Danish Diet Research Articles

Modifiable Lifestyle Recommendations and Mortality in Denmark: A Cohort Study

Modifiable lifestyle behaviors represent a central target for public health interventions. This study investigates the association between adherence to 4 modifiable lifestyle recommendations and all-cause, cancer, or cardiovascular disease mortality. Investigators used data from the Danish Diet, Cancer and Health cohort (1993-2013; N=54,276). Lifestyle recommendations included smoking (never smoking), diet (adherence to 6 national food-based dietary guidelines), alcohol consumption (≤7 units per week for women and ≤14 units per week for men), and physical activity (≥30 minutes per day of moderate-to-vigorous leisure-time physical activity). Pseudo-values were used to estimate the adjusted risk differences and 95% CIs for all-cause, cancer, or cardiovascular disease mortality. Data were analyzed in 2019-2020. A total of 8,860 participants died during a median follow-up of 17.0 years. Adherence to all modifiable lifestyle recommendations was associated with an 18.46% (95% CI= -20.52%, -16.41%) lower absolute risk of all-cause mortality than no adherence. Never smokers had a 13.19% (95% CI= -13.95%, -12.44%) lower risk, those adhering to dietary guidelines (diet score ≥5) had a 7.52% (95% CI= -8.89%, -6.14%) lower risk, and those adhering to recommended levels of alcohol (2.11%, 95% CI= -2.75%, -1.48%) and physical activity (1.58%, 95% CI= -2.20%, -1.00%) had a lower risk than those who did not adhere. Stronger associations were observed in men than in women and in older than in middle-aged participants. Findings suggest that adherence to modifiable lifestyle recommendations is associated with a lower risk of mortality from all causes, cancer, and cardiovascular disease, underlining the importance of supporting adherence to national guidelines for lifestyle recommendations.

Organic food consumption is associated with a healthy lifestyle, socio-demographics and dietary habits: a cross-sectional study based on the Danish Diet, Cancer and Health cohort.

To study the association between organic food consumption and lifestyle, socio-demographics and dietary habits. Cohort participants completed detailed questionnaires about organic food consumption, diet and lifestyle between 1999 and 2002. Polytomous logistic regression models were used to estimate the association between organic food consumption, and lifestyle, socio-demographics, and dietary habits. This cross-sectional study uses data from the Danish Diet, Cancer and Health cohort. A total of 43 209 men and women aged between 54 and 73 years were included in the study. Overall, 15 % reported never consuming organic food, 39 % had low organic food consumption, 37 % had medium organic food consumption and 10 % had high organic food consumption. The relative risk of consuming organic food versus never consuming organic food was highest among women, persons with BMI < 25 kg/m2, persons with low alcohol intake, persons participating in sports, persons who did not smoke or were former smokers, and among persons who adhered to the Danish national dietary guidelines. Associations were more distinct with higher levels of organic food consumption. Based on a historical cohort of Danish adults, organic food consumption was associated with a generally healthy lifestyle, more favourable socio-demographics and dietary habits. These findings have to be considered in the adjustment strategy for future studies linking organic food consumption with health outcomes.

Linoleic acid in adipose tissue and the risk of myocardial infarction: a case-cohort study.

We investigated risk of myocardial infarction (MI) associated with the content of linoleic acid (LA) in adipose tissue, a biomarker of long-term dietary intake of LA and a marker of endogenous LA exposure. Between 1993 and 1997, 57,053 middle-aged subjects were included in the Danish Diet, Cancer and Health cohort. We performed a case-cohort study that included a random sample of the full cohort (n = 3167) and all incident MI cases appearing during 16years of follow-up (n = 2819). Information on incident MI cases was obtained by linkage with Danish nationwide registries. Adipose tissue biopsies were taken from the buttocks of the participants, and their fatty acid composition was determined using gas chromatography. HRs (hazard ratios) with 95% confidence intervals (CIs) were used to describe the associations between content of LA in adipose tissue and the risk of MI. HRs were calculated using weighted Cox proportional hazards regression with robust variance. After adjustment for established risk factors of MI, adipose tissue content of LA was not associated with the risk of MI in men and women combined (quintiles 5 versus 1, HR, 1.03 (95% CI, 0.85-1.25), P-trend = 0.970) or in men and women separately (quintiles 5 versus 1, HR, 1.05 (95% CI, 0.83-1.33), P-trend = 0.871 and quintiles 5 versus 1, HR, 0.99 (95% CI 0.72-1.37), P-trend = 0.928, respectively). Investigating the association between LA and MI with a shorter, 5- or 10-year duration of follow-up provided similar results. Content of LA in adipose tissue was not associated with the risk of MI.

