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Aging is a complex multidimensional process of progressive decline affecting multiple organ systems by a number of processes that are still not well understood. While many studies have focused on the approach of studying aging across multiple organs, assessment of the contribution of individual organs to overall aging processes is under appreciated. The ability to study and compare organs in the context of organismal aging has been documented recently using a geropathology grading platform in laboratory mice. This concept consists of identifying and grading age-related histologic lesions within organs to generate a quantitative lesion score for each organ, which is representative of the presence and degree of organ-related pathology, and can be compared to scores from other organs examined. This geropathology approach provides a powerful tool to elucidate the basic mechanisms of aging in multiple organs, as well as the response of organs to therapeutic interventions. Furthermore, ongoing work with the concept has expanded and adapted the geropathology grading system to other preclinical animal model species that are commonly used to understand disease associated phenotypes in aging humans, ultimately adding to the utility of the concept.

COVID-19 mitigation strategies have previously been argued to affect the mental health of people differently depending on sociodemographic factors. Denmark and Sweden have long used mandatory restrictions and guidelines, respectively, to curb the spread of COVID-19. This study compares generalised anxiety under Danish and Swedish mitigation strategies and the influence of suspected, vulnerable sociodemographic factors in relation to these. This contributes to an existing empirical gap of direct comparisons between Denmark and Sweden in this regard. An online cross-sectional survey covering a six-month reference period was adopted. Data was gathered using a snowball and convenience sampling of 503 respondents, 64.8% (n= 326) living in Denmark and 35.2% (n= 177) living in Sweden. Generalised anxiety scores were reported through an adjusted GAD-7 scale. Though effect sizes and mean differences tended to be small, results from Mann-Whitney U and Kruskal-Wallis tests showed that those who had lived under the Swedish mitigation strategy scored significantly higher levels of anxiety than those, who lived under the Danish strategy. Sociodemographic factors of age, gender, and occupational status had the biggest effect on anxiety across countries. While mitigation approaches certainly mattered in terms of generalised anxiety; younger age, female gender, and being a student mattered as well regardless of approach. It is argued that the Danish strategy, which combines its mandatory restrictions with a message of shared responsibility, may have been better at addressing general anxiety risks. Yet, younger, female, and student groups were vulnerable to general anxiety regardless of national context.

COVID-19 mitigation strategies have previously been argued to affect the mental health of people differently depending on sociodemographic factors. Denmark and Sweden have long used mandatory restrictions and guidelines, respectively, to curb the spread of COVID-19. This study compares generalised anxiety under Danish and Swedish mitigation strategies and the influence of suspected, vulnerable sociodemographic factors in relation to these. This contributes to an existing empirical gap of direct comparisons between Denmark and Sweden in this regard. An online cross-sectional survey covering a six-month reference period was adopted. Data was gathered using a snowball and convenience sampling of 503 respondents, 64.8% (n= 326) living in Denmark and 35.2% (n= 177) living in Sweden. Generalised anxiety scores were reported through an adjusted GAD-7 scale. Though effect sizes and mean differences tended to be small, results from Mann-Whitney U and Kruskal-Wallis tests showed that those who had lived under the Swedish mitigation strategy scored significantly higher levels of anxiety than those, who lived under the Danish strategy. Sociodemographic factors of age, gender, and occupational status had the biggest effect on anxiety across countries. While mitigation approaches certainly mattered in terms of generalised anxiety; younger age, female gender, and being a student mattered as well regardless of approach. It is argued that the Danish strategy, which combines its mandatory restrictions with a message of shared responsibility, may have been better at addressing general anxiety risks. Yet, younger, female, and student groups were vulnerable to general anxiety regardless of national context.

Analysis of circulating tumor cells (CTCs) from blood samples provides a non‐invasive approach for early cancer detection. However, the rarity of CTCs makes it challenging to establish assays with the required sensitivity and specificity. We combine a highly sensitive CTC capture assay exploiting the cancer cell binding recombinant malaria VAR2CSA protein (rVAR2) with the detection of colon‐related mRNA transcripts (USH1C and CKMT1A). Cancer cell transcripts are detected by RT‐qPCR using proprietary Target Enrichment Long‐probe Quantitative Amplified Signal (TELQAS) technology. We validate each step of the workflow using colorectal cancer (CRC) cell lines spiked into blood and compare this with antibody‐based cell detection. USH1C and CKMT1A are expressed in healthy colon tissue and CRC cell lines, while only low‐level expression can be detected in healthy white blood cells (WBCs). The qPCR reaction shows a near‐perfect amplification efficiency for all primer targets with minimal interference of WBC cDNA. Spike‐in of 10 cancer cells in 3 mL blood can be detected and statistically separated from control blood using the RT‐qPCR assay after rVAR2 capture (p < 0.01 for both primer targets, Mann‐Whitney test). Our results provide a validated workflow for highly sensitive detection of magnetically enriched cancer cells.

