Susanna C Larsson - Academia.edu (original) (raw)

Papers by Susanna C Larsson

Research paper thumbnail of Association of diet with serum insulin-like growth factor I in middle- aged and elderly men1-3

Background: Insulin-like growth factor I (IGF-I) has been impli- cated in several chronic disease... more Background: Insulin-like growth factor I (IGF-I) has been impli- cated in several chronic diseases, including cancer, heart disease, and osteoporosis. Objective: Our aim was to assess whether intakes of total energy, alcohol, vitamins, minerals, and foods rich in protein and minerals (includingredmeat,fishandseafood,poultry,andmilk)areassociated with serum IGF-I concentrations in middle-aged and elderly men. Design:WemeasuredserumIGF-Iconcentrationsin226free-living healthy men aged 42-76 y. The average of

Research paper thumbnail of Obesity and colon and rectal cancer risk: a meta-analysis of prospective studies1-3

Background: Whereas obesity has been associated with an in- creased risk of colon cancer in men, ... more Background: Whereas obesity has been associated with an in- creased risk of colon cancer in men, a weak or no association has been observed in women. Results for rectal cancer have also been inconsistent. Objective: The objective was to perform a meta-analysis to sum- marize the available evidence from prospective studies on the asso- ciations of overall and abdominal obesity

Research paper thumbnail of Calcium and dairy food intakes are inversely associated with colorectal cancer risk in the Cohort of Swedish Men1-3

Background: Recent epidemiologic studies have generally re- ported a modest inverse association b... more Background: Recent epidemiologic studies have generally re- ported a modest inverse association between calcium intake and the risk of colorectal cancer. However, findings pertaining to specific subsites in the colorectum have been conflicting. Objective:Ourobjectivewastoprospectivelyexaminetherelations betweenintakesofcalciumanddairyfoodsandtheriskofcolorectal cancer, overall and by anatomic subsite, in men from the Cohort of Swedish Men. Design: In 1997, 45 306 men aged 45-79 y and without

Research paper thumbnail of Physical activity is associated with a reduced risk of atrial fibrillation in middle-aged and elderly women

Heart, 2015

Previous studies have found that regular participation in intense physical activity increases the... more Previous studies have found that regular participation in intense physical activity increases the risk of developing atrial fibrillation (AF) in men, but it remains unclear how physical activity influences the risk of AF in women. We aimed to examine whether physical activity of different types and at different ages influences the development of AF in women. In the population-based Swedish Mammography Cohort, information about physical activity was obtained from 36 513 AF-free women (49-83 years old, median age 60 years) who had completed a questionnaire at study entry (1997). Participants reported their time spent on leisure-time exercise and on walking or bicycling throughout their lifetime (at study entry, and at 30 and 50 years of age). We used the Swedish National Inpatient Register (IPR) to determine whether the participants were diagnosed with AF. Cox proportional hazards regression models were used to estimate relative risks (RR) with 95% CI, adjusted for potential confounders. During a median follow-up of 12 years (10th percentile 7.5 years, 90th percentile 12.0 years), 2915 cases of AF were diagnosed. The risk of AF decreased with increasing levels of leisure-time exercise at study entry (RR 0.85, 95% CI 0.75 to 0.95 for ≥4 h/week vs <1 h/week) and walking/bicycling (RR 0.81, 95% CI 0.72 to 0.92, for ≥40 min/day vs almost never). Physical activity is associated with a reduced risk of AF in women. Moderate amount of physical activity was sufficient to significantly reduce AF risk.

Research paper thumbnail of Coffee and Tea Consumption and Risk of Stroke Subtypes in Male Smokers

Background and Purpose—Coffee and tea consumption could potentially reduce the risk of stroke bec... more Background and Purpose—Coffee and tea consumption could potentially reduce the risk of stroke because these beverages have antioxidant properties, and coffee may improve insulin sensitivity. We examined the associations of coffee and tea consumption with risk of stroke subtypes. Methods—We used prospective data from the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a cohort study of 26 556 male Finnish smokers aged

Research paper thumbnail of Primary prevention of stroke by a healthy lifestyle in a high-risk group

Neurology, 2015

To examine the impact of a healthy lifestyle on stroke risk in men at higher risk of stroke becau... more To examine the impact of a healthy lifestyle on stroke risk in men at higher risk of stroke because of other cardiovascular diseases or conditions. Our study population comprised 11,450 men in the Cohort of Swedish Men who had a history of hypertension, high cholesterol levels, diabetes, heart failure, or atrial fibrillation. Participants had completed a questionnaire about diet and lifestyle and were free from stroke and ischemic heart disease at baseline (January 1, 1998). We defined a healthy lifestyle as a low-risk diet (≥5 servings/d of fruits and vegetables and <30 g/d of processed meat), not smoking, ≥150 min/wk of physical activity, body mass index of 18.5 to 25 kg/m(2), and low to moderate alcohol consumption (>0 to ≤30 g/d). Ascertainment of stroke cases was accomplished through linkage with the National Inpatient Register and the Swedish Cause of Death Register. During a mean follow-up of 9.8 years, we ascertained 1,062 incident stroke cases. The risk of total strok...

Research paper thumbnail of Dietary cysteine and other amino acids and stroke incidence in women

Stroke; a journal of cerebral circulation, 2015

Cysteine could potentially lower the risk of stroke through antihypertensive and antioxidant effe... more Cysteine could potentially lower the risk of stroke through antihypertensive and antioxidant effects. Our aim was to evaluate the hypothesis that cysteine intake is inversely associated with stroke incidence. We used data from the Swedish Mammography Cohort, a population-based prospective cohort of 34 250 women who were free of cardiovascular disease and cancer and had completed a food-frequency questionnaire about diet and other risk factors for stroke in the autumn of 1997. Stroke cases were identified by linkage of the study population with the Swedish Inpatient Register and the Swedish Cause of Death Register. Relative risks (RR) with 95% confidence intervals, adjusted for potential confounders, were estimated by using Cox proportional hazards regression model. We ascertained 1751 incident cases of stroke during 10.4 years of follow-up. Dietary cysteine intake (mean, 635 mg/d) was inversely associated with stroke risk. The multivariable RR of total stroke comparing the highest w...

