Anette Hjartåker

• Birkeland, Einar Elvbakken; Kværner, Ane Sørlie; Avershina, Ekaterina; Johannessen, Cecilie Bucher -; Bemanian, Vahid & Blix, Hege Salvesen [Show all 14 contributors for this article] (2026). Microbiome signatures for detection of colorectal lesions in population-based FIT screening. Nature Communications. 17. doi: 10.1038/s41467-026-75962-1. Full text in Research Archive Show summary

  The gut microbiome has been linked to colorectal cancer (CRC) development, with microbe-based classifiers distinguishing between CRC patients and healthy controls. However, there is a lack of studies addressing the utility of the microbiome in screening-relevant settings, including both precancers and CRC. In this Norwegian population-based study, we used fecal immunochemical test (FIT) leftovers from 1034 FIT-positive (i.e. positive for occult blood) screening participants for gut metagenome profiling using shotgun sequencing. Using comprehensive clinical, demographic, and lifestyle data, we modeled gut microbiome associations with CRC screening outcomes. Combining microbial profiles with quantitative FIT values improved detection of premalignant lesions beyond optimizing the FIT value alone, even after incorporating established CRC risk factors. Still, the FIT value maintained superior discriminative ability for CRC. We confirmed enrichment of bacteria such as Fusobacterium nucleatum and Peptostreptococcus stomatis in CRC. In contrast, other bacteria previously associated with the presence of CRC, including Hungatella hathewayi and Clostridium symbiosum, as well as pks-negative Escherichia coli, were enriched in those with no neoplastic findings, suggesting that in a FIT-positive population their presence may reflect other conditions causing intestinal bleeding rather than underlying neoplasia. Microbial profiles were predominantly associated with distal rather than proximal lesions. Together, our findings highlight the potential for microbial markers to improve FIT-based CRC screening, especially by differentiating those with premalignant lesions from those who test FIT-positive for other reasons.

• Bålsrud, Pia; Ulven, Stine Marie; Hjartåker, Anette; Ottestad, Inger Olaug; Retterstøl, Kjetil & Schwab, Ursula [Show all 9 contributors for this article] (2026). Association between dietary protein intake and frailty index among home-dwelling older adults; an 8-year follow-up study. The Journal of Nutrition, Health & Aging. ISSN 1279-7707. 30(6). doi: 10.1016/j.jnha.2026.100850. Full text in Research Archive
• Kværner, Ane Sørlie; Birkeland, Einar Elvbakken; Avershina, Ekaterina; Botteri, Edoardo; Bucher-Johannessen, Cecilie & Knudsen, Markus Dines [Show all 14 contributors for this article] (2026). Alcohol consumption and colorectal carcinogenesis: an exploration of the gut microbial pathway as a potential mediator. European Journal of Nutrition. ISSN 1436-6207. 65(4), p. 1–18. doi: 10.1007/s00394-026-03960-6. Full text in Research Archive Show summary

  Background Alcohol consumption is one of the major risk factors of colorectal cancer (CRC), yet the mechanisms underlying this relationship, particularly the role of gut microbes, are not fully understood. Objective To study associations of alcohol intake with the gut microbiome and colorectal lesions among CRC screening participants. Of particular interest was the potential role of gut microbes in mediating the association between alcohol intake and colorectal lesions. Methods Screening participants with a positive faecal immunochemical test at ages 55–77 were eligible for the CRCbiome study. Alcohol intake was assessed using a validated, semi-quantitative food frequency questionnaire and linked with shotgun metagenome based gut microbial profiles to study associations with screen-detected colorectal lesions. The potential role of alcohol-associated gut microbes in mediating the association between alcohol intake and colorectal lesions was examined using causal mediation analysis. Results Of 1468 participants with dietary data, 414 were diagnosed with advanced lesions. Alcohol intake was positively associated with advanced lesions in a dose-dependent manner (ptrend = 0.008), with odds ratio of 1.09 (95% confidence interval, 1.00, 1.19) per 10 g/day increase. Compared to non-consumers, those consuming alcohol were characterized by a distinct microbial profile, manifested as modest, but consistent, shifts in α- and β-diversity, and differentially abundant bacteria. A causal mediation analysis showed that 12% of the association between alcohol intake and advanced lesions was mediated by alcohol-associated gut bacteria. Conclusion Alcohol consumption was associated with a distinct microbial profile, which partly explained the association between alcohol intake and advanced colorectal lesions.

• Skammelsrud, Thorbjørn Brun; Hjartåker, Anette; Klingberg, Sofia & Brekke, Hilde Kristin (2025). Breastfeeding duration and maternal weight change through adulthood in a population-based cohort study. American Journal of Clinical Nutrition. ISSN 0002-9165. doi: 10.1016/j.ajcnut.2025.101134. Full text in Research Archive Show summary

  Background Weight retention postpartum can increase long-term risk of maternal overweight and obesity. In theory, breastfeeding may facilitate postpartum weight loss, but its association with maternal weight change, especially long-term, remains uncertain. Objectives The aim of this study was to investigate the association between breastfeeding duration and maternal weight change through adulthood emphasizing possible variations based on early adulthood BMI and the time of childbirth during the 1940s through the 1990s. Methods Women (n = 172,472) in the Norwegian Women and Health Study, born 1927 to 1965, completed ≤3 questionnaires (Q1–Q3) between 1991 and 2014. A linear mixed model was applied to assess the association between BMI change from age 18 y in relation to mean breastfeeding duration per child (0, >0 to <3, 3 to <6, 6 to <9, 9 to <12, 12 to <15, ≥15 mo), including a 3-way interaction with categories of BMI at age 18 y and time period of first birth. Results We found a significant interaction between breastfeeding duration per child, BMI at age 18 y, and year of first birth in relation to BMI change from age 18 y. Longer breastfeeding duration per child was associated with a lower increase in BMI among both mothers who either had overweight or obesity or had normal weight at age 18 y (P-trend < 0.001), irrespective of time of first birth. Among mothers with overweight or obesity at age 18 y who had their first child ≥1980, breastfeeding for ≥3 mo per child was significantly associated with lower increase in BMI from age 18 y, ranging from −1.26 kg/m2 [95% confidence interval (CI): −2.19, −0.32] to −2.11 kg/m2 (95% CI: −2.93, −1.30), compared with >0 to <3 mo. Conclusions We found a significant association between longer breastfeeding duration per child and lower maternal weight gain through adulthood, which was particularly pronounced among mothers with overweight or obesity at age 18 y and among mothers who had their first child ≥1980.

• Knudsen, Markus Dines; Wang, Kai; Wang, Liang; Polychronidis, Georgios; Berstad, Paula Marianna & Hjartåker, Anette [Show all 10 contributors for this article] (2025). Lifestyle Change After Initial Colonoscopy Screening and Incidence of Colorectal Cancer and Major Chronic Diseases. American Journal of Gastroenterology. ISSN 0002-9270. p. 1–10. doi: 10.14309/ajg.0000000000003686. Full text in Research Archive Show summary

  INTRODUCTION: The impact of lifestyle changes after colorectal cancer (CRC) screening on risk of CRC and major chronic diseases remains unknown. METHODS: Leveraging the repeatedly collected dietary, lifestyle, and screening data in the Nurses' Health Study (1988–2018), Nurses' Health Study II (1993–2019) and Health Professionals Follow-up Study (1988–2016), we assessed changes after initial colonoscopy screening in a healthy lifestyle score (0–5) based on smoking, body mass index, physical activity, alcohol intake, and diet. We used time-varying multivariable Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incidence of CRC and major chronic diseases (including cancer, cardiovascular disease, and type 2 diabetes), among 118,396 and 88,558 individuals, respectively. RESULTS: During a median follow-up of 10.0 years (interquartile range 6.2–12.6) and 9.6 years (interquartile range 6.0–12.3 years), we documented 537 CRC and 14,165 major chronic disease cases, respectively. Forty-eight percent of participants changed their lifestyle score with at least 1 point. One-unit increase in the lifestyle score was associated with 14% lower risk of CRC (HR 0.86, 95% CI 0.77–0.95) and 11% lower risk of major chronic diseases (HR 0.89, 95% CI 0.88–0.91). Similar associations were observed for proximal and distal CRC and individual chronic diseases. Changes in smoking and physical activity were associated with CRC and chronic diseases, whereas changes in weight, alcohol intake, and diet were associated with chronic diseases only. DISCUSSION: Adopting a healthier lifestyle after initial colonoscopy screening may reduce risk of CRC and chronic diseases, suggesting colonoscopy screening could be a teachable moment for health promotion.

• Henriksen, Hege; Knudsen, Markus Dines; Hjartåker, Anette; Blomhoff, Rune & Carlsen, Monica Hauger (2024). Digital Food Frequency Questionnaire Assessing Adherence to the Norwegian Food-Based Dietary Guidelines and Other National Lifestyle Recommendations: Instrument Validation Study. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 26. doi: 10.2196/53442. Full text in Research Archive Show summary

  Background: Valid assessment tools are needed when investigating adherence to national dietary and lifestyle guidelines. Objective: The relative validity of the new digital food frequency questionnaire, the DIGIKOST-FFQ, against 7-day weighed food records and activity sensors was investigated. Methods: In total, 77 participants were included in the validation study and completed the DIGIKOST-FFQ and the weighed food record, and of these, 56 (73%) also used the activity sensors. The DIGIKOST-FFQ estimates the intake of foods according to the Norwegian food–based dietary guidelines (FBDGs) in addition to lifestyle factors. Results: At the group level, the DIGIKOST-FFQ showed good validity in estimating intakes according to the Norwegian FBDG. The median differences were small and well below portion sizes for all foods except “water” (median difference 230 g/day). The DIGIKOST-FFQ was able to rank individual intakes for all foods (r=0.2-0.7). However, ranking estimates of vegetable intakes should be interpreted with caution. Between 69% and 88% of the participants were classified into the same or adjacent quartile for foods and between 71% and 82% for different activity intensities. The Bland-Altman plots showed acceptable agreements between DIGIKOST-FFQ and the reference methods. The absolute amount of time in “moderate to vigorous intensity” was underestimated with the DIGIKOST-FFQ. However, estimated time in “moderate to vigorous intensity,” “vigorous intensity,” and “sedentary time” showed acceptable correlations and good agreement between the methods. The DIGIKOST-FFQ was able to identify adherence to the Norwegian FBDG and physical activity recommendations. Conclusions: The DIGIKOST-FFQ gave valid estimates of dietary intakes and was able to identify individuals with different degrees of adherence to the Norwegian FBDG and physical activity recommendations. Moderate physical activity was underreported, water was overreported, and vegetables showed poor correlation, which are important to consider when interpreting the data. Good agreement was observed between the methods in estimating dietary intakes and time in “moderate to vigorous physical activity,” “sedentary time,” and “sleep.”

• Henjum, Sigrun; Rosendahl-Riise, Hanne; Morseth, Marianne S.; Hevrøy, Thyra Jensen; Hjartåker, Anette & Engebretsen, Ingunn Marie Stadskleiv [Show all 7 contributors for this article] (2024). Iodine nutrition in Community-dwelling Older Persons from Norway. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 22(4), p. 179–188. doi: 10.18261/ntfe.22.4.2. Full text in Research Archive Show summary

  Background: Older persons are vulnerable to malnutrition and inadequate micronutrient intake, including iodine deficiency. Objectives: To assess urinary iodine concentration (UIC) and dietary iodine intake in a group of community-dwelling older persons receiving home care services in Oslo. Method: One spot urine sample and two 24-hour dietary recalls were collected in 60 community-dwelling older persons (34 women and 26 men). UIC was analyzed by the Sandell-Kolthoff reaction and dietary iodine intake was calculated and compared to the provisional Average Requirement (AR). Multiple linear regression analyses were performed to find predictors for iodine intake. Results: The median UIC (p25-p75) was 102 (64–168) μg/L and dietary iodine intake was 104 (69–173) μg/day. In total, 58% had iodine intakes below provisional AR. The main source of iodine was milk and dairy products, accounting for 42% of total iodine intake. In multiple linear regression analyses, iodine supplement use and oral supplement use were largely associated with iodine intake, (β, 95 % CI): 132 (76, 187) and 92 (23, 187), respectively. Increasing number of meals (β, 95 % CI): 48 (9, 86) and older age 2 (0, 4) was also associated with iodine intake. Conclusions: Iodine status was found to be adequate at the group level, however, median iodine intake was below provisional AR. We found that the number of meals and total energy intake directly influenced iodine status. Most of the older persons consumed iodine-rich food items, thus the largest risk was not limited intake of iodine-rich food sources but limited energy intake.

