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General purpose: To study the effects of a lifestyle intervention on health-related quality of life (HRQoL) and metabolic risk factors in persons with psychosis. Methodology: A longitudinal intervention study with a matched reference sample. Results: HRQoL measured by the EQ-VAS improved from 57.6 to 63.3 (17.8) in the intervention group (p=0.05). The HDL cholesterol concentration increased from 1.03 to 1.11 (0.19) mmol/l in the intervention group (p=0.02). There was no significant change in body weight. Conclusion: A lifestyle intervention based on group meetings improves HRQoL in patients with psychosis. There are also small improvements in metabolic risk factors.

Background: Low levels of vitamin D have been related to increased mortality and morbidity in several non-diabetic studies. We aimed to prospectively study relationships between serum 25-OH vitamin D-3 (vitamin D) and of serum parathyroid hormone (PTH) to total mortality in type 2 diabetes. We also aimed to compare the levels of these potential risk-factors in patients with and without diabetes. Methods: The main study design was prospective and observational. We used baseline data from 472 men and 245 women who participated in the "Cardiovascular Risk factors in Patients with Diabetes-a Prospective study in Primary care" study. Patients were 55-66 years old at recruitment, and an age-matched non-diabetic sample of 129 individuals constituted controls for the baseline data. Carotid-femoral pulse-wave velocity (PWV) was measured with applanation-tonometry and carotid intima-media thickness (IMT) with ultrasound. Patients with diabetes were followed for all-cause mortality using the national Swedish Cause of Death Registry. Results: Levels of vitamin D were lower in patients with diabetes than in controls, also after correction for age and obesity, while PTH levels did not differ. Nine women and 24 men died during 6 years of median follow up of the final cohort (n = 698). Vitamin D levels were negatively related to all-cause mortality in men independently of age, PTH, HbA1c, waist circumference, 24-h systolic ambulatory-blood pressure (ABP) and serum-apoB (p = 0.049). This finding was also statistically significant when PWV and IMT were added to the analyses (p = 0.028) and was not affected statistically when medications were also included in the regression-analysis (p = 0.01). In the women with type 2 diabetes, levels of PTH were positively related with all-cause mortality in the corresponding calculations (p = 0.016 without PWV and IMT, p = 0.006 with PWV and IMT, p = 0.045 when also adding medications to the analysis), while levels of vitamin D was without statisti, Funding Agencies|Medical Research Council of Southeast Sweden; Futurum; King Gustaf V and Queen Victoria Freemason Foundation; GE Healthcare; Swedish Heart-Lung Foundation; Swedish Research Council [12661]; County Council of Ostergotland; Linkoping University, Department of Medical and Health Sciences

AIMS: The aim of the study was to determine whether left ventricular systolic function, in terms of global left ventricular longitudinal strain (GLS), and diastolic function, expressed as the ratio between early diastolic transmitral flow and mitral annular motion velocities (E/e'), can predict cardiovascular events in patients with diabetes mellitus type 2. METHODS AND RESULTS: We prospectively investigated 406 consecutive patients, aged 55-65 years, with diabetes mellitus, who participated in the CARDIPP study. Echocardiography, pulse pressure (pp), and glycosylated haemoglobin (HbA1c) were analysed. Twelve cases of myocardial infarction and seven cases of stroke were identified during the follow-up period of 67 ± 17 months. Univariate Cox regression analysis showed that E/e' was a strong predictor of cardiovascular events (hazards ratio 1.12; 95% confidence interval 1.06-1.18, P < 0.001). E/e' was prospectively associated with cardiovascular events independent of age, sex, GLS, left ventricular ejection fraction (LVEF), pp, and HbA1c in multivariate analysis. Receiver operating characteristic curves showed that E/e' and HbA1c were the strongest predictors for cardiovascular events, both having an area under the curve (AUC) of 0.71 followed by LVEF with an AUC of 0.65 and GLS of 0.61. In a Kaplan-Meyer analysis, the cumulative probability of an event during the follow-up period was 8.6% for patients with an E/e' ratio >15 compared with 2.6% for patients with E/e' ≤15, P = 0.011. CONCLUSION: In middle-aged patients with type 2 diabetes, E/e' is a strong predictor of myocardial infarction and stroke, comparable with HbA1c and superior to GLS and LVEF., Funding agencies: FORSS; Research Council of Southeastern Sweden; King Gustaf V and Queen Victoria Freemason Foundation, Sweden; Linkoping University; Futurum-the Academy for Healthcare, Jonkoping County Council