Analysis of circulating tumor cells (CTCs) from blood samples provides a non‐invasive approach for early cancer detection. However, the rarity of CTCs makes it challenging to establish assays with the required sensitivity and specificity. We combine a highly sensitive CTC capture assay exploiting the cancer cell binding recombinant malaria VAR2CSA protein (rVAR2) with the detection of colon‐related mRNA transcripts (USH1C and CKMT1A). Cancer cell transcripts are detected by RT‐qPCR using proprietary Target Enrichment Long‐probe Quantitative Amplified Signal (TELQAS) technology. We validate each step of the workflow using colorectal cancer (CRC) cell lines spiked into blood and compare this with antibody‐based cell detection. USH1C and CKMT1A are expressed in healthy colon tissue and CRC cell lines, while only low‐level expression can be detected in healthy white blood cells (WBCs). The qPCR reaction shows a near‐perfect amplification efficiency for all primer targets with minimal interference of WBC cDNA. Spike‐in of 10 cancer cells in 3 mL blood can be detected and statistically separated from control blood using the RT‐qPCR assay after rVAR2 capture (p < 0.01 for both primer targets, Mann‐Whitney test). Our results provide a validated workflow for highly sensitive detection of magnetically enriched cancer cells.

This research aims to identify the role of the physical store within the high involvement products buying process in the context of an omnichannel customer journey. Furthermore, we aim to recreate an entirely new customer journey based on the importance of creating epic customer experiences, both in-store and online channels, by integrating an omnichannel strategy in the furniture industry.

This research aims to identify the role of the physical store within the high involvement products buying process in the context of an omnichannel customer journey. Furthermore, we aim to recreate an entirely new customer journey based on the importance of creating epic customer experiences, both in-store and online channels, by integrating an omnichannel strategy in the furniture industry.

Circulating tumor cells (CTCs) are accessible by liquid biopsies via an easy blood draw. They represent not only the primary tumor site, but also potential metastatic lesions, and could thus be an attractive supplement for cancer diagnostics. However, the analysis of rare CTCs in billions of normal blood cells is still technically challenging and novel specific CTC markers are needed. The formation of metastasis is a complex process supported by numerous molecular alterations, and thus novel CTC markers might be found by focusing on this process. One example of this is specific changes in the cancer cell glycocalyx, which is a network on the cell surface composed of carbohydrate structures. Proteoglycans are important glycocalyx components and consist of a protein core and covalently attached long glycosaminoglycan chains. A few CTC assays have already utilized proteoglycans for both enrichment and analysis of CTCs. Nonetheless, the biological function of proteoglycans on clinical CTCs has not been studied in detail so far. Therefore, the present review describes proteoglycan functions during the metastatic cascade to highlight their importance to CTCs. We also outline current approaches for CTC assays based on targeting proteoglycans by their protein cores or their glycosaminoglycan chains. Lastly, we briefly discuss important technical aspects, which should be considered for studying proteoglycans.

Early detection and monitoring of cancer progression is key to successful treatment. Therefore, much research is invested in developing technologies, enabling effective and valuable use of non-invasive liquid biopsies. This includes the detection and analysis of circulating tumor cells (CTCs) from blood samples. Recombinant malaria protein VAR2CSA (rVAR2) binds a unique chondroitin sulfate modification present on the vast majority of cancers and thereby holds promise as a near-universal tumor cell-targeting reagent to isolate CTCs from complex blood samples. This study describes a technical approach for optimizing the coupling of rVAR2 to magnetic beads and the development of a CTC isolation platform targeting a range of different cancer cell lines. We investigate both direct and indirect approaches for rVAR2-mediated bead retrieval of cancer cells and conclude that an indirect capture approach is most effective for rVAR2-based cancer cell retrieval.

Circulating tumor cells (CTCs) are accessible by liquid biopsies via an easy blood draw. They represent not only the primary tumor site, but also potential metastatic lesions, and could thus be an attractive supplement for cancer diagnostics. However, the analysis of rare CTCs in billions of normal blood cells is still technically challenging and novel specific CTC markers are needed. The formation of metastasis is a complex process supported by numerous molecular alterations, and thus novel CTC markers might be found by focusing on this process. One example of this is specific changes in the cancer cell glycocalyx, which is a network on the cell surface composed of carbohydrate structures. Proteoglycans are important glycocalyx components and consist of a protein core and covalently attached long glycosaminoglycan chains. A few CTC assays have already utilized proteoglycans for both enrichment and analysis of CTCs. Nonetheless, the biological function of proteoglycans on clinical CTCs has not been studied in detail so far. Therefore, the present review describes proteoglycan functions during the metastatic cascade to highlight their importance to CTCs. We also outline current approaches for CTC assays based on targeting proteoglycans by their protein cores or their glycosaminoglycan chains. Lastly, we briefly discuss important technical aspects, which should be considered for studying proteoglycans.

Early detection and monitoring of cancer progression is key to successful treatment. Therefore, much research is invested in developing technologies, enabling effective and valuable use of non-invasive liquid biopsies. This includes the detection and analysis of circulating tumor cells (CTCs) from blood samples. Recombinant malaria protein VAR2CSA (rVAR2) binds a unique chondroitin sulfate modification present on the vast majority of cancers and thereby holds promise as a near-universal tumor cell-targeting reagent to isolate CTCs from complex blood samples. This study describes a technical approach for optimizing the coupling of rVAR2 to magnetic beads and the development of a CTC isolation platform targeting a range of different cancer cell lines. We investigate both direct and indirect approaches for rVAR2-mediated bead retrieval of cancer cells and conclude that an indirect capture approach is most effective for rVAR2-based cancer cell retrieval.