• Vetlesen, Hanna Skorstad; Wik-Klokk, Merete; Wallace, Sean Ciaran; Rasmussen, Magnhild; Hjartåker, Anette & Nordstrøm, Marianne (2024). Nutritional status and dietary intake in children and adolescents with spinal muscular atrophy types II and III on treatment with nusinersen. Clinical Nutrition Open Science. 53, p. 57–67. doi: 10.1016/j.nutos.2023.12.005. Full text in Research Archive Show summary

  Background There are few assessments of nutritional care needs of children and adolescents with spinal muscular atrophy (SMA) after disease-modifying treatments became available. Aims To assess nutritional status, dietary intake and feeding difficulties in children and adolescents with SMA II and SMA III on treatment with nusinersen, and to explore possible associations between feeding difficulties and dietary intake. Methods Nutritional status was assessed by anthropometric measures and blood samples from annual follow-up appointments over a three-year period. Three 24-hour dietary recalls by phone were used to assess dietary intake. Feeding difficulties were assessed by the Egen Klassifikation- 2 scale. Results This study included 20 participants with SMA II with a median age of 7.0 (Q1 2.0; Q3 12.9) years and 20 participants with SMA III with a median age of 8.4 (Q1 4.3; Q3 12.2) years. Adequate intake of iron and vitamin D was dependent on use of supplementation. Iron deficiency was implied in 17.5 %, whereas vitamin D deficiency was documented in 5 % and vitamin D insufficiency in 37.5 % of the total SMA cohort. Growth failure with small mean decrease in height-for-age z-score over time was observed in both subgroups, however only significant in the SMA II group (P=0.02). Feeding difficulties were associated with reduced intake of protein -4.6 grams per day, 95 % CI [-7.3; -1.8], P=0.002. Conclusions Systematic monitoring of nutritional status continues to be important in pediatric patients with SMA II and SMA III on disease-modifying treatment. Attention in clinical care should be on prevention and treatment of nutritional deficits, with emphasis on iron and vitamin D status and adequate protein intake in persons with feeding difficulties.

• Knudsen, Markus Dines; Wang, Kai; Wang, Liang; Polychronidis, Georgios; Berstad, Paula Marianna & Hjartåker, Anette [Show all 10 contributors for this article] (2024). Colorectal Cancer Incidence and Mortality After Negative Colonoscopy Screening Results. JAMA Oncology. ISSN 2374-2437. 11(1), p. 46–54. doi: 10.1001/jamaoncol.2024.5227. Full text in Research Archive
• Uchai, Shreeshti; Andersen, Lene Frost; Thoresen, Magne; Hopstock, Laila Arnesdatter & Hjartåker, Anette (2024). Does the association between adiposity measures and pre-frailty among older adults vary by social position? Findings from the Tromsø study 2015/2016. BMC Public Health. 24(1). doi: 10.1186/s12889-024-18939-3. Full text in Research Archive Show summary

  Introduction - Pre-frailty provides an ideal opportunity to prevent physical frailty and promote healthy ageing. Excess adiposity has been associated with an increased risk of pre-frailty, but limited studies have explored whether the association between adiposity measures and pre-frailty varies by social position.<p> <p>Methods - We used data from the seventh survey of the Tromsø Study (Tromsø7) conducted in 2015–2016. Our primary sample consisted of 2,945 women and 2,794 men aged ≥ 65 years. Pre-frailty was defined as the presence of one or two of the five frailty components: low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity. Adiposity was defined by body mass index (BMI), waist circumference (WC), fat mass index (FMI) and visceral adipose tissue (VAT) mass. Education and subjective social position were used as measures of social position. Poisson regression with robust variance was used to assess the association between adiposity measures and pre-frailty, and the interaction term between adiposity measures and social position measures were utilised to explore whether the association varied by social position.<p> <p>Results - In our sample, 28.7% of women and 25.5% of men were pre-frail. We found sub-multiplicative interaction of BMI-defined obesity with education in women and subjective social position in men with respect to development of pre-frailty. No other adiposity measures showed significant variation by education or subjective social position. Regardless of the levels of education or subjective social position, participants with excess adiposity (high BMI, high WC, high FMI and high VAT mass) had a higher risk of pre-frailty compared to those with low adiposity.<p> <p>Conclusion - We consistently observed that women and men with excess adiposity had a greater risk of pre-frailty than those with low adiposity, with only slight variation by social position. These results emphasize the importance of preventing excess adiposity to promote healthy ageing and prevent frailty among all older adults across social strata.

• Konglevoll, Dina Moxness; Andersen, Lene Frost; Thoresen, Magne; Totland, Torunn Holm; Hopstock, Laila Arnesdatter & Hjartåker, Anette [Show all 7 contributors for this article] (2024). Dietary trajectories over 21 years and frailty in Norwegian older adults: the Tromsø Study 1994–2016. European Journal of Nutrition. ISSN 1436-6207. 63, p. 2987–2998. doi: 10.1007/s00394-024-03482-z. Full text in Research Archive Show summary

  Purpose To investigate the association between five dietary trajectories over 21 years and frailty in Norwegian older adults.<p> <p>Methods This study used data from three surveys of the Tromsø Study. Diet was measured using food frequency questionnaires at baseline (Tromsø4, 1994–95), after 7 years (Tromsø5, 2001) and at the end of follow-up (Tromsø7, 2015–16). Survey-specific diet scores were constructed based on the Nordic Nutrition Recommendations 2023 and group-based trajectory modelling was used to derive dietary trajectories. At follow-up, frailty was assessed with a 41-item frailty index. Linear regression analysis was performed to assess the associations between dietary trajectories and frailty, adjusted for baseline variables. <p>Results Among the 715 participants, 55% were women, with an average age of 54 years at baseline and 74 years at followup. The dietary trajectories ‘moderately healthy’ and ‘healthy increase’ were associated with a lower frailty index score at follow-up (β = −0.02, 95% confidence interval (CI)=−0.04, −0.002, β = −0.03, 95% CI=−0.06, −0.007), compared with the ‘unhealthy’ trajectory. <p>Conclusion Our findings suggest that maintaining a moderately healthy to very healthy diet from mid-life into older age is associated with a lower risk of frailty and supports the promotion of a healthy diet from adulthood to facilitate healthy ageing.

• Knudsen, Markus Dines; Carlsen, Monica Hauger; Hjartåker, Anette; Blomhoff, Rune & Henriksen, Hege (2024). Reproducibility and comparison of a digital food frequency questionnaire (DIGIKOST-FFQ) assessing adherence to national diet and lifestyle recommendations. Food & Nutrition Research (FNR). ISSN 1654-6628. 68. doi: 10.29219/fnr.v68.10366. Full text in Research Archive Show summary

  Background: We have developed a digital semi-quantitative food frequency and lifestyle questionnaire, the DIGIKOST-FFQ, based on the validated paper-based NORDIET-FFQ. Objective: The study aims to investigate the reproducibility of the DIGIKOST-FFQ and to compare the DIGIKOST-FFQ against the NORDIET-FFQ for the adjusted questions for intakes of fruits, vegetables, whole grains, fish, meat, and dairy products. Design: Participants were recruited from May to September 2021 through a random sample from the National Population Register and advertisements on Facebook in Norway. In the reproducibility study, the DIGIKOST-FFQ was completed twice by the participants, 1–2 months apart. In the comparison study, the DIGIKOST-FFQ was completed 1–2 months prior to the NORDIET-FFQ. Results: In the reproducibility study, 317 individuals were included. For 12 out of 16 food groups there were no significant differences in intake estimations between the first and second DIGIKOST-FFQ administrations. A small but significant median difference was observed for fruits (6 g/day) and vegetables (24 g/day). Correlations were satisfactory for all items (r = 0.60–1.00), and in the cross-classification 85% of the participants were classified into the same or adjacent quartile for all items. The comparison study included 81 individuals. Compared to the NORDIET-FFQ a significant median difference was observed for fruits 29 g/day, vegetables 36 g/day, whole grains –10 g/day, and red meat –11 g/day, but not for fish, processed meat, or dairy products. Conclusion: The DIGIKOST-FFQ was able to reproduce diet and lifestyle at the group level. An intended difference for the food groups where questions had been adjusted, was observed between DIGIKOST-FFQ and NORDIET-FFQ in the comparison study.

• Sabir, Zoya; Dierkes, Jutta; Hjartåker, Anette & Rosendahl-Riise, Hanne (2023). The association of dietary patterns with muscle mass and strength in old age: The Hordaland Health Study. European Journal of Nutrition. ISSN 1436-6207. 62, p. 2739–2750. doi: 10.1007/s00394-023-03206-9. Full text in Research Archive Show summary

  Purpose: The single nutrient approach in nutrition research lacks the ability to account for synergistic relationships between dietary components. Current evidence suggests that diet quality, reflecting overall dietary intake, may influence muscle health. In a community-based observational study in Western Norway, we examined dietary patterns in relation to muscle mass and strength at age 67–70. Methods: The current analysis was conducted in men and women of The Hordaland Health Study (HUSK), who participated in both the second (HUSK2) and third study wave (HUSK3). Dietary patterns were extracted by principal component analysis (PCA) on food frequency questionnaire (FFQ) data. Individual dietary pattern scores (DPS) for HUSK2 (age 46–49) and HUSK3 (age 67–70), and overall DPS (oDPS) were calculated. Outcome variables were appendicular skeletal muscle mass (ASMM) and handgrip strength (HGS) measured in HUSK3. The relationships of HUSK3 DPS and oDPS with ASMM and HGS were assessed by multivariate linear regression analysis adjusted for potential confounding factors. Results: We identified three distinct dietary patterns, labelled ‘Western’, ‘Healthy’, and ‘Sweets-focused’. A significant positive association was observed between the oDPS for the ‘Healthy’ dietary pattern and ASMM in both men and women at age 67–70. No significant associations were found between HUSK3 DPS or oDPS for any of the identified dietary patterns and HGS in our population. Conclusion: Higher oDPS on a dietary pattern predominantly rich in fish, vegetables, nuts and seeds, fruit and berries, and eggs was associated with better ASMM at age 67–70. To establish the influence of diet quality on muscle health, further long-term studies with repeated dietary assessments are warranted.

• Karavasiloglou, Nena; Hughes, David J.; Murphy, Neil; Schomburg, Lutz; Sun, Qian & Seher, Vartiter [Show all 42 contributors for this article] (2023). Prediagnostic serum calcium concentrations and risk of colorectal cancer development in 2 large European prospective cohorts. American Journal of Clinical Nutrition. ISSN 0002-9165. 117(1), p. 33–45. doi: 10.1016/j.ajcnut.2022.10.004. Full text in Research Archive
• Uchai, Shreeshti; Andersen, Lene Frost; Hopstock, Laila Arnesdatter & Hjartåker, Anette (2023). Body mass index, waist circumference and pre-frailty/frailty: the Tromsø study 1994−2016. BMJ Open. 13:e065707(2), p. 1–11. doi: 10.1136/bmjopen-2022-065707. Full text in Research Archive Show summary

  Objective This study investigated the association between obesity, assessed using body mass index (BMI) and waist circumference (WC), and pre-frailty/frailty among older adults over 21 years of follow-up. <p>Design Prospective cohort study. <p>Setting Population-based study among communitydwelling adults in Tromsø municipality, Norway. <p>Participants 2340women and 2169 men aged ≥45 years attending the Tromsø study in 1994–1995 (Tromsø4) and 2015–2016 (Tromsø7), with additional BMI and WC measurements in 2001 (Tromsø5) and 2007–2008 (Tromsø6). <p>Primary outcome measure Physical frailty was defined as the presence of three or more and pre-frailty as the presence of one to two of the five frailty components suggested by Fried et al: low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity. <p>Results Participants with baseline obesity (adjusted OR 2.41, 95% CI 1.93 to 3.02), assessed by BMI, were more likely to be pre-frail/frail than those with normal BMI. Participants with high (OR 2.14, 95%CI 1.59 to 2.87) or moderately high (OR 1.57, 95%CI 1.21 to 2.03) baseline WC were more likely to be pre-frail/frail than those with normal WC. Those at baseline with normal BMI but moderately high/high WC or overweight with normal WC had no significantly increased odds for pre-frailty/frailty. However, those with both obesity and moderately high/ high WC had increased odds of pre-frailty/frailty. Higher odds of pre-frailty/frailty were observed among those in ‘overweight to obesity’ or ‘increasing obesity’ trajectories than those with stable normal BMI. Compared with participants in a stable normal WC trajectory, those with high WC throughout follow-up were more likely to be prefrail/frail. <p>Conclusion Both general and abdominal obesity, especially over time during adulthood, is associated with an increased risk of pre-frailty/frailty in later years. Thus maintaining normal BMI and WC throughout adult life is important.

• Sabir, Zoya; Hjartåker, Anette; Dierkes, Jutta & Rosendahl-Riise, Hanne (2023). The Association of Isocaloric Substitution of Dietary Protein in Middle Age with Muscle Mass and Strength in Old Age: The Hordaland Health Study. Current Developments in Nutrition (CDN). 8(1). doi: 10.1016/j.cdnut.2023.102052. Full text in Research Archive Show summary

  Background Age-associated loss of muscle mass and strength is an important predictor of disability in older persons. Although several mechanisms contribute to the decline in muscle mass and function seen with aging, the process is thought to be accelerated by an inadequate protein intake. However, the optimal amount and source of protein and the role of dietary protein intake over the life course remain uncertain. Objectives In a sample of community-dwelling adults in Western Norway, the current study examined both cross-sectional and longitudinal associations over 20 y of dietary protein intake with appendicular skeletal muscle mass (ASMM) and muscle strength measured by handgrip strength (HGS) in older age. Methods Dietary intake was assessed using food frequency questionnaires (FFQs) in middle age (46–49 y) and older age (67–70 y) within the community-based Hordaland Health Study. Results Adjusted, multivariate linear regression analyses revealed a negative cross-sectional association between the substitution of total protein (TP) and animal protein (AP), with fat and carbohydrates, on ASMM in women but not in men. No longitudinal associations were found between substitution of dietary protein intake and ASMM in either sex in adjusted models. Similarly, no cross-sectional or longitudinal associations were evident between substitution of dietary protein intake and HGS in either sex in adjusted models. Conclusion The findings in the current study highlight the need to clarify the role of dietary protein intake in the maintenance of muscle mass and muscle strength in healthy older adults.