Background: New and clinically useful markers of cardiovascular risk are of essence in type 2 diabetes since ischemic heart disease is a major cause of death in these patients. Methods: We analyzed baseline data from 476 men and 244 women who participated in "Cardiovascular Risk factors in Patients with Diabetes -a Prospective study in Primary care" study. All participants had type 2 diabetes and were 55-66 years old at recruitment during year 2005 to 2008. Except for established traditional risk markers for vascular disease, we also estimated vascular complications non-invasively by performance of carotid-femoral pulse-wave velocity (PWV, with applanation-tonometry) and intima-media thickness of carotid arteries (IMT, with B-mode ultrasound). Patients were followed for incidence of ischemic heart disease mortality and morbidity until end of the year 2012, using the national Swedish Cause of Death and Hospitalization Registries. Results: During the follow-up period of a median of 6 years 47 men and 10 women died or were hospitalized for ischemic heart disease including myocardial infarction. Leptin levels were positively related to the hazard ratio (HR) in men (HR for each log 10 unit 4.9, CI 1.99 to 11.8) and women (HR 11.5, CI 1.47 to 89.7). Leptin predicted ischemic heart disease independently of age, HbA1c, BMI, systolic blood pressure and LDL-cholesterol/HDL-cholesterol ratio (men: HR 12.9 CI 3.2-53, women: HR 19.9, CI 1.2-327) This finding of increased risk related to high leptin levels was also statistically significant when carotid-femoral PWV and IMT were both added to the equations in men (hazard ratio 9.2 CI 2.1-41). Conclusions: Our data support the use of serum leptin in type 2 diabetes to add independent prognostic information in terms of ischemic heart disease when compared with traditional cardiovascular risk factors. In the men of the cohort this prognostic information was in addition also to data on IMT and PWV, two non-invasive measurements of the, Funding Agencies|Medical Research Council of Southeast Sweden; Futurum; King Gustaf V and Queen Victoria Freemason Foundation; GE Healthcare; Swedish Heart-Lung Foundation; Swedish Research Council Grant [12661]; County Council of Ostergosland; Linkoping University, Department of Medical and Health Sciences

Objective Type 1 diabetes (T1D) is associated with low IGF-I and altered levels of IGF-binding proteins (IGFBPs) in plasma. This may be of importance for insulin sensitivity and the risk of developing diabetic complications. We hypothesized that IGF-I bioactivity is affected by the route of insulin administration and that continuous intraperitoneal insulin infusion (CIPII) has a more pronounced effect than continuous subcutaneous insulin infusion (CSII). Design and methods We compared 10 patients with T1D on CIPII with 20 age- and sex-matched patients on CSII. Blood sampling was carried out 7–9 am after an overnight fast. All patients were C-peptide negative. IGF-I bioactivity was measured in vitro using a specific IGF-I kinase receptor activation (KIRA) assay. IGF-I was also measured by immunoassay together with IGF-II, IGFBP-1 and IGFBP-2. Results When compared with subcutaneous insulin, intraperitoneal insulin resulted in (CIPII vs CSII) higher IGF-I bioactivity (1·83 ± 0·76 vs 1·16 ± 0·24 μg/l; P = 0·02), IGF-I (120 ± 35 vs 81 ± 19 μg/l; P = 0·01) and IGF-II (1050 ± 136 vs 879 ± 110 μg/l; P = 0·02). By contrast, log-transformed IGFBP-1 was reduced (P = 0·013), whereas log-transformed IGFBP-2 was not different (P = 0·12). There was a positive correlation between IGF bioactivity and IGF-I (r = 0·69; P < 0·001) and an inverse correlation between IGF-I bioactivity and log10 IGFBP-1 (r = −0·68, P < 0·001). Conclusion The in vitro IGF-I bioactivity was higher in patients treated with CIPII compared with CSII supporting the theory that the route of insulin administration is of importance for the activity of the IGF system. Intraperitoneal insulin administration may therefore be beneficial by correcting the alterations of the IGF system in T1D.