Changes in intake of dairy product subgroups and risk of type 2 diabetes: modelling specified food substitutions in the Danish Diet, Cancer and Health cohort

We investigated the association between an increased intake of one dairy product subgroup at the expense of another within a 5-year period and the subsequent 10-year risk of type 2 diabetes. The cohort included 39,393 adults with two measurements of diet assessed using food frequency questionnaires (FFQ) administered in 1993-1997 and 1999-2003. Dairy products were milk (skimmed, semi-skimmed, whole fat), buttermilk, low-fat yogurt, whole-fat yogurt, cheese and butter. Type 2 diabetes cases were ascertained from the Danish National Diabetes Register. The pseudo-observation method was used to calculate risk differences (RD) with 95% confidence intervals (CI). The data were analysed in age strata to fulfil the assumption of independent entry. Among participants aged 56-59years at completion of the follow-up FFQ, increased intake of whole-fat yogurt in place of skimmed, semi-skimmed or whole-fat milk was associated with a reduced risk (RD% [95% CI]: -0.8% [-1.3, -0.2]; -0.6% [-1,1, -0.1]; -0.7 [-1.2, -0.1]; per 50g/d, respectively). Among participants aged 60-64 and 65-72, substitution of skimmed milk for semi-skimmed milk was associated with an increased risk of type 2 diabetes (0.5% [0.2, 0.7]; 0.4% [0.1, 0.7]; per 50g/d, respectively). Similar patterns of associations were found after adjustment for potential mediators. Our results suggest that substitution of whole-fat yogurt for milk among those aged 56-59 decreases risk of type 2 diabetes and substitution of skimmed milk for semi-skimmed milk may increase the risk among those aged 60-64 and 65-72.

Urine cadmium and acute myocardial infarction among never smokers in the Danish Diet, Cancer and Health cohort

Cadmium exposure has been associated with cardiovascular disease. Cigarette smoking is a key source of cadmium exposure and thus a potential confounder in observational studies of environmental cadmium and cardiovascular disease that include tobacco smokers. We leveraged up to 20 years of follow-up in the Danish Diet, Cancer and Health cohort to test the hypothesis that cadmium exposure is associated with acute myocardial infarction (AMI) among people who never smoked. Between 1993 and 1997, 19,394 never-smoking participants (ages 50–64 years) were enrolled and provided a urine sample. From this sample, we randomly selected a subcohort of 600 males and 600 females. We identified 809 AMI cases occurring between baseline and the end of 2015 using the Danish National Patient Registry. We quantified cadmium, creatinine, and osmolality in baseline urine samples. Using an unweighted case-cohort approach, we estimated adjusted hazard ratios (aHR) for AMI in Cox proportional hazards models with age as the time axis. Participants had relatively low concentrations of urinary cadmium, as expected for never smokers (median = 0.20; 25th, 75th = 0.13, 0.32 μg cadmium/g creatinine). We did not find strong evidence to support an association between higher urinary cadmium and AMI when comparing the highest versus lowest quartile (aHR = 1.16; 95% CI: 0.86 – 1.56) and per IQR increment in cadmium concentration (aHR = 1.02; 95% CI: 0.93 – 1.12). Results were not materially different across strata defined by sex. Results were generally similar using creatinine or osmolality to account for differences in urine dilution. While cadmium exposure has been identified as a risk factor for cardiovascular disease, we did not find strong evidence that urinary cadmium at relatively low-levels is associated with AMI among people who have never smoked.

