Rune Blomhoff

• Eklo, Rakel R.; Alavi, Dena Treider; Konglevoll, Dina Moxness; Kolle, Åshild; Henriksen, Hege Berg & Rising, Russell [Show all 8 contributors for this article] (2026). Predictive equations commonly used in clinics underestimate resting energy expenditure compared with whole-room indirect calorimetry in colorectal cancer survivors. American Journal of Clinical Nutrition. ISSN 0002-9165. doi: 10.1016/j.ajcnut.2026.101209. Full text in Research Archive Show summary

  Background: Accurate methods for estimating resting energy expenditure (REE) are important to ensure adequate nutritional treatment in colorectal cancer (CRC) survivors. Objective: To determine the agreement between REE estimated by commonly used predictive equations and by whole-room indirect calorimetry (WRIC). Design: This cross-sectional study included 31 CRC survivors (age: 53–78 years; mean (standard deviation (SD)) body mass index (BMI) 28.7 (4.28) kg/m2), who underwent curative surgery. Body composition was measured by dual-energy x-ray absorptiometry (DXA). Predicted REE from equations in clinical use and derived from DXA and bioelectrical impedance analysis (BIA) were compared against REE measured by 30-min WRIC. Equations included Harris-Benedict, Mifflin-St. Jeor, FAO/WHO/UNU, Henry, Mifflin-St. JeorDXA, and FAO/WHO/UNUBIA. Paired sample t-test, Lin’s concordance correlation coefficient (CCC) and Bland-Altman analysis were used to determine the agreement between measured REEWRIC and predicted REE. Accuracy was defined as the percentage of predicted REE values that fell within ± 10 % of REEWRIC. Results: Mean (SD) REEWRIC was 1710 kcal/d (353), and respiratory quotient (RQ) was 0.79 (0.05). Most equations underestimated REE. On average, Harris-Benedict, Henry, and FAO/WHO/UNUBIA showed the best overall agreement with REEWRIC. However, these equations showed low accuracy with 65 %, 68 %, and 62 % of predicted REE values within ± 10 % of REEWRIC, respectively. Conclusions: Most predictive equations tended to underestimate REE in CRC survivors compared with REEWRIC. The Harris-Benedict, Henry and FAO/WHO/UNUBIA equations showed both best accuracy and agreement with WRIC. They were still inaccurate, with individual variability for a relevant part of the sample. Future studies need to develop improved predictive equations for CRC survivors.

• Knudsen, Ann Kristin Skrindo; Baravelli, Carl Michael; Madsen, Christian; Clarsen, Benjamin Matthew; TopeAmobonye, Ayodeji Emmanuel & Brauer, Michael [Show all 27 contributors for this article] (2026). The burden of dietary risk factors in the Nordic and Baltic countries: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet Regional Health - Europe. 61, p. 1–12. doi: 10.1016/j.lanepe.2025.101543. Full text in Research Archive Show summary

  Background Detailed knowledge about the disease burden from unhealthy diet in Nordic and Baltic countries is lacking. This study quantifies and compares deaths and disability-adjusted life-years (DALYs) from dietary risks in these countries. Methods Data from the Global Burden of Disease study 2023 (GBD 2023) was used. Attributable disease burden from 15 dietary risks was analysed using the comparative risk assessment framework. Steps included: (1) estimating dietary intake; (2) assessing relative risks of dietary factors on disease endpoints; (3) determining theoretical minimum risk exposure levels (TMREL); and (4) estimating dietary risk-attributable disease burden as numbers and age-standardised rates (ASR) of deaths and DALYs. Findings Across the Nordic and Baltic countries (total population = 34,064,020), dietary risks resulted in 38,450 attributed deaths (95% uncertainty interval 10,749–59,386) and 735,284 DALYs (242,417–1,06,638) in 2023. Leading dietary risks included high intake of processed meat and low intake of fruits and whole grains. Dietary risks accounted for 24.9% of cardiovascular disease burden (5.0–37.6), 29.6% of diabetes and kidney disease burden (18.6–40.0), and 7.8% of neoplasm burden (2.9–12.1), with higher burden in the Baltic countries and Greenland than in the Nordic countries. Interpretation A substantial disease burden can be attributed to dietary risks in the Nordic and Baltic countries. Knowledge about the impact from unhealthy diet can inform targeted public health policies. Funding Gates Foundation and Norwegian Institute of Public Health.

• Arjmand, Elaheh Javadi; Thomassen, Lise Margrete; Druckrey-Fiskaaen, Karl Trygve; Furulund, Einar; Vold, Jørn Henrik & Madebo, Tesfaye [Show all 13 contributors for this article] (2025). The effect of fruit smoothie supplementation on psychological distress and biomarkers among people with opioid dependence receiving opioid agonist therapy: a randomized controlled trial. BMC Medicine. 23. doi: 10.1186/s12916-025-04347-w. Full text in Research Archive Show summary

  Unhealthy diets are common among individuals with opioid dependence. While fruit- and vegetable-rich diets have shown mental health benefits, evidence is limited for those receiving opioid agonist therapy (OAT). This trial evaluated the effectiveness of fruit smoothie supplementation for people receiving OAT compared to standard treatment without fruit smoothie supplementation. In this multicenter randomized controlled trial (FruktBAR), 311 participants receiving OAT were randomized (5:3 intervention:control) to receive either a daily 250 ml fruit smoothie for 16 weeks in addition to standard OAT or standard OAT alone. The primary outcome was the difference between the arms in changes in psychological distress, measured by the ten-item Hopkins Symptom Checklist (SCL-10%) from baseline to the end of the intervention. The secondary outcomes included changes in fatigue symptoms, measured using the three-item Fatigue Severity Scale, physical fitness, measured by a 4-min step test, carotenoid and folate biomarkers. At baseline, 131 participants (70%) in the intervention arm and 91 (73%) in the control arm had a low intake of fruits and vegetables. In the intervention arm, the mean SCL-10% score at baseline was 43.9% (95% confidence interval (CI): 40.4, 47.4), which was reduced to 41.6% (CI: 38.0, 5.1) at the end of the trial. In the control arm, the mean SCL-10% score was 43.6% at baseline (CI: 39.3, 48.0) and decreased to 41.5% (CI: 37.1, 45.8) at the end of the trial period. No significant difference in the change of psychological distress between the intervention and control arms was found (− 0.14%; CI: − 4.49, 2.22). Additionally, no changes were found between the intervention and control arms regarding fatigue symptoms, physical fitness, carotenoid, or folate biomarkers. The mean consumed fruit smoothies reported in the intervention arm was 3.9 bottles per week (SD 1.5).  Fruit smoothie supplementation over a 16-week period did not impact psychological distress, fatigue, physical fitness, carotenoids, or folate biomarkers among people receiving OAT. Although the smoothies were successfully delivered to the participants, our data indicates suboptimal adherence to the intervention rather than the lack of efficacy.  ClinicalTrials.gov NCT05229770. Registered on 08 February 2022.