Aims To compare the effects on health-related quality of life (HRQoL) of a 2-year intervention with a low-fat diet (LFD) or a low-carbohydrate diet (LCD) based on four group-meetings to achieve compliance. To describe different aspects of taking part in the intervention following the LFD or LCD. Methods Prospective, randomized trial of 61 adults with Type 2 diabetes mellitus. The SF-36 questionnaire was used at baseline, 6, 12 and 24 months. Patients on LFD aimed for 55–60 energy percent (E%) and those on LCD for 20 E% from carbohydrates. The patients were interviewed about their experiences of the intervention. Results Mean body-mass-index was 32.7 ± 5.4 kg/m2 at baseline. Weight-loss did not differ between groups and was maximal at 6 months, LFD: −3.99 ± 4.1 kg, LCD: −4.31 ± 3.6 kg (p < 0.001 within groups). There was an increase in the physical component score of SF-36 from 44.1 (10.0) to 46.7 (10.5) at 12 months in the LCD group (p < 0.009) while no change occurred in the LFD group (p < 0.03 between groups). At 12 months the physical function, bodily pain and general health scores improved within the LCD group (p values 0.042–0.009) while there was no change within the LFD group. Conclusions Weight-changes did not differ between the diet groups while improvements in HRQoL only occurred after one year during treatment with LCD. No changes of HRQoL occurred in the LFD group in spite of a similar reduction in body weight.

Background. The improvement of insulin sensitivity by exercise has been shown to be inhibited by supplementation of vitamins acting as antioxidants. Objective. To examine effects of exercise with or without blueberries, containing natural antioxidants, on cardio-metabolic risk factors. Methods. Fifteen healthy men and 17 women, 27.6 ± 6.5 years old, were recruited, and 26 completed a randomized cross-over trial with 4 weeks of exercise by running/jogging 5 km five times/week and 4 weeks of minimal physical activity. Participants were also randomized to consume 150 g of blueberries, or not, on exercise days. Laboratory variables were measured before and after a 5 km running-race at maximal speed at the beginning and end of each period, i.e. there were four maximal running-races and eight samplings in total for each participant. Results. Insulin and triglyceride levels were reduced while HDL-cholesterol increased by exercise compared with minimal physical activity. Participants randomized to consume blueberries showed an increase in fasting glucose levels compared with controls, during the exercise period (blueberries: from 5.12 ± 0.49 mmol/l to 5.32 ± 0.29 mmol/l; controls: from 5.24 ± 0.27 mmol/l to 5.17 ± 0.23 mmol/l, P = 0.04 for difference in change). Triglyceride levels fell in the control group (from 1.1 ± 0.49 mmol/l to 0.93 ± 0.31 mmol/l, P = 0.02), while HDL-cholesterol increased in the blueberry group (from 1.51 ± 0.29 mmol/l to 1.64 ± 0.33 mmol/l, P = 0.006). Conclusions. Ingestion of blueberries induced differential effects on cardio-metabolic risk factors, including increased levels of both fasting glucose and HDL-cholesterol. However, since it is possible that indirect effects on food intake were induced, other than consumption of blueberries, further studies are needed to confirm the findings., Funding Agencies|University Hospital of Linkoping, Linkoping University||County Council of Ostergotland

The purpose of this study is to explore prerequisites for a healthy lifestyle as described by individuals diagnosed with psychosis. Forty participants who had performed a lifestyle intervention focusing on physical activities and lifestyle education were interviewed. Conventional content analysis was used. The results are described in two categories: (1) Individual Prerequisites and (2) Being a Part of Society. The individuals said that they got stuck in a state of planning without taking action. It was pointless to make a bigger effort because the psychotic disorder could, at any time, worsen the prerequisites. They also said that they wanted to live like everybody else and therefore tried to adopt a normal lifestyle. Future interventions or professional support by mental health nurses and other health care givers should target the transition from planning to action to achieve a healthy lifestyle, and should help the individual to taking part in society.

Objective. To prospectively evaluate the effects of resistance training combined with increased energy intake or protein-supplementation on lean body-mass, resting metabolic-rate (RMR) and cardiovascular risk factors. Methods. Twenty-four healthy males (aged 19-32 years) performed resistance exercise for 12 weeks aiming for at least 1 hour training-sessions 3 times a week. The participants were randomized to consume extra protein (33 g whey protein/day) or a meal of fast-food/day (1350 kcal, 41 g protein). Body-composition was measured with Dual-Energy X-ray Absorptiometry (DEXA) and RMR by indirect calorimetry. Fasting blood samples were drawn before and after the 3-month training period and after 12 months. Results. The body weight increased from 75.1 +/- 6.9 kg to 78.7 +/- 7.2 kg (p andlt; 0.0001), without differences between the groups. RMR increased from 1787 +/- 143 kcal/24 h to 1954 +/- 187 kcal/24 h (p andlt; 0.0001, N = 24), which was more than expected from the increase in lean body-mass (increase from 59.7 +/- 4.3 kg to 61.8 +/- 4.1 kg p = 0.004). Fasting serum-insulin levels increased in the fast-food group compared with the extra-protein group (p = 0.03). ApoB increased from 0.691 +/- 0.14 g/L to 0.768 +/- 0.17 g/L, p = 0.004, in the fast-food group only. Long-term follow up after 12 months showed that RMR, body weight, total fat and lean body-masses did not differ from baseline (n = 19). Conclusions. Resistance training for 12 weeks increased RMR and lean body-mass similarly when based on either an increased energy-intake or protein supplement. However, the increase in RMR was higher than expected from the increase in lean body-mass. Thus resistance training could potentially decrease the risk of obesity by induction of increased RMR., Funding Agencies|University Hospital of Linkoping Research Funds||Linkoping University||Gamla Tjanarinnor||Medical Research Council of Southeast Sweden||Diabetes Research Centre of Linkoping University