The health impact of substituting unprocessed red meat by pulses in the Danish diet.

Diets consisting of high amounts of animal-based protein have been associated with adverse public health effects and are often deemed environmentally unsustainable. Therefore, replacing red meat by pulses has been proposed to reduce the adverse impact on human health and environment. However, unprocessed red meat is an important source of nutrients, such as vitamin B12, iron, zinc and selenium, and the substitution may have negative impact on nutrient adequacy. Using a risk-benefit assessment (RBA) approach, we, therefore, estimated the health impact of substituting unprocessed red meat by pulses on the burden of non-communicable diseases in Denmark, using Disability-Adjusted Life Years (DALY). Furthermore, we assessed the impact of the substitution on nutrient adequacy. We found that 187 (95% UI: 209; 168) healthy years of life could be gained per 100,000 individuals per year by substituting 100% of unprocessed red meat by pulses in the Danish diet. We found a decrease in the intake of vitamin B12, zinc and selenium due to the substitution. An additional 10% of the Danish population will become at risk of vitamin B12 and selenium inadequacy, and an additional 20% will be at risk of zinc inadequacy due to the substitution. For iron, a small decrease in the proportion at risk of inadequacy was found. Substitution of unprocessed red meat by pulses was estimated to provide a beneficial health impact on the burden of non-communicable disease, expressed in DALY. Additionally, it was found that the complete substitution will lead to a higher risk of nutrient inadequacies.

Replacement of potatoes with other vegetables and risk of myocardial infarction in the Danish Diet, Cancer and Health cohort.

Intake of vegetables is recommended for the prevention of myocardial infarction (MI). However, vegetables make up a heterogeneous group, and subgroups of vegetables may be differentially associated with MI. The aim of this study was to examine replacement of potatoes with other vegetables or subgroups of other vegetables and the risk of MI. Substitutions between subgroups of other vegetables and risk of MI were also investigated. We followed 29142 women and 26029 men aged 50-64 years in the Danish Diet, Cancer and Health cohort. Diet was assessed at baseline by using a detailed validated FFQ. Hazard ratios (HR) with 95 % CI for the incidence of MI were calculated using Cox proportional hazards regression. During 13·6 years of follow-up, 656 female and 1694 male cases were identified. Among women, the adjusted HR for MI was 1·02 (95 % CI 0·93, 1·13) per 500 g/week replacement of potatoes with other vegetables. For vegetable subgroups, the HR was 0·93 (95 % CI 0·77, 1·13) for replacement of potatoes with fruiting vegetables and 0·91 (95 % CI 0·77, 1·07) for replacement of potatoes with other root vegetables. A higher intake of cabbage replacing other vegetable subgroups was associated with a statistically non-significant higher risk of MI. A similar pattern of associations was found when intake was expressed in kcal/week. Among men, the pattern of associations was overall found to be similar to that for women. This study supports food-based dietary guidelines recommending to consume a variety of vegetables from all subgroups.

Intake of marine n-3 polyunsaturated fatty acids and the risk of incident peripheral artery disease.

A high intake of marine n-3 polyunsaturated fatty acids (PUFAs) may lower the risk of coronary heart disease and ischemic stroke. The association between intake of marine n-3 PUFAs and development of peripheral artery disease (PAD), however, remains unexplored. We hypothesised that intake of marine n-3 PUFAs, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and the sum of EPA + DHA was associated with a lower risk of incident PAD. We used data from the Danish Diet, Cancer and Health cohort and investigated the associations between intake of EPA, DHA and EPA + DHA and development of PAD. Information on intake of n-3 PUFAs was obtained through a validated food frequency questionnaire. Potential PAD cases were identified through linkage to the Danish National Patient Register and subsequently, all cases were validated. Data were available from 55,248 participants and during a median of 13.6 years of follow-up, 950 cases of PAD were identified. Multivariate Cox regression analyses with adjustments for established risk factors showed no statistically significant associations between intake of EPA (p = 0.255), DHA (p = 0.071) or EPA + DHA (p = 0.168) and the rate of incident PAD. We did not confirm our hypothesis that intake of EPA, DHA or EPA + DHA was associated with a lower risk of incident PAD.