• Uchai, Shreeshti; Andersen, Lene Frost; Johansson, Jonas; Hopstock, Laila Arnesdatter & Hjartåker, Anette (2023). Dual-Energy X-Ray Absorptiometry Derived Adiposity Measures and Pre-Frailty/Frailty among Norwegian Adults: The Tromsø Study 2007–2015. The Journal of Nutrition, Health & Aging. ISSN 1279-7707. 27, p. 403–410. doi: 10.1007/s12603-023-1920-2. Full text in Research Archive Show summary

  Objectives Aging is associated with changes in body composition. Excess adiposity among older adults has been linked with metabolic syndromes and aggravated age-associated decline in physical functioning. Few longitudinal studies have explored the association between dual-energy X-ray absorptiometry (DXA)-derived total as well as central adiposity measures and frailty. We examined the association of DXA-derived total and central adiposity with pre-frailty/frailty among Norwegian adults after 8 years of follow-up. Design Prospective observational study. Setting Community-dwelling adults from Tromsø, Norway. Measurements Adiposity was defined by fat mass index (FMI) and visceral adipose tissue (VAT) mass assessed using DXA measures. Frailty status was assessed by low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity level. Pre-frail and frail participants at baseline were excluded. Sex-stratified multivariable logistic regression models were used to investigate the association. Results Participants comprised 234 women (mean age 68 years) and 146 men (mean age 69 years) attending the population-based Tromsø Study in 2007–2008 (Tromsø6) and 2015–2016 (Tromsø7). At the end of follow-up, 25.6% of the women and 27.4% of the men were pre-frail/frail. Compared with women in the lowest tertiles, those in the highest tertile of baseline FMI (odds ratio [OR] 4.42, 95% confidence interval [CI] 1.88–10.35) and VAT mass (OR 2.47, 95% CI 1.10–5.50), respectively had higher odds for pre-frailty/frailty at follow-up. Conclusion We found a higher likelihood of pre-frailty/frailty in later years among women with general and central adiposity in adulthood, highlighting the importance of preventing excess adiposity for healthy aging.

• Konglevoll, Dina Moxness; Andersen, Lene Frost; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Totland, Torunn Holm [Show all 8 contributors for this article] (2023). Fish intake and pre-frailty in Norwegian older adults - a prospective cohort study: the Tromsø Study 1994–2016. BMC Geriatrics. 23(1). doi: 10.1186/s12877-023-04081-z. Full text in Research Archive Show summary

  Background Pre-frailty is an intermediate, potentially reversible state before the onset of frailty. Healthy dietary choices may prevent pre-frailty. Fish is included in most healthy diets, but little is known about the association between long-term habitual fish intake and pre-frailty. We aimed to elucidate the longitudinal association between the frequency of fish intake and pre-frailty in a cohort of older adults in Norway.<p> <p>Methods 4350 participants (52% women,≥65 years at follow-up) were included in this prospective cohort study. Data was obtained from three waves of the population-based Tromsø Study in Norway; Tromsø4 (1994–1995), Tromsø6 (2007–2008) and Tromsø7 (follow-up, 2015–2016). Frailty status at follow-up was defined by a modifed version of Fried’s phenotype. Fish intake was self-reported in the three surveys and assessed as three levels of frequency of intake: low (0–3 times/month), medium (1–3 times/week) and high (≥4 times/week). The fsh–pre-frailty association was analysed using multivariable logistic regression in two ways; (1) frequency of intake of lean, fatty and total fish in Tromsø6 and pre-frailty at follow-up, and (2) patterns of total fsh intake across the three surveys and pre-frailty at follow-up. <p>Results At follow-up, 28% (n=1124) were pre-frail. Participants with a higher frequency of lean, fatty and total fish intake had 28% (odds ratio (OR)=0.72, 95% confidence interval (CI)=0.53, 0.97), 37% (OR=0.63, 95% CI=0.43, 0.91) and 31% (OR=0.69, 95% CI=0.52, 0.91) lower odds of pre-frailty 8 years later compared with those with a low intake, respectively. A pattern of stable high fish intake over 21 years was associated with 41% (OR=0.59, 95% CI=0.38, 0.91) lower odds of pre-frailty compared with a stable low intake. <p>Conclusions A higher frequency of intake of lean, fatty and total fish, and a pattern of consistent frequent fish intake over time, were associated with lower odds of pre-frailty in older community-dwelling Norwegian adults. These results emphasise the important role of fish in a healthy diet and that a frequent fish intake should be promoted to facilitate healthy ageing.

• Kværner, Ane Sørlie; Andersen, Astrid Riseth; Henriksen, Hege Berg; Knudsen, Markus Dines; Johansen, Anne Marte Wetting & Hjartåker, Anette [Show all 13 contributors for this article] (2023). Associations of the 2018 World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) cancer prevention recommendations with stages of colorectal carcinogenesis. Cancer Medicine. 12(13), p. 14806–14819. doi: 10.1002/cam4.6119. Full text in Research Archive Show summary

  Background: While adherence to cancer prevention recommendations is linked to lower risk of colorectal cancer (CRC), few have studied associations across the entire spectrum of colorectal carcinogenesis. Here, we studied the relationship of the standardized 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score for cancer prevention recommendations with detection of colorectal lesions in a screening setting. As a secondary objective, we examined to what extent the recommendations were being followed in an external cohort of CRC patients. Methods: Adherence to the seven-point 2018 WCRF/AICR Score was measured in screening participants receiving a positive fecal immunochemical test and in CRC patients participating in an intervention study. Dietary intake, body fatness and physical activity were assessed using self-administered questionnaires. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for screen-detected lesions. Results: Of 1486 screening participants, 548 were free from adenomas, 524 had non-advanced adenomas, 349 had advanced lesions and 65 had CRC. Adherence to the 2018 WCRF/AICR Score was inversely associated with advanced lesions; OR 0.82 (95% CI 0.71, 0.94) per score point, but not with CRC. Of the seven individual components included in the score, alcohol, and BMI seemed to be the most influential. Of the 430 CRC patients included in the external cohort, the greatest potential for lifestyle improvement was seen for the recommendations concerning alcohol and red and processed meat, where 10% and 2% fully adhered, respectively. Conclusions: Adherence to the 2018 WCRF/AICR Score was associated with lower probability of screen-detected advanced precancerous lesions, but not CRC. Although some components of the score seemed to be more influential than others (i.e., alcohol and BMI), taking a holistic approach to cancer prevention is likely the best way to prevent the occurrence of precancerous colorectal lesions.

• Knudsen, Markus Dines; Kværner, Ane Sørlie; Botteri, Edoardo; Holme, Øyvind; Hjartåker, Anette & Song, Mingyang [Show all 10 contributors for this article] (2022). Lifestyle predictors for inconsistent participation to fecal based colorectal cancer screening. BMC Cancer. 22(172). doi: 10.1186/s12885-022-09287-9. Full text in Research Archive Show summary

  Background: Consistent participation in colorectal cancer (CRC) screening with repeated fecal immunochemical test (FIT) is important for the success of the screening program. We investigated whether lifestyle risk factors for CRC were related to inconsistent participation in up to four rounds of FIT-screening. Method: We included data from 3,051 individuals who participated in up to four FIT-screening rounds and returned a lifestyle questionnaire. Using logistic regression analyses, we estimated associations between smoking habits, body mass index (BMI), physical activity, alcohol consumption, diet and a healthy lifestyle score (from least favorable 0 to most favorable 5), and inconsistent participation (i.e. not participating in all rounds of eligible FIT screening invitations). Results: Altogether 721 (24%) individuals were categorized as inconsistent participants Current smoking and BMI ≥30 kg/m2 were associated with inconsistent participation; odds ratios (ORs) and 95% confidence intervals (CIs) were 1.54 (1.21-2.95) and 1.54 (1.20-1.97), respectively. A significant trend towards inconsistent participation by a lower healthy lifestyle score was observed (p

• Brunvoll, Sonja Hjellegjerde; Flote, Vidar Gordon; Halset, Eline Holli; Bertheussen, Gro Falkener; Skjerven, Helle & Lømo, Jon [Show all 8 contributors for this article] (2022). Normal and unusual days for dietary intake during the 12 months after a breast cancer diagnosis in women. European Journal of Nutrition. ISSN 1436-6207. 61, p. 3873–3885. doi: 10.1007/s00394-022-02925-9. Full text in Research Archive Show summary

  Purpose There are several reasons to report days as being unusual with regard to dietary intake, including special occasions and celebrations. For breast cancer patients during the 12 month post-surgery period, unusual days may also include days that are affected by being a cancer patient. The aim of this study was to study dietary intake on “normal” and “unusual” days, and to study what is reported in “free text fields” of a food diary. Methods Women (n = 456), mean age 55.5 years newly diagnosed with invasive breast cancer (stage I/II) were included in this clinical study. “Normal” and “unusual” days in general, over time and during the week and weekends were studied using repeated administration of a 7-day pre-coded food diary. Results The breast cancer patients reported 26% of all days as unusual. The intake of energy, most nutrients, especially alcohol and sugar, red and processed meat, and sweets, cakes, and snacks was 5–126% higher, whereas intake of fiber, fruit and berries, vegetables, and dairy products was 7–17% lower on unusual than on normal days (P < 0.001). The same pattern was seen for normal/unusual days during the weekdays, weekends and over time. Finally, 99% of the breast cancer patients used the free text fields to report additional intake with a mean energy of 1.1 MJ/day. Conclusion For breast cancer patients during the 12-month post-surgery period, unusual days are important drivers of total intake, especially for alcohol. The free text fields in the pre-coded food diary contributed substantially to the total intake.

• Sabir, Zoya; Rosendahl-Riise, Hanne; Dierkes, Jutta; Dahl, Helene & Hjartåker, Anette (2022). Comparison of dietary intake measured by a web-based FFQ and repeated 24-hour dietary recalls: the Hordaland Health Study. Journal of Nutritional Science (JNS). 11, p. 1–10. doi: 10.1017/jns.2022.97. Full text in Research Archive Show summary

  All dietary assessment methods inevitably introduce measurement errors, which should ideally be considered during data analysis and interpretation. Methodological studies should be conducted to address how well a given assessment method captures dietary intake and to highlight the extent and direction of the measurement error. Within a subgroup of the Hordaland Health Study (HUSK3), we examined the relative validity of a web-based food frequency questionnaire (WebFFQ) by comparing its estimates of mean daily intake of nutrients and foods with estimated mean daily intakes from repeated administrations of 24-hour dietary recall interviews (24-HDRs). Men and women born between 1950 and 1951 were recruited from HUSK3. The participants (n = 67) completed a WebFFQ and three non-consecutive 24-HDRs over the course of a year. Relative validity was assessed using Spearman's rank correlation, crosstab analysis and Bland–Altman plots. Linear regression models were used to compute the calibration coefficients. The estimated correlation coefficients were acceptable or strong for all nutrients and foods except iodine (rs = 0⋅19). The highest correlation coefficient was found for juice (rs = 0⋅71), whereas the lowest correlation coefficient was found for iodine (rs = 0⋅19). Cross-classification by quartiles categorised more than 72 % of the participants into the same or adjacent quartiles using the two methods. Few data points fell outside the limits of agreement in the Bland–Altman plots. Calibration coefficients ranged from 0⋅10 (wholegrain) to 0⋅81 (alcohol). Our findings suggest that the WebFFQ has reasonable ranking abilities for all the included nutrients and foods, except for iodine.

• Henriksen, Hege; Knudsen, Markus Dines; Carlsen, Monica Hauger; Hjartåker, Anette & Blomhoff, Rune (2022). A Short Digital Food Frequency Questionnaire (DIGIKOST-FFQ) Assessing Dietary Intake and Other Lifestyle Factors Among Norwegians: Qualitative Evaluation With Focus Group Interviews and Usability Testing. JMIR Formative Research. 6(11). doi: 10.2196/35933. Full text in Research Archive Show summary

  Background In-person dietary counseling and interventions have shown promising results in changing habits toward healthier lifestyles, but they are costly to implement in large populations. Developing digital tools to assess individual dietary intake and lifestyle with integrated personalized feedback systems may help overcome this challenge. We developed a short digital food frequency questionnaire, known as the DIGIKOST-FFQ, to assess diet and other lifestyle factors based on the Norwegian Food-Based Dietary Guidelines. The DIGIKOST-FFQ includes a personalized feedback system, the DIGIKOST report, that benchmarks diet and lifestyle habits. We used qualitative focus group interviews and usability tests to test the feasibility and usability of the DIGIKOST application. Objective We aimed to explore attitudes, perceptions, and challenges in completing the DIGIKOST-FFQ. We also investigated perceptions and understanding of the personalized feedback in the DIGIKOST report and the technical flow and usability of the DIGIKOST-FFQ and the DIGIKOST report. Methods Healthy individuals and cancer survivors were invited to participate in the focus group interviews. The transcripts were analyzed using thematic analysis. Another group of healthy individuals completed the usability testing, which was administered individually by a moderator and 2 observers. The results were analyzed based on predefined assignments and discussion with the participants about the interpretation of the DIGIKOST report and technical flow of the DIGIKOST-FFQ. Results A total of 20 individuals participated in the focus group interviews, divided into 3 groups of healthy individuals and 3 groups of cancer survivors. Each group consisted of 3 to 4 individuals. Five main themes were investigated: (1) completion time (on average 19.1, SD 8.3, minutes, an acceptable duration), (2) layout (participants reported the DIGIKOST-FFQ was easy to navigate and had clear questions but presented challenges in reporting dietary intake, sedentary time, and physical activity in the last year), (3) questions (the introductory questions on habitual intake worked well), (4) pictures (the pictures were very helpful, but some portion sizes were difficult to differentiate and adding weight in grams would have been helpful), and (5) motivation (users were motivated to obtain personalized feedback). Four individuals participated in the usability testing. The results showed that the users could seamlessly log in, give consent, fill in the DIGIKOST-FFQ, and receive, print, and read the DIGIKOST report. However, parts of the report were perceived as difficult to interpret. Conclusions The DIGIKOST-FFQ was overall well received by participants, who found it feasible to use; however, some adjustments with regard to reporting dietary intake and lifestyle habits were suggested. The DIGIKOST report with personalized feedback was the main motivation to complete the questionnaire. The results from the usability testing revealed a need for adjustments and updates to make the report easier to read.