• Selland, Mette; Rognli, Sylvia; Skaali, Tone Margrethe Olsbu; Blomhoff, Rune; Tjønnfjord, Geir Erland & Eriksen, Astrid M.A. [Show all 8 contributors for this article] (2025). Distress, problems and unmet rehabilitation needs after haematopoietic stem cell transplantation for haematologic malignancies: A cross-sectional study. European Journal of Oncology Nursing. ISSN 1462-3889. 80, p. 1–6. doi: 10.1016/j.ejon.2025.103083. Full text in Research Archive
• Nordengen, Anne Lene; Krutto, Annika; Kværner, Ane Sørlie; Alavi, Dena Treider; Henriksen, Hege Berg & Kolle, Åshild [Show all 13 contributors for this article] (2025). Plant-based diet and oxidative stress-induced DNA damage in post-surgery colorectal cancer patients: Results from a randomized controlled trial. Free Radical Biology & Medicine. ISSN 0891-5849. 233, p. 240–249. doi: 10.1016/j.freeradbiomed.2025.03.047. Full text in Research Archive Show summary

  Oxidative stress-induced DNA damage may impact long-term outcomes in colorectal cancer (CRC) patients. While bioactive compounds in plant foods have been linked to DNA protection, evidence among patients in remission remains limited. The present study aimed to investigate the effect of a one-year personalized intensive dietary intervention on DNA damage in post-surgery, non-metastatic CRC patients. Participants were enrolled 2–9 months after surgery in the ongoing randomized controlled trial, Norwegian dietary guidelines and colorectal cancer survival (CRC-NORDIET). Eligible participants (aged 50–80 years, primary stage I-III CRC) were randomized to either a plant-based dietary intervention targeting oxidative stress and inflammation, or to a control group that received standard dietary advice as a part of routine cancer care. As a secondary analysis, this study included 156 participants (78 in the intervention group and 78 in the control group) from the total 503 patients enrolled in CRC-NORDIET study. DNA damage in peripheral mononuclear blood cells (PBMCs) was assessed using the enzyme-modified comet assay during a 12-month follow-up period. A significant intervention effect on DNA base oxidation from baseline to 12 months was observed (P = 0.04), representing a 32 % reduction in the intervention group compared to the control group. No significant effect on DNA strand breaks was found. In conclusion, adherence to a plant-based dietary pattern may reduce DNA base oxidation in post-surgery CRC patients.

• Henriksen, Hege Berg; Kolle, Åshild; Stenling, Andreas; Paur, Ingvild; Bøhn, Siv Kjølsrud & Brøto, Pernille [Show all 9 contributors for this article] (2025). Spillover effect of a dietary intervention on physical activity in a randomized controlled trial with colorectal cancer patients. International Journal of Behavioral Nutrition and Physical Activity. 22, p. 1–13. doi: 10.1186/s12966-025-01757-0. Full text in Research Archive Show summary

  Background Randomized controlled studies (RCTs) targeting dietary changes may also lead to other, untargeted changes in lifestyle habits, as spillover effects. In particular, the isolated impact of the dietary intervention may be difficult to separate due to spillover effects from changes in physical activity and physical function. Therefore, the aim of this study was to investigate the spillover effect of a one-year dietary intervention in post-surgery colorectal cancer patients by comparing the changes in physical activity and physical function between the diet intervention Group and the control group in a randomized controlled trial, called the CRC-NORDIET study. Methods Men and women, aged 50–80 years were randomized into either the intervention group (n=240) or the control group (n=229). Both groups received similar incentives on physical activity. Activity sensors were used to collect data on physical activity at baseline, 6 months, and 12 months. Physical function was estimated by results from handgrip strength, 30 s sit-to-stand test and 6-min walking test. Anthropometric measurements and body composition were also measured. Results We found a significantly higher increase in moderate-to-vigorous intensity physical activity (MVPA) of 0.18 h per day from baseline to 6 months in the diet intervention group compared to the control group, respectively. However, the spillover effect of the dietary intervention on physical activity diminished to 0.10 h per day at 12 months follow-up which was not statistically significantly different (p=0.24) from the control group. All measures of physical function increased in both groups from baseline to 6 months with no further increase at the 12-month follow-up. Conclusions The dietary intervention did not induce a significant spillover effect on physical activity after 12 months of baseline, which was the main timepoint of the intervention. Providing identical physical activity guidance to both study groups during the 12-month intensive dietary intervention period, ensured comparable levels of physical activity across both study groups. This approach facilitated the isolation and analysis of the dietary intervention’s effects on primary endpoints, as well as effects of behaviour interventions in secondary preventions, such as the CRCNORDIET study. Trial registration The study is registered on the National Institutes of Health Clinical Trials website (www.ClinicalTrials.gov; Identifier: NCT01570010)

• Dahlgren, Monica Linnea; Berstad, Paula Marianna; Henriksen, Hege Berg; Blomhoff, Rune & Kværner, Ane Sørlie (2025). Characterization of Nova-classified foods in a large cohort of Norwegian colorectal cancer screening participants. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 23(1), p. 7–19. doi: 10.18261/ntfe.23.1.3. Full text in Research Archive Show summary

  Background: Epidemiological studies on Nova-classified ultra-processed foods (Nova 4) often rely on food frequency questionnaire (FFQ) data without specifying the foods that fall into this category. We aimed to provide a detailed characterization of Nova-classified food intake relevant to the Norwegian context. Method: We applied the Nova classification system on FFQ data obtained from a large sample of Norwegian colorectal cancer screening participants (the CRCbiome study). The contribution of each Nova category (1–4) to the total diet was assessed, identifying the main food and beverage contributors within each group, both by weight (g/day) and as percentage of total energy intake (E%). Results: Nova categories 1, 2, 3, and 4 contributed 1633, 4, 329 and 562 g/day, respectively, accounting for 31, 1, 18 and 50% of total E%. Bread was the largest contributor to Nova 4, providing 19 E%. Other significant contributors included desserts and sweets (5 E%), processed meat (4 E%), processed fish (2 E%), margarine (2 E%), and dairy products (1 E%). For Nova categories 1, 2, and 3, the main contributors were fruits (4 E%), oils (1 E%), and cheese (5 E%), respectively. Although men had a slightly higher intake of Nova category 4 foods than women (51 vs. 47 E%), the overall distribution and within-group contributors were largely similar between sexes. Conclusion: Using FFQ data, as much as half of the energy intake of the present population was derived from ultra-processed foods. Bread was the predominant contributor to ultra-processed foods, far surpassing the other items.