Natural Vitamin D in Food: To What Degree Does 25-Hydroxyvitamin D Contribute to the Vitamin D Activity in Food?

ABSTRACTVitamin D3, vitamin D2, 25‐hydroxyvitamin D3 [25(OH)D3], and 25‐hydroxyvitamin D2 [25(OH)D2]constitute the vitamin D activity in food. In general, vitamin D activity in food depends on the food's fat content, the feed the animals have been fed, and the animal's exposure to ultraviolet B (UVB) light. There are many gaps in our knowledge of 25‐hydroxyvitamin D in food, including the amount present in different types of food, and the amount we process in our daily dietary intake. We aimed to assess the vitamin D vitamers in food (eggs, milk, dairy products, chicken, veal, beef, and pork) on the Danish market using accredited analytical methods. We then combined these data with existing Danish data, as well as with the information from the Danish Dietary Survey to estimate the dietary intake of vitamin D3 and of 25(OH)D3 by Danes. We report the level of vitamin D in 10% minced pork from free‐range pigs slaughtered in summer as 1.39 μg vitamin D3/100 g and 0.40 μg 25(OH)D3/100 g, which are significantly higher amounts (p < 0.001) than in early spring. The levels of vitamin D2 and 25(OH)D2 are usually <0.05 μg/100 g, though in beef they are up to 0.14 μg/100 g. 25(OH)D3 accounts for up to 100% in veal and 8% in fat from free‐range pigs. In the Danish diet, the share of 25(OH)D3 is 24% for children (4–17 years) and 18% for adults (18‐75 years). Changes in animal‐feeding strategy in the agriculture sector could change the share of 25(OH)D3 to 11% and 12% if extra vitamin D3 is added to the feed, and the animals are exposed to sunlight or UVB lightlight. Replacing vitamin D3 by 25(OH)D3 in the feed may result in a share of 25(OH)D3 of 52% and 40%, respectively, in children and adults. These estimates are based on the assumption that vitamin D3 and 25(OH)D3 contribute equally to the vitamin D activity. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

Flavonoid intake and incident dementia in the Danish Diet, Cancer, and Health cohort.

IntroductionProspective studies investigating flavonoid intake and dementia risk are scarce. The aims of this study were to examine associations between flavonoid intake and the risk of incident dementia and to investigate whether this association differs in the presence of lifestyle risk factors for dementia.MethodsWe examined associations in 55,985 participants of the Danish Diet, Cancer, and Health Study followed for 23 years. The Phenol‐Explorer database was used to estimate flavonoid intakes. Information on incident dementia and dementia subtypes was obtained using Danish patient and prescription registries. Hazard ratios (HRs) were calculated using restricted cubic splines in multivariable‐adjusted Cox proportional hazards models.ResultsFor incident dementia, moderate compared to low intakes of flavonols (HR: 0.90 [0.82, 0.99]), flavanol oligo+polymers (HR: 0.87 [0.79, 0.96]), anthocyanins (HR: 0.84 [0.76, 0.93]), flavanones (HR: 0.89 [0.80, 0.99]), and flavones (HR: 0.85 [0.77, 0.95]) were associated with a lower risk. For vascular dementia, moderate intakes of flavonols (HR: 0.69 [0.53, 0.89]) and flavanol oligo + polymers (HR: 0.65 [0.51, 0.83]) were associated with lower risk. Flavonoid intakes were not significantly associated with Alzheimer's disease or unspecified dementia. The inverse association between total flavonoid intake and incident dementia was stronger in “ever” smokers than in “never” smokers and in those without hypercholesterolemia versus those with hypercholesteremia. Furthermore, the inverse association of vascular dementia with a moderate total flavonoid intake was stronger in “ever” smokers and those who were “normal” to “overweight” versus “never” smokers or those who were “obese,” respectively.ConclusionA moderate intake of flavonoid‐rich foods may help to reduce dementia risk.