Diffuse gliomas are the most common primary malignant brain tumor. Although extracranial metastases are rarely observed, recent studies have shown the presence of circulating tumor cells (CTCs) in the blood of glioma patients, confirming that a subset of tumor cells are capable of entering the circulation. The isolation and characterization of CTCs could provide a non-invasive method for repeated analysis of the mutational and phenotypic state of the tumor during the course of disease. However, the efficient detection of glioma CTCs has proven to be challenging due to the lack of consistently expressed tumor markers and high inter- and intra-tumor heterogeneity. Thus, for this field to progress, an omnipresent but specific marker of glioma CTCs is required. In this article, we demonstrate how the recombinant malaria VAR2CSA protein (rVAR2) can be used for the capture and detection of glioma cell lines that are spiked into blood through binding to a cancer-specific oncofetal chondroitin sulfate (ofCS). When using rVAR2 pull-down from glioma cells, we identified a panel of proteoglycans, known to be essential for glioma progression. Finally, the clinical feasibility of this work is supported by the rVAR2-based isolation and detection of CTCs from glioma patient blood samples, which highlights ofCS as a potential clinical target for CTC isolation.

Diffuse gliomas are the most common primary malignant brain tumor. Although extracranial metastases are rarely observed, recent studies have shown the presence of circulating tumor cells (CTCs) in the blood of glioma patients, confirming that a subset of tumor cells are capable of entering the circulation. The isolation and characterization of CTCs could provide a non-invasive method for repeated analysis of the mutational and phenotypic state of the tumor during the course of disease. However, the efficient detection of glioma CTCs has proven to be challenging due to the lack of consistently expressed tumor markers and high inter- and intra-tumor heterogeneity. Thus, for this field to progress, an omnipresent but specific marker of glioma CTCs is required. In this article, we demonstrate how the recombinant malaria VAR2CSA protein (rVAR2) can be used for the capture and detection of glioma cell lines that are spiked into blood through binding to a cancer-specific oncofetal chondroitin sulfate (ofCS). When using rVAR2 pull-down from glioma cells, we identified a panel of proteoglycans, known to be essential for glioma progression. Finally, the clinical feasibility of this work is supported by the rVAR2-based isolation and detection of CTCs from glioma patient blood samples, which highlights ofCS as a potential clinical target for CTC isolation.

Malaria research has led to the discovery of oncofetal chondroitin sulfate, which appears to be shared between placental trophoblasts and cancer cells and can be detected by the evolutionary refined malaria protein VAR2CSA. Interestingly, using recombinant VAR2CSA to target oncofetal chondroitin sulfate shows promise for novel cancer diagnostics and therapeutics.

Diffuse gliomas are the most common primary malignant brain tumor. Although extracranial metastases are rarely observed, recent studies have shown the presence of circulating tumor cells (CTCs) in the blood of glioma patients, confirming that a subset of tumor cells are capable of entering the circulation. The isolation and characterization of CTCs could provide a non-invasive method for repeated analysis of the mutational and phenotypic state of the tumor during the course of disease. However, the efficient detection of glioma CTCs has proven to be challenging due to the lack of consistently expressed tumor markers and high inter- and intra-tumor heterogeneity. Thus, for this field to progress, an omnipresent but specific marker of glioma CTCs is required. In this article, we demonstrate how the recombinant malaria VAR2CSA protein (rVAR2) can be used for the capture and detection of glioma cell lines that are spiked into blood through binding to a cancer-specific oncofetal chondroitin sulfate (ofCS). When using rVAR2 pull-down from glioma cells, we identified a panel of proteoglycans, known to be essential for glioma progression. Finally, the clinical feasibility of this work is supported by the rVAR2-based isolation and detection of CTCs from glioma patient blood samples, which highlights ofCS as a potential clinical target for CTC isolation.

Isolation of metastatic circulating tumor cells (CTCs) from cancer patients is of high value for disease monitoring and molecular characterization. Despite the development of many new CTC isolation platforms in the last decade, their isolation and detection has remained a challenge due to the lack of specific and sensitive markers. In this feasibility study, we present a method for CTC isolation based on the specific binding of the malaria rVAR2 protein to oncofetal chondroitin sulfate (ofCS). We show that rVAR2 efficiently captures CTCs from hepatic, lung, pancreatic, and prostate carcinoma patients with minimal contamination of peripheral blood mononuclear cells. Expression of ofCS is present on epithelial and mesenchymal cancer cells and is equally preserved during epithelial-mesenchymal transition of cancer cells. In 25 stage I-IV prostate cancer patient samples, CTC enumeration significantly correlates with disease stage. Lastly, rVAR2 targets a larger and more diverse population of CTCs compared to anti-EpCAM strategies.

Isolation of metastatic circulating tumor cells (CTCs) from cancer patients is of high value for disease monitoring and molecular characterization. Despite the development of many new CTC isolation platforms in the last decade, their isolation and detection has remained a challenge due to the lack of specific and sensitive markers. In this feasibility study, we present a method for CTC isolation based on the specific binding of the malaria rVAR2 protein to oncofetal chondroitin sulfate (ofCS). We show that rVAR2 efficiently captures CTCs from hepatic, lung, pancreatic, and prostate carcinoma patients with minimal contamination of peripheral blood mononuclear cells. Expression of ofCS is present on epithelial and mesenchymal cancer cells and is equally preserved during epithelial-mesenchymal transition of cancer cells. In 25 stage I-IV prostate cancer patient samples, CTC enumeration significantly correlates with disease stage. Lastly, rVAR2 targets a larger and more diverse population of CTCs compared to anti-EpCAM strategies.

A four-year-old girl was referred to a paediatric department with low height, obesity and hypothyroidism. Her paraclinical tests were characteristic with elevated P-parathyroid hormone concentration, hypothyroidism, growth hormone deficiency, abnormal phenotype with brachydactyly, tooth problems and mental retardation, which led to a suspicion of Albright's hereditary osteodystrophy (AHO). The diagnosis was verified by molecular genetic testing. Less than 1% of children with obesity have an endocrine disorder, and AHO is one of them.