• Gjelstad, Ingrid Merethe Fange; Lyckander, Christian; Høidalen, Anne; Bratland, Åse; Blomhoff, Rune & Paur, Ingvild [Show all 7 contributors for this article] (2025). Impact of radiotherapy on body weight in head and neck cancer patients: A prospective study. Clinical Nutrition ESPEN. ISSN 2405-4577. 65, p. 390–399. doi: 10.1016/j.clnesp.2024.12.019. Full text in Research Archive Show summary

  Background Patients with head and neck cancer (HNC) undergoing radiotherapy or chemoradiotherapy often experience symptoms that affect their ability to eat. This study aimed to explore the impact of radiotherapy on body weight in HNC patients and compare the characteristics of patients receiving enteral tube feeding with those maintaining an oral diet. Methods In this prospective study, 52 patients with HNC were examined at diagnosis, at the start and end of radiotherapy, and six weeks after end of treatment. The nutritional assessment included measurements of body weight, food intake, and malnutrition using Patient-Generated Subjective Global Assessment (PG-SGA). Other variables were retrieved from the electronic patient record. Results Critical weight loss (defined as >5 % from start of radiotherapy) was present in 60 % of the patients at the end of radiotherapy, and only half of these patients received any enteral nutrition therapy. The mean weight loss was 5.8 % during radiotherapy, and an additional 2.1 % at follow-up (n = 48). A nasogastric feeding tube was used by 42 % at the end of radiotherapy, and 29 % at follow-up. The tube feeding users had a lower energy intake and higher weight loss than non-tube feeding users (22 vs 27 kcal/kg body weight, 7.8 vs 4.4 % weight loss) at the end of radiotherapy treatment. According to PG-SGA, 92 % of the patients were malnourished at the end of treatment and 71 % at follow-up (p < 0.001). Conclusion Critical weight loss and malnutrition were common in HNC patients after radiotherapy, and enteral tube feeding was initiated in only half of the cases with critical weight loss. Patients receiving enteral tube feeding may need closer monitoring to ensure adequate energy intake, and other treatment options may be necessary. These results emphasize the need for improved nutritional intervention during and after radiotherapy.

• Treider, Martin; Romandini, Elisa; Alavi, Dena Treider; Aghayan, Davit; Rasmussen, Margrethe Kallestad & Marchegiani, Giovanni [Show all 11 contributors for this article] (2025). Postoperative changes in body composition after laparoscopic and open resection of colorectal liver metastases: data from the randomized OSLO-COMET trial. Surgical Endoscopy. ISSN 0930-2794. 39, p. 2450–2457. doi: 10.1007/s00464-025-11613-8. Full text in Research Archive Show summary

  Background Low muscle mass is negatively associated with survival in patients undergoing surgery for colorectal cancer. Current evidence is limited regarding whether the surgical approach for liver resection of colorectal metastasis impacts postoperative changes in body composition and whether preoperative body composition can impact complication rate and survival. Method This study included patients previously included in the randomized OSLO-COMET trail where patients was allocated to laparoscopic or open liver resection for colorectal liver metastasis. CT scans 0–3 months before and 2–6 months after liver resection were segmented with the artificial intelligence-based tool BodySegAI to measure skeletal muscle mass (SM), visceral adipose tissue (VAT), and inter- and intramuscular adipose tissue (IMAT). SM, VAT and IMAT was compared between the open and laparoscopic group and as predictors for 5-year survival and postoperative complications. Results This study included 216 patients, median age was 67, 127 (59%) were male, 91 (42%) had primary tumor in rectum and 86 (40%) had multiple liver metastasis. There was no significant difference in postoperative change in SM, VAT or IMAT between those undergoing laparoscopy or open surgery. In multivariate analysis, high preoperative IMAT was a predictor for increased risk of postoperative complications (HR (95% CI): 1.045 (CI 95%: 1.003–1.089), p = 0.034). Moreover, postoperative increase in IMAT was a negative predictor for 5-year survival (HR (95%CI):1.009 (1.003–1.016), p = 0.003). Conclusion Postoperative change in body composition did not differ between patients randomly assigned to open or laparoscopic liver resection for colorectal metastasis. High preoperative IMAT was associated with an increased risk of postoperative complications.

• Mansoor, Mohammad Azam; Stea, Tonje Holte; Slettan, Audun; Perera, Erandie; Maddumage, Rimi & Kottahachi, Darshana [Show all 9 contributors for this article] (2025). Impact of single nucleotide polymorphisms (SNPs) in antioxidant-enzyme genes on the concentrations of folate, homocysteine and glutathione in plasma from healthy subjects after folic acid supplementation – a randomized controlled crossover trial. Genes & Nutrition. ISSN 1555-8932. 20. doi: 10.1186/s12263-024-00761-6. Full text in Research Archive Show summary

  Background One-carbon metabolism links folate and methionine metabolism and this is essential for nucleotide synthesis in the cells. Alterations in one-carbon metabolism are associated with cardiovascular disease (CVD), type 2 diabetes and cancer. Our aim was to investigate whether SNPs in antioxidant-enzyme genes impact the concentrations of folate in serum (s-folate), plasma total homocysteine (p-tHcy) and total glutathione in plasma (p-tGSH) in healthy subjects after supplementation with folic acid. Methods In a randomized, double blind, crossover study, healthy subjects received 0.8 mg folic acid per day or a placebo for two weeks. Twenty-four male, and sixty-seven female subjects participated in this study. Participants were aged 36.4 ± 14.8 years (mean ± SD). We studied SNPs in six genes by PCR methods. The concentrations of s-folate, p-tHcy and p-tGSH were measured in fasting samples with Cobas and an HPLC-fluorescence method. Student T-tests and ANOVA were used for the statistical calculations. Main findings The subjects with SNP (rs4880) in superoxide dismutase (SOD2) gene (CC) allele had higher concentrations of s-folate and lower concentrations of p-tHcy than subjects with (CT + TT) alleles, (p = 0.014 and p = 0.012). Contrary to SOD2 (CC) allele, the subjects with SNP (rs1001179) catalase (CAT) CC allele had lower concentrations of s-folate (p = 0.029), higher concentrations of p-tGSH (0.017) and higher concentrations of p-tHcy before and after folic acid supplementations (p = 0.015, p = 0.017) than the subjects with (CT + TT) allele. Glutathione transferase (theta)1 (GST-T1) genotype was associated with higher concentrations of s-folate than GST-T0 before (p = 0.025) and after folic acid supplementation (p = 0.047). SNP (rs1050450) in glutathione peroxidase (GPX1) had also impact on the concentrations of p-tGSH (p = 0.011) in healthy subjects. Conclusion SNPs in SOD2 (rs4880), CAT (rs1001179), and GST1 impact the concentrations of s-folate, and p-tHcy in healthy subjects before and after folic acid supplementation. Our findings suggest that SNPs in antioxidant-genes have a role in health and disease by impacting the concentrations of s-folate, p-tHcy and p-tGSH.