Higher habitual flavonoid intakes are associated with a lower risk of peripheral artery disease hospitalizations

ABSTRACTBackgroundThe role of nutrition in the primary prevention of peripheral artery disease (PAD), the third leading cause of atherosclerotic cardiovascular disease, is undetermined. Flavonoids may attenuate atherosclerosis and therefore persons who consume flavonoid-rich foods may have a lower risk of developing PAD.ObjectivesWe aimed to examine the association between flavonoid intake and PAD hospitalizations and investigate if the association differs according to established risk factors for PAD.MethodsBaseline data from 55,647 participants of the Danish Diet, Cancer, and Health Study without PAD, recruited from 1993 to 1997, were cross-linked with Danish nationwide registries. Flavonoid intake was calculated from FFQs using the Phenol-Explorer database. Associations were examined using multivariable-adjusted restricted cubic splines based on Cox proportional hazards models.ResultsAfter a median [IQR] follow-up time of 21 [20–22] y, 2131 participants had been hospitalized for any PAD. The association between total flavonoid intake and total PAD hospitalizations was nonlinear, reaching a plateau at ∼750–1000 mg/d. Compared with the median flavonoid intake in quintile 1 (174 mg/d), an intake of 1000 mg/d was associated with a 32% lower risk of any PAD hospitalization (HR: 0.68; 95% CI: 0.60, 0.77), a 26% lower risk of atherosclerosis (HR: 0.74; 95% CI: 0.62, 0.88), a 28% lower risk of an aneurysm (HR: 0.72; 95% CI: 0.59, 0.88), and a 47% lower risk of a hospitalization for other peripheral vascular disease (HR: 0.53; 95% CI: 0.42, 0.67). A higher total flavonoid intake was also significantly associated with a lower incidence of revascularization or endovascular surgery and lower extremity amputation. The association between total flavonoid intake and PAD hospitalizations differed according to baseline smoking status, alcohol intake, BMI, and diabetes status.ConclusionsEnsuring the adequate consumption of flavonoid-rich foods, particularly in subpopulations prone to the development of atherosclerosis, may be a key strategy to lower the risk of PAD.

Adherence to the Danish food-based dietary guidelines and risk of type 2 diabetes: the Danish diet, cancer, and health cohort.

We evaluated the association between adherence to the 2013 Danish dietary guidelines and the risk of type 2 diabetes (T2D) in a Danish cohort. We used data from the Danish Diet, Cancer, and Health cohort. Participants aged 50-64 years were included from 1993-1997. Information on diet and covariates was collected at baseline using questionnaires and physical assessments. A diet index was developed to assess adherence to the Danish dietary guidelines. T2D cases were identified using the Danish National Diabetes Register. Cox proportional hazards regression was used to estimate hazard ratios (HR), and the pseudo-observation method was used to estimate risk differences, and 95% confidence intervals (CI). A total of 54,305 subject were included. During a median follow-up of 15 years, 7136 participants were diagnosed with T2D. After multivariable adjustment, the HR for high versus low adherence to the index was 0.57 (95 % CI: 0.48, 0.69) in men, and 0.71 (95% CI: 0.60, 0.83) in women. Compared with the lowest adherence to the index, high adherence was associated with a 6.58% (95% CI: -8.69; -4.47%) or 3.17% (95% CI: -4.90, -1.44%) lower risk of T2D in men and women, respectively. High adherence to the Danish food-based dietary guidelines was associated with lower risk of T2D in a Danish cohort, both on a relative and an absolute scale. Shifting from low to high adherence to the dietary guidelines may provide public health benefit.