• Kværner, Ane Sørlie; Birkeland, Einar Elvbakken; Vinberg, Elina; Hoff, Geir; Hjartåker, Anette & Rounge, Trine Ballestad [Show all 7 contributors for this article] (2022). Associations of red and processed meat intake with screen-detected colorectal lesions. British Journal of Nutrition. ISSN 0007-1145. p. 1–36. doi: 10.1017/S0007114522002860. Full text in Research Archive Show summary

  Limited data exist regarding the role of meat consumption in early-stage colorectal carcinogenesis. We examined associations of red and processed meat intake with screen-detected colorectal lesions in immunochemical fecal occult blood test (FIT)-positive participants, enrolled in the Norwegian CRCbiome study during 2017-2021, aged 55-77 years. Absolute and energy-adjusted intakes of red and processed meat (combined and individually) were assessed using a validated, semiquantitative food frequency questionnaire. Associations between meat intake and screen-detected colorectal lesions were examined using multinomial logistic regression analyses with adjustment for key covariates. Of 1,162 participants with available dietary data, 319 (27%) presented with advanced colorectal lesions at colonoscopy. High vs low energy-adjusted intakes of red and processed meat combined, as well as red meat alone, were borderline to significantly positively associated with advanced colorectal lesions (ORs (95% CIs) of 1.24 (0.98, 1.57) and 1.34 (1.07, 1.69), respectively). A significant dose-response-relationship was also observed for absolute intake levels (OR (95% CI) of 1.32 (1.09, 1.60) per 100 g/day increase in red and processed meat). For processed meat, no association was observed between energy-adjusted intakes and advanced colorectal lesions. A significant positive association was, however, observed for the small proportion of participants (10%) with absolute intake levels ≥100 vs <50 g/day (OR (95% CI) of 1.19 (1.09, 1.31)). In summary, high intakes of red and processed meat were associated with presence of advanced colorectal lesions at colonoscopy in FIT-positive participants. The study demonstrates a potential role of using dietary data to improve the performance of FIT-based screening.

• Konglevoll, Dina Moxness; Hjartåker, Anette; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Andersen, Lene Frost [Show all 7 contributors for this article] (2022). Protein Intake and the Risk of Pre-Frailty and Frailty in Norwegian Older Adults. The Tromsø Study 1994–2016. Journal of Frailty & Aging (JFA). ISSN 2260-1341. 11(3), p. 256–266. doi: 10.14283/jfa.2022.16. Full text in Research Archive Show summary

  Background Protein intake is suggested as an important dietary factor in the prevention of frailty, however, the influence of lifelong intake remains unclear. Objectives The present study investigated the relationship between daily protein intake and patterns of protein intake over 21 years and the risk of pre-frailty/frailty. Design Prospective cohort study. Setting The population-based Tromsø Study in Tromsø municipality, Norway. Participants In total, 1,906 women and 1,820 men aged ≥45 years in 1994 who participated in both Tromsø4 (1994–95) and Tromsø7 (2015–16). Measurements Frailty status in Tromsø7 was measured according to Fried’s phenotype, classifying participants as “robust” (frailty components present: 0), “pre-frail” (1–2) or “frail” (≥3). Daily intake of protein was estimated from self-reported habitual dietary intake using food frequency questionnaires and assessed as grams per kilogram bodyweight (g/kg BW) and per megajoule energy intake (g/MJ). The protein–frailty association was assessed via longitudinal and cross-sectional multivariable logistic regression analyses. Results The prevalence of pre-frailty and frailty in this study was 27% and 1.0%, respectively. Longitudinal analysis showed that the odds of pre-frailty/frailty decreased by 57% (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.31;0.58, p<0.001) with the increase in intake of one additional gram of dietary protein per kg BW. The results obtained from cross-sectional analysis were similar. Tracking analysis showed that, compared to a stable high intake of protein in g/kg BW over time, other patterns of protein intake increased the risk of pre-frailty/frailty. No associations were found between intake of protein in g/MJ and pre-frailty/frailty. Conclusions Intake of protein in g/kg BW both in mid-life and later in life was inversely associated with pre-frailty/frailty in older adults. This emphasizes the importance of an adequate protein intake to facilitate healthy ageing in Norwegian older adults.

• Brunvoll, Sonja Hjellegjerde; Nygaard, Anders Benteson; Ellingjord-Dale, Merete; Holland, Petter; Istre, Mette Stausland & Kalleberg, Karl Trygve [Show all 15 contributors for this article] (2022). Prevention of covid-19 and other acute respiratory infections with cod liver oil supplementation, a low dose vitamin D supplement: quadruple blinded, randomised placebo controlled trial. The BMJ. 378. doi: 10.1136/bmj-2022-071245. Full text in Research Archive Show summary

  Objective To determine if daily supplementation with cod liver oil, a low dose vitamin D supplement, in winter, prevents SARS-CoV-2 infection, serious covid-19, or other acute respiratory infections in adults in Norway. Design Quadruple blinded, randomised placebo controlled trial. Setting Norway, 10 November 2020 to 2 June 2021. Participants 34601 adults (aged 18-75 years), not taking daily vitamin D supplements. Intervention 5 mL/day of cod liver oil (10 µg of vitamin D, n=17278) or placebo (n=17323) for up to six months. Main outcome measures Four co-primary endpoints were predefined: the first was a positive SARS-CoV-2 test result determined by reverse transcriptase-quantitative polymerase chain reaction and the second was serious covid-19, defined as self-reported dyspnoea, admission to hospital, or death. Other acute respiratory infections were indicated by the third and fourth co-primary endpoints: a negative SARS-CoV-2 test result and self-reported symptoms. Side effects related to the supplementation were self-reported. The fallback method was used to handle multiple comparisons. Results Supplementation with cod liver oil was not associated with a reduced risk of any of the co-primary endpoints. Participants took the supplement (cod liver oil or placebo) for a median of 164 days, and 227 (1.31%) participants in the cod liver oil group and 228 (1.32%) participants in the placebo group had a positive SARS-CoV-2 test result (relative risk 1.00, multiple comparison adjusted confidence interval 0.82 to 1.22). Serious covid-19 was identified in 121 (0.70%) participants in the cod liver oil group and in 101 (0.58%) participants in the placebo group (1.20, 0.87 to 1.65). 8546 (49.46%) and 8565 (49.44%) participants in the cod liver oil and placebo groups, respectively, had ≥1 negative SARS-CoV-2 test results (1.00, 0.97 to 1.04). 3964 (22.94%) and 3834 (22.13%) participants in the cod liver oil and placebo groups, respectively, reported ≥1 acute respiratory infections (1.04, 0.97 to 1.11). Only low grade side effects were reported in the cod liver oil and placebo groups. Co nclusion Supplementation with cod liver oil in the winter did not reduce the incidence of SARS-CoV-2 infection, serious covid-19, or other acute respiratory infections compared with placebo. Trial registration ClinicalTrials.gov NCT04609423.

• Carlsen, Monica Hauger; Andersen, Lene F. & Hjartåker, Anette (2021). Reproducibility and feasibility of an online self-administered food frequency questionnaire for use among adult norwegians. Food & Nutrition Research (FNR). ISSN 1654-6628. 65, p. 1–14. doi: 10.29219/FNR.V65.7561. Full text in Research Archive
• Bøhn, Siv Kjølsrud; Thune, Inger; Flote, Vidar Gordon; Frydenberg, Hanne; Bertheussen, Gro Falkener & Husøy, Anders [Show all 12 contributors for this article] (2021). Effects of a One-Year Physical Activity Intervention on Markers of Hemostasis among Breast Cancer Survivors - A Randomized Controlled Trial. TH Open. 5(1), p. e14–e23. doi: 10.1055/s-0040-1721782. Full text in Research Archive Show summary

  Introduction: Physical activity may reduce the development of breast cancer. Whereas hypercoagulability has been linked to adverse outcomes in breast cancer patients, the effects of physical activity on their hemostatic factors are unknown. The study aimed to assess whether long-term (1 year) physical activity can affect hemostatic factors in breast cancer patients. Methods: Fifty-five women (35–75 years) with invasive breast cancer stage I/II were randomized to a physical activity intervention (n = 29) lasting 1 year or to a control group (n = 26), and analyzed as intention to treat. Fibrinogen, factor VII antigen, tissue factor pathway inhibitor, and von Willebrand factor (VWF) antigen as well as prothrombin fragment 1 + 2, the endogenous thrombin potential and D-dimer, were measured in plasma before intervention (baseline), and then after 6 and 12 months. Results: Maximal oxygen uptake (measure of cardiorespiratory fitness) decreased the first 6 months among the controls, but remained stable in the intervention group. We found no significant differences between the two study groups regarding any of the hemostatic factors, except a significantly higher increase in factor VII antigen in the intervention group. The effect of the intervention on VWF was, however, significantly affected by menopausal stage, and a significant effect of the intervention was found on VWF among postmenopausal women, even after adjustment for dietary intake. Conclusion: Long-term physical activity had no effect on the majority of the hemostatic factors measured, but led to increased plasma concentrations of factor VII antigen and prevented an increase in VWF concentration after breast cancer treatment in postmenopausal women. The clinical impact of these findings for risk of vascular thrombosis warrants further studies.

• Carlsen, Monica Hauger; Andersen, Lene Frost & Hjartåker, Anette (2021). Reproducibility and feasibility of an online self-administered food frequency questionnaire for use among adult Norwegians. Food & Nutrition Research (FNR). ISSN 1654-6628. doi: 10.29219/fnr.v65.7561. Full text in Research Archive Show summary

  Background: New methods of dietary assessment are increasingly making use of online technologies. The development of a new online food frequency questionnaire warranted investigation of its feasibility and the reproducibility of its results. Objective: To investigate the feasibility and reproducibility of a newly developed online FFQ (WebFFQ). Design: The semiquantitative WebFFQ was designed to assess the habitual diet the previous year, with questions about frequency of intake and portion sizes. Estimations of portion sizes include both pictures and household measures, depending on the type of food in question. In two independent cross-sectional studies conducted in 2015 and 2016, adults were recruited by post following random selection from the general population. In the first study, participants (n = 229) filled in the WebFFQ and answered questions about its feasibility, and in two subsequent focus group meetings, participants (n = 9) discussed and gave feedback about the feasibility of the WebFFQ. In the second study, the WebFFQ’s reproducibility was assessed by asking participants (n = 164) to fill it in on two separate occasions, 12 weeks apart. Moreover, in the second study, participants were offered personal dietary feedback, a monetary gift certificate, or both, as incentives to complete the study. Results: In the feasibility study, evaluation form results showed that participants raised issues regarding the estimation of portion size and the intake of seasonal foods as being particularly challenging; furthermore, in the focus group discussions, personal feedback on diet was perceived to be a more motivating factor than monetary reward. In the reproducibility study, total food intake was lower in the second WebFFQ; however, 63% of the food groups were not significantly different from those in the first WebFFQ. Correlations of food intake ranged from 0.62 to 0.90, >86% of the participants were classified into the same or adjacent quartiles, and misclassification ranged from 0 to 3%. Average energy intake was 3.5% lower (p = 0.001), fiber showed the least difference at 1.6% (p = 0.007), and sugar intake differed the most at −6.8% (borderline significant, p = 0.08). Percentage energy obtained from macronutrients did not differ significantly between the first and second WebFFQs. Conclusion: Our results suggest that at group level, the WebFFQ showed good reproducibility for the estimations of intake of food groups, energy, and nutrients. The feasibility of the WebFFQ is good; however, revisions to further improve portion size estimations should be included in future versions. The WebFFQ is considered suitable for dietary assessments for healthy adults in the Norwegian population.