• Benton, Tim G.; Harwatt, Helen; Høyer-Lund, Anne; Meltzer, Helle Margrete; Trolle, Ellen & Blomhoff, Rune (2024). An overview of approaches for assessing the environmental sustainability of diets – a scoping review for Nordic Nutrition Recommendations 2023. Food & Nutrition Research (FNR). ISSN 1654-6628. 68. doi: 10.29219/fnr.v68.10453. Full text in Research Archive Show summary

  Assessing the environmental impacts of food, food systems and diets is highly complex due to the multitude of processes involved, the uncertainty in assessment models, the variability in production systems and the large range of products available. No single assessment method alone can provide a complete evidence base. The increasing number of Life Cycle Assessment and food system analyses, and more recently the integration of planetary boundaries offer insights from which we can draw some robust high-level conclusions, whilst recognising there is a need for more detailed analysis to capture the inherent nuances of more location and context-specific situations. Despite the complexity of assessing the environmental sustainability of food, diets and food systems, there are a number of key considerations that could be used to guide this process, and in doing so, they help to increase utility of the outcomes and limit unintended adverse consequences. We identified five key considerations that can be applied (consider the thresholds, consider the system, consider the variables, consider the context and consider the spillover) to ensure assessments are comprehensive.

• Bøhn, Synne-Kristin Hoffart; Oldervoll, Line Merethe; Reinertsen, Kristin Valborg; Selland, Mette; Fosså, Alexander & Kiserud, Cecilie E. [Show all 17 contributors for this article] (2024). The feasibility of a multidimensional intervention in lymphoma survivors with chronic fatigue. Supportive Care in Cancer. ISSN 0941-4355. 32(1). doi: 10.1007/s00520-023-08204-5. Full text in Research Archive Show summary

  Purpose: Chronic fatigue (CF) affects 25–30% of lymphoma survivors, but interventions designed to reduce fatigue are lacking. The main aim of this study was to test the feasibility of a multidimensional intervention study in lymphoma survivors with CF. Secondary aims were to describe individual changes in fatigue, quality of life (QoL) and physical performance from pre (T0) to post (T1) intervention. Methods: This feasibility study was as a one-armed intervention study performed in 2021. Hodgkin or aggressive non-Hodgkin lymphoma survivors received mailed study information and Chalder Fatigue Questionnaire and were asked to respond if they suffered from fatigue. The 12-week intervention included patient education, physical exercise, a cognitive behavioural therapy (CBT)-based group program and nutritional counselling. Feasibility data included patient recruitment, completion of assessments, adherence to the intervention and patient-reported experience measures. Participants responded to questionnaires and underwent physical tests at T0 and T1. Results: Seven lymphoma survivors with CF were included. Of all assessments, 91% and 83% were completed at T0 and T1, respectively. Adherence to the interventional components varied from 69% to 91%. At T1, all participants rated exercise as useful, of whom five rated the CBT-based program and five rated individual nutritional counselling as useful. Five participants reported improved fatigue, QoL and physical performance. Conclusion: Lymphoma survivors with CF participating in a multidimensional intervention designed to reduce the level of fatigue showed high assessment completion rate and intervention adherence rate. Most of the participants evaluated the program as useful and improved their level of fatigue, QoL and physical performance after the intervention.

• 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.”

• Harwatt, Helen; Benton, Tim G.; Bengtsson, Jan; Birgisdόttir, Bryndis Eva; Brown, Kerry Ann & Dooren, Corné Van [Show all 17 contributors for this article] (2024). Environmental sustainability of food production and consumption in the nordic and baltic region - a scoping review for nordic nutrition recommendations 2023. Food & Nutrition Research (FNR). ISSN 1654-6628. 68. doi: 10.29219/fnr.v68.10539. Full text in Research Archive Show summary

  This scoping review examines environmental impacts related to food production and consumption in Nordic and Baltic countries. The overarching advice to all Nordic and Baltic countries, in line with the current body of scientific literature, is to shift to a more plant based dietary pattern and avoid food waste. Taking into account current consumption patterns, there is a high potential and necessity to shift food consumption across the countries to minimize its environmental impact. More specifically, a substantial reduction in meat and dairy consumption and increased consumption of legumes/pulses, whole grains, vegetables, fruits, nuts and seeds is suggested as a priority intervention. Reducing the environmental impacts of seafoods is also key and suggestions include a shift to seafoods with lower environmental impacts such as seaweed and bivalves. As part of the suggested transition to a more plant-based diet, the scope for increasing the provision of plant-based foods through increasing the cultivation of legumes/pulses, vegetables and grains and through feed-to-food shifts within the region should be explored.