AIMS/HYPOTHESIS: The study aimed to compare the effects of a 2 year intervention with a low-fat diet (LFD) or a low-carbohydrate diet (LCD), based on four group meetings to achieve compliance. METHODS: This was a prospective randomised parallel trial involving 61 adults with type 2 diabetes consecutively recruited in primary care and randomised by drawing ballots. Patients that did not speak Swedish could not be recruited. The primary outcomes in this non-blinded study were weight and HbA(1c). Patients on the LFD aimed for 55-60 energy per cent (E%) and those on LCD for 20 E% from carbohydrate. RESULTS: The mean BMI and HbA(1c) of the participants were 32.7 ± 5.4 kg/m(2) and 57.0 ± 9.2 mmol/mol, respectively. No patients were lost to follow-up. Weight loss did not differ between groups and was maximal at 6 months: LFD -3.99 ± 4.1 kg (n = 31); LCD -4.31 ± 3.6 kg (n = 30); p < 0.001 within groups. At 24 months, patients on the LFD had lost -2.97 ± 4.9 kg and those on LCD -2.34 ± 5.1 kg compared with baseline (p = 0.002 and p = 0.020 within groups, respectively). HbA(1c) fell in the LCD group only (LCD at 6 months -4.8 ± 8.3 mmol/mol, p = 0.004, at 12 months -2.2 ± 7.7 mmol/mol, p = 0.12; LFD at 6 months -0.9 ± 8.8 mmol/mol, p = 0.56). At 6 months, HDL-cholesterol had increased with the LCD (from 1.13 ± 0.33 mmol/l to 1.25 ± 0.47 mmol/l, p = 0.018) while LDL-cholesterol did not differ between groups. Insulin doses were reduced in the LCD group (0 months, LCD 42 ± 65 E, LFD 39 ± 51 E; 6 months, LCD 30 ± 47 E, LFD 38 ± 48 E; p = 0.046 for between-group change). CONCLUSIONS/INTERPRETATION: Weight changes did not differ between the diet groups, while insulin doses were reduced significantly more with the LCD at 6 months, when compliance was good. Thus, aiming for 20% of energy intake from carbohydrates is safe with respect to cardiovascular risk compared with the traditional LFD and this approach could constitute a treatment alternative. TRIAL REGISTRATION: ClinicalTria

Background Fear of hypoglycaemia is common in patients with type 1 diabetes and many patients deliberately aim at higher blood glucose than recommended to avoid hypoglycaemia. Patient empowerment is a process whereby patients have the skills, attitudes, and self-awareness necessary to influence the quality of their lives. An empowered patient has sufficient knowledge to take relevant decisions about their illness, medical treatment and their own health. Aim The aim was to study empowerment, fear of hypoglycaemia and problem areas among patients with type1 diabetes. Method Four hundred fifty-seven patients, mean age 48.5 (±15.4) years, completed an questionnaire including questions on the duration of diabetes, episodes of severe hypoglycaemias and metabolic control, the Swedish Diabetes Empowerment Scale – 23 (Swe-DES-23), Fear of Hypoglycaemia Survey (HFS) and the Problem Areas in Diabetes scale (SWE-PAID-20) . Results The level of HbA1c was not associated with fear of hypoglycaemia while patients with newly diagnosed (0-5 years) diabetes had significantly lower (p=0.001) fear of hypoglycaemia than those with longer duration. Episodes of severe hypoglycaemia during the last year also influenced the rating on HFS. HFS was 24.7(11.6) in those with no episodes, 30.5(13.9) 1 episode, 33.0(15.4) 2-4 episodes (all p<0.01). Patients with HbA1c ≥ 8.0 % rated lower empowerment (SWE-DES-23) compared to those who had an HbA1c between 6.1-7.9% (p=0.02) and compared to those with HbA1c lower or equal to 6.0 % (p<0.001). On the SWE-PAID-20 patients with HbA1c ≥8 % scored in average 32.2(20.5) while those with HbA1c ≤6.0% scored 20.0(17.6) (p<0.001) (higher value indicates more emotional distress related to diabetes). Conclusion Patients with poor metabolic control, HbA1c ≥8 % are less empowered and also experiences more emotional distress related to their diabetes. Fear of hypoglycaemia was lowest in patient with up to 5 years duration of type 1 diabetes. HbA1c was not a