Research paper thumbnail of Incidence of atrial fibrillation in relation to birth weight and preterm birth

International journal of cardiology, Jan 15, 2015

Hypertension, type 2 diabetes and other cardiovascular diseases, all risk factors for atrial fibr... more Hypertension, type 2 diabetes and other cardiovascular diseases, all risk factors for atrial fibrillation, are associated with birth weight. It remains unclear, however, whether risk of atrial fibrillation is also associated with birth weight. We investigated the associations of birth weight and preterm birth (i.e., born more than one month before term) with risk of atrial fibrillation (AF). The study population comprised 29551 men and 23454 women who were free from AF at baseline. Information on birth weight, preterm birth, and risk factors for AF was obtained from a questionnaire. Incident AF cases were ascertained by linkage to the Swedish Inpatient Register. During 12years of follow-up, AF developed in 2711 men and 1491 women. High birth weight (≥5000g) was associated with an increased risk of AF after adjustment for age and other risk factors for AF, but the association did not persist after further adjustment for adult height. In men but not in women, low birth weight was asso...

Research paper thumbnail of Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies

British journal of cancer, Jan 8, 2007

Cohort studies of excess body weight and risk of liver cancer were identified for a meta-analysis... more Cohort studies of excess body weight and risk of liver cancer were identified for a meta-analysis by searching MEDLINE and EMBASE databases from 1966 to June 2007 and the reference lists of retrieved articles. Results from individual studies were combined using a random-effects model. We identified 11 cohort studies, of which seven on overweight (with a total of 5037 cases) and 10 on obesity (with 6042 cases) were suitable for meta-analysis. Compared with persons of normal weight, the summary relative risks of liver cancer were 1.17 (95% confidence interval (CI): 1.02-1.34) for those who were overweight and 1.89 (95% CI: 1.51-2.36) for those who were obese. This meta-analysis finds that excess body weight is associated with an increased risk of liver cancer.

Research paper thumbnail of Dietary long-chain n-3 fatty acids for the prevention of cancer: a review of potential mechanisms

The American journal of clinical nutrition, 2004

Increasing evidence from animal and in vitro studies indicates that n-3 fatty acids, especially t... more Increasing evidence from animal and in vitro studies indicates that n-3 fatty acids, especially the long-chain polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid, present in fatty fish and fish oils inhibit carcinogenesis. The epidemiologic data on the association between fish consumption, as a surrogate marker for n-3 fatty acid intake, and cancer risk are, however, somewhat less consistent. This review highlights current knowledge of the potential mechanisms of the anticarcinogenic actions of n-3 fatty acids. Moreover, a possible explanation of why some epidemiologic studies failed to find an association between n-3 fatty acid intake and cancer risk is provided. Several molecular mechanisms whereby n-3 fatty acids may modify the carcinogenic process have been proposed. These include suppression of arachidonic acid-derived eicosanoid biosynthesis; influences on transcription factor activity, gene expression, and signal transduction pathways; alteration of es...

Research paper thumbnail of Overall obesity, abdominal adiposity, diabetes and cigarette smoking in relation to the risk of pancreatic cancer in two Swedish population-based cohorts

Br. J. Cancer, 2005

We examined the associations of body mass index (BMI), waist circumference, a history of diabetes... more We examined the associations of body mass index (BMI), waist circumference, a history of diabetes, and cigarette smoking with risk of pancreatic cancer among 37 147 women and 45 906 men followed up during 560 666 person-years in the Swedish Mammography Cohort and the Cohort of Swedish Men; 136 incident cases of pancreatic cancer were diagnosed. The multivariate rate ratio (RR) of pancreatic cancer for obese women and men (BMI X30 kg/m 2 ) was 1.81 (95% CI: 1.04 -3.15) compared to those with a BMI of 20 -25 kg/m 2 . For a difference of 20 cm (about two standard deviations) in waist circumference, the multivariate RRs were 1.32 (95% CI: 0.73 -2.37) among women and 1.74 (95% CI: 1.00 -3.01) among men. Pancreatic cancer risk was associated with history of diabetes (multivariate RR: 1.88; 95% CI: 1.09 -3.26) and cigarette smoking (multivariate RR for current compared with never smokers: 3.06; 95% CI: 1.99 -4.72). Current smokers of X40 pack-years had a five-fold elevated risk compared with never smokers. Risk among past smokers approached the RR for never smokers within 5 -10 years following smoking cessation. Findings from this prospective study support positive relationships of overall obesity, abdominal adiposity, diabetes and smoking with risk of pancreatic cancer.

Research paper thumbnail of Whole grain consumption and risk of colorectal cancer: a population-based cohort of 60 000 women

Br. J. Cancer, 2005

We examined prospectively the association between whole grain consumption and colorectal cancer r... more We examined prospectively the association between whole grain consumption and colorectal cancer risk in the population-based Swedish Mammography Cohort. A total of 61,433 women completed a food-frequency questionnaire at baseline (1987-1990) and, through linkage with the Swedish Cancer Registry, 805 incident cases of colorectal cancer were identified during a mean follow-up of 14.8 years. High consumption of whole grains was associated with a lower risk of colon cancer, but not of rectal cancer. The multivariate rate ratio (RR) of colon cancer for the top category of whole grain consumption (&gt; or = 4.5 servings day(-1)) compared with the bottom category (&lt;1.5 servings day(-1)) was 0.67 (95% confidence interval (CI), 0.47-0.96; P-value for trend=0.06). The corresponding RR after excluding cases occurring within the first 2 years of follow-up was 0.65 (95% CI, 0.45-0.94; P-value for trend=0.04). Our findings suggest that high consumption of whole grains may decrease the risk of colon cancer in women.

