedures. Uncontrolled studies suggest that duodenal switch induces greater weight loss than gastric bypass. Objective: To determine whether duodenal switch leads to greater weight loss and more favorable improvements in cardiovascular risk factors and quality of life than gastric bypass. Design: Randomized, parallel-group trial. (ClinicalTrials.gov registration number: NCT00327912) Setting: 2 academic medical centers (1 in Norway and 1 in Sweden). Patients: 60 participants with a body mass index (BMI) between 50 and 60 kg/m 2. Intervention: Gastric bypass (n ϭ 31) or duodenal switch (n ϭ 29). Measurements: The primary outcome was the change in BMI after 2 years. Secondary outcomes included anthropometric measures; concentrations of blood lipids, glucose, insulin, C-reactive protein, and vitamins; and health-related quality of life and adverse events. Results: Fifty-eight of 60 participants (97%) completed the study. The mean reductions in BMI were 17.3 kg/m 2 (95% CI, 15.7 to 19.0 kg/m 2) after gastric bypass and 24.8 kg/m 2 (CI, 23.0 to 26.5 kg/m 2) after duodenal switch (mean between-group difference, 7.44 kg/m 2 [CI, 5.24 to 9.64 kg/m 2 ]; P Ͻ 0.001). Total cholesterol concentration decreased by 0.24 mmol/L (CI, Ϫ0.03 to 0.50 mmol/L) (9.27 mg/dL [CI, Ϫ1.16 to 19.3 mg/dL]) after gastric bypass and 1.07 mmol/L (CI, 0.79 to 1.35 mmol/L) (41.3 mg/dL [CI, 30.5 to 52.1 mg/dL]) after duodenal switch (mean betweengroup difference, 0.83 mmol/L [CI, 0.48 to 1.18 mmol/L]; 32.0 mg/dL [CI, 18.5 to 45.6 mg/dL]; P Ͻ 0.001). Reductions in lowdensity lipoprotein cholesterol concentration, anthropometric measures, fat mass, and fat-free mass were also greater after duodenal switch (P Յ 0.010 for each between-group comparison). Both groups had reductions in blood pressure and mean concentrations of glucose, insulin, and C-reactive protein, with no between-group differences. The duodenal switch group, but not the gastric bypass group, had reductions in concentrations of vitamin A and 25hydroxyvitamin D. Most Short Form-36 Health Survey dimensional scores improved in both groups, with greater improvement in 1 of 8 domains (bodily pain) after gastric bypass. From surgery until 2 years, 10 participants (32%) had adverse events after gastric bypass and 18 (62%) after duodenal switch (P ϭ 0.021). Adverse events related to malnutrition occurred only after duodenal switch. Limitation: Clinical experience was greater with gastric bypass than with duodenal switch at the study centers. Conclusion: Duodenal switch surgery was associated with greater weight loss, greater reductions of total and low-density lipoprotein cholesterol concentrations, and more adverse events. Improvements in other cardiovascular risk factors and quality of life were similar after both procedures.

Saturday, 16 JUNE 2018, 2018

risk of infections (33%), and history of malignancy (22.6%), whereas a preference for an oral dru... more risk of infections (33%), and history of malignancy (22.6%), whereas a preference for an oral drug drove the choice only in 7% of patients. Abstract SAT0327-Table 1. baseline prevalence of comorbidities Conclusions: Based on our analysis, apremilast is mainly used in PsA with oligoarthritis, enthesitis, mild skin involvement, and low risk of disease progression, carrying comorbidities (especially history of infections and malignancies) with contraindications to the use of biologic drugs.