Background: There have been no human prospective randomized studies of the amount of alcohol that can induce hepatic steatosis. Methods: Thirty-two healthy women and twelve healthy men (34 ± 9 years of age) were randomized to consume 150 ml of red wine/day for women (16 g ethanol/day) or double that amount for men (33 g ethanol/day), or to alcohol abstention for 90 days. Participants underwent proton-nuclear magnetic-resonance spectroscopy for measurement of hepatic triglyceride content (HTGC). Blood samples for assessment of cardiovascular risk were drawn before and after the intervention. Results: After exclusion of three subjects with steatosis at baseline a trend towards increased HTGC was apparent for red wine (before median: 1.1%, range 0.2-3.9%, after median: 1.1%, range 0.5-5.2 %, P = 0.059) a difference that was statistically significant compared with abstainers (p = 0.02). However, no subject developed hepatic steatosis. Low-density lipoprotein (LDL)-cholesterol was lowered by red wine (-0.3 mmol/l, SE -0.1, 95% CI -0.6 to -0.04). Conclusions: Moderate consumption of red wine during three months increased HTGC in subjects without steatosis at baseline. However, since not a single participant developed steatosis we suggest that the threshold of alcohol consumption to define nonalcoholic fatty liver disease should not be lower than the amount in our study.

Determination of lipid levels is fundamental in cardiovascular risk assessment. We studied the short-term effects of fast food–based hyperalimentation on lipid levels in healthy subjects. Twelve healthy men and six healthy women with a mean age of 26 ± 6.6 years and an aged-matched control group were recruited for this prospective interventional study. Subjects in the intervention group aimed for a body weight increase of 5–15% by doubling the baseline caloric intake by eating at least two fast food–based meals a day in combination with adoption of a sedentary lifestyle for 4 weeks. This protocol induced a weight gain from 67.6 ± 9.1 kg to 74.0 ± 11 kg (P < 0.001). A numerical increase in the levels of high-density lipoprotein (HDL)-cholesterol occurred in all subjects during the study and this was apparent already at the first week in 16/18 subjects (mean increase at week 1: +22.0 ± 16%, range from –7 to +50%), whereas the highest level of HDL during the study as compared with baseline values varied from +6% to +58% (mean +31.6 ± 15%). The intake of saturated fat in the early phase of the trial related positively with the HDL-cholesterol-increase in the second week (r = 0.53, P = 0.028). Although the levels of insulin doubled at week 2, the increase in low-density lipoprotein (LDL)-cholesterol was only +12 ± 17%, and there was no statistically significant changes in fasting serum triglycerides. We conclude that hyperalimentation can induce a fast but transient increase in HDL-cholesterol that is of clinical interest when estimating cardiovascular risk based on serum lipid levels., Original Publication:Torbjörn Lindström, Stergios Kechagias, Martin Carlsson and Fredrik H. Nystrom, Transient increase in HDL cholesterol during weight gain by hyper-alimentation in healthy subjects, 2010, Obesity, (Sept).http://dx.doi.org/10.1038/oby.2010.190Copyright: NAASO The Obesity Society

Background: Asymmetric dimethylarginine (ADMA) has in some, but not all studies been associated with insulin resistance (IR). We wanted to challenge the hypothesis that plasma ADMA levels are associated with IR in an intervention study using an insulin sensitizing drug. Another aim of the study was to study daytime ADMA variation and if food intake influence ADMA concentration. Methods: Nine patients with diet treated type 2 diabetes were investigated with daytime profiles of ADMA (8 am-5 pm) before and during treatment with rosiglitazone for 8 weeks. A control group matched for age and sex underwent a similar investigation at baseline. Results: After treatment with rosiglitazone, ADMA (0.63- 0.64 mmol/L; p=0.26) and homocysteine (10.3 -10.6 mol/L; p=0.61) concentrations did not change. Postprandial (10 am – 5 pm) ADMA concentrations were 10% higher than fasting morning levels (p=0.006) and this difference was similar for controls and diabetes patients both pre and post treatment with rosiglitazone. Conclusions: Treatment with rosiglitazone aiming to improve insulin sensitivity did not affect ADMA concentration in type 2 diabetes patients. The ADMA daytime variation and the relation to food intake appear to be a novel finding and should be considered in future studies.