This thesis covers the evaluation of two new interactive web- and meal-based food frequency questionnaires (FFQ). In addition, it investigates the potential association between dietary intake as well as physical activity and the susceptibility to upper respiratory tract infection (URTI). In Paper I and II, the validity of Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q was evaluated among 163 participants in the validation study VALMA. MiniMeal-Q is a shorter version of Meal-Q, including about 30% less food items. As reference methods, we used 7-day weighed food records (WFR) for energy and nutrients and doubly labeled water for energy expenditure. Evaluating ranking ability with the WFR, Meal-Q and MiniMeal-Q classified 69-90% and 67-89% of the participants into the same/adjacent quartile for energy, macro- and micronutrients and fiber, respectively. The corresponding proportion with the doubly labeled water was 77%. The correlation coefficients with the WFR ranged r=0.33-0.74 for macronutrients and r=0.25-0.69 for micronutrients and fiber, and was r=0.18 for energy. Correlations with the doubly labeled water were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Bland-Altman agreement plots with the WFR showed on average large variances and trends of increasing underestimation with increasing intakes. Regarding reproducibility, the intra-class correlations for Meal-Q ranged r=0.57-0.90 for energy and macronutrients and r=0.50-0.76 for micronutrients and fiber. The results were in line with previous validation studies on FFQs. Furthermore, both Meal-Q and MiniMeal-Q had a short answering time of 17 and 7 minutes, respectively and were rated as highly user-friendly by the participants. In Paper III, we evaluated the adherence to the Nordic Nutrition Recommendations (NNR) as a measure of a healthy diet and susceptibility to URTI. In a prospective cohort study of four months among 1,509 participants aged 20-60 years, diet was assessed with a web-based FFQ an

This thesis covers the evaluation of two new interactive web- and meal-based food frequency questionnaires (FFQ). In addition, it investigates the potential association between dietary intake as well as physical activity and the susceptibility to upper respiratory tract infection (URTI). In Paper I and II, the validity of Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q was evaluated among 163 participants in the validation study VALMA. MiniMeal-Q is a shorter version of Meal-Q, including about 30% less food items. As reference methods, we used 7-day weighed food records (WFR) for energy and nutrients and doubly labeled water for energy expenditure. Evaluating ranking ability with the WFR, Meal-Q and MiniMeal-Q classified 69-90% and 67-89% of the participants into the same/adjacent quartile for energy, macro- and micronutrients and fiber, respectively. The corresponding proportion with the doubly labeled water was 77%. The correlation coefficients with the WFR ranged r=0.33-0.74 for macronutrients and r=0.25-0.69 for micronutrients and fiber, and was r=0.18 for energy. Correlations with the doubly labeled water were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Bland-Altman agreement plots with the WFR showed on average large variances and trends of increasing underestimation with increasing intakes. Regarding reproducibility, the intra-class correlations for Meal-Q ranged r=0.57-0.90 for energy and macronutrients and r=0.50-0.76 for micronutrients and fiber. The results were in line with previous validation studies on FFQs. Furthermore, both Meal-Q and MiniMeal-Q had a short answering time of 17 and 7 minutes, respectively and were rated as highly user-friendly by the participants. In Paper III, we evaluated the adherence to the Nordic Nutrition Recommendations (NNR) as a measure of a healthy diet and susceptibility to URTI. In a prospective cohort study of four months among 1,509 participants aged 20-60 years, diet was assessed with a web-based FFQ an

Background: The meal-and Web-based food frequency questionnaires, Meal-Q and MiniMeal-Q, were developed for cost-efficient assessment of dietary intake in epidemiological studies. Objective: The objective of this study was to evaluate the relative validity of micronutrient and fiber intake assessed with Meal-Q and MiniMeal-Q. The reproducibility of Meal-Q was also evaluated. Methods: A total of 163 volunteer men and women aged between 20 and 63 years were recruited from Stockholm County, Sweden. Assessment of micronutrient and fiber intake with the 174-item Meal-Q was compared to a Web-based 7-day weighed food record (WFR). Two administered Meal-Q questionnaires were compared for reproducibility. The 126-item MiniMeal-Q, developed after the validation study, was evaluated in a simulated validation by using truncated Meal-Q data. Results: The study population consisted of approximately 80% women (129/163) with a mean age of 33 years (SD 12) who were highly educated (130/163, 80% with >12 years of education) on average. Cross-classification of quartiles with the WFR placed 69% to 90% in the same/adjacent quartile for Meal-Q and 67% to 89% for MiniMeal-Q. Bland-Altman plots with the WFR and the questionnaires showed large variances and a trend of increasing underestimation with increasing intakes. Deattenuated and energy-adjusted Spearman rank correlations between the questionnaires and the WFR were in the range rho=.25-.69, excluding sodium that was not statistically significant. Cross-classifications of quartiles of the 2 Meal-Q administrations placed 86% to 97% in the same/adjacent quartile. Intraclass correlation coefficients for energy-adjusted intakes were in the range of .50-.76. Conclusions: With the exception of sodium, this validation study demonstrates Meal-Q and MiniMeal-Q to be useful methods for ranking micronutrient and fiber intake in epidemiological studies with Web-based data collection., QC 20140414