• Kværner, Ane Sørlie; Birkeland, Einar Elvbakken; Bucher-Johannessen, Cecilie; Vinberg, Elina; Nordby, Jan Inge & Kangas, Harri [Show all 27 contributors for this article] (2021). The CRCbiome study: a large prospective cohort study examining the role of lifestyle and the gut microbiome in colorectal cancer screening participants. BMC Cancer. 21. doi: 10.1186/s12885-021-08640-8. Full text in Research Archive Show summary

  Background: Colorectal cancer (CRC) screening reduces CRC incidence and mortality. However, current screening methods are either hampered by invasiveness or suboptimal performance, limiting their effectiveness as primary screening methods. To aid in the development of a non-invasive screening test with improved sensitivity and specificity, we have initiated a prospective biomarker study (CRCbiome), nested within a large randomized CRC screening trial in Norway. We aim to develop a microbiome-based classification algorithm to identify advanced colorectal lesions in screening participants testing positive for an immunochemical fecal occult blood test (FIT). We will also examine interactions with host factors, diet, lifestyle and prescription drugs. The prospective nature of the study also enables the analysis of changes in the gut microbiome following the removal of precancerous lesions. Methods: The CRCbiome study recruits participants enrolled in the Bowel Cancer Screening in Norway (BCSN) study, a randomized trial initiated in 2012 comparing once-only sigmoidoscopy to repeated biennial FIT, where women and men aged 50–74 years at study entry are invited to participate. Since 2017, participants randomized to FIT screening with a positive test result have been invited to join the CRCbiome study. Self-reported diet, lifestyle and demographic data are collected prior to colonoscopy after the positive FIT-test (baseline). Screening data, including colonoscopy findings are obtained from the BCSN database. Fecal samples for gut microbiome analyses are collected both before and 2 and 12 months after colonoscopy. Samples are analyzed using metagenome sequencing, with taxonomy profiles, and gene and pathway content as primary measures. CRCbiome data will also be linked to national registries to obtain information on prescription histories and cancer relevant outcomes occurring during the 10 year follow-up period. Discussion: The CRCbiome study will increase our understanding of how the gut microbiome, in combination with lifestyle and environmental factors, influences the early stages of colorectal carcinogenesis. This knowledge will be crucial to develop microbiome-based screening tools for CRC. By evaluating biomarker performance in a screening setting, using samples from the target population, the generalizability of the findings to future screening cohorts is likely to be high.

• Brunvoll, Sonja Hjellegjerde; Thune, Inger; Bertheussen, Gro Falkener; Fjeldheim, Frøydis Nyborg; Flote, Vidar Gordon & Frydenberg, Hanne [Show all 13 contributors for this article] (2020). Dietary changes in early-stage breast cancer patients from pre-surgery and over the 12 months post-surgery. British Journal of Nutrition. ISSN 0007-1145. 125(2), p. 172–182. doi: 10.1017/S0007114520002627. Full text in Research Archive Show summary

  The time after a breast cancer diagnosis is a potential period for making positive dietary changes, but previous results are conflicting. The main aim of the present study was to study breast cancer patients’ dietary changes during the 12 months post-surgery and from 12 months pre-surgery to 12 months post-surgery with repeated administration of a 7-d pre-coded food diary and an FFQ, respectively. Women (n 506), mean age 55·3 years diagnosed with invasive breast cancer (stages I and II), were included. The dietary intake was quite stable over time, but the intake was lower for energy (0·3 and 0·4 MJ/d), alcohol (1·9 and 1·5 g/d) and vegetables (17 and 22 g/d) at 6 months than 3 weeks post-surgery (food diary) and at 12 months post-surgery than pre-surgery (FFQ), respectively. Furthermore, energy percentage (E%) from carbohydrates increased between 0·8 and 1·2 E% and E% from fat decreased between 0·6 and 0·8 E% over time, measured by both dietary assessment methods. We observed a higher intake of dairy products (11 g/d) at 6 months post-surgery (food diary), and a lower intake of dairy products (34 g/d) and red and processed meat (7·2 g/d) at 12 months post-surgery (FFQ). Moreover, 24 % of the patients claimed they made dietary changes, but mostly they did not change their diet differently compared with those patients who claimed no changes. In conclusion, breast cancer patients reported only minor dietary changes from 12 months pre-surgery and during the 12 months post-surgery.

• Knudsen, Markus Dines; Botteri, Edoardo; Holme, Øyvind; Hjartåker, Anette; Song, Mingyang & Thiis-Evensen, Espen [Show all 11 contributors for this article] (2020). Association between lifestyle and site-specific advanced colorectal lesions in screening with faecal immunochemical test and sigmoidoscopy. Digestive and Liver Disease. ISSN 1590-8658. p. 1–7. doi: 10.1016/j.dld.2020.11.021. Full text in Research Archive Show summary

  Background: Lifestyle factors may help to identify individuals at high-risk for colorectal cancer (CRC). Aims: To examine the association between lifestyle, referral for follow-up colonoscopy and proximal neoplasia detection in CRC screening. Methods: In this observational study, 14,832 individuals aged 50-74 years were invited to faecal immunochemical test (FIT) or sigmoidoscopy screening. Advanced lesions (AL), including advanced adenomas, advanced serrated lesions and CRC were divided according to location: distal-only, or proximal with or without distal AL. We collected information on smoking habit, body mass index and alcohol intake through a questionnaire. Results: Out of 3,318 FIT and 2,988 sigmoidoscopy participants, 516 (16%) and 338 (11%), respectively, were referred for follow-up colonoscopy after a positive screening test. Two-hundred-and-fifty-six (4%) had distal-only and 119 (2%) proximal AL. In FIT participants, obesity and high alcohol intake were associated with proximal AL; odds ratio (95% confidence interval) 2.68 (1.36-5.26) and 2.16 (1.08-4.30), respectively. In sigmoidoscopy participants, current smoking was associated with proximal AL; 4.58 (2.24-9.38), and current smoking and obesity were associated with referral for colonoscopy; 2.80 (2.02-3.89) and 1.42 (1.01-2.00), respectively. Conclusion: Current smoking, obesity and high alcohol intake were associated with screen-detected proximal colorectal AL. Current smoking and obesity were associated with referral for follow-up colonoscopy in sigmoidoscopy screening.

• Hanvold, Susanna; Vinknes, Kathrine; Løken, Elin Bjørge; Hjartåker, Anette; Klungsøyr, Ole & Birkeland, Eline [Show all 10 contributors for this article] (2019). Does Lifestyle Intervention After Gastric Bypass Surgery Prevent Weight Regain? A Randomized Clinical Trial. Obesity Surgery. ISSN 0960-8923. 29(11), p. 3419–3431. doi: 10.1007/s11695-019-04109-7. Full text in Research Archive
• Johansen, Anne Marte Wetting; Myhre, Jannicke Borch; Hjartåker, Anette & Andersen, Lene Frost (2019). Validation of energy intake recorded by a 7-day pre-coded food diary against measured energy expenditure in a group of Norwegian adults. PLOS ONE. 14(4), p. 1–12. doi: 10.1371/journal.pone.0215638. Full text in Research Archive Show summary

  The aim of this study was to validate energy intake (EI) reported by a pre-coded food diary (PFD) against energy expenditure (EE) measured by the ActiReg system consisting of an activity and position monitor and a calculation program (ActiCalc). Dietary intake was recorded by the PFD and EE was measured by the ActiReg system over a 7-day period. One hundred and twenty adult participants completed the study, 42 men and 78 women. The average group EI was 17% lower compared to measured EE. The 95% limits of agreement were 6.7 and -2.9 MJ/day. Of all participants, 68% were classified as acceptable reporters, 29% as underreporters and only 3% as overreporters. Fifty percent of the men and 30% of the women were classified into the same quartile for EI and EE, whereas 5% of both men and women were ranked in the opposite quartile by the two methods (weighted kappa coefficient = 0.29). Pearson correlation coefficient between reported EI and measured EE was 0.49 (p<0.001). High BMI was related to larger underreporting when EE was low. Furthermore, this study found that PFD underestimates EI on the group level with an average of 17% and showed large variation in the validity of the PFD on the individual level.

• Lundblad, Marie Wasmuth; Andersen, Lene Frost; Jacobsen, Bjarne Koster; Carlsen, Monica Hauger; Hjartåker, Anette & Grimsgaard, Sameline [Show all 7 contributors for this article] (2019). Energy and nutrient intakes in relation to National Nutrition Recommendations in a Norwegian population-based sample: the Tromsø Study 2015–16. Food & Nutrition Research (FNR). ISSN 1654-6628. 63:3616, p. 1–10. doi: 10.29219/fnr.v63.3616. Full text in Research Archive Show summary

  <i>Introduction</i>: According to the Global Burden of Disease project, unhealthy diet accounts for most of the disease burden in Norway. Current recommendations on nutrient intake in Norway reflect those published in the evidence-based Nordic Nutrition Recommendations from 2012 (NNR2012).<p> <p><i>Aim</i>: To study energy and nutrient intakes and compliance with the NNR2012 among women and men in a population-based study.<p> <p><i>Methods</i>: A total of 15,146 participants (aged 40–99 years) completed a validated food frequency questionnaire (261 questions on food items, meals, and beverages) in the seventh survey of the Tromsø Study in 2015–16; 11,425 participants were eligible for the current analysis. Nutrient intake was estimated by a food and nutrient calculation system at the University of Oslo, Norway. We compared energy, macronutrient, and micronutrient intakes with the NNR2012.<p> <p><i>Results</i>: In total, 85% of the women and men were not in compliance with the maximum recommended intake of saturated fat, and 40 and 77% of women and men, respectively, were not in compliance with the lowest recommended intake of fiber. More than 30% of women and 25% of men had a relatively high probability of inadequate intake of vitamin D, and more than 10% of the men had a relatively high probability of inadequate intake of vitamin B6 and vitamin C. More than 20% of women and men had a high probability of excessive intake of niacin, and almost 40% of women had a high probability of excessive intake of vitamin A.<p> <p><i>Conclusion</i>: Although most participants were in compliance with NNR2012, a large proportion of participants had higher intakes than maximum recommended for saturated fat, and lower than recommended for fiber and vitamin D.

• Brunvoll, Sonja Hjellegjerde; Thune, Inger; Frydenberg, Hanne; Flote, Vidar Gordon; Bertheussen, Gro Falkener & Schlichting, Ellen [Show all 8 contributors for this article] (2018). Validation of repeated self-reported n-3 PUFA intake using serum phospholipid fatty acids as a biomarker in breast cancer patients during treatment 11 Medical and Health Sciences 1112 Oncology and Carcinogenesis. Nutrition Journal. 17:94, p. 1–12. doi: 10.1186/s12937-018-0402-6. Full text in Research Archive Show summary

  <p><i>Background</i>: The role of n-3 polyunsaturated fatty acids (PUFAs) in breast cancer is not clear and under debate. To explore this relationship it is important to have proper validated dietary assessment methods for measuring the intake of n-3 PUFAs. The aim of the current study is to validate two different methods used to assess the intake of selected n-3 PUFAs as well as food sources of long-chained n-3 PUFAs. Also, we aim to study how stable the intake of fatty acids is during breast cancer treatment.</p> <p><i>Methods</i>: The study-population was patients with breast cancer (Stages I-II) or ductal carcinoma in situ (DCIS-grade III) undergoing treatment (n = 49) in Norway. Dietary intake was assessed by two self-administered methods, a 256 food item food frequency questionnaire (FFQ) and a 7-day pre-coded food diary (PFD). The FFQ was administered presurgery and twelve months postsurgery, and the PFD was administered shortly after surgery (10 +/− 2 days), six and twelve months postsurgery. Fasting blood samples (presurgery, six and twelve months postsurgery) were analysed for serum phospholipid fatty acids, a biomarker for intake of n-3 PUFAs.</p> <p><i>Results</i>: Mean (SD) age was 54.2 (7.8) years at diagnosis, and the mean (SD) body mass index (BMI) was 24.8 (3.4) kg/m2. Correlation coefficients between dietary intakes of n-3 PUFAs measured with the FFQ and the PFD ranged from 0.35 to 0.66. The correlation coefficients between the PFD and the biomarker (serum phospholipid n-3 PUFAs) as well as between the FFQ and the biomarker demonstrated stronger correlations twelve months after surgery (ρ 0.40–0.56 and 0.36–0.53, respectively) compared to around surgery (ρ 0.08–0.20 and 0.28–0.38, respectively). The same pattern was observed for intake of fatty fish. The intake of n-3 PUFAs did not change during treatment assessed by the FFQ, PFD or biomarker.</p> <p><i>Conclusion</i>: These results indicate that the FFQ and the PFD can be used to assess dietary intake of fish and n-3 PUFAs in breast cancer patients during breast cancer treatment. Still, the PFD shortly after surgery should be used with caution. The diet of patients undergoing breast cancer treatment was quite stable, and the intake of n-3 PUFAs did not change.

• Carlsen, Monica Hauger; Andersen, Lene Frost; Dahl, Lisbeth; Norberg, Nina & Hjartåker, Anette (2018). New iodine Food composition database and updated calculations of iodine intakes amongs Norwegians. Nutrients. 10(7). doi: 10.3390/nu10070930. Full text in Research Archive Show summary

  Iodine food composition data of Norwegian foods have been sparse and knowledge about different dietary iodine sources limited. We compiled a comprehensive iodine food composition database and estimated dietary iodine intake among adults in the latest Norwegian national dietary survey (Norkost 3). The iodine content of food and beverages were compiled using international guidelines and standards. Iodine content of 3259 food items were compiled, including analytical values, values from other food composition databases, estimated values, and values that were based on recipes. Estimated iodine intake in the Norkost 3 population ranged from 15 to 1462 µg/day. Men had significantly higher intake of iodine than women (p < 0.001). The proportion of men and women with estimated iodine intake below average requirement was 19% and 33%, respectively. In young women, 46% had estimated iodine intakes below average requirement and a high probability of inadequate iodine intake. Several dietary sources contributed to iodine intake and differences in the consumption pattern may put subgroups at risk of insufficient iodine intake. In the coming years, the determination of iodine in foods and national dietary surveys should be regularly performed to monitor the iodine intake in the Norwegian population.