Research paper thumbnail of Alcohol consumption, specific alcoholic beverages, and abdominal aortic aneurysm

Circulation, 2014

Studies investigating the role of alcohol consumption in the development of abdominal aortic aneu... more Studies investigating the role of alcohol consumption in the development of abdominal aortic aneurysm (AAA) are scarce. We aimed to examine associations between total alcohol consumption and specific alcoholic beverages and the hazard of AAA. The study population was made up of 44 715 men from the Cohort of Swedish Men and 35 569 women from the Swedish Mammography Cohort who were 46 to 84 years of age at baseline in 1998. Cox proportional hazards models were used to estimate hazard ratios with 95% confidence intervals for the associations between alcohol consumption, assessed through a food frequency questionnaire, and AAA, identified by means of linkage to the Swedish Inpatient Register and the Swedish Vascular Registry (Swedvasc). Over the 14-year follow-up until December 2011 (1 019 954 person-years), AAAs occurred in 1020 men and 194 women. Compared with the consumption of 1 glass of alcohol per week (12 g of ethanol), the hazard ratio of AAA among men who consumed 10 glasses per week was 0.80 (95% confidence interval, 0.68-0.94). The corresponding hazard ratio among women who consumed 5 glasses per week was 0.57 (95% confidence interval, 0.40-0.82). Among participants free from cardiovascular disease, total alcohol consumption did not seem to be associated with hazard of the disease. The most commonly consumed alcoholic beverages, beer among men and wine among women, were inversely associated, whereas no association was observed for liquor. Moderate alcohol consumption, specifically wine and beer, was associated with a lower hazard of abdominal aortic aneurysm. The associations between higher doses of alcohol and risk of the disease remain unknown.

Research paper thumbnail of Atrial fibrillation is associated with different levels of physical activity levels at different ages in men

Heart, 2014

This study examines the influence of physical activity at different ages and of different types, ... more This study examines the influence of physical activity at different ages and of different types, on the risk of developing atrial fibrillation (AF) in a large cohort of Swedish men. Information about physical activity was obtained from 44 410 AF-free men, aged 45-79 years (mean age=60), who had completed a self-administered questionnaire at baseline in 1997. Participants reported retrospectively their time spent on leisure-time exercise and on walking or bicycling throughout their lifetime (at 15, 30 and 50 years of age, and at baseline (mean age=60)). Participants were followed-up in the Swedish National Inpatient Register for ascertainment of AF. Cox proportional hazards regression models were used to estimate relative risks (RR) with 95% CIs, adjusted for potential confounders. During a median follow-up of 12 years, 4568 cases of AF were diagnosed. We observed a RR of 1.19 (95% CI 1.05 to 1.36) of developing AF in men who at the age of 30 years had exercised for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5 h/week compared with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 h/week. The risk was even higher (RR 1.49, 95% CI 1.14 to 1.95) among the men who exercised &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5 h/week at age 30 and quit exercising later in life (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 h/week at baseline). Walking/bicycling at baseline was inversely associated with risk of AF (RR 0.87, 95% CI 0.77 to 0.97 for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 h/day vs almost never) and the association was similar after excluding men with previous coronary heart disease or heart failure at baseline (corresponding RR 0.88, 95% CI 0.77 to 0.998). Leisure-time exercise at younger age is associated with an increased risk of AF, whereas walking/bicycling at older age is associated with a decreased risk.

Research paper thumbnail of Differences in survival associated with processed and with nonprocessed red meat consumption

Am. J. Clin. Nutr., 2014

High red meat consumption is associated with an increased mortality risk. This association is par... more High red meat consumption is associated with an increased mortality risk. This association is partly explained by the negative effect of processed meat consumption, which is widely established. The role of nonprocessed meat is unclear. The objective was to examine the combined association of processed and nonprocessed meat consumption with survival in a Swedish large prospective cohort. In a population-based cohort of 74,645 Swedish men (40,089) and women (34,556), red meat consumption was assessed through a self-administered questionnaire. We estimated differences in survival [15th percentile differences (PDs), differences in the time by which the first 15% of the cohort died] according to levels of total red meat and combined levels of processed and nonprocessed red meat consumption. During 15 y of follow-up (January 1998 to December 2012), we documented 16,683 deaths (6948 women; 9735 men). Compared with no consumption, consumption of red meat &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;100 g/d was progressively associated with shorter survival--up to 2 y for participants consuming an average of 300 g/d (15th PD: -21 mo; 95% CI: -31, -10). Compared with no consumption, high consumption of processed red meat (100 g/d) was associated with shorter survival (15th PD: -9 mo; 95% CI: -16, -2). High and moderate intakes of nonprocessed red meat were associated with shorter survival only when accompanied by a high intake of processed red meat. We found that high total red meat consumption was associated with progressively shorter survival, largely because of the consumption of processed red meat. Consumption of nonprocessed red meat alone was not associated with shorter survival.