This thesis covers the evaluation of two new interactive web- and meal-based food frequency questionnaires (FFQ). In addition, it investigates the potential association between dietary intake as well as physical activity and the susceptibility to upper respiratory tract infection (URTI). In Paper I and II, the validity of Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q was evaluated among 163 participants in the validation study VALMA. MiniMeal-Q is a shorter version of Meal-Q, including about 30% less food items. As reference methods, we used 7-day weighed food records (WFR) for energy and nutrients and doubly labeled water for energy expenditure. Evaluating ranking ability with the WFR, Meal-Q and MiniMeal-Q classified 69-90% and 67-89% of the participants into the same/adjacent quartile for energy, macro- and micronutrients and fiber, respectively. The corresponding proportion with the doubly labeled water was 77%. The correlation coefficients with the WFR ranged r=0.33-0.74 for macronutrients and r=0.25-0.69 for micronutrients and fiber, and was r=0.18 for energy. Correlations with the doubly labeled water were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Bland-Altman agreement plots with the WFR showed on average large variances and trends of increasing underestimation with increasing intakes. Regarding reproducibility, the intra-class correlations for Meal-Q ranged r=0.57-0.90 for energy and macronutrients and r=0.50-0.76 for micronutrients and fiber. The results were in line with previous validation studies on FFQs. Furthermore, both Meal-Q and MiniMeal-Q had a short answering time of 17 and 7 minutes, respectively and were rated as highly user-friendly by the participants. In Paper III, we evaluated the adherence to the Nordic Nutrition Recommendations (NNR) as a measure of a healthy diet and susceptibility to URTI. In a prospective cohort study of four months among 1,509 participants aged 20-60 years, diet was assessed with a web-based FFQ an

Background: The meal-and Web-based food frequency questionnaires, Meal-Q and MiniMeal-Q, were developed for cost-efficient assessment of dietary intake in epidemiological studies. Objective: The objective of this study was to evaluate the relative validity of micronutrient and fiber intake assessed with Meal-Q and MiniMeal-Q. The reproducibility of Meal-Q was also evaluated. Methods: A total of 163 volunteer men and women aged between 20 and 63 years were recruited from Stockholm County, Sweden. Assessment of micronutrient and fiber intake with the 174-item Meal-Q was compared to a Web-based 7-day weighed food record (WFR). Two administered Meal-Q questionnaires were compared for reproducibility. The 126-item MiniMeal-Q, developed after the validation study, was evaluated in a simulated validation by using truncated Meal-Q data. Results: The study population consisted of approximately 80% women (129/163) with a mean age of 33 years (SD 12) who were highly educated (130/163, 80% with >12 years of education) on average. Cross-classification of quartiles with the WFR placed 69% to 90% in the same/adjacent quartile for Meal-Q and 67% to 89% for MiniMeal-Q. Bland-Altman plots with the WFR and the questionnaires showed large variances and a trend of increasing underestimation with increasing intakes. Deattenuated and energy-adjusted Spearman rank correlations between the questionnaires and the WFR were in the range rho=.25-.69, excluding sodium that was not statistically significant. Cross-classifications of quartiles of the 2 Meal-Q administrations placed 86% to 97% in the same/adjacent quartile. Intraclass correlation coefficients for energy-adjusted intakes were in the range of .50-.76. Conclusions: With the exception of sodium, this validation study demonstrates Meal-Q and MiniMeal-Q to be useful methods for ranking micronutrient and fiber intake in epidemiological studies with Web-based data collection.

This thesis covers the evaluation of two new interactive web- and meal-based food frequency questionnaires (FFQ). In addition, it investigates the potential association between dietary intake as well as physical activity and the susceptibility to upper respiratory tract infection (URTI). In Paper I and II, the validity of Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q was evaluated among 163 participants in the validation study VALMA. MiniMeal-Q is a shorter version of Meal-Q, including about 30% less food items. As reference methods, we used 7-day weighed food records (WFR) for energy and nutrients and doubly labeled water for energy expenditure. Evaluating ranking ability with the WFR, Meal-Q and MiniMeal-Q classified 69-90% and 67-89% of the participants into the same/adjacent quartile for energy, macro- and micronutrients and fiber, respectively. The corresponding proportion with the doubly labeled water was 77%. The correlation coefficients with the WFR ranged r=0.33-0.74 for macronutrients and r=0.25-0.69 for micronutrients and fiber, and was r=0.18 for energy. Correlations with the doubly labeled water were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Bland-Altman agreement plots with the WFR showed on average large variances and trends of increasing underestimation with increasing intakes. Regarding reproducibility, the intra-class correlations for Meal-Q ranged r=0.57-0.90 for energy and macronutrients and r=0.50-0.76 for micronutrients and fiber. The results were in line with previous validation studies on FFQs. Furthermore, both Meal-Q and MiniMeal-Q had a short answering time of 17 and 7 minutes, respectively and were rated as highly user-friendly by the participants. In Paper III, we evaluated the adherence to the Nordic Nutrition Recommendations (NNR) as a measure of a healthy diet and susceptibility to URTI. In a prospective cohort study of four months among 1,509 participants aged 20-60 years, diet was assessed with a web-based FFQ an