The water consumption of different diets in Denmark

The quantity of water required to grow our food is largely influenced by our dietary consumption habits. The following study was a data-based assessment of the water footprint of national consumption of agricultural products in Denmark between 2009 and 2013 in relation to three diet scenarios: The EAT diet, the Insects_REF diet, and the Insects_EAT diet. The EAT diet is a diet that follows the dietary recommendations of the EAT-Lancet Commission on food, planet, and health. The Insects_REF diet is a diet identical to the Danish diet but having all meat replaced by insects. The Insects_EAT diet is a diet identical to the EAT diet but having all meat replaced by insects. The study found that the Danish consumption compared to the EAT diet of meat, sugar, and other animal products is high whereas the consumption of pulses, nuts, oil crops and cereal products needs to be increased. The three diet scenarios result in a reduction of −26% or −682 l/cap/d for the EAT diet, −4% or −112 l/cap/d for the Insects_REF diet, and −24% or −646 l/cap/d for the Insects_EAT diet of the total water footprint with respect to the Danish diet (2651 l/cap/d). The reduction in meat and sugar contribute to most of the water footprint reduction. Coffee remains a large contributor of the total water footprint of agricultural consumption.

Comparing creatinine and osmolality for urine dilution adjustment in a case-cohort study of urine cadmium and risk of incident heart failure in the Danish Diet, Cancer, and Health Cohort

Background/Aim: Traditionally, analyses using urinary biomarkers adjusted for urine creatinine to account for differences in urine dilution. Urine creatinine, however, is associated with muscle mass, dietary intake of creatine, and meat intake; therefore consideration of other measures for urine dilution adjustment may be critical. We measured osmolality, in addition to creatinine, and compared epidemiologic associations of urine cadmium with heart failure across several strategies of urine dilution adjustment.Methods: In our case-cohort study of never smokers from the Danish Diet, Cancer, and Health cohort, we identified 958 cases of incident heart failure occurring between baseline (1993-1997) and 2015 using the Danish National Patient Registry and we randomly selected a sub-cohort of 600 males and 600 females for comparison. We quantified cadmium concentrations, creatinine, and osmolality in urine samples collected at baseline. Using an unweighted case-cohort approach we estimated adjusted hazard ratios for heart failure in Cox proportional hazards models with age as the time scale.Results: In our primary analysis using creatinine standardized cadmium levels (μg Cd/g cr), we report HR=1.12 per interquartile range difference (95% CI= 1.02-1.22) in models adjusted for gender, BMI, education, and urine cotinine. Findings were similar when other strategies for urine dilution adjustment were implemented: regression adjustment for creatinine (HR=1.15; 95% CI=1.02-1.30); standardization for covariate-adjusted creatinine (HR=1.17; 95% CI=1.05-1.30); osmolality standardized cadmium (HR=1.11; 95% CI=1.01-1.22); and regression adjustment for osmolality (HR=1.13; 95% CI=1.02-1.26). Results were also similar when we compared upper quartile with lower quartile exposure; additional case populations of stroke and acute myocardial infarction also showed similar results.Conclusion: In our case-cohort study of cadmium and heart failure among never-smokers, selection of urine dilution marker or adjustment strategy did not alter findings.

Urinary cadmium and risk of incident heart failure and acute myocardial infarction among never-smokers in the Danish Diet, Cancer, and Health Cohort

Background: Epidemiologic studies suggest cadmium exposure is associated with hypertension, peripheral arterial disease, and risk of cardiovascular mortality. However, these associations may be confounded by tobacco smoking, a dominant source of cadmium exposure. To clarify cardiovascular risk of cadmium exposure independent of smoking, we investigated the association of urinary cadmium with risk of incident heart failure and acute myocardial infarction (AMI) in a case-cohort study of never-smokers.Methods: Between 1993-1997, 19,394 never-smoking participants (ages 50-64 years) were enrolled in The Danish Diet, Cancer, and Health cohort. From the full cohort, we identified incident heart failure (n=958) and AMI (n=809) cases occurring between baseline and 2015 using the Danish National Patient Registry. We randomly selected a sub-cohort of 600 males and 600 females for comparison. We quantified cadmium and creatinine concentrations in urine samples collected at baseline. Using an unweighted case-cohort approach, we estimated adjusted hazard ratios for heart failure and AMI in separate Cox proportional hazards models with age as the time scale, and stratified by sex.Results: Overall, participants had relatively low concentrations of urinary cadmium as expected for never smokers (median= 0.20; 25th, 75th= 0.13, 0.32 g cadmium/g creatinine). In adjusted models, higher urinary cadmium concentrations were associated with a higher risk for heart failure (HR=1.11 per interquartile range difference; 95% CI= 1.02-1.21). Furthermore, sex modified this association (Pheterogeneity=0.012). Higher urinary cadmium concentrations were associated with higher risk for heart failure among males (HR= 1.48; 95% CI= 1.18, 1.85), but not among females (HR= 1.06; 95%CI= 0.97, 1.17). Higher urinary cadmium concentrations were not associated with a higher risk of AMI (HR=1.02; 95% CI= 0.93, 1.12).Conclusion: Among never-smokers, urinary cadmium may be associated with higher risk for heart failure, especially among males. We did not observe an association between urinary cadmium and risk of AMI.