• Knudsen, Markus Dines; Hjartåker, Anette; Robb, Kathryn A.; Lange, Thomas de; Hoff, Geir & Berstad, Paula Marianna (2018). Improving Cancer Preventive Behaviors: A Randomized Trial of Tailored Lifestyle Feedback in Colorectal Cancer Screening. Cancer Epidemiology, Biomarkers and Prevention. ISSN 1055-9965. 27(12), p. 1442–1449. doi: 10.1158/1055-9965.EPI-18-0268. Full text in Research Archive Show summary

  Background: Cancer screening provides an opportunity to increase awareness of cancer-preventive lifestyle behaviors such as nonsmoking, physical activity, low alcohol consumption, and a healthy diet. We tested the effect of standardized, individually tailored written feedback (TF), and a standard leaflet (SL) on 1-year lifestyle behaviors in a colorectal cancer screening setting. Methods: A total of 3,642 men and women aged 50–74 years invited to sigmoidoscopy screening were randomly assigned to: (i) TF; (ii) SL for cancer-preventive lifestyle behaviors; or (iii) control. Participants were mailed two self-reported lifestyle questionnaires (LSQ) 1 year apart. The TF intervention was based on the prescreening LSQ answers. We analyzed differences [with 95% confidence intervals (CI)] by comparing prescreening to 1-year follow-up of single cancer-preventive factors and the number of cancer-preventive lifestyle behaviors (range 0–4) between the groups by multivariable logistic regression and analysis of covariance (ANCOVA). Results: A total of 1,054 screening participants without neoplastic findings (29% of those invited to screening) were included in this study. Participants in the TF group increased their number of cancer-preventive lifestyle behaviors significantly compared with those in the control group by 0.11 (95% CI, 0.02 to 0.19). Overweight/obese individuals in the TF group had a −0.84 kg (95% CI, −1.47 to −0.22) larger reduction in body weight compared with the control group. Conclusions: TF at sigmoidoscopy screening led to small improvements in cancer-preventive behaviors.

• Bakken, Toril; Braaten, Tonje; Olsen, Anja; Hjartåker, Anette; Lund, Eiliv & Skeie, Guri (2018). Milk and risk of colorectal, colon and rectal cancer in the Norwegian Women and Cancer (NOWAC) Cohort Study. British Journal of Nutrition. ISSN 0007-1145. 119(11), p. 1274–1285. doi: 10.1017/S0007114518000752. Full text in Research Archive Show summary

  According to World Cancer Research Fund International/American Institute for Cancer Research, it is ‘probable’ that dairy products decrease the risk of colorectal cancer (CRC). However, meta-analyses restricted to women have not shown associations between milk intake and risk of CRC. The aim of this study was to examine the association between milk intake and risk of CRC, colon cancer and rectal cancer among women. Data from 81 675 participants in the Norwegian Women and Cancer Cohort Study were included, and multivariable Cox proportional hazard regression models were used to investigate milk intake using two different analytical approaches: one that included repeated measurements and one that included baseline measurements only (872 and 1084 CRC cases, respectively). A weak inverse association between milk intake and risk of colon cancer may be indicated both in repeated measurements analyses and in baseline data analyses. Hazard ratios (HR) for colon cancer of 0·80 (95 % CI 0·62, 1·03, <i>P</i> _trend 0·07) and 0·81 (95 % CI 0·64, 1·01, <i>P</i> _trend 0·03) and HR for rectal cancer of 0·97 (95 % CI 0·67, 1·42, <i>P</i> _trend 0·92) and 0·71 (95 % CI 0·50, 1·01, <i>P</i> _trend 0·03) were found when comparing the high with the no/seldom milk intake group in energy-adjusted multivariable models. Our study indicates that there may be a weak inverse association between milk intake and risk of colon cancer among women. The two analytical approaches yielded different results for rectal cancer and hence CRC. Our study indicates that the use of single or repeated measurements in analyses may influence the results.

• Banjari, Ines & Hjartåker, Anette (2018). Dietary sources of iron and vitamin B12: Is this the missing link in colorectal carcinogenesis? Medical Hypotheses. ISSN 0306-9877. 116, p. 105–110. doi: 10.1016/j.mehy.2018.05.003. Full text in Research Archive
• Ellingjord-Dale, Merete; Vos, Linda; Vik, Kirsti Lund; Hjartåker, Anette; Russnes, Hege Elisabeth Giercksky & Treti, Steinar [Show all 9 contributors for this article] (2018). Number of Risky Lifestyle Behaviors and Breast Cancer Risk. JNCI Cancer Spectrum. 2(3). doi: 10.1093/jncics/pky030. Full text in Research Archive Show summary

  Lifestyle factors are associated with overall breast cancer risk, but less is known about their associations, alone or jointly, with risk of specific breast cancer subtypes. We conducted a case–control subjects study nested within a cohort of women who participated in the Norwegian Breast Cancer Screening Program during 2006–2014 to examine associations between risky lifestyle factors and breast cancer risk. In all, 4402 breast cancer cases subjects with information on risk factors and hormone receptor status were identified. Conditional logistic regression was used to estimate odds ratios (ORs), with 95% confidence intervals (CIs), in relation to five risky lifestyle factors: body mass index (BMI) of 25 kg/m² or greater, three or more glasses of alcoholic beverages per week, ever smoking, fewer than four hours of physical activity per week, and ever use of menopausal hormone therapy. Analyses were adjusted for education, age at menarche, number of pregnancies, and menopausal status. All statistical tests were two-sided. Compared with women with no risky lifestyle behaviors, those with five had 85% (OR = 1.85, 95% CI = 1.42 to 2.42, Ptrend &lt; .0001) increased risk of breast cancer overall. This association was limited to luminal A–like (OR = 2.20, 95% CI = 1.55 to 3.12, Ptrend &lt; .0001) and luminal B–like human epidermal growth factor receptor 2 (HER2)–positive (OR = 1.66, 95% CI = 0.61 to 4.54, Ptrend &lt; .004) subtypes. Number of risky lifestyle factors was not associated with increased risk of luminal B–like HER2-negative, HER2-positive, or triple-negative subtypes (Ptrend &gt; .18 for all). Number of risky lifestyle factors was positively associated with increased risk for luminal A–like and luminal B–like HER2-positive breast cancer.

• Myhre, Jannicke Borch; Johansen, Anne Marte Wetting; Hjartåker, Anette & Andersen, Lene Frost (2018). Relative validation of a pre-coded food diary in a group of Norwegian adults - Comparison of underreporters and acceptable reporters. PLOS ONE. 13(8). doi: 10.1371/journal.pone.0202907. Full text in Research Archive Show summary

  Estimating dietary intake is important for both epidemiological and clinical studies. In large studies, a balance has to be achieved between methods with high accuracy and methods that are easy to use. The aim of the present study was to compare results from a pre-coded scanable food diary (PFD) with results from a weighed record (WR) in a group of Norwegian adults. We also explored differences in day-to-day energy intake and the distribution of energy intake across the day in acceptable reporters (ARs) and underreporters (URs). Participants (n = 114, mean age 35 years, 68% women) recorded dietary intake with the PFD for 7 consecutive days. One week after completing the PFD, participants completed a 7 days WR. No difference in mean energy intake was seen between methods. Few differences were seen for the macronutrients, the most noticeable difference being the percentage of energy (E%) from carbohydrates which was significantly lower with the PFD (47 E%) than with the WR (49 E%). For the micronutrients, intakes of calcium and vitamin A were both significantly higher with the PFD than with the WR. Pearson's correlation coefficient ranged from 0.47 (tocopherol) to 0.76 (E% carbohydrates) for all nutrients. Bread intake was significantly lower with the PFD while the intakes of edible fats, cheese and beverages were higher. Twenty-eight percent of the participants were found to be URs with the PFD. No clear pattern of underreporting at certain recording days or times of the day was seen. In conclusion, the results showed similar energy intakes and few differences in food and nutrient intakes between the PDF and the WR at the group level. Somewhat larger differences between the methods were seen at the individual level. Because of the reduced work load on both participants and researchers, the PFD seems a suitable alternative to the WR.

• Knudsen, Markus Dines; Hjartåker, Anette; Olsen, Marie Kristin Ek; Hoff, Geir; Lange, Thomas de & Bernklev, Tomm [Show all 7 contributors for this article] (2018). Changes in health behavior 1 year after testing negative at a colorectal cancer screening: a randomized-controlled study. European Journal of Cancer Prevention. ISSN 0959-8278. 27(4), p. 316–322. doi: 10.1097/CEJ.0000000000000328. Full text in Research Archive
• Deschasaux, Mélanie; Huybrechts, Inge; Murphy, Neil; Julia, Chantal; Hercberg, Serge & Srour, Bernard [Show all 56 contributors for this article] (2018). Nutritional quality of food as represented by the FSAm-NPS nutrient profiling system underlying the Nutri-Score label and cancer risk in Europe: Results from the EPIC prospective cohort study. Nature Methods. ISSN 1548-7091. 15:e1002651(9), p. 1–21. doi: 10.1371/journal.pmed.1002651. Full text in Research Archive Show summary

  <p><i>Background - </i>Helping consumers make healthier food choices is a key issue for the prevention of cancer and other diseases. In many countries, political authorities are considering the implementation of a simplified labelling system to reflect the nutritional quality of food products. The Nutri-Score, a five-colour nutrition label, is derived from the Nutrient Profiling System of the British Food Standards Agency (modified version) (FSAm-NPS). How the consumption of foods with high/low FSAm-NPS relates to cancer risk has been studied in national/regional cohorts but has not been characterized in diverse European populations. <p><i>Methods and findings - </i>This prospective analysis included 471,495 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC, 1992–2014, median follow-up: 15.3 y), among whom there were 49,794 incident cancer cases (main locations: breast, <i>n</i> = 12,063; prostate, <i>n</i> = 6,745; colon-rectum, <i>n</i> = 5,806). Usual food intakes were assessed with standardized country-specific diet assessment methods. The FSAm-NPS was calculated for each food/beverage using their 100-g content in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. The FSAm-NPS scores of all food items usually consumed by a participant were averaged to obtain the individual FSAm-NPS Dietary Index (DI) scores. Multi-adjusted Cox proportional hazards models were computed. A higher FSAm-NPS DI score, reflecting a lower nutritional quality of the food consumed, was associated with a higher risk of total cancer (HR_Q5 versus _Q1 = 1.07; 95% CI 1.03–1.10, <i>P</i>-trend < 0.001). Absolute cancer rates in those with high and low (quintiles 5 and 1) FSAm-NPS DI scores were 81.4 and 69.5 cases/10,000 person-years, respectively. Higher FSAm-NPS DI scores were specifically associated with higher risks of cancers of the colon-rectum, upper aerodigestive tract and stomach, lung for men, and liver and postmenopausal breast for women (all <i>P</i> < 0.05). The main study limitation is that it was based on an observational cohort using self-reported dietary data obtained through a single baseline food frequency questionnaire; thus, exposure misclassification and residual confounding cannot be ruled out. <p><i>Conclusions - </i>In this large multinational European cohort, the consumption of food products with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of cancer. This supports the relevance of the FSAm-NPS as underlying nutrient profiling system for front-of-pack nutrition labels, as well as for other public health nutritional measures.

• Botteri, Edoardo; Ferrari, Pietro; Roswall, Nina; Tjønneland, Anne; Hjartåker, Anette & Huerta, José María [Show all 26 contributors for this article] (2017). Alcohol consumption and risk of urothelial cell bladder cancer in the European prospective investigation into cancer and nutrition cohort. International Journal of Cancer. ISSN 0020-7136. 141(10), p. 1963–1970. doi: 10.1002/ijc.30894. Full text in Research Archive Show summary

  Findings on the association between alcohol consumption and bladder cancer are inconsistent. We investigated that association in the European Prospective Investigation into Cancer and Nutrition cohort. We included 476,160 individuals mostly aged 35-70 years, enrolled in ten countries and followed for 13.9 years on average. Hazard ratios (HR) for developing urothelial cell carcinoma (UCC; 1,802 incident cases) were calculated using Cox proportional hazards models. Alcohol consumption at baseline and over the life course was analyzed, as well as different types of beverages (beer, wine, spirits). Baseline alcohol intake was associated with a statistically non-significant increased risk of UCC (HR 1.03; 95% confidence interval (CI) 1.00-1.06 for each additional 12 grams/day). HR in smokers was 1.04 (95% CI 1.01-1.07). Men reporting high baseline intakes of alcohol (>96 grams/day) had an increased risk of UCC (HR 1.57; 95% CI 1.03-2.40) compared to those reporting moderate intakes (<6 grams/day), but no dose-response relationship emerged. In men, an increased risk of aggressive forms of UCC was observed even at lower doses (>6 to 24 grams/day). Average lifelong alcohol intake was not associated with the risk of UCC, however intakes of spirits > 24 grams/day were associated with an increased risk of UCC in men (1.38; 95% CI 1.01-1.91) and smokers (1.39; 95% CI 1.01-1.92), compared to moderate intakes. We found no association between alcohol and UCC in women and never smokers. In conclusion, we observed some associations between alcohol and UCC in men and in smokers, possibly due to residual confounding by tobacco smoking.