Objective: Increase of resistin and/or reduction of adiponectin have beenimplicated in the development of insulin resistance followingweight gain. We aimed to study this prospectively in humans. Design: Prospective and interventional with parallel control group. Methods: Twelve healthy men and six healthy women (age 26±6.6years) and an age-matched control group were recruited. Subjectsin the intervention group aimed for a bodyweight increase of5–15% by doubling the baseline caloric intake by eatingat least two fast food-based meals a day in combination withadoption of a sedentary lifestyle for 4 weeks. Results: Bodyweight increased from 67.6±9.1 to 74.0±11kg, P<0.001, by the intervention. Insulin levels increased(before: 27.4±12 pmol/l, after: 53.0±22 pmol/l,P=0.004), while plasma levels of adiponectin (before: 5038±3736ng/ml, after: 6739±7949 ng/ml, P=0.18) and resistin (before:21.8±19 ng/ml, after: 14.4±6.8 ng/ml, P=0.074)remained unchanged by the weight gain and were similar as incontrols. On the other hand, leptin levels increased about threefoldfollowing the intervention (before: 5.7±7.4, after: 16±20ng/ml, P=0.008), and also the inflammatory marker C-reactiveprotein (CRP) increased from 0.34±0.44 to 0.71±0.87mg/l, P=0.03, when two outliers >10 mg/l were disregarded. Conclusions: Hyperalimentation reduces insulin sensitivity when weight gainof 9% was combined with reduction of exercise. However, thelevels of resistin and adiponectin were unaffected by the intervention,while CRP levels increased within this short time period suggestingthat low-grade inflammation can occur early in the process ofdeveloping a metabolic syndrome., Disclaimer. This is not the definitive version of record of this article. This manuscript has been accepted for publication in European Journal of Endocrinology, but the version presented here has not yet been copy edited, formatted or proofed. Consequently, the journal accepts no responsibility for any errors or omissions it may contain. The definitive version is now freely available at: Olov Åstrand, Martin Carlsson, Ingela Nilsson, Torbjörn Lindström, Magnus Borga and Fredrik Nyström, Weight gain by hyperalimentation elevates C-reactive protein levels but does not affect circulating levels of adiponectin or resistin in healthy subjects, 2010, European Journal of Endocrinology, (163), 6, 879-885. http://dx.doi.org/10.1530/EJE-10-0763 Copyright: Bio Scientifica http://www.eje-online.org

Background: A sedentary lifestyle and increased consumption of energy dense food have become more common in many parts of the world. The aim of this study was to study long term effects on body composition after a four week intervention with fast food based hyper-alimentation and limited physical activity in young normal weight subjects. Method: Eighteen subjects, mean age 26 (6.6) years, increased their energy intake with in average 70% and physical activity were not to exceed 5000 steps/day. Body composition was measured by Dual energy x-ray (DXA) at baseline, after the intervention and after 12 months. A matched control group was also included. ANOVA and Student's paired and unpaired t-test were used. Result: During the intervention body weight increased with 6.4 (2.8) kg and DXA measurements showed increases of both fat free mass and fat mass. Six months after the intervention the subjects had lost most of the weight gain, - 4.7 (3.1) kg. Twelve months after the intervention body weight had increased with 1.5 (2.4) kg compared to baseline (p = 0.018). DXA measurements at 12 months showed unchanged fat free mass compared to baseline but higher fat mass, + 1.4 (1.9) kg (p = 0.01). After 2.5 years the increase of body weight was 3.1 (4.0) kg (p = 0.01) while there was no change in controls compared to baseline, + 0.1(2.5) kg (p = 0.88). Conclusion: One year after a short term intervention with increased fast food based hyper-alimentation there was an increase of fat mass but unchanged fat free mass. As the change of fat mass was larger than expected from prospective epidemiological studies and as there was no increase of body weight in controls it raises the issue whether there is a long-term effect to increase fat mass of a short period of hyper-alimentation., Original Publication: Åsa Ernersson, Fredrik Nyström and Torbjörn Lindström, Long-term increase of fat mass after a four week intervention with fast food based hyper-alimentation and limitation of physical activity, 2010, Nutrition & Metabolism, (7), 68. http://dx.doi.org/10.1186/1743-7075-7-68 Copyright: BioMed Central http://www.biomedcentral.com