Research paper thumbnail of Sex differences in the association between smoking and abdominal aortic aneurysm

Br J Surg, 2014

It is unclear whether recommendations about ultrasound screening programmes for abdominal aortic ... more It is unclear whether recommendations about ultrasound screening programmes for abdominal aortic aneurysm (AAA) among men should be extended to include women who smoke. The aim was to examine sex-specific dose-response associations between AAA risk and smoking status, pack-years smoked and time since smoking cessation. Women in the Swedish Mammography Cohort and men in the Cohort of Swedish Men were followed up from 1998 to 2011. AAA was identified through linkage of the cohorts to the Swedish Inpatient Register and the Swedish National Register for Vascular Surgery (Swedvasc), and not through general ultrasound screening. Associations were estimated with Cox proportional hazards models. The cohorts included 35 550 women and 42 596 men, aged 46-84 years. During follow-up, AAA was identified in 199 women and 958 men. The incidence of AAA per 100 000 person-years was 76 among men who never smoked and 136 among women who currently smoke. Regarding AAA risk, women were more sensitive to current smoking (Pinteraction = 0·002). Compared with never smokers, the hazard ratio (HR) for AAA in current smokers with more than 20 pack-years was 10·97 (95 per cent confidence interval 7·41 to 16·26) among women and 6·55 (5·36 to 7·99) among men. Following smoking cessation, women had a more rapid decline in excess risk (Pinteraction &lt; 0·001). The risk was halved after 11 years (HR 0·51, 0·32 to 0·81) among women and after 23 years (HR 0·50, 0·42 to 0·60) among men. There were sex differences in the associations between smoking status and AAA risk. These data support further investigation of targeted AAA screening among women who smoke.

Research paper thumbnail of Coffee Consumption and Mortality From All Causes, Cardiovascular Disease, and Cancer: A Dose-Response Meta-Analysis

Am. J. Epidemiol., 2014

Several studies have analyzed the relationship between coffee consumption and mortality, but the ... more Several studies have analyzed the relationship between coffee consumption and mortality, but the shape of the association remains unclear. We conducted a dose-response meta-analysis of prospective studies to examine the dose-response associations between coffee consumption and mortality from all causes, cardiovascular disease (CVD), and all cancers. Pertinent studies, published between 1966 and 2013, were identified by searching PubMed and by reviewing the reference lists of the selected articles. Prospective studies in which investigators reported relative risks of mortality from all causes, CVD, and all cancers for 3 or more categories of coffee consumption were eligible. Results from individual studies were pooled using a random-effects model. Twenty-one prospective studies, with 121,915 deaths and 997,464 participants, met the inclusion criteria. There was strong evidence of nonlinear associations between coffee consumption and mortality for all causes and CVD (P for nonlinearity &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The largest risk reductions were observed for 4 cups/day for all-cause mortality (16%, 95% confidence interval: 13, 18) and 3 cups/day for CVD mortality (21%, 95% confidence interval: 16, 26). Coffee consumption was not associated with cancer mortality. Findings from this meta-analysis indicate that coffee consumption is inversely associated with all-cause and CVD mortality.

Research paper thumbnail of Dietary fiber intake is inversely associated with stroke incidence in healthy Swedish adults

J. Nutr., 2014

Background: Prospective studies of dietary fiber intake in relation to stroke risk have reported ... more Background: Prospective studies of dietary fiber intake in relation to stroke risk have reported inconsistent results.

Research paper thumbnail of Low-risk diet and lifestyle habits in the primary prevention of myocardial infarction in men: a population-based prospective cohort study

J. Am. Coll. Cardiol., 2014

Adherence to a combination of healthy dietary and lifestyle practices may have an impressive impa... more Adherence to a combination of healthy dietary and lifestyle practices may have an impressive impact on the primary prevention of myocardial infarction (MI). The aim of this study was to examine the benefit of combined low-risk diet and healthy lifestyle practices on the incidence of MI in men. The population-based, prospective cohort of Swedish men comprised 45- to 79-year-old men who completed a detailed questionnaire on diet and lifestyle at baseline in 1997. In total, 20,721 men with no history of cancer, cardiovascular disease, diabetes, hypertension, or high cholesterol levels were followed through 2009. Low-risk behavior included 5 factors: a healthy diet (top quintile of Recommended Food Score), moderate alcohol consumption (10 to 30 g/day), no smoking, being physically active (walking/bicycling ≥40 min/day and exercising ≥1 h/week), and having no abdominal adiposity (waist circumference &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;95 cm). During 11 years of follow-up, we ascertained 1,361 incident cases of MI. The low-risk dietary choice together with moderate alcohol consumption was associated with a relative risk of 0.65 (95% confidence interval [CI]: 0.48 to 0.87) compared with men having 0 of 5 low-risk factors. Men having all 5 low-risk factors compared with those with 0 low-risk factors had a relative risk of 0.14 (95% CI: 0.04 to 0.43). This combination of healthy behaviors, present in 1% of the men, could prevent 79% (95% CI: 34% to 93%) of the MI events on the basis of the study population. Almost 4 of 5 MIs in men may be preventable with a combined low-risk behavior.

Research paper thumbnail of Healthy diet and lifestyle and risk of stroke in a prospective cohort of women

Neurology, Jan 4, 2014

To investigate the association between a low-risk lifestyle and risk of stroke. The study populat... more To investigate the association between a low-risk lifestyle and risk of stroke. The study population comprised 31,696 women, in the population-based Swedish Mammography Cohort who at baseline had completed a questionnaire about diet and lifestyle and were free from cardiovascular disease and cancer. We defined a low-risk lifestyle as a healthy diet (top 50% of a Recommended Food Score), moderate alcohol consumption (5-15 g/d), never smoking, physically active (walking/bicycling ≥40 min/d and exercise ≥1 h/wk), and body mass index below 25 kg/m(2). Stroke cases were identified from the Swedish National Patient Register and the Swedish Cause of Death Register. We ascertained 1,554 incident stroke cases, including 1,155 cerebral infarctions, 246 hemorrhagic strokes, and 153 unspecified strokes during 10.4 years of follow-up. The risk of stroke, in particular cerebral infarction, decreased steadily with increasing number of low-risk lifestyle factors. Compared with no low-risk factors, ...