• Knudsen, Markus Dines; Berstad, Paula Marianna; Hjartåker, Anette; Gulichsen, Elisabeth Haagensen; Hoff, Geir & Lange, Thomas de [Show all 8 contributors for this article] (2017). Lifestyle predictors for non-participation and outcome in the second round of faecal immunochemical test in colorectal cancer screening. British Journal of Cancer. ISSN 0007-0920. 117(4), p. 461–469. doi: 10.1038/bjc.2017.189. Full text in Research Archive Show summary

  Background: To reduce colorectal cancer (CRC) mortality through population-based screening programmes using faecal tests, it is important that individuals continue to participate in the repeated rounds of screening. We aimed to identify lifestyle predictors for discontinuation of faecal immunochemical test (FIT) screening after the first round, as well as lifestyle predictors for colorectal neoplasia detected in the second-round FIT screening. Methods: In this longitudinal study, we invited 6959 individuals aged 50–74 years from south-east Norway for a first round of FIT screening and to complete a self-reported lifestyle questionnaire on demographic factors, body mass index (BMI, kg m−2), smoking habits, physical activity, consumption of alcohol and dietary items. Two years later, we estimated the associations between these factors, non-participation and screening results in the second round of FIT screening using adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: Of the 3114 responders to the questionnaire who completed the first-round FIT and who were invited to participate in second-round FIT screening, 540 (17%) did not participate. The OR and (95% CI) for discontinuation of FIT screening after the first round was 1.61 (1.24–2.10) for current smoking compared with non-smoking; 2.01 (1.25–3.24) for BMI ≥ 35 kg m−2 compared with BMI 16.9–24.9 kg m−2 and 0.70 (0.52–0.94) for physical activity in the third quartile vs the first. Among participants, smoking, high BMI and high alcohol consumption were associated with an increased odds of detecting colorectal neoplasia (n=107). Conclusions: These results may indicate that Norwegian FIT screening participants who discontinue after the first round have lifestyle behaviours associated with increased risk of CRC.

• Chajès, Véronique; Assi, Nada; Biessy, Carine; Ferrari, P.; Rinaldi, Sabina & Slimani, Nadia [Show all 35 contributors for this article] (2017). A prospective evaluation of plasma phospholipid fatty acids and breast cancer risk in the EPIC study. Annals of Oncology. ISSN 0923-7534. 28(11), p. 2836–2842. doi: 10.1093/annonc/mdx482. Full text in Research Archive Show summary

  <p><i>Background</i>: Intakes of specific fatty acids have been postulated to impact breast cancer risk but epidemiological data based on dietary questionnaires remain conflicting.</p> <p><i>Materials and methods</i>: We assessed the association between plasma phospholipid fatty acids and breast cancer risk in a case–control study nested within the European Prospective Investigation into Cancer and Nutrition study. Sixty fatty acids were measured by gas chromatography in pre-diagnostic plasma phospholipids from 2982 incident breast cancer cases matched to 2982 controls. Conditional logistic regression models were used to estimate relative risk of breast cancer by fatty acid level. The false discovery rate (q values) was computed to control for multiple comparisons. Subgroup analyses were carried out by estrogen receptor (ER) and progesterone receptor expression in the tumours.</p> <p><i>Results</i>: A high level of palmitoleic acid [odds ratio (OR) for the highest quartile compared with the lowest OR (Q4–Q1) 1.37; 95% confidence interval (CI), 1.14–1.64; P for trend = 0.0001, q value = 0.004] as well as a high desaturation index (DI16) (16:1n–7/16:0) [OR (Q4–Q1), 1.28; 95% C, 1.07–1.54; P for trend = 0.002, q value = 0.037], as biomarkers of <i>de novo</i> lipogenesis, were significantly associated with increased risk of breast cancer. Levels of industrial <i>trans</i>-fatty acids were positively associated with ER-negative tumours [OR for the highest tertile compared with the lowest (T3–T1)=2.01; 95% CI, 1.03–3.90; P for trend = 0.047], whereas no association was found for ER-positive tumours (P-heterogeneity =0.01). No significant association was found between n-3 polyunsaturated fatty acids and breast cancer risk, overall or by hormonal receptor.</p> <p><i>Conclusion</i>: These findings suggest that increased <i>de novo</i> lipogenesis, acting through increased synthesis of palmitoleic acid, could be a relevant metabolic pathway for breast tumourigenesis. Dietary <i>trans</i>-fatty acids derived from industrial processes may specifically increase ER-negative breast cancer risk.

• Ellingjord-Dale, Merete; Vos, Linda; Vik, Kirsti Lund; Hjartåker, Anette; Russnes, Hege Elisabeth Giercksky & Tretli, Steinar [Show all 9 contributors for this article] (2017). Alcohol, physical activity, smoking and breast cancer subtypes in a large nested case-control study from the Norwegian Breast Cancer Screening Program. Cancer Epidemiology, Biomarkers and Prevention. ISSN 1055-9965. 26(12), p. 1736–1744. doi: 10.1158/1055-9965.EPI-17-0611. Full text in Research Archive
• Knudsen, Markus Dines; Lange, Thomas de; Botteri, Edoardo; Nguyen, Dung-Hong; Evensen, Helge & Steen, Chloe Beate [Show all 10 contributors for this article] (2016). Favorable lifestyle before diagnosis associated with lower risk of screen-detected advanced colorectal neoplasia. World Journal of Gastroenterology (WJG). ISSN 1007-9327. 22(27), p. 6276–6286. doi: 10.3748/wjg.v22.i27.6276. Full text in Research Archive
• Zamora-Ros, Raul; Knaze, Viktoria; Rothwell, Joseph A.; Hémon, Bertrand; Moskal, Aurelie & Overvad, Kim [Show all 45 contributors for this article] (2016). Dietary polyphenol intake in europe: The european prospective investigation into cancer and nutrition (EPIC) study. European Journal of Nutrition. ISSN 1436-6207. 55(4), p. 1359–1375. doi: 10.1007/s00394-015-0950-x. Full text in Research Archive
• Frydenberg, Hanne; Flote, Vidar Gordon; Larsson, Ine Marie; Barrett, Emily S.; Furberg, Anne-Sofie & Ursin, Giske [Show all 12 contributors for this article] (2015). Alcohol consumption, endogenous estrogen and mammographic density among premenopausal women. Breast Cancer Research. ISSN 1465-5411. 17:103. doi: 10.1186/s13058-015-0620-1. Full text in Research Archive Show summary

  Introduction: Alcohol consumption may promote aromatization of androgens to estrogens, which may partly explain the observations linking alcohol consumption to higher breast cancer risk. Whether alcohol consumption is associated with endogenous estrogen levels, and mammographic density phenotypes in premenopausal women remains unclear.<p> <p>Methods: Alcohol consumption was collected by self-report and interview, using semi quantitative food frequency questionnaires, and a food diary during seven days of a menstrual cycle among 202 premenopausal women, participating in the Energy Balance and Breast Cancer Aspects (EBBA) study I. Estrogen was assessed in serum and daily in saliva across an entire menstrual cycle. Computer-assisted mammographic density (Madena) was obtained from digitized mammograms taken between days 7–12 of the menstrual cycle. Multivariable regression models were used to investigate the associations between alcohol consumption, endogenous estrogen and mammographic density phenotypes.<p> <p>Results: Current alcohol consumption was positively associated with endogenous estrogen, and absolute mammographic density. We observed 18 % higher mean salivary 17β-estradiol levels throughout the menstrual cycle, among women who consumed more than 10 g of alcohol per day compared to women who consumed less than 10 g of alcohol per day (p = 0.034). Long-term and past-year alcohol consumption was positively associated with mammographic density. We observed a positive association between alcohol consumption (past year) and absolute mammographic density; high alcohol consumers (≥7 drinks/week) had a mean absolute mammographic density of 46.17 cm² (95 % confidence interval (CI) 39.39, 52.95), while low alcohol consumers (<1 drink/week) had a mean absolute mammographic density of 31.26 cm2 (95 % CI 25.89, 36.64) (p-trend 0.001). After adjustments, high consumers of alcohol (≥7 drinks/week), had 5.08 (95 % CI 1.82, 14.20) times higher odds of having absolute mammographic density above median (>32.4 cm² ), compared to low (<1 drink/week) alcohol consumers.<p> <p>Conclusion: Alcohol consumption was positively associated with daily endogenous estrogen levels and mammographic density in premenopausal women. These associations could point to an important area of breast cancer prevention.

• Wozniak, Magdalena B.; Brennan, Paul; Brenner, Darren R.; Overvad, Kim; Olsen, Anja & Tjønneland, Anne [Show all 42 contributors for this article] (2015). Alcohol consumption and the risk of renal cancers in the European prospective investigation into cancer and nutrition (EPIC). International Journal of Cancer. ISSN 0020-7136. 137(8), p. 1953–1966. doi: 10.1002/ijc.29559. Full text in Research Archive
• Kyrø, Cecilie; Zamora-Ros, Raul; Scalbert, Augustin; Tjønneland, Anne; Dossus, Laure & Johansen, Christoffer [Show all 49 contributors for this article] (2015). Pre-diagnostic polyphenol intake and breast cancer survival: the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Breast Cancer Research and Treatment. ISSN 0167-6806. 154(2), p. 389–401. doi: 10.1007/s10549-015-3595-9. Full text in Research Archive
• Battle, J de; Ferrari, P; Chajes, V; Park, JY; Slimani, N & Mckenzie, F [Show all 43 contributors for this article] (2015). Dietary folate intake and breast cancer risk: European prospective investigation into cancer and nutrition. Journal of the National Cancer Institute. ISSN 0027-8874. 107(1). doi: 10.1093/jnci/dju367. Full text in Research Archive
• Buonaccorsi, John P.; Dalen, Ingvild; Laake, Petter; Hjartåker, Anette; Engeset, Dagrun & Thoresen, Magne (2015). Sensitivity of regression calibration to non-perfect validation data with application to the Norwegian Women and Cancer Study. Statistics in Medicine. ISSN 0277-6715. 34(8), p. 1389–1403. doi: 10.1002/sim.6420. Full text in Research Archive
• Rohrmann, Sabine; Linseisen, Jakob; Overvad, Kim; Würtz, Anne Mette Lund; Roswall, Nina & Tjønneland, Anne [Show all 45 contributors for this article] (2015). Meat and fish consumption and the risk of renal cell carcinoma in the European prospective investigation into cancer and nutrition. International Journal of Cancer. ISSN 0020-7136. 136(5), p. E423–E431. doi: 10.1002/ijc.29236. Full text in Research Archive

View all works in NVA

• Hjartåker, Anette; Retterstøl, Kjetil; Müller, Hanne & Anderssen, Sigmund Alfred (2026). Grunnleggende ernæringslære. Gyldendal. ISBN 9788205614734. 485 p. Full text in Research Archive Show summary

  Boken legger særlig vekt på betydningen av samspillet mellom kosthold og fysisk aktivitet for god helse. Innholdet i denne fjerde utgaven er oppdatert i tråd med aktuell forskningslitteratur og nasjonale anbefalinger, og den er spesielt tilpasset norske forhold. Boken henvender seg til et bredt spekter av studenter ved universitets- og høyskoler, blant annet innenfor medisin, ernæring, idrettsfag og fysioterapi, i tillegg til andre fagområder som jobber med forebygging og folkehelse. Boken gir også et solid grunnlag for videre studier innenfor mer spesialiserte, tilgrensende områder som klinisk ernæring, samfunnsernæring og næringsmiddelteknologi.

• Hjartåker, Anette; Pedersen, Jan Ivar; Müller, Hanne & Anderssen, Sigmund Alfred (2017). Grunnleggende ernæringslære. Gyldendal Norsk Forlag A/S. ISBN 9788205496934. 475 p. Full text in Research Archive Show summary

  Grunnleggende ernæringslære er en basisbok om menneskets ernæring og kostens betydning for god helse.Det er lagt særlig vekt på betydningen av samspillet mellom kosthold og fysisk aktivitet for god helse. Teksten i denne tredje utgaven er oppdatert på sentrale områder i henhold til nyere forskningslitteratur. Boka er spesielt tilpasset norske forhold.Den henvender seg til en bred gruppe av studenter i universitets- og høyskolesektoren, blant annet innenfor medisin, ernæring, idrettsfag og fysioterapi og andre studentkategorier innenfor forebyggende og helsefremmende fagområder.Boka gir også et godt grunnlag for videre studier innenfor mer spesialiserte, tilgrensende områder som klinisk ernæring, samfunnsernæring og næringsmiddelteknologi.

View all works in NVA

• Dahlgren, Monica Linnea; Kværner, Ane Sørlie; Berstad, Paula Marianna; Hjartåker, Anette & Meshkovska, Biljana (2026). Acceptability of a digital diet- and lifestyle intervention in the Norwegian colorectal cancer screening program – A qualitative interview study. Full text in Research Archive
• Kværner, Ane Sørlie; Dahlgren, Monica Linnea; Berstad, Paula Marianna & Hjartåker, Anette (2026). The KoloPrev Study: A Randomized Controlled Trial of a Personalized Digital Diet and Lifestyle Intervention at Colorectal Cancer Screening. Full text in Research Archive Show summary

  Poster presentation

• Isaksen, Irja Minde; Skeie, Guri; Brustad, Magritt; Kværner, Ane Sørlie; Thoresen, Magne & Hjartåker, Anette (2026). Dietary protein source and colorectal cancer risk in a prospective cohort of Norwegian women: preliminary results. Full text in Research Archive
• Skammelsrud, Thorbjørn Brun; Hjartåker, Anette; Klingberg, Sofia & Brekke, Hilde Kristin (2025). Breastfeeding duration and maternal weight change through adulthood in a population-based cohort study. Full text in Research Archive
• Konglevoll, Dina Moxness; Andersen, Lene Frost; Thoresen, Magne; Totland, Torunn Holm; Hopstock, Laila Arnesdatter & Hjartåker, Anette [Show all 7 contributors for this article] (2025). Dietary trajectories over 21 years and frailty in Norwegian older adults. doi: 10.1007/s00394-024-03482-z. Full text in Research Archive Show summary

  This study investigated the association between dietary trajectories over two decades and frailty in older adults in the large Norwegian population-based study, the Tromsø Study. We found that there was an association between maintaining a moderately healthy to very healthy diet through adulthood and lower frailty in older age.