• Berg, Hedda Beate; Alavi, Dena Treider; Beichmann, Benedicte; Pesonen, Maiju; Henriksen, Christine & Paur, Ingvild [Show all 10 contributors for this article] (2024). The choice of diagnostic modality influences the proportion of low muscle strength, low muscle mass, and sarcopenia in colorectal cancer patients. Clinical Nutrition ESPEN. ISSN 2405-4577. 60, p. 17–23. doi: 10.1016/j.clnesp.2024.01.001. Full text in Research Archive Show summary

  Background and aims: Low muscle strength, low muscle mass, and sarcopenia have a negative impact on health outcomes in colorectal cancer (CRC) patients. Different diagnostic modalities are used to identify these conditions but it is unknown how well the modalities agree. The aim of this study was to compare different diagnostic modalities by means of calculating the proportion of low muscle strength, low muscle mass, and sarcopenia in CRC patients, and to investigate the agreement for sarcopenia between the various modalities. Methods: Men and women participating in the Norwegian Dietary Guidelines and colorectal cancer Survival (CRC-NORDIET) study were included in the analyses. Cut-off values for low muscle strength, low muscle mass, and sarcopenia were de ned according to the second consensus set by the European Working Group on Sarcopenia in Older People (EWGSOP2). The diagnostic modalities used to assess muscle strength were handgrip strength and the sit-to-stand test. For muscle mass, computed tomography, dual-energy X-ray absorptiometry (DXA), multi-frequency bioelectrical impedance analysis (MF-BIA), and single-frequency BIA (SF-BIA) were applied. Cohen's kappa was calculated to determine the agreement for low muscle strength and con rmed sarcopenia between diagnostic modalities. Results: Five hundred and three men and women (54 % men, mean age of 66 (range 50e80) years old) were included in the analysis. As much as 99 % (n¼ 70) of the population was identi ed with low muscle mass by MF-BIA, while the other modalities identi ed 9e49 % as having low muscle mass. Handgrip strength identi ed a lower proportion of low muscle strength as compared with the sit-to-stand test (4 % vs. 8 %). When applying various combinations of diagnostic modalities for low muscle strength and low muscle mass, the proportion of sarcopenia was found to be between 0.3 and 11.4 %. There was relatively poor agreement between the different diagnostic modalities with Cohen's Kappa ranging from 0.0 to 0.55, except for the agreement between SF-BIASergi and MF-BIASergi, which was 1. Conclusion: The proportion of low muscle strength, low muscle mass, and sarcopenia in CRC patients varied considerably depending on the diagnostic modalities used. Further studies are needed to provide modality-speci c cut-off values, adjusted to sex, age and body size.

• Nordengen, Anne Lene; Krutto, Annika; Kværner, Ane Sørlie; Alavi, Dena Treider; Henriksen, Hege & Smeland, Sigbjørn [Show all 11 contributors for this article] (2024). Attenuation of DNA base oxidation in post-surgery colorectal stage III patients at subsequent follow-ups. Free Radical Biology & Medicine. ISSN 0891-5849. 221, p. 75–80. doi: 10.1016/j.freeradbiomed.2024.05.029. Full text in Research Archive Show summary

  DNA damage caused by oxidative reactions plays a crucial role in the pathogenesis of colorectal cancer (CRC). In a previous cross-sectional study, CRC patients diagnosed with regional disease (stage III) exhibited a higher level of DNA base oxidation in peripheral blood mononuclear cells (PBMCs) 2–9 months post-surgery compared to those with localized disease (stage I-II). To further explore this observation over time, the present study aimed to investigate DNA base oxidation in CRC patients with localized versus regional disease 6 and 12 months after the initial measurements. The present study included patients enrolled in the randomized controlled trial Norwegian Dietary Guidelines and Colorectal Cancer Survival (CRC-NORDIET). The standard comet assay, modified with the lesion-specific enzyme formamidopyrimidine DNA glycosylase (Fpg), was applied to measure DNA base oxidation in PBMCs at the 6- and 12-month follow-ups. Of the 255 patients assessed at baseline, 156 were included at the 6-month follow-up, with 89 of these patients included in the 12-month follow-up. In contrast to our observation at baseline, there were no significant differences in the levels of DNA base oxidation between patients diagnosed with localized disease and those with regional involvement at the 6- and 12-month follow-up visits (P = 0.81 and P = 0.09, respectively). Patients with stage III disease exhibited a significant decrease in the levels of DNA base oxidation from baseline to 6 months (P < 0.01) and baseline to 12 months (P = 0.03), but no significant difference from 6 to 12 months (P = 0.80). In conclusion, the initially elevated levels of DNA base oxidation in PBMCs, observed 2–9 months post-surgery in patients diagnosed with regional disease (stage III), subsequently decreased to levels comparable to patients with localized disease (stage I-II) at the 6- and 12-month follow-ups.

• Olsen, Thomas; Christensen, Jacob Juel; Arnesen, Erik Kristoffer; Lysne, Vegard & Blomhoff, Rune (2024). Preparatory work for the update of the tolerable upper intake levels for vitamin A. EFSA Supporting publication. ISSN 2397-8325. doi: 10.2903/sp.efsa.2024.EN-8651. Full text in Research Archive
• Nordengen, Anne Lene; Zheng, Congying; Krutto, Annika; Kværner, Ane Sørlie; Alavi, Dena Treider & Henriksen, Hege [Show all 13 contributors for this article] (2024). Effect of a personalized intensive dietary intervention on base excision repair (BER) in colorectal cancer patients: Results from a randomized controlled trial. Free Radical Biology & Medicine. ISSN 0891-5849. 218, p. 178–189. doi: 10.1016/j.freeradbiomed.2024.04.211. Full text in Research Archive Show summary

  DNA repair is essential to maintain genomic integrity and may affect colorectal cancer (CRC) patients’ risk of secondary cancers, treatment efficiency, and susceptibility to various comorbidities. Bioactive compounds identified in plant food have the potential to modulate DNA repair mechanisms, but there is limited evidence of how dietary factors may affect DNA repair activity in CRC patients in remission after surgery. The aim of this study was to investigate the effect of a 6 months personalized intensive dietary intervention on DNA repair activity in post-surgery CRC patients (stage I-III). The present study included patients from the randomized controlled trial CRC-NORDIET, enrolled 2-9 months after surgery. The intervention group received an intensive dietary intervention emphasizing a prudent diet with specific plant-based foods suggested to dampen inflammation and oxidative stress, while the control group received only standard care advice. The comet-based in vitro repair assay was applied to assess DNA repair activity, specifically base excision repair (BER), in peripheral blood mononuclear cells (PBMCs). Statistical analyses were conducted using gamma generalized linear mixed models (Gamma GLMM). A total of 138 CRC patients were included, 72 from the intervention group and 66 from the control group. The BER activity in the intervention group did not change significantly compared to the control group. Our findings revealed a substantial range in both inter- and intra-individual levels of BER. In conclusion, the results do not support an effect of dietary intervention on BER activity in post-surgery CRC patients during a 6-month intervention period.

• 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.