Research paper thumbnail of Association of diet with serum insulin-like growth factor I in middle- aged and elderly men1-3

Background: Insulin-like growth factor I (IGF-I) has been impli- cated in several chronic disease... more Background: Insulin-like growth factor I (IGF-I) has been impli- cated in several chronic diseases, including cancer, heart disease, and osteoporosis. Objective: Our aim was to assess whether intakes of total energy, alcohol, vitamins, minerals, and foods rich in protein and minerals (includingredmeat,fishandseafood,poultry,andmilk)areassociated with serum IGF-I concentrations in middle-aged and elderly men. Design:WemeasuredserumIGF-Iconcentrationsin226free-living healthy men aged 42-76 y. The average of

Research paper thumbnail of Obesity and colon and rectal cancer risk: a meta-analysis of prospective studies1-3

Background: Whereas obesity has been associated with an in- creased risk of colon cancer in men, ... more Background: Whereas obesity has been associated with an in- creased risk of colon cancer in men, a weak or no association has been observed in women. Results for rectal cancer have also been inconsistent. Objective: The objective was to perform a meta-analysis to sum- marize the available evidence from prospective studies on the asso- ciations of overall and abdominal obesity

Research paper thumbnail of Calcium and dairy food intakes are inversely associated with colorectal cancer risk in the Cohort of Swedish Men1-3

Background: Recent epidemiologic studies have generally re- ported a modest inverse association b... more Background: Recent epidemiologic studies have generally re- ported a modest inverse association between calcium intake and the risk of colorectal cancer. However, findings pertaining to specific subsites in the colorectum have been conflicting. Objective:Ourobjectivewastoprospectivelyexaminetherelations betweenintakesofcalciumanddairyfoodsandtheriskofcolorectal cancer, overall and by anatomic subsite, in men from the Cohort of Swedish Men. Design: In 1997, 45 306 men aged 45-79 y and without

Research paper thumbnail of Physical activity is associated with a reduced risk of atrial fibrillation in middle-aged and elderly women

Heart, 2015

Previous studies have found that regular participation in intense physical activity increases the... more Previous studies have found that regular participation in intense physical activity increases the risk of developing atrial fibrillation (AF) in men, but it remains unclear how physical activity influences the risk of AF in women. We aimed to examine whether physical activity of different types and at different ages influences the development of AF in women. In the population-based Swedish Mammography Cohort, information about physical activity was obtained from 36 513 AF-free women (49-83 years old, median age 60 years) who had completed a questionnaire at study entry (1997). Participants reported their time spent on leisure-time exercise and on walking or bicycling throughout their lifetime (at study entry, and at 30 and 50 years of age). We used the Swedish National Inpatient Register (IPR) to determine whether the participants were diagnosed with AF. Cox proportional hazards regression models were used to estimate relative risks (RR) with 95% CI, adjusted for potential confounders. During a median follow-up of 12 years (10th percentile 7.5 years, 90th percentile 12.0 years), 2915 cases of AF were diagnosed. The risk of AF decreased with increasing levels of leisure-time exercise at study entry (RR 0.85, 95% CI 0.75 to 0.95 for ≥4 h/week vs &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 h/week) and walking/bicycling (RR 0.81, 95% CI 0.72 to 0.92, for ≥40 min/day vs almost never). Physical activity is associated with a reduced risk of AF in women. Moderate amount of physical activity was sufficient to significantly reduce AF risk.

Research paper thumbnail of Coffee and Tea Consumption and Risk of Stroke Subtypes in Male Smokers

Background and Purpose—Coffee and tea consumption could potentially reduce the risk of stroke bec... more Background and Purpose—Coffee and tea consumption could potentially reduce the risk of stroke because these beverages have antioxidant properties, and coffee may improve insulin sensitivity. We examined the associations of coffee and tea consumption with risk of stroke subtypes. Methods—We used prospective data from the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a cohort study of 26 556 male Finnish smokers aged

Research paper thumbnail of Primary prevention of stroke by a healthy lifestyle in a high-risk group

Neurology, 2015

To examine the impact of a healthy lifestyle on stroke risk in men at higher risk of stroke becau... more To examine the impact of a healthy lifestyle on stroke risk in men at higher risk of stroke because of other cardiovascular diseases or conditions. Our study population comprised 11,450 men in the Cohort of Swedish Men who had a history of hypertension, high cholesterol levels, diabetes, heart failure, or atrial fibrillation. Participants had completed a questionnaire about diet and lifestyle and were free from stroke and ischemic heart disease at baseline (January 1, 1998). We defined a healthy lifestyle as a low-risk diet (≥5 servings/d of fruits and vegetables and <30 g/d of processed meat), not smoking, ≥150 min/wk of physical activity, body mass index of 18.5 to 25 kg/m(2), and low to moderate alcohol consumption (>0 to ≤30 g/d). Ascertainment of stroke cases was accomplished through linkage with the National Inpatient Register and the Swedish Cause of Death Register. During a mean follow-up of 9.8 years, we ascertained 1,062 incident stroke cases. The risk of total strok...

Research paper thumbnail of Dietary cysteine and other amino acids and stroke incidence in women

Stroke; a journal of cerebral circulation, 2015

Cysteine could potentially lower the risk of stroke through antihypertensive and antioxidant effe... more Cysteine could potentially lower the risk of stroke through antihypertensive and antioxidant effects. Our aim was to evaluate the hypothesis that cysteine intake is inversely associated with stroke incidence. We used data from the Swedish Mammography Cohort, a population-based prospective cohort of 34 250 women who were free of cardiovascular disease and cancer and had completed a food-frequency questionnaire about diet and other risk factors for stroke in the autumn of 1997. Stroke cases were identified by linkage of the study population with the Swedish Inpatient Register and the Swedish Cause of Death Register. Relative risks (RR) with 95% confidence intervals, adjusted for potential confounders, were estimated by using Cox proportional hazards regression model. We ascertained 1751 incident cases of stroke during 10.4 years of follow-up. Dietary cysteine intake (mean, 635 mg/d) was inversely associated with stroke risk. The multivariable RR of total stroke comparing the highest w...