• Skammelsrud, Thorbjørn Brun; Hjartåker, Anette; Klingberg, Sofia & Brekke, Hilde Kristin (2025). Sammenhengen mellom amming og vektutvikling gjennom livet blant mødre i "Kvinner og kreft"-studien. Full text in Research Archive
• Skammelsrud, Thorbjørn Brun; Hjartåker, Anette; Klingberg, Sofia & Brekke, Hilde Kristin (2024). Amming og vektutvikling blant mødre: Resultater fra «Kvinner og kreft»- studien. Full text in Research Archive
• Knudsen, Markus Dines; Wang, Kai; Wang, Liang; Polychronidis, Georgios; Berstad, Paula & Hjartåker, Anette [Show all 10 contributors for this article] (2024). Colorectal cancer incidence and mortality after negative colonoscopy screening according to individuals’ risk profiles. Full text in Research Archive
• Hjartåker, Anette; Konglevoll, Dina Moxness & Uchai, Shreeshti (2024). Nutrition and physical frailty in Norwegian older adults: investigating the role of protein, fish and adiposity. The NutriFrail project. Full text in Research Archive
• Konglevoll, Dina Moxness; Hjartåker, Anette; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Andersen, Lene Frost [Show all 7 contributors for this article] (2023). Proteininntak og skrøpelighet hos eldre deltagere i Tromsøundersøkelsen (1994–2016). Full text in Research Archive
• Konglevoll, Dina Moxness; Andersen, Lene Frost; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Totland, Torunn Holm [Show all 8 contributors for this article] (2023). Fish intake and pre-frailty in Norwegian older adults. A prospective cohort: the Tromsø Study 1994-2016. Full text in Research Archive
• Hjartåker, Anette (2023). Anthropometric measures and physical frailty among older adults. The NutriFrail study. Full text in Research Archive
• Konglevoll, Dina Moxness; Andersen, Lene Frost; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Totland, Torunn Holm [Show all 8 contributors for this article] (2023). Fish intake and pre-frailty in Norwegian older adults. A prospective cohort: the Tromsø Study 1994-2016. Full text in Research Archive
• Konglevoll, Dina Moxness; Andersen, Lene Frost; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Totland, Torunn Holm [Show all 8 contributors for this article] (2023). Fish intake and pre-frailty in Norwegian older adults. A prospective cohort study: the Tromsø Study 1994-2016. Full text in Research Archive
• Konglevoll, Dina Moxness; Andersen, Lene Frost; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Totland, Torunn Holm [Show all 8 contributors for this article] (2023). Fiskeinntak of pre-skrøpelighet hos eldre deltagere i Tromsøundersøkelsen: et prospektivt studie (1994-2016). Full text in Research Archive
• Uchai, Shreeshti; Andersen, Lene Frost; Johansson, Jonas Lars; Hopstock, Laila Arnesdatter & Hjartåker, Anette (2023). Dual-Energy X-Ray Absorptiometry Derived Adiposity Measures and Pre-Frailty/Frailty among Norwegian Adults: The Tromsø Study 2007–2015. Full text in Research Archive
• Uchai, Shreeshti; Andersen, Lene Frost; Johansson, Jonas Lars; Hopstock, Laila Arnesdatter & Hjartåker, Anette (2023). Dual-Energy X-Ray Absorptiometry Derived Adiposity Measures and Pre-Frailty/Frailty among Norwegian Adults: The Tromsø Study 2007–2015. Full text in Research Archive
• Bjørndal, Bodil; Vildmyren, Iselin Thowsen; Aadland, Eli Kristin; Hjartåker, Anette; Djupegot, Ingrid Laukeland & Vatne, Julie Meinseth (2023). Er brød farlig no igjen? Full text in Research Archive
• Hjartåker, Anette & Carlsen, Monica Hauger (2023). NutriFoodCalc (NFC) a new web-based food and nutrient calculation system. Full text in Research Archive
• Henriksen, Hege Berg; Carlsen, Monica Hauger; Knudsen, Markus Dines; Hjartåker, Anette & Blomhoff, Rune (2023). Digikost: A digital application for diet and lifestyle assessment and benchmarking against national guidelines. Full text in Research Archive
• Sabir, Zoya; Dierkes, Jutta; Hjartåker, Anette; Dahl, Helene; Gerdts, Eva & Rosendahl-Riise, Hanne (2023). Dietary Intake And Adherence To Food-Based Dietary Guidelines In Older Norwegian Adults – The Hordaland Health Studies. Clinical Nutrition ESPEN. ISSN 2405-4577. 54, p. 612–612. doi: 10.1016/j.clnesp.2022.09.453. Full text in Research Archive
• Knudsen, Markus Dines; Kai, Wang; Wang, Liang; Polychronidis, Georgios; Berstad, Paula & Hjartåker, Anette [Show all 10 contributors for this article] (2023). LONG-TERM INCIDENCE AND MORTALITY OF COLORECTAL CANCER AFTER NEGATIVE COLONOSCOPY SCREENING IN THREE U.S POPULATION-BASED COHORTS. Full text in Research Archive
• Konglevoll, Dina Moxness; Hjartåker, Anette; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Andersen, Lene Frost [Show all 7 contributors for this article] (2022). Protein intake and the risk of pre-frailty/frailty in Norwegian older adults. The Tromsø Study 1994-2016. Full text in Research Archive
• Konglevoll, Dina Moxness; Hjartåker, Anette; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Andersen, Lene Frost [Show all 7 contributors for this article] (2022). Protein intake and the risk of pre-frailty/frailty in Norwegian older adults. The Tromsø Study 1994-2016. Full text in Research Archive
• Konglevoll, Dina Moxness; Hjartåker, Anette; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Andersen, Lene Frost [Show all 7 contributors for this article] (2022). Protein intake and the risk of pre-frailty/frailty in Norwegian older adults. The Tromsø Study 1994-2016. Full text in Research Archive
• Konglevoll, Dina Moxness; Hjartåker, Anette; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Andersen, Lene Frost [Show all 7 contributors for this article] (2022). Protein intake and the risk of pre-frailty/frailty in Norwegian older adults. The Tromsø Study 1994-2016. Full text in Research Archive
• Uchai, Shreeshti; Andersen, Lene Frost; Hopstock, Laila Arnesdatter & Hjartåker, Anette (2022). Body Mass Index and Waist Circumference as predictors of Pre-frailty/frailty among older adults (Poster). Full text in Research Archive
• Bruun, Dorthe Elise Rustand; Diab, Simone; Hjartåker, Anette; Almaas, Runar; Brunvand, Leif & Hansen, Kari Margrethe [Show all 7 contributors for this article] (2022). Vitamin D and calcium intake in children with Fontan circulation in relationship to vitamin D status and bone mineral density. Cardiology in the Young. ISSN 1047-9511. Full text in Research Archive
• Sabir, Zoya; Rosendahl-Riise, Hanne; Dierkes, Jutta; Dahl, Helene & Hjartåker, Anette (2021). Validation of a web-based food frequency questionnaire for dietary intake assessment in the Hordaland Health Study. Full text in Research Archive Show summary

  Introduction: Valid assessment of dietary intake is essential when exploring associations between dietary factors and disease, as imprecise dietary intake data may reduce our understanding of such associations. All dietary assessment methods inevitably introduce measurement error to some extent, which ideally should be considered during data analysis and interpretation. Being aware of this, methodological studies should be conducted to address how well a given assessment method captures dietary intake, and to highlight the extent and direction of the measurement error. Aims: Within a sub-group of the community-based Hordaland Health Study (HUSK3), we conduct a validation study of an extensive web-based food-frequency questionnaire (web-FFQ) developed by the Department of Nutrition, University of Oslo. We compare dietary intake registered by the web-FFQ with dietary intake from repeat administrations of 24-hour dietary recall interviews (24-HDRs). Methods: The validation study is based on data from HUSK3 which included 2192 men and women born 1950-51. All HUSK3 participants were requested to complete the web-FFQ as a part of the health survey. For the present sub-study, 175 participants granted their consent to be contacted for repeated 24-HDRs via telephone. A total of 120 participants completed at least two 24-HDRs while 67 participants completed three 24-HDRs. Information on intake of foods, energy and nutrients was generated through Kostberegningssystemet (KBS), a software developed at the Department of Nutrition, University of Oslo. Results: Preliminary analyses in participants completing three 24-HDRs, show that intakes of energy, protein, fat, carbohydrates, fiber and micronutrients were higher in the FFQ than in the 24-HDRs. The FFQ overestimated the intakes of most food groups. Spearman’s rank correlation coefficient ranged from 0.17 (cakes) to 0.71 (juice) for foods, and from 0.19 (iodine) to 0.69 (vitamin D) for nutrients. Agreement of quartile membership indicated that foods eaten frequently were ranked quite similarly by both methods, while foods eaten infrequently were misclassified to a greater extent. Conclusion: The FFQ seemed to rank individuals well for foods consumed frequently, while ranking abilities were weaker for foods consumed less frequently. Ranking abilities of the FFQ varied within the category of macronutrients and micronutrients.

• Uchai, Shreeshti; Andersen, Lene Frost; Hopstock, Laila Arnesdatter & Hjartåker, Anette (2021). Body Mass Index and Waist Circumference as predictors of Pre-frailty/frailty among older adults. Full text in Research Archive
• Kværner, Ane Sørlie; Knudsen, Markus Dines; Hjartåker, Anette; Henriksen, Hege; Blomhoff, Rune & Hoff, Geir Svein [Show all 9 contributors for this article] (2021). Kost, livsstil og tarmscreening. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. Full text in Research Archive
• Milford, Anna Birgitte & Hjartåker, Anette (2018). Det norske kostholdet er ikke som det bør være. Hvem bør opplyse oss om sunn og bærekraftig mat? Full text in Research Archive
• Knudsen, Markus Dines; Berstad, Paula Marianna; Hjartåker, Anette; Gulichsen, Elisabeth Haagensen; Hugin, Silje & Hoff, Geir [Show all 9 contributors for this article] (2017). People discontinuing colorectal cancer screening is properly the ones benefiting the most from screening. Full text in Research Archive
• Lundblad, Marie Wasmuth; Andersen, Lene Frost; Jacobsen, Bjarne K.; Carlsen, Monica Hauger; Hjartåker, Anette & Grimsgaard, Sameline [Show all 7 contributors for this article] (2017). Nutrient intake in the 7th survey of the Tromsø Study 2015-16, and comparison with Norwegian national dietary recommendations. Norsk Epidemiologi, Supplement. ISSN 0803-4206. Full text in Research Archive
• Knudsen, Markus Dines; Berstad, Paula Marianna; Hjartåker, Anette; Gulichsen, Elisabeth Haagensen; Hoff, Geir & Lange, Thomas de [Show all 8 contributors for this article] (2017). Lifestyle predictors for non-participation and outcome in the second round of faecal immunochemical test in colorectal cancer screening. Norsk Epidemiologi, Supplement. ISSN 0803-4206. Full text in Research Archive
• Ellingjord-Dale, Merete; Vos, Linda; Tretli, Steinar; Hofvind, Solveig; Hjartåker, Anette & Russnes, Hege G. [Show all 8 contributors for this article] (2017). Number of risky lifestyle behaviors and breast cancer subtypes in a large nested case-control study from Norway. Epidemiology. ISSN 1044-3983. doi: 10.1158/1538-7445.AM2017-2287. Full text in Research Archive
• Lundblad, Marie Wasmuth; Andersen, Lene Frost; Jacobsen, Bjarne K.; Carlsen, Monica Hauger; Hjartåker, Anette & Grimsgaard, Sameline [Show all 7 contributors for this article] (2017). Nutrient intake in the 7th survey of the Tromsø Study 2015-16, and comparison with Norwegian national dietary recommendations. Full text in Research Archive
• Hjartåker, Anette; Weiderpass, E & Bray, Freddie Ian (2016). Cancer Mortality. In Quah, Stella R. (Eds.), International Encyclopedia of Public Health. Academic Press. ISSN 9780128036785. p. 369–380. doi: 10.1016/B978-0-12-803678-5.00049-7. Full text in Research Archive
• Knudsen, Markus Dines; Lange, Thomas de; Hjartåker, Anette & Berstad, Paula Marianna (2016). Association between colorectal cancer screening and health behavior at one-year follow-up, a randomized control study with two screening modalities. Full text in Research Archive
• Carlsen, Monica Hauger; Norberg, Nina & Hjartåker, Anette (2016). Assigning fatty acid composition to foods in a comprehensive nutrient calculation system (KBS). Full text in Research Archive
• Knudsen, Markus Dines; Hjartåker, Anette; Hoff, Geir; Lange, Thomas de; Bernklev, Tomm & Berstad, Paula Marianna (2016). Differences in health behavior at 1-year follow-up between attendees of two screening modalities having a negative screening test result, and controls. Full text in Research Archive
• Skammelsrud, Thorbjørn Brun; Hjartåker, Anette; Klingberg, Sofia & Brekke, Hilde Kristin (2024). Breastfeeding and weight development among parous women: Results from the Norwegian Women and Cancer Study. Universitetet i Oslo. Full text in Research Archive

View all works in NVA