• Hafskjold, Ingrid; Rangul, Vegar; Ringvoll, Hanne; Kolberg, Marit; Haug, Eirin Beate & Blomhoff, Rune [Show all 8 contributors for this article] (2023). Postpartum Lifestyle Behaviors among Women with Hypertensive Disorders of Pregnancy: Data from the HUNT Study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 20(21). doi: 10.3390/ijerph20217025. Full text in Research Archive Show summary

  Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disease later in life. Clinical guidelines for postpartum follow-up after HDP often recommend lifestyle counseling to reduce this risk. However, knowledge about lifestyle behaviors and perceptions among women with a history of HDP is limited. We linked data from the fourth survey of the population-based Trøndelag Health Study (HUNT4) with data from the Medical Birth Registry of Norway. The associations between HDP and postpartum lifestyle behaviors and perceptions were examined using multivariable logistic regression. In a secondary analysis, HUNT4 participants with a recent history of pre-eclampsia were compared with women with a recent history of pre-eclampsia participating in a postpartum pilot intervention study. Lifestyle behaviors and perceptions were self-reported and included diet (intake frequency of fruits, vegetables, meat, fish, and sugar-sweetened beverages), alcohol intake, physical activity, sleep, smoking, lifestyle satisfaction, and the importance of a healthy lifestyle. Among 7551 parous HUNT4 participants, 610 had a history of HDP. We found no differences in lifestyle behaviors between women with and without a history of HDP. However, women with HDP had higher odds of being unsatisfied with their lifestyle. Women with pre-eclampsia participating in a postpartum lifestyle intervention study tended to have a healthier lifestyle at baseline than women participating in HUNT4. Future studies should explore how lifestyle intervention programs could be adapted to the needs of women who have experienced HDP or other pregnancy complications that are associated with an increased risk of CVD.

• Henriksen, Hege Berg; Henriksen, Christine; Sousa, Ana Rita Sequeira de; Alavi, Dena Helene; Augestad, Elin Maria Sandstad & Rising, Russell [Show all 12 contributors for this article] (2023). Validity and reproducibility of a whole-room indirect calorimeter for the estimation of VO<inf>2</inf>, VCO<inf>2</inf>, and resting metabolic rate. Physiological Reports. 11(7). doi: 10.14814/phy2.15658. Full text in Research Archive Show summary

  Abstract Whole‐room indirect calorimeters (WRICs) provide accurate instruments for the measurement of respiratory exchange, energy expenditure, and macronutrient oxidation. Here, we aimed to determine the validity and reproducibility of a 7500 L WRIC for the measurement of ventilation rates and resting metabolic rate (RMR). Technical validation was performed with propane combustion tests ( n  = 10) whereas biological reproducibility was tested in healthy subjects (13 women, 6 men, mean ± SD age 39.6 ± 15.3) in two 60 min measurements separated by 24 h. Subjects followed a run‐in protocol prior to measurements. The coefficient of variation (CV) and intraclass correlation coefficient (ICC) were calculated for ventilation rates of O2 (VO2), CO2 (VCO2), the respiratory quotient (RQ; VCO2/VO2), and RMR. Technical validation showed good validity with CVs ranging from 0.67% for VO 2 to 1.00% for energy expenditure. For biological reproducibility, CVs were 2.89% for VO 2 ; 2.67% for VCO 2 ; 1.95% for RQ; and 2.68% for RMR. With the exception of RQ (74%), ICCs were excellent for VO 2 (94%), VCO 2 (96%) and RMR (95%). Excluding participants that deviated from the run‐in protocol did not alter results. In conclusion, the 7500 L WRIC is technically valid and reproducible for ventilation rates and RMR.

• Horn, Julie; Kolberg, Marit; Rangul, Vegar; Magnussen, Elisabeth Balstad; Åsvold, Bjørn Olav & Henriksen, Hege Berg [Show all 9 contributors for this article] (2023). Feasibility of a Postpartum Web- and Phone-Based Lifestyle Program for Women with a History of Preeclampsia or Gestational Diabetes: A Pilot Intervention Study. Women's Health Reports. 4(1), p. 345–357. doi: 10.1089/whr.2023.0039. Full text in Research Archive Show summary

  Background: Women with a history of preeclampsia (PE) or gestational diabetes mellitus (GDM) are at increased risk of diabetes and cardiovascular disease (CVD) later in life. Increased awareness of pregnancy complications as early warning signs for CVD has called for postpartum primordial prevention strategies. The aim of this study was to evaluate the feasibility of a postpartum web- and phone-based lifestyle program promoting healthy lifestyle behaviors to women after a pregnancy complicated by PE or GDM. Materials and Methods: Women with a validated history of PE or GDM were invited to participate in a nonrandomized pilot intervention study 3–12 months after delivery. The intervention was delivered over 6 months. All participants received tailored lifestyle counseling by a registered dietitian and access to information material on healthy lifestyle behaviors on the study's website. After inclusion, participants were invited to three study visits at baseline, 3 months, and 6 months. Feasibility outcomes included assessment of recruitment, retention, and acceptability. Secondary outcomes were changes in lifestyle behaviors and cardiovascular risk factors. Results: Of the 207 women invited, 44 were enrolled in the feasibility study and 40 women completed the intervention, corresponding to a recruitment rate of 21% and a retention rate of 91%. At the 3-month study visit, 94.6% of participants reported they had used the website. A total of 41.7% of the participants reported that they had achieved their personal goals during the intervention period. Conclusions: This study suggested the feasibility and potential acceptability of a web- and phone-based lifestyle intervention for mothers with recent PE or GDM.

• Western, Benedikte; Demmelmaier, Ingrid; Vistad, Ingvild; Hansen, Bjørge Hermann; Stenling, Andreas & Henriksen, Hege [Show all 9 contributors for this article] (2023). How many days of continuous physical activity monitoring reliably represent time in different intensities in cancer survivors. PLOS ONE. 18(4). doi: 10.1371/journal.pone.0284881. Full text in Research Archive Show summary

  Background Physical activity (PA) monitoring is applied in a growing number of studies within cancer research. However, no consensus exists on how many days PA should be monitored to obtain reliable estimates in the cancer population. The objective of the present study was to determine the minimum number of monitoring days required for reliable estimates of different PA intensities in cancer survivors when using a six-days protocol. Furthermore, reliability of monitoring days was assessed stratified on sex, age, cancer type, weight status, and educational level. Methods Data was obtained from two studies where PA was monitored for seven days using the SenseWear Armband Mini in a total of 984 cancer survivors diagnosed with breast, colorectal or prostate cancer. Participants with ≥22 hours monitor wear-time for six days were included in the reliability analysis (n = 736). The intra-class correlation coefficient (ICC) and the Spearman Brown prophecy formula were used to assess the reliability of different number of monitoring days. Results For time in light PA, two monitoring days resulted in reliable estimates (ICC >0.80). Participants with BMI ≥25, low-medium education, colorectal cancer, or age ≥60 years required one additional monitoring day. For moderate and moderate-to-vigorous PA, three monitoring days yielded reliable estimates. Participants with BMI ≥25 or breast cancer required one additional monitoring day. Vigorous PA showed the largest within subject variations and reliable estimates were not obtained for the sample as a whole. However, reliable estimates were obtained for breast cancer survivors (4 days), females, BMI ≥30, and age <60 years (6 days). Conclusion Shorter monitoring periods may provide reliable estimates of PA levels in cancer survivors when monitored continuously with a wearable device. This could potentially lower the participant burden and allow for less exclusion of participants not adhering to longer protocols.