This thesis covers the evaluation of two new interactive web- and meal-based food frequency questionnaires (FFQ). In addition, it investigates the potential association between dietary intake as well as physical activity and the susceptibility to upper respiratory tract infection (URTI). In Paper I and II, the validity of Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q was evaluated among 163 participants in the validation study VALMA. MiniMeal-Q is a shorter version of Meal-Q, including about 30% less food items. As reference methods, we used 7-day weighed food records (WFR) for energy and nutrients and doubly labeled water for energy expenditure. Evaluating ranking ability with the WFR, Meal-Q and MiniMeal-Q classified 69-90% and 67-89% of the participants into the same/adjacent quartile for energy, macro- and micronutrients and fiber, respectively. The corresponding proportion with the doubly labeled water was 77%. The correlation coefficients with the WFR ranged r=0.33-0.74 for macronutrients and r=0.25-0.69 for micronutrients and fiber, and was r=0.18 for energy. Correlations with the doubly labeled water were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Bland-Altman agreement plots with the WFR showed on average large variances and trends of increasing underestimation with increasing intakes. Regarding reproducibility, the intra-class correlations for Meal-Q ranged r=0.57-0.90 for energy and macronutrients and r=0.50-0.76 for micronutrients and fiber. The results were in line with previous validation studies on FFQs. Furthermore, both Meal-Q and MiniMeal-Q had a short answering time of 17 and 7 minutes, respectively and were rated as highly user-friendly by the participants. In Paper III, we evaluated the adherence to the Nordic Nutrition Recommendations (NNR) as a measure of a healthy diet and susceptibility to URTI. In a prospective cohort study of four months among 1,509 participants aged 20-60 years, diet was assessed with a web-based FFQ an

This thesis covers the evaluation of two new interactive web- and meal-based food frequency questionnaires (FFQ). In addition, it investigates the potential association between dietary intake as well as physical activity and the susceptibility to upper respiratory tract infection (URTI). In Paper I and II, the validity of Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q was evaluated among 163 participants in the validation study VALMA. MiniMeal-Q is a shorter version of Meal-Q, including about 30% less food items. As reference methods, we used 7-day weighed food records (WFR) for energy and nutrients and doubly labeled water for energy expenditure. Evaluating ranking ability with the WFR, Meal-Q and MiniMeal-Q classified 69-90% and 67-89% of the participants into the same/adjacent quartile for energy, macro- and micronutrients and fiber, respectively. The corresponding proportion with the doubly labeled water was 77%. The correlation coefficients with the WFR ranged r=0.33-0.74 for macronutrients and r=0.25-0.69 for micronutrients and fiber, and was r=0.18 for energy. Correlations with the doubly labeled water were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Bland-Altman agreement plots with the WFR showed on average large variances and trends of increasing underestimation with increasing intakes. Regarding reproducibility, the intra-class correlations for Meal-Q ranged r=0.57-0.90 for energy and macronutrients and r=0.50-0.76 for micronutrients and fiber. The results were in line with previous validation studies on FFQs. Furthermore, both Meal-Q and MiniMeal-Q had a short answering time of 17 and 7 minutes, respectively and were rated as highly user-friendly by the participants. In Paper III, we evaluated the adherence to the Nordic Nutrition Recommendations (NNR) as a measure of a healthy diet and susceptibility to URTI. In a prospective cohort study of four months among 1,509 participants aged 20-60 years, diet was assessed with a web-based FFQ an

Background: Meal-Q and its shorter version, MiniMeal-Q, are 2 new Web-based food frequency questionnaires. Their meal-based and interactive format was designed to promote ease of use and to minimize answering time, desirable improvements in large epidemiological studies. Objective: We evaluated the validity of energy and macronutrient intake assessed with Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q. Methods: Healthy volunteers aged 20-63 years recruited from Stockholm County filled out the 174-item Meal-Q. The questionnaire was compared to 7-day weighed food records (WFR; n=163), for energy and macronutrient intake, and to doubly labeled water (DLW; n=39), for total energy expenditure. In addition, the 126-item MiniMeal-Q was evaluated in a simulated validation using truncated Meal-Q data. We also assessed the answering time and ease of use of both questionnaires. Results: Bland-Altman plots showed a varying bias within the intake range for all validity comparisons. Cross-classification of quartiles placed 70%-86% in the same/adjacent quartile with WFR and 77% with DLW. Deattenuated and energy-adjusted Pearson correlation coefficients with the WFR ranged from r=0.33-0.74 for macronutrients and was r=0.18 for energy. Correlations with DLW were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Intraclass correlations for Meal-Q ranged from r=0.57-0.90. Median answering time was 17 minutes for Meal-Q and 7 minutes for MiniMeal-Q, and participants rated both questionnaires as easy to use. Conclusions: Meal-Q and MiniMeal-Q are easy to use and have short answering times. The ranking agreement is good for most of the nutrients for both questionnaires and Meal-Q shows fair reproducibility., QC 20130709

Background: Meal-Q and its shorter version, MiniMeal-Q, are 2 new Web-based food frequency questionnaires. Their meal-based and interactive format was designed to promote ease of use and to minimize answering time, desirable improvements in large epidemiological studies. Objective: We evaluated the validity of energy and macronutrient intake assessed with Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q. Methods: Healthy volunteers aged 20-63 years recruited from Stockholm County filled out the 174-item Meal-Q. The questionnaire was compared to 7-day weighed food records (WFR; n=163), for energy and macronutrient intake, and to doubly labeled water (DLW; n=39), for total energy expenditure. In addition, the 126-item MiniMeal-Q was evaluated in a simulated validation using truncated Meal-Q data. We also assessed the answering time and ease of use of both questionnaires. Results: Bland-Altman plots showed a varying bias within the intake range for all validity comparisons. Cross-classification of quartiles placed 70%-86% in the same/adjacent quartile with WFR and 77% with DLW. Deattenuated and energy-adjusted Pearson correlation coefficients with the WFR ranged from r=0.33-0.74 for macronutrients and was r=0.18 for energy. Correlations with DLW were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Intraclass correlations for Meal-Q ranged from r=0.57-0.90. Median answering time was 17 minutes for Meal-Q and 7 minutes for MiniMeal-Q, and participants rated both questionnaires as easy to use. Conclusions: Meal-Q and MiniMeal-Q are easy to use and have short answering times. The ranking agreement is good for most of the nutrients for both questionnaires and Meal-Q shows fair reproducibility., QC 20130709