Research paper thumbnail of Incidence of atrial fibrillation in relation to birth weight and preterm birth

International journal of cardiology, Jan 15, 2015

Hypertension, type 2 diabetes and other cardiovascular diseases, all risk factors for atrial fibr... more Hypertension, type 2 diabetes and other cardiovascular diseases, all risk factors for atrial fibrillation, are associated with birth weight. It remains unclear, however, whether risk of atrial fibrillation is also associated with birth weight. We investigated the associations of birth weight and preterm birth (i.e., born more than one month before term) with risk of atrial fibrillation (AF). The study population comprised 29551 men and 23454 women who were free from AF at baseline. Information on birth weight, preterm birth, and risk factors for AF was obtained from a questionnaire. Incident AF cases were ascertained by linkage to the Swedish Inpatient Register. During 12years of follow-up, AF developed in 2711 men and 1491 women. High birth weight (≥5000g) was associated with an increased risk of AF after adjustment for age and other risk factors for AF, but the association did not persist after further adjustment for adult height. In men but not in women, low birth weight was asso...

Research paper thumbnail of Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies

British journal of cancer, Jan 8, 2007

Cohort studies of excess body weight and risk of liver cancer were identified for a meta-analysis... more Cohort studies of excess body weight and risk of liver cancer were identified for a meta-analysis by searching MEDLINE and EMBASE databases from 1966 to June 2007 and the reference lists of retrieved articles. Results from individual studies were combined using a random-effects model. We identified 11 cohort studies, of which seven on overweight (with a total of 5037 cases) and 10 on obesity (with 6042 cases) were suitable for meta-analysis. Compared with persons of normal weight, the summary relative risks of liver cancer were 1.17 (95% confidence interval (CI): 1.02-1.34) for those who were overweight and 1.89 (95% CI: 1.51-2.36) for those who were obese. This meta-analysis finds that excess body weight is associated with an increased risk of liver cancer.

Research paper thumbnail of Dietary long-chain n-3 fatty acids for the prevention of cancer: a review of potential mechanisms

The American journal of clinical nutrition, 2004

Increasing evidence from animal and in vitro studies indicates that n-3 fatty acids, especially t... more Increasing evidence from animal and in vitro studies indicates that n-3 fatty acids, especially the long-chain polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid, present in fatty fish and fish oils inhibit carcinogenesis. The epidemiologic data on the association between fish consumption, as a surrogate marker for n-3 fatty acid intake, and cancer risk are, however, somewhat less consistent. This review highlights current knowledge of the potential mechanisms of the anticarcinogenic actions of n-3 fatty acids. Moreover, a possible explanation of why some epidemiologic studies failed to find an association between n-3 fatty acid intake and cancer risk is provided. Several molecular mechanisms whereby n-3 fatty acids may modify the carcinogenic process have been proposed. These include suppression of arachidonic acid-derived eicosanoid biosynthesis; influences on transcription factor activity, gene expression, and signal transduction pathways; alteration of es...

Research paper thumbnail of Overall obesity, abdominal adiposity, diabetes and cigarette smoking in relation to the risk of pancreatic cancer in two Swedish population-based cohorts

Br. J. Cancer, 2005

We examined the associations of body mass index (BMI), waist circumference, a history of diabetes... more We examined the associations of body mass index (BMI), waist circumference, a history of diabetes, and cigarette smoking with risk of pancreatic cancer among 37 147 women and 45 906 men followed up during 560 666 person-years in the Swedish Mammography Cohort and the Cohort of Swedish Men; 136 incident cases of pancreatic cancer were diagnosed. The multivariate rate ratio (RR) of pancreatic cancer for obese women and men (BMI X30 kg/m 2 ) was 1.81 (95% CI: 1.04 -3.15) compared to those with a BMI of 20 -25 kg/m 2 . For a difference of 20 cm (about two standard deviations) in waist circumference, the multivariate RRs were 1.32 (95% CI: 0.73 -2.37) among women and 1.74 (95% CI: 1.00 -3.01) among men. Pancreatic cancer risk was associated with history of diabetes (multivariate RR: 1.88; 95% CI: 1.09 -3.26) and cigarette smoking (multivariate RR for current compared with never smokers: 3.06; 95% CI: 1.99 -4.72). Current smokers of X40 pack-years had a five-fold elevated risk compared with never smokers. Risk among past smokers approached the RR for never smokers within 5 -10 years following smoking cessation. Findings from this prospective study support positive relationships of overall obesity, abdominal adiposity, diabetes and smoking with risk of pancreatic cancer.

Research paper thumbnail of Whole grain consumption and risk of colorectal cancer: a population-based cohort of 60 000 women

Br. J. Cancer, 2005

We examined prospectively the association between whole grain consumption and colorectal cancer r... more We examined prospectively the association between whole grain consumption and colorectal cancer risk in the population-based Swedish Mammography Cohort. A total of 61,433 women completed a food-frequency questionnaire at baseline (1987-1990) and, through linkage with the Swedish Cancer Registry, 805 incident cases of colorectal cancer were identified during a mean follow-up of 14.8 years. High consumption of whole grains was associated with a lower risk of colon cancer, but not of rectal cancer. The multivariate rate ratio (RR) of colon cancer for the top category of whole grain consumption (&gt; or = 4.5 servings day(-1)) compared with the bottom category (&lt;1.5 servings day(-1)) was 0.67 (95% confidence interval (CI), 0.47-0.96; P-value for trend=0.06). The corresponding RR after excluding cases occurring within the first 2 years of follow-up was 0.65 (95% CI, 0.45-0.94; P-value for trend=0.04). Our findings suggest that high consumption of whole grains may decrease the risk of colon cancer in women.