• Wouda, Matthijs Ferdinand; Slettahjell, Hanne Bjørg; Lundgaard, Eivind; Bastani, Nasser Ezzatkhah; Raastad, Truls & Blomhoff, Rune [Show all 7 contributors for this article] (2023). Acute changes in antioxidants and oxidative stress to vigorous arm exercise: an intervention trial in persons with spinal cord injury and healthy controls. Spinal Cord Series and Cases. 9. doi: 10.1038/s41394-023-00590-6. Full text in Research Archive Show summary

  Background: Literature remains unclear on possible health benefits and risks assosciated with high intensity exercise for persons with SCI. Elevated oxidative stress levels might influence their ability to exercise at high intensity. We investigated several biomarkers of oxidative stress and antioxidant defense at rest, during and after vigorous exercise among persons with chronic SCI. Setting: Sunnaas Rehabilitation Hospital, Norway. Methods: Six participants (five males) with chronic SCI (AIS A, injury level thoracic 2–8, >1 year postinjury) and six matched able-bodied controls performed two maximal arm-cranking tests, with one-three days in between. During the second exercise test, participants performed three bouts with four minutes arm cranking at high intensity (85–95% of peak heart rate (HRpeak)), before they reached maximal effort. Blood and urine biomarkers for oxidative stress and antioxidant levels were collected at six time points at the day of the second exercise test; baseline, at high intensity exercise, at maximal effort, at five, 30 and 60 min post-exercise, and 24 h post exercise. Results: Participants with SCI had significant lower levels of creatinine (∆16 µmol/L, p = 0.03), α-carotene (∆0.14 nmol/L, p ＜ 0.001) and β-carotene (∆0.51 nmol/L, p = 0.001) at baseline compared to controls. Urine and blood biomarkers of oxidative stress and antioxidant levels showed similar response to vigorous exercise in the SCI and control group. Conclusions: SCI participants showed similar changes in redox status during high intensity exercise compared to matched able-bodied. SCI participants had lower levels of exogen antioxidants both before, during and after vigorous exercise.

• Ringvoll, Hanne; Kolberg, Marit; Rangul, Vegar; Hafskjold, Ingrid; Haug, Eirin Beate & Blomhoff, Rune [Show all 8 contributors for this article] (2023). Postpartum lifestyle behaviour among women with prior gestational diabetes mellitus: evidence from the HUNT study. BMJ Nutrition, Prevention and Health. 6(2). doi: 10.1136/bmjnph-2022-000612. Full text in Research Archive Show summary

  Introduction Women with a history of gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Recommendations for postpartum follow-up include targeted lifestyle advice to lower the risk. The aim of this study was to compare postpartum lifestyle behaviours and perceptions among women with and without a history of GDM. In addition, we examined whether lifestyle behaviours of women with a history of GDM participating in a lifestyle intervention study differed from lifestyle behaviours of women with a history of GDM in the general population. Research design and methods We linked data from the fourth survey of the population-based Trøndelag Health Study (HUNT4) to information from the Medical Birth Registry of Norway for women with registered births between 2000 and 2019. Using logistic regression, we compared lifestyle behaviours in women with and without GDM. In secondary analyses, lifestyle behaviours in women with GDM participating in a postpartum lifestyle intervention study were compared with HUNT participants with GDM using Fisher’s exact tests/t-tests. Results A high proportion of the women in our population, regardless of GDM history, reported several unhealthy lifestyle behaviours. We found no significant association between history of GDM and lifestyle behaviours. The lifestyle intervention study for women with a history of GDM appeared to recruit women with more favourable lifestyle behaviours. Conclusions Women, regardless of GDM history, could potentially benefit from further support for lifestyle improvement, but it may be especially important in women with a history of GDM given their increased risk of T2DM and CVD. Interventions targeting women with GDM might not reach the women with the unhealthiest lifestyle behaviours, and measures to reach out to all women should be further investigated.

• Nordengen, Anne Lene; Kværner, Ane Sørlie; Krutto, Annika; Alavi, Dena Treider; Henriksen, Hege & Henriksen, Christine [Show all 12 contributors for this article] (2023). DNA base oxidation in relation to TNM stages and chemotherapy treatment in colorectal cancer patients 2–9 months post-surgery. Free Radical Biology & Medicine. ISSN 0891-5849. 212, p. 174–185. doi: 10.1016/j.freeradbiomed.2023.12.016. Full text in Research Archive Show summary

  Accumulation of DNA damage is a critical feature of genomic instability, which is a hallmark of various cancers. The enzyme-modified comet assay is a recognized method to detect specific DNA lesions at the level of individual cells. In this cross-sectional investigation, we explore possible links between clinicopathological and treatment related factors, nutritional status, physical activity and function, and DNA damage in a cohort of colorectal cancer (CRC) patients with non-metastatic disease. Levels of DNA damage in peripheral mononuclear blood cells (PBMCs) assessed 2–9 months post-surgery, were compared across tumour stage (localized (stage I-II) vs. regional (stage III) disease), localization (colon vs. rectosigmoid/rectum cancer), and adjuvant chemotherapy usage, with the last dosage administrated 2–191 days prior to sampling. Associations between DNA damage and indicators of nutritional status, physical activity and function were also explored. In PBMCs, DNA base oxidation was higher in patients diagnosed with regional compared with localized tumours (P = 0.03), but no difference was seen for DNA strand breaks (P > 0.05). Number of days since last chemotherapy dosage was negatively associated with DNA base oxidation (P ＜ 0.05). In conclusion, DNA base oxidation measured with the enzyme-modified comet assay varies according to tumour and lifestyle related factors in CRC patients treated for non-metastatic disease.