Background: Meal-Q and its shorter version, MiniMeal-Q, are 2 new Web-based food frequency questionnaires. Their meal-based and interactive format was designed to promote ease of use and to minimize answering time, desirable improvements in large epidemiological studies. Objective: We evaluated the validity of energy and macronutrient intake assessed with Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q. Methods: Healthy volunteers aged 20-63 years recruited from Stockholm County filled out the 174-item Meal-Q. The questionnaire was compared to 7-day weighed food records (WFR; n=163), for energy and macronutrient intake, and to doubly labeled water (DLW; n=39), for total energy expenditure. In addition, the 126-item MiniMeal-Q was evaluated in a simulated validation using truncated Meal-Q data. We also assessed the answering time and ease of use of both questionnaires. Results: Bland-Altman plots showed a varying bias within the intake range for all validity comparisons. Cross-classification of quartiles placed 70%-86% in the same/adjacent quartile with WFR and 77% with DLW. Deattenuated and energy-adjusted Pearson correlation coefficients with the WFR ranged from r=0.33-0.74 for macronutrients and was r=0.18 for energy. Correlations with DLW were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Intraclass correlations for Meal-Q ranged from r=0.57-0.90. Median answering time was 17 minutes for Meal-Q and 7 minutes for MiniMeal-Q, and participants rated both questionnaires as easy to use. Conclusions: Meal-Q and MiniMeal-Q are easy to use and have short answering times. The ranking agreement is good for most of the nutrients for both questionnaires and Meal-Q shows fair reproducibility., QC 20130709

Background: Meal-Q and its shorter version, MiniMeal-Q, are 2 new Web-based food frequency questionnaires. Their meal-based and interactive format was designed to promote ease of use and to minimize answering time, desirable improvements in large epidemiological studies. Objective: We evaluated the validity of energy and macronutrient intake assessed with Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q. Methods: Healthy volunteers aged 20-63 years recruited from Stockholm County filled out the 174-item Meal-Q. The questionnaire was compared to 7-day weighed food records (WFR; n=163), for energy and macronutrient intake, and to doubly labeled water (DLW; n=39), for total energy expenditure. In addition, the 126-item MiniMeal-Q was evaluated in a simulated validation using truncated Meal-Q data. We also assessed the answering time and ease of use of both questionnaires. Results: Bland-Altman plots showed a varying bias within the intake range for all validity comparisons. Cross-classification of quartiles placed 70%-86% in the same/adjacent quartile with WFR and 77% with DLW. Deattenuated and energy-adjusted Pearson correlation coefficients with the WFR ranged from r=0.33-0.74 for macronutrients and was r=0.18 for energy. Correlations with DLW were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Intraclass correlations for Meal-Q ranged from r=0.57-0.90. Median answering time was 17 minutes for Meal-Q and 7 minutes for MiniMeal-Q, and participants rated both questionnaires as easy to use. Conclusions: Meal-Q and MiniMeal-Q are easy to use and have short answering times. The ranking agreement is good for most of the nutrients for both questionnaires and Meal-Q shows fair reproducibility., QC 20130709

Background: Meal-Q and its shorter version, MiniMeal-Q, are 2 new Web-based food frequency questionnaires. Their meal-based and interactive format was designed to promote ease of use and to minimize answering time, desirable improvements in large epidemiological studies. Objective: We evaluated the validity of energy and macronutrient intake assessed with Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q. Methods: Healthy volunteers aged 20-63 years recruited from Stockholm County filled out the 174-item Meal-Q. The questionnaire was compared to 7-day weighed food records (WFR; n=163), for energy and macronutrient intake, and to doubly labeled water (DLW; n=39), for total energy expenditure. In addition, the 126-item MiniMeal-Q was evaluated in a simulated validation using truncated Meal-Q data. We also assessed the answering time and ease of use of both questionnaires. Results: Bland-Altman plots showed a varying bias within the intake range for all validity comparisons. Cross-classification of quartiles placed 70%-86% in the same/adjacent quartile with WFR and 77% with DLW. Deattenuated and energy-adjusted Pearson correlation coefficients with the WFR ranged from r=0.33-0.74 for macronutrients and was r=0.18 for energy. Correlations with DLW were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Intraclass correlations for Meal-Q ranged from r=0.57-0.90. Median answering time was 17 minutes for Meal-Q and 7 minutes for MiniMeal-Q, and participants rated both questionnaires as easy to use. Conclusions: Meal-Q and MiniMeal-Q are easy to use and have short answering times. The ranking agreement is good for most of the nutrients for both questionnaires and Meal-Q shows fair reproducibility.