Research paper thumbnail of Alcohol consumption, specific alcoholic beverages, and abdominal aortic aneurysm

Circulation, 2014

Studies investigating the role of alcohol consumption in the development of abdominal aortic aneu... more Studies investigating the role of alcohol consumption in the development of abdominal aortic aneurysm (AAA) are scarce. We aimed to examine associations between total alcohol consumption and specific alcoholic beverages and the hazard of AAA. The study population was made up of 44 715 men from the Cohort of Swedish Men and 35 569 women from the Swedish Mammography Cohort who were 46 to 84 years of age at baseline in 1998. Cox proportional hazards models were used to estimate hazard ratios with 95% confidence intervals for the associations between alcohol consumption, assessed through a food frequency questionnaire, and AAA, identified by means of linkage to the Swedish Inpatient Register and the Swedish Vascular Registry (Swedvasc). Over the 14-year follow-up until December 2011 (1 019 954 person-years), AAAs occurred in 1020 men and 194 women. Compared with the consumption of 1 glass of alcohol per week (12 g of ethanol), the hazard ratio of AAA among men who consumed 10 glasses per week was 0.80 (95% confidence interval, 0.68-0.94). The corresponding hazard ratio among women who consumed 5 glasses per week was 0.57 (95% confidence interval, 0.40-0.82). Among participants free from cardiovascular disease, total alcohol consumption did not seem to be associated with hazard of the disease. The most commonly consumed alcoholic beverages, beer among men and wine among women, were inversely associated, whereas no association was observed for liquor. Moderate alcohol consumption, specifically wine and beer, was associated with a lower hazard of abdominal aortic aneurysm. The associations between higher doses of alcohol and risk of the disease remain unknown.

Research paper thumbnail of Atrial fibrillation is associated with different levels of physical activity levels at different ages in men

Heart, 2014

This study examines the influence of physical activity at different ages and of different types, ... more This study examines the influence of physical activity at different ages and of different types, on the risk of developing atrial fibrillation (AF) in a large cohort of Swedish men. Information about physical activity was obtained from 44 410 AF-free men, aged 45-79 years (mean age=60), who had completed a self-administered questionnaire at baseline in 1997. Participants reported retrospectively their time spent on leisure-time exercise and on walking or bicycling throughout their lifetime (at 15, 30 and 50 years of age, and at baseline (mean age=60)). Participants were followed-up in the Swedish National Inpatient Register for ascertainment of AF. Cox proportional hazards regression models were used to estimate relative risks (RR) with 95% CIs, adjusted for potential confounders. During a median follow-up of 12 years, 4568 cases of AF were diagnosed. We observed a RR of 1.19 (95% CI 1.05 to 1.36) of developing AF in men who at the age of 30 years had exercised for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5 h/week compared with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 h/week. The risk was even higher (RR 1.49, 95% CI 1.14 to 1.95) among the men who exercised &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5 h/week at age 30 and quit exercising later in life (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 h/week at baseline). Walking/bicycling at baseline was inversely associated with risk of AF (RR 0.87, 95% CI 0.77 to 0.97 for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 h/day vs almost never) and the association was similar after excluding men with previous coronary heart disease or heart failure at baseline (corresponding RR 0.88, 95% CI 0.77 to 0.998). Leisure-time exercise at younger age is associated with an increased risk of AF, whereas walking/bicycling at older age is associated with a decreased risk.

Research paper thumbnail of Differences in survival associated with processed and with nonprocessed red meat consumption

Am. J. Clin. Nutr., 2014

High red meat consumption is associated with an increased mortality risk. This association is par... more High red meat consumption is associated with an increased mortality risk. This association is partly explained by the negative effect of processed meat consumption, which is widely established. The role of nonprocessed meat is unclear. The objective was to examine the combined association of processed and nonprocessed meat consumption with survival in a Swedish large prospective cohort. In a population-based cohort of 74,645 Swedish men (40,089) and women (34,556), red meat consumption was assessed through a self-administered questionnaire. We estimated differences in survival [15th percentile differences (PDs), differences in the time by which the first 15% of the cohort died] according to levels of total red meat and combined levels of processed and nonprocessed red meat consumption. During 15 y of follow-up (January 1998 to December 2012), we documented 16,683 deaths (6948 women; 9735 men). Compared with no consumption, consumption of red meat &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;100 g/d was progressively associated with shorter survival--up to 2 y for participants consuming an average of 300 g/d (15th PD: -21 mo; 95% CI: -31, -10). Compared with no consumption, high consumption of processed red meat (100 g/d) was associated with shorter survival (15th PD: -9 mo; 95% CI: -16, -2). High and moderate intakes of nonprocessed red meat were associated with shorter survival only when accompanied by a high intake of processed red meat. We found that high total red meat consumption was associated with progressively shorter survival, largely because of the consumption of processed red meat. Consumption of nonprocessed red meat alone was not associated with shorter survival.