We studied the effect of increased water intake on ambulatory blood pressure (BP) in healthy individuals. Blood pressure was recorded after 2 weeks of either regular (RWI) or extra water intake (EWI, an additional 30 ml water/kg body weight per day) in 20 healthy subjects (10 males, 10 females). The extra water intake (RWI: 1.7 +/- 0.59 l, EWI: 3.7 +/- 0.84 l, respectively, p andlt; 0.0001, i.e., an increase of 2 liters) induced an increase in mean arterial daytime BP from 89.0 +/- 5.5 mmHg during RWI to 91.4 +/- 6.4 mmHg during the EWI phase (p = 0.005), while night-time BP was unchanged by the intervention. The visual-analogue-scale (VAS, maximum score of 10) score corresponding to the statement "I often experience vertigo" was 3.1 +/- 2.6 during RWI and decreased to 2.1 +/- 2. 1 during EWI phase (p = 0.008). In conclusion, two liters of extra water intake for 2 weeks significantly increased daytime blood pressure and reduced a sense of vertigo in healthy individuals., Original Publication:Anders Jormeus, Samuel Karlsson, Christina Dahlgren, Torbjörn Lindström and Fredrik Nyström, Doubling of Water Intake Increases Daytime Blood Pressure and Reduces Vertigo in Healthy Subjects, 2010, CLINICAL AND EXPERIMENTAL HYPERTENSION, (32), 7, 439-443.http://dx.doi.org/10.3109/10641961003686450Copyright: Informa Healthcarehttp://informahealthcare.com

Aims: To explore the associations between ß-blocker treatment and clinic, ambulatory, and central pulse pressure (PP) and central augmentation index (AIx), and left ventricular mass index (LVMI), respectively, in patients with type 2 diabetes.Methods: In 124 middle-aged patients with type 2 diabetes who were treated in primary care and used at least one antihypertensive drug, we measured clinic PP (mean value of three nurse-recorded measurements in the sitting position) and ambulatory PP (24-hour ambulatory measurements with the Spacelab 90217 measurement device). Central PP was measured non-invasively, using applanation tonometry (SphygmoCor), which also yielded values of AIx. LVMI was determined echocardiographically in all patients.Results: Patients whose antihypertensive drug regimen included a ß-blocker (n=67) had significantly higher central PP compared with patients whose antihypertensive drug regimen did not include a ß-blocker (ß-blocker: 49.6±12.2 mmHg, no ß-blocker: 45.1±10.2 mmHg; p=0.03) despite having similar clinic PP (ß-blocker: 60.4±16.3 mmHg, no ß-blocker: 58.9±13.1 mmHg; p=0.59) and similar ambulatory PP (ß-blocker: 55.2±9.1 mmHg, no ß-blocker: 54.8±10.6 mmHg; p=0.40). Patients treated with ß-blockers also had significantly higher AIx (ß-blocker: 30.7±8.4%, no ß-blocker: 25.8±8.8%; p<0.01) and higher LVMI (ß-blocker: 129.5±29.7 g/m2, no ß-blocker: 117.4±27.4 g/m2; p=0.02) compared with patients who were not treated with ß-blockers.Conclusions: In our cohort, ß-blocker use was associated with high central but not brachial PP and with high central AIx and high LVMI. Non-invasive measurement of central hemodynamic parameters may improve the evaluation of antihypertensive treatment efficacy in patients with type 2 diabetes.