Dietary patterns generated by the Treelet Transform and risk of stroke: a Danish cohort study.

To relate empirically derived dietary patterns identified using the Treelet Transform (TT) to risk of stroke. A prospective cohort study using the Danish Diet, Cancer and Health cohort. Dietary information was obtained in 1993-1997 using a validated semi-quantitative FFQ. Incident stroke diagnoses, obtained from the Danish National Patient Register, were verified by record review. Dietary patterns were generated using TT, and participants were categorised into quintiles based on their adherence to each pattern. Sex-specific Cox proportional hazard models estimated associations between dietary patterns and stroke. Denmark. 55 061 men and women aged 50-64 years at the time of enrolment. Three dietary patterns explaining 15·4 % of the total variance were identified: a Prudent pattern, a Western pattern and a Wine & Snacks pattern. During a follow-up time of 10 years, 1513 cases occurred. Comparing the highest to lowest quintiles of intake, adherence to a Prudent pattern was inversely associated with stroke (HRmen 0·74, 95 % CI 0·60, 0·91; HRwomen 0·82, 95 % CI 0·62, 1·08), while adherence to a Western pattern was associated with greater risk (HRmen 1·61, 95 % CI 1·23, 2·10; HRwomen 2·01, 95 % CI 1·48, 2·72). No association was found for a Wine & Snacks pattern for women, but a weak inverse association was found for men (HR 0·81, 95 % CI 0·67, 0·99). The results of this study are broadly in line with current recommendations for a healthy diet to prevent stroke.

Antidepressant prescriptions and associated factors in men with prostate cancer and their female partners

PurposeTo estimate the risk of first-time antidepressant prescriptions as a proxy for depression or anxiety and associated risk factors in patients with prostate cancer and their female partners.MethodsWe followed all men (n = 25,126) and their female cohabiting partners (n = 8785) without a history of cancer or antidepressants from the Danish Diet, Cancer and Health cohort from 1997 to 2014 or 2010, respectively. We estimated the cumulative incidence of first-time antidepressant prescriptions in men with prostate cancer compared with cancer-free men and their respective female partners, using the Danish National Prescription Registry. Sociodemographic, lifestyle-related, and clinical risk factors were assessed using Cox regression models.ResultsA total of 1828 men were diagnosed with prostate cancer of whom 15% received antidepressants. The unadjusted hazard ratio of antidepressant prescription was 2.18 (95%CI, 1.92, 2.48) for men with prostate cancer and 1.27 (95%CI, 0.87, 1.85) for their partners, compared with cancer-free men and their partners, respectively. After adjusting for sociodemographic, lifestyle-related, and comorbidity factors, this risk was 2-fold to 4-fold increased among patients, but not significantly increased among partners. Significant risk factors among patients were curative and palliative treatment (vs. active surveillance and watchful waiting), nonlocalized disease, and short education.ConclusionsMen with prostate cancer have a higher risk of receiving antidepressant medication than cancer-free men. Clinical characteristics can help clinicians in identifying patients at a high risk of depression or anxiety.Implications for Cancer SurvivorsMen with prostate cancer who experience symptoms of depression or anxiety should seek professional help early on. Patient education could aid in raising awareness and reducing the stigma associated with mental disorders.