Background: Meal-Q and its shorter version, MiniMeal-Q, are 2 new Web-based food frequency questionnaires. Their meal-based and interactive format was designed to promote ease of use and to minimize answering time, desirable improvements in large epidemiological studies. Objective: We evaluated the validity of energy and macronutrient intake assessed with Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q. Methods: Healthy volunteers aged 20-63 years recruited from Stockholm County filled out the 174-item Meal-Q. The questionnaire was compared to 7-day weighed food records (WFR; n=163), for energy and macronutrient intake, and to doubly labeled water (DLW; n=39), for total energy expenditure. In addition, the 126-item MiniMeal-Q was evaluated in a simulated validation using truncated Meal-Q data. We also assessed the answering time and ease of use of both questionnaires. Results: Bland-Altman plots showed a varying bias within the intake range for all validity comparisons. Cross-classification of quartiles placed 70%-86% in the same/adjacent quartile with WFR and 77% with DLW. Deattenuated and energy-adjusted Pearson correlation coefficients with the WFR ranged from r=0.33-0.74 for macronutrients and was r=0.18 for energy. Correlations with DLW were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Intraclass correlations for Meal-Q ranged from r=0.57-0.90. Median answering time was 17 minutes for Meal-Q and 7 minutes for MiniMeal-Q, and participants rated both questionnaires as easy to use. Conclusions: Meal-Q and MiniMeal-Q are easy to use and have short answering times. The ranking agreement is good for most of the nutrients for both questionnaires and Meal-Q shows fair reproducibility., QC 20130709

Background: Increased use of the Internet provides new opportunities for collecting data in large studies. The aim of our new Web-based questionnaire, Active-Q, is to assess total physical activity and inactivity in adults. Active-Q assesses habitual activity during the past year via questions in four different domains: (1) daily occupation, (2) transportation to and from daily occupation, (3) leisure time activities, and (4) sporting activities. Objective: The objective of our study is to validate Active-Q's energy expenditure estimates using the doubly labeled water (DLW) method, and to assess the reproducibility of Active-Q by comparing the results of the questionnaire completed by the same group on two occasions. Methods: The validity and reproducibility of Active-Q were assessed in a group of 37 individuals, aged 20 to 65 years. Active-Q was distributed via email to the participants. The total energy expenditure of the participants was assessed using DLW for 11 consecutive days. Results: The median time to complete Active-Q was 6.1 minutes. The majority of participants (27/37, 73%) reported that the questionnaire was "easy" or "very easy" to answer. On average, Active-Q overestimated the total daily energy expenditure by 440 kJ compared with the DLW. The Spearman correlation between the two methods was r = 0.52 (P < .001). The intraclass correlation coefficient for total energy expenditure between the results of Active-Q completed on two occasions was 0.83 (95% CI 0.73-0.93). Conclusions: Active-Q is a valid and reproducible method of assessing total energy expenditure. It is also a user-friendly method and suitable for Web-based data collection in large epidemiological studies.

Objective: The Nordic countries have published joint dietary recommendations, the Nordic Nutrition Recommendations (NNR), since 1980. We evaluated adherence to the NNR as a measure of a healthy diet and its potential association with self-reported upper respiratory tract infection (URTI). Design: A prospective, population-based study with a follow-up period of 4 months. Dietary intake was assessed using a semi-quantitative FFQ with ninety-six items, along with other lifestyle factors, at baseline. URTI was assessed every three weeks. A Poisson regression model was used to control for age, sex and other confounding factors. Setting: A middle-sized county in northern Sweden. Subjects: Swedish men and women (n 1509) aged 20-60 years. Results: The NNR include recommendations on macronutrient proportions, physical activity and intake of micronutrients, sodium, fibre and alcohol. We found that overall adherence to the NNR was moderately good. In addition, we found that high adherence to the NNR (>5.5 adherence points) was not associated with a lower risk of URTI (incidence rate ratio (IRR) 0.89, 95% CI 0.73, 1.08) compared with low adherence (<4.5 adherence points). When investigating individual components of the NNR, only high physical activity was associated with lower URTI risk (IRR=0.82, 95% CI 0.69, 0.97) whereas none of the dietary components were associated with risk of URTI. Conclusions: Overall adherence to the NNR was moderately good. Overall adherence to the NNR was not associated with URTI risk in our study. However, when investigating individual components of the NNR, we found that high physical activity was associated with lower URTI risk., QC 20110616

Objective: The Nordic countries have published joint dietary recommendations, the Nordic Nutrition Recommendations (NNR), since 1980. We evaluated adherence to the NNR as a measure of a healthy diet and its potential association with self-reported upper respiratory tract infection (URTI). Design: A prospective, population-based study with a follow-up period of 4 months. Dietary intake was assessed using a semi-quantitative FFQ with ninety-six items, along with other lifestyle factors, at baseline. URTI was assessed every three weeks. A Poisson regression model was used to control for age, sex and other confounding factors. Setting: A middle-sized county in northern Sweden. Subjects: Swedish men and women (n 1509) aged 20-60 years. Results: The NNR include recommendations on macronutrient proportions, physical activity and intake of micronutrients, sodium, fibre and alcohol. We found that overall adherence to the NNR was moderately good. In addition, we found that high adherence to the NNR (>5.5 adherence points) was not associated with a lower risk of URTI (incidence rate ratio (IRR) 0.89, 95% CI 0.73, 1.08) compared with low adherence (<4.5 adherence points). When investigating individual components of the NNR, only high physical activity was associated with lower URTI risk (IRR=0.82, 95% CI 0.69, 0.97) whereas none of the dietary components were associated with risk of URTI. Conclusions: Overall adherence to the NNR was moderately good. Overall adherence to the NNR was not associated with URTI risk in our study. However, when investigating individual components of the NNR, we found that high physical activity was associated with lower URTI risk.