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Our aim was to study, at the same glycemic control, how treatment with either the insulin secretagogue repaglinide or exogenous insulin aspart affects endogenous insulin secretion, plasma insulin and IAPP (islet amyloid polypeptide) levels, GH-IGF (growth hormone-insulin-like growth factor) axis and plasma lipoprotein concentrations in patients with type 2 diabetes. Five patients, age 65.0 +/- A 4.1 years (mean +/- A SE), body weight 82.5 +/- A 5.0 kg, BMI (body mass index) 27.7 +/- A 1.5 kg/m(2) were treated for 10 weeks with repaglinide or insulin aspart in a randomized, cross-over study. At the end of each treatment a 24-h metabolic profile was performed. Blood glucose, C-peptide, free human insulin, free total (human and analogue) insulin, proinsulin, IAPP, IGF-I, IGFBP-1 (IGF binding protein-1), GHBP (growth hormone binding protein) and plasma lipoprotein concentrations were measured. Similar 24-h blood glucose profiles were obtained with repaglinide and insulin aspart treatment. During the repaglinide treatment, the meal related peaks of C-peptide and free human insulin were about twofold higher than during treatment with insulin aspart. Proinsulin, GHBP were higher and IAPP levels tended to be higher during repaglinide compared to insulin aspart. Postprandial plasma total cholesterol, triglycerides and apolipoprotein B concentrations were higher on repaglinide than on insulin aspart treatment. Our results show that, at the same glycemic control, treatment with exogenous insulin aspart in comparison with the insulin secretagogue repaglinide result in a lower endogenous insulin secretion, and a tendency towards a less atherogenic postprandial lipid profile., The original publication is available at www.springerlink.com: Ioana Simona Chisalita, Torbjörn Lindström, Pär Eson Jennersjö, Johan Paulsson, Gunilla Westermark, Anders Olsson and Hans Arnqvist, Differential lipid profile and hormonal response in type 2 diabetes by exogenous insulin aspart versus the insulin secretagogue repaglinide, at the same glycemic control, 2009, ACTA DIABETOLOGICA, (46), 1, 35-42. http://dx.doi.org/10.1007/s00592-008-0055-6 Copyright: Springer -- Verlag http://www.springerlink.com

Background: The interaction of the PPARγ Pro12Ala with obesity and cardiovascular risk is controversial. We aimed to study potential associations of the Ala isoform of this polymorphism with obesity, blood pressure and markers of cardiovascular disease and organ damage in middle aged patients with type 2 diabetes. Subjects and methods: We recruited 148 women and 246 men in the CArdiovascular Risk factors in Patients with DIabetes – a Prospective study in the Primary health care setting (CARDIPP) study in which early markers of organ damage by cardiac echocardiography, determination of carotid intima media thickness (IMT) and measurement of pulse wave velocity (PWV) was performed. Blood pressures were measured as both as 24-hour ambulatory blood pressure and as a noninvasive recording of central blood pressure. Allelic discrimination was detected with the ABI prism 7500HT Sequence Detection System. Due to the low prevalence of Ala homozygotes, heterozygotes and homozygotes of Ala were defined as Ala isoform in the analyses. Results: Men with Ala isoform exhibited higher sagittal abdominal diameter (Pro: 25.4±3.4 cm, Ala: 26.7±4.9 cm, p= 0.04) waist circumference (Pro: 104±11 cm, Ala: 108±15 cm, p= 0.046) and body weight (Pro: 91.6±14, Ala: 96.5±18, p= 0.035) than homozygotes for the Pro isoform. However, there were no differences in either gender with respect to blood pressures, left-ventricular mass-index, carotid IMT or carotid-femoral PWV in the participants. Conclusion: It is unlikely that determination of the PPARγ Pro12Ala isoform in clinic practice adds any major information on cardiovascular risk or circulatory organ damage in patients with type 2 diabetes.

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Objective: To study the effects of snacking based on fast acting carbohydrates (candy) or fat and protein (peanuts) in a prospective randomized, parallel intervention study. Methods: Basal metabolic rate (BMR) and cardiovascular risk factors were measured before and after hyper-alimentation by addition of 20 kcal/kg (84 kJ/kg) body weight of either candy or roasted peanuts, to the regular caloric intake, for two weeks in healthy subjects. Eleven men and 14 women completed the randomized study. Results: Energy-intake increased similarly in the groups (candy: +46.1 +/- 35%, peanuts: +46.8 +/- 28%, p = 0.96). Body-weight (candy: from 67.3 +/- 7.6 kg to 68.1 +/- 7.3 kg, p = 0.01, nuts: from 68.7 +/- 6.1 kg to 69.0 +/- 5.7 kg, p = 0.3) and waist circumference increased significantly only in the candy group. At the end of the study LDL cholesterol (candy: 2.6 +/- 0.4 mmol/L, peanuts: 2.1 +/- 0.4 mmol/L, p = 0.005) and ApoB/ApoA-1-ratio (candy: 0.68 +/- 0.16, peanuts: 0.53 +/- 0.11, p = 0.01) were higher in the candy group than in the peanut group. On the other hand, BMR increased only in the peanut group (candy: from 6.657 +/- 1.1 MJ/24 h to 6.762 +/- 1.1 MJ/24 h, p - 0.3, nuts: from 6.896 +/- 0.98 MJ/24 h to 7.256 +/- 1.1 MJ/24 h, p = 0.02). Conclusion: Two weeks of snacking based on peanuts does not cause the same negative metabolic effects as an isocaloric diet in which the snacking is based on short acting carbohydrates in the form of candy in non-obese healthy subjects.