Table S1. Disease activity and function before and after weight loss treatment in the 29 patients... more Table S1. Disease activity and function before and after weight loss treatment in the 29 patients with PsA who did not have minimal disease activity at baseline. (DOCX 16 kb)

Clinical and Experimental Dental Research

Objectives: To describe the oral health profile of individuals who had undergone gastric bypass s... more Objectives: To describe the oral health profile of individuals who had undergone gastric bypass surgery (GBP) or sleeve gastrectomy (SG) to generate hypotheses for further studies. Material and Methods: Fourteen individuals treated with GBP or SG surgery ≥ 2 years ago and with observed and/or perceived oral problems were recruited to a case series. The documentation included clinical and radiographic examinations, biomedical sampling, and self-reported diet and questionnaires. The results are presented descriptively. Results: The age range was 31 to 66 years and all had a BMI > 25 (range 25.4-44.7). Only four participants were fully dentate. Eleven out of 14 individuals exhibited severe decay. A majority had poor oral hygiene and high bacterial counts. The flow rates of unstimulated saliva were extremely low and hyposalivation was present in ten of the fourteen cases. Most perceived several oral health problems, such as chewing difficulty and tooth hypersensitivity. Conclusions: Individuals who had undergone GBP or SG surgery had poor clinically diagnosed oral health and perceived oral health problems. Longitudinal studies are needed to monitor the patients' oral health, from before bariatric surgery to longterm postoperatively. K E Y W O R D S bariatric surgery, case series, oral health 1 | INTRODUCTION Obesity is a global health issue today with worldwide rates tripling since 1975. In 2016, 650 million adults (13%) were reported as obese that is, a Body Mass Index (BMI) greater than or equal to 30 kg/m 2 (WHO, 2020). The corresponding proportion in Sweden is 15%, according to a recent national health survey (The Public Health Agency of Sweden, 2018). Obesity is considered a risk factor for an array of chronic diseases (The Global Burden of Disease 2015 Collaborators, 2017) however, studies on the association between an obese condition and oral disease show somewhat contradictory results and causal relationships are not well established (Nascimento et al., 2016; Shivakumar, Srivastava, & Shivakumar, 2018). Obesity is difficult to treat despite several treatment options, including reduced dietary energy intake, physical activity,

Backgroun Obesity is overrepresented in patients with psoriatic arthritis (PsA) and associated wi... more Backgroun Obesity is overrepresented in patients with psoriatic arthritis (PsA) and associated with increased disease activity. We have previously shown in 41 patients with PsA (Caspar criteria) and obesity (body mass index; BMI ≥33 kg/m2) that weight loss treatment with Very Low Energy Liquid Diet (VLED), 640 kcal/day during 12-16 weeks, followed by a structured reintroduction of an energy restricted diet resulted in a median weight loss of 18.6% and concomitantly a significant improvement of the disease activity in joints, entheses and skin.The objectives of this follow-up were to study the effects of the weight loss treatment on disease activity in longer term (12 and 24 months) and to study the effects on cardiovascular risk factors.Methods The patients were assessed with 66/68 joints count, Leeds enthesitis index (LEI), body surface area, blood pressure, BMI, questionnaires and fasting blood samples at the 12- and 24-month visits.Results In total, 39 and 35 PsA patients attende...

Clinical Obesity

There is a paucity of studies on the frequency of binge‐eating disorder (BED) and nocturnal eatin... more There is a paucity of studies on the frequency of binge‐eating disorder (BED) and nocturnal eating (NE) and their potential role as barriers in non‐surgical weight loss treatment in subjects with severe obesity (body mass index [BMI] ≥35 kg m2). The aim was to identify BED and NE, and their effect on weight loss treatment. In total, 1132 (727 women, 405 men), BMI ~41 kg/m2 were patients in a 12‐month weight loss programme at a specialist clinic. The questionnaire for eating and weight patterns‐revised was completed by the patients before start of treatment. BED was diagnosed in 5.1% of men and 12.4% of women. NE prevalence was 13.5% and 12.7%, respectively. Mean (±SEM) 12‐month weight loss was less in patients with NE compared to those without (−11.0 ± 1.5 vs –14.6 ± 0.7 kg, P = .008) but did not differ in patients with and without BED, (−12.3 ± 1.9 vs –14.2 ± 0.6 kg, P = .24). Factors associated with dropout were BED (odds ratio, OR 1.57, 95% confidence interval (CI) 1.14‐2.17; P = .006) and previous weight loss attempts (OR 1.35, 95% CI 1.0‐1.7; P = .02). BED did not seem to hinder weight loss whereas NE resulted in less weight loss in patients with severe obesity who completed a 12‐month treatment programme. Previous weight loss attempts affect both dropout and ability to lose weight.

American Journal of Clinical Nutrition, 2009