Research paper thumbnail of Sex differences in the association between smoking and abdominal aortic aneurysm

Br J Surg, 2014

It is unclear whether recommendations about ultrasound screening programmes for abdominal aortic ... more It is unclear whether recommendations about ultrasound screening programmes for abdominal aortic aneurysm (AAA) among men should be extended to include women who smoke. The aim was to examine sex-specific dose-response associations between AAA risk and smoking status, pack-years smoked and time since smoking cessation. Women in the Swedish Mammography Cohort and men in the Cohort of Swedish Men were followed up from 1998 to 2011. AAA was identified through linkage of the cohorts to the Swedish Inpatient Register and the Swedish National Register for Vascular Surgery (Swedvasc), and not through general ultrasound screening. Associations were estimated with Cox proportional hazards models. The cohorts included 35 550 women and 42 596 men, aged 46-84 years. During follow-up, AAA was identified in 199 women and 958 men. The incidence of AAA per 100 000 person-years was 76 among men who never smoked and 136 among women who currently smoke. Regarding AAA risk, women were more sensitive to current smoking (Pinteraction = 0·002). Compared with never smokers, the hazard ratio (HR) for AAA in current smokers with more than 20 pack-years was 10·97 (95 per cent confidence interval 7·41 to 16·26) among women and 6·55 (5·36 to 7·99) among men. Following smoking cessation, women had a more rapid decline in excess risk (Pinteraction &lt; 0·001). The risk was halved after 11 years (HR 0·51, 0·32 to 0·81) among women and after 23 years (HR 0·50, 0·42 to 0·60) among men. There were sex differences in the associations between smoking status and AAA risk. These data support further investigation of targeted AAA screening among women who smoke.

Research paper thumbnail of Coffee Consumption and Mortality From All Causes, Cardiovascular Disease, and Cancer: A Dose-Response Meta-Analysis

Am. J. Epidemiol., 2014

Several studies have analyzed the relationship between coffee consumption and mortality, but the ... more Several studies have analyzed the relationship between coffee consumption and mortality, but the shape of the association remains unclear. We conducted a dose-response meta-analysis of prospective studies to examine the dose-response associations between coffee consumption and mortality from all causes, cardiovascular disease (CVD), and all cancers. Pertinent studies, published between 1966 and 2013, were identified by searching PubMed and by reviewing the reference lists of the selected articles. Prospective studies in which investigators reported relative risks of mortality from all causes, CVD, and all cancers for 3 or more categories of coffee consumption were eligible. Results from individual studies were pooled using a random-effects model. Twenty-one prospective studies, with 121,915 deaths and 997,464 participants, met the inclusion criteria. There was strong evidence of nonlinear associations between coffee consumption and mortality for all causes and CVD (P for nonlinearity &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The largest risk reductions were observed for 4 cups/day for all-cause mortality (16%, 95% confidence interval: 13, 18) and 3 cups/day for CVD mortality (21%, 95% confidence interval: 16, 26). Coffee consumption was not associated with cancer mortality. Findings from this meta-analysis indicate that coffee consumption is inversely associated with all-cause and CVD mortality.

Research paper thumbnail of Dietary fiber intake is inversely associated with stroke incidence in healthy Swedish adults

J. Nutr., 2014

Background: Prospective studies of dietary fiber intake in relation to stroke risk have reported ... more Background: Prospective studies of dietary fiber intake in relation to stroke risk have reported inconsistent results.

Research paper thumbnail of Low-risk diet and lifestyle habits in the primary prevention of myocardial infarction in men: a population-based prospective cohort study

J. Am. Coll. Cardiol., 2014

Adherence to a combination of healthy dietary and lifestyle practices may have an impressive impa... more Adherence to a combination of healthy dietary and lifestyle practices may have an impressive impact on the primary prevention of myocardial infarction (MI). The aim of this study was to examine the benefit of combined low-risk diet and healthy lifestyle practices on the incidence of MI in men. The population-based, prospective cohort of Swedish men comprised 45- to 79-year-old men who completed a detailed questionnaire on diet and lifestyle at baseline in 1997. In total, 20,721 men with no history of cancer, cardiovascular disease, diabetes, hypertension, or high cholesterol levels were followed through 2009. Low-risk behavior included 5 factors: a healthy diet (top quintile of Recommended Food Score), moderate alcohol consumption (10 to 30 g/day), no smoking, being physically active (walking/bicycling ≥40 min/day and exercising ≥1 h/week), and having no abdominal adiposity (waist circumference &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;95 cm). During 11 years of follow-up, we ascertained 1,361 incident cases of MI. The low-risk dietary choice together with moderate alcohol consumption was associated with a relative risk of 0.65 (95% confidence interval [CI]: 0.48 to 0.87) compared with men having 0 of 5 low-risk factors. Men having all 5 low-risk factors compared with those with 0 low-risk factors had a relative risk of 0.14 (95% CI: 0.04 to 0.43). This combination of healthy behaviors, present in 1% of the men, could prevent 79% (95% CI: 34% to 93%) of the MI events on the basis of the study population. Almost 4 of 5 MIs in men may be preventable with a combined low-risk behavior.

Research paper thumbnail of Healthy diet and lifestyle and risk of stroke in a prospective cohort of women

Neurology, Jan 4, 2014

To investigate the association between a low-risk lifestyle and risk of stroke. The study populat... more To investigate the association between a low-risk lifestyle and risk of stroke. The study population comprised 31,696 women, in the population-based Swedish Mammography Cohort who at baseline had completed a questionnaire about diet and lifestyle and were free from cardiovascular disease and cancer. We defined a low-risk lifestyle as a healthy diet (top 50% of a Recommended Food Score), moderate alcohol consumption (5-15 g/d), never smoking, physically active (walking/bicycling ≥40 min/d and exercise ≥1 h/wk), and body mass index below 25 kg/m(2). Stroke cases were identified from the Swedish National Patient Register and the Swedish Cause of Death Register. We ascertained 1,554 incident stroke cases, including 1,155 cerebral infarctions, 246 hemorrhagic strokes, and 153 unspecified strokes during 10.4 years of follow-up. The risk of stroke, in particular cerebral infarction, decreased steadily with increasing number of low-risk lifestyle factors. Compared with no low-risk factors, ...