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Bondonno NP, Dalgaard F, Hodgson JM et al. Flavonoid intake is associated with lower mortality in the Danish Diet Cancer and Health Cohort. Nature Communications 2019; 10: 3651

Intake of whole grain and associations with lifestyle and demographics: a cross-sectional study based on the Danish Diet, Cancer and Health-Next Generations cohort.

The aim was to analyze the intake of whole grain (WG) and associations with lifestyle and demographics in a newly established cohort of Danish adults. Between 2015 and 2019, Danes were enrolled into The Diet, Cancer and Health-Next Generations cohort. A total of 38,553 persons were included in the current cross-sectional study, where all completed a 376-item food frequency questionnaire, a lifestyle questionnaire, and a physical examination in a study center where physical measurements and biological samples were collected. The median intake of WG was 79g/10 mega joule (MJ) and 54% of the participants consumed the amount of WG recommended in Denmark, which is 75g/10MJ. The probability of consuming the recommended amount of WG was highest among men, persons < 30years, students, persons with body mass index (BMI) < 25kg/m2, persons participating in sports, who did not exceed the recommended maximum intake of alcohol and did not smoke. The probability of having a low intake of WG defined as < 25g/10MJ was highest among persons with short education, BMI ≥ 25kg/m2, persons not participating in sports, persons having an alcohol intake above the recommended maximum level and persons being active smokers. The median intake of WG was 79g/10MJ. The probability of consuming at least 75g WG/10MJ was highest among persons who also adhered to healthy lifestyle measured by other factors. Only 6% of the cohort participants consumed < 25g WG/10MJ, these persons were more likely to have a general less healthy lifestyle.

P0945STUDY PROTOCOL: ADIPOSE TISSUE CONTENT OF N-3 POLYUNSATURATED FATTY ACIDS AND THE RISK OF CHRONIC KIDNEY DISEASE

Abstract Background Chronic kidney disease (CKD) is associated with life style diseases such as hypertension and type 2 diabetes. However the role of diet is not yet clearly defined for development of CKD. Recent studies have shown that n-3 polyunsaturated fatty acids (PUFAs) may exert favourable effects on several processes that may inhibit the development and progression of CKD. A gold standard biomarker for long-term intake and metabolism of n-3 PUFAs, is their content in adipose tissue; because these fatty acids are essential and not endogenously produced. Aims The primary aim of this study is to investigate the association of adipose tissue content of marine and plant-based n-3 PUFAs to the risk of incident CKD. This study will also examine associations between the content of n-3 PUFAs in adipose tissue and the risk of main subtypes of CKD: Proteinuria with unknown cause, Hypertensive nephropathy, Glomerular diseases, Diabetic nephropathy and Chronic renal failure of unknown cause. Method In this case-cohort study based on data from the prospective Danish Diet, Cancer and Health cohort (DCH), information concerning diet and other lifestyle factors was obtained from 57,053 Danish men and women aged 50 to 65 years, using questionnaires and interviews. Anthropometric measurements were undertaken, and adipose tissue biopsies were taken from the buttocks of all participants at baseline. The follow-up period was from December 1993 to September 2017. The outcome CKD is defined as having a diagnosis of one of the CKDs causes in the Danish National Patient Registry (DNPR). Cases of CKD will be identified and included together with a randomly drawn subcohort, representative for all participants of the cohort. Adipose tissue samples will be analyzed by gas chromatography in all incident CKD cases and in 5,000 randomly drawn participants from the whole cohort. The outcome will be adjusted for age, sex, body mass index, physical activity, energy intake, alcohol consumption, fermented dairy products, education, smoking status, hormone replacement therapy and comorbidity. The study is approved by the Danish National Committee on Health Research Ethics (N-20180074) and the Danish Data Protection Agency (2018-139). Results No results are available yet. Conclusion Our hypothesis is that the content of total n-3 PUFAs, as well as both marine and plant-based n-3 PUFAs, in adipose tissue is inversely associated with the risk of CKD and its subtypes.