• Skaali, Tone Margrethe Olsbu; Blomhoff, Rune; Lindemann, Kristina Yvonne Kathe; Smeland, Sigbjørn; Bruheim, Kjersti & Selland, Mette [Show all 7 contributors for this article] (2023). Self-reported distress and problems after treatment for gynecological cancer – Correlation between a short screening tool and longer measures of anxiety/depression and health-related quality of life. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. doi: 10.1111/aogs.14709. Full text in Research Archive Show summary

  Abstract Introduction The National Comprehensive Cancer Network (NCCN) distress thermometer and problem list (DTPL) is a brief self‐report screening measure for use in follow‐up cancer care. The aims of this study were to explore the correlations between scores on the DTPL and scores on longer measures of anxiety/depression and health‐related quality of life among women treated for gynecological cancer, and to define a cutoff score on the DT representing high levels of psychological distress in this patient group. Material and methods During outpatient visits, 144 women filled in the DTPL, the Hospital Anxiety and Depression Scale (HADS) and the RAND‐36‐Item Short Form Health Survey (RAND‐36) between October 2019 and March 2020. We assessed the agreement between the DT‐scores and the HADS scores, explored variables associated with high levels of distress on the DT, and studied the associations between DTPL‐scores and scores of health‐related quality of life (HRQoL) from RAND‐36. Results In receiver operating characteristic curve analysis between the distress score from the DT and a HADS total score ≥15 (defining high levels of anxiety/depression symptoms), the area under the curve was 0.81 (95% CI: 0.74–0.89). Using a cutoff of ≥5 on the DT (scale 0–10), we found a balanced level of sensitivity (81%) and specificity (71%) towards a HADS total score of ≥15. The scores of distress and problems reported on the DTPL correlated significantly with the majority of HRQoL function scales from RAND‐36. Conclusions The NCCN DTPL can be used as a screening measure for self‐reported distress and problems after treatment for gynecological cancer. A score of ≥5 on DT may indicate high level of anxiety/depression as measured by HADS. The tool may help identify patients in need of referral to supportive care and rehabilitation facilities.

• Alavi, Dena Treider; Henriksen, Hege Berg; Lauritzen, Peter Mæhre; Zucknick, Manuela; Bøhn, Siv Kjølsrud & Henriksen, Christine [Show all 9 contributors for this article] (2023). Effect of a one-year personalized intensive dietary intervention on body composition in colorectal cancer patients: Results from a randomized controlled trial. Clinical Nutrition ESPEN. ISSN 2405-4577. 57, p. 414–422. doi: 10.1016/j.clnesp.2023.06.037. Full text in Research Archive Show summary

  Background & aims Changes in body composition may affect colorectal cancer (CRC) patient's risk of cancer recurrence, secondary cancer, and other chronic diseases. The suggested interventions for changes in body composition such as low muscle mass or high fat mass, are diet and physical activity. Nevertheless, there is limited evidence of how dietary intervention alone can impact body composition. This study aimed to investigate the effect of a 6 and 12 month dietary intervention with a focus on healthy eating according to Norwegian food-based dietary guidelines on weight and body composition in patients with CRC stage I-III, post-surgery.<p> <p>Methods This study included participants from the randomized controlled trial CRC-NORDIET study 2–9 months after surgery. The intervention group received an intensive dietary intervention, while the control group underwent similar measurements, but no dietary intervention. Body composition was measured with Lunar iDXA, and the results were analyzed using linear mixed models. <p>Results A total of 383 participants were included, 192 in the intervention group and 191 in the control group. After 6 months, the intervention group showed a 0.7 kg lower mean weight gain (p = 0.020) and 0.6 kg lower fat mass gain (p = 0.019) than the control group, but no difference at 12 months. Moreover, the fat mass increase was 0.5 percentage points lower at 6 months (p = 0.012), and 0.7 percentage points lower at 12 months (p = 0.011) in the intervention group compared to the controls. At 6 months, the intervention group had 63 g lower gain of visceral adipose tissue compared to the control group (p = 0.031). No differences were seen for fat-free mass or subcutaneous adipose tissue at any time point. The intervention group showed a lower increase in the ratio between fat mass and fat-free mass at both 6 months (p = 0.025) and 12 months (p = 0.021). <p>Conclusion The dietary intervention reduced the increases in total weight and fat masses, without changing fat-free mass. Although the individual changes are small, the dietary intervention may have resulted in an overall more favourable body composition profile. These findings suggest that dietary intervention may be part of a treatment strategy for prevention of weight and fat mass gain in CRC survivors.

• Christensen, Jacob J.; Arnesen, Erik Kristoffer; Rundblad, Amanda; Telle-Hansen, Vibeke; Narverud, Ingunn & Blomhoff, Rune [Show all 10 contributors for this article] (2023). Dietary fat quality, plasma atherogenic lipoproteins, and atherosclerotic cardiovascular disease: An overview of the rationale for dietary recommendations for fat intake. Atherosclerosis. ISSN 0021-9150. 389. doi: 10.1016/j.atherosclerosis.2023.117433. Full text in Research Archive Show summary

  The scientific evidence supporting the current dietary recommendations for fat quality keeps accumulating; however, a paradoxical distrust has taken root among many researchers, clinicians, and in parts of the general public. One explanation for this distrust may relate to an incomplete overview of the totality of the evidence for the link between fat quality as a dietary exposure, and health outcomes such as atherosclerotic cardiovascular disease (ASCVD). Therefore, the main aim of the present narrative review was to provide a comprehensive overview of the rationale for dietary recommendations for fat intake, limiting our discussion to ASCVD as outcome. Herein, we provide a core framework – a causal model – that can help us understand the evidence that has accumulated to date, and that can help us understand new evidence that may become available in the future. The causal model for fat quality and ASCVD is comprised of three key research questions (RQs), each of which determine which scientific methods are most appropriate to use, and thereby which lines of evidence that should feed into the causal model. First, we discuss the link between low-density lipoprotein (LDL) particles and ASCVD (RQ1); we draw especially on evidence from genetic studies, randomized controlled trials (RCTs), epidemiology, and mechanistic studies. Second, we explain the link between dietary fat quality and LDL particles (RQ2); we draw especially on metabolic ward studies, controlled trials (randomized and non-randomized), and mechanistic studies. Third, we explain the link between dietary fat quality, LDL particles, and ASCVD (RQ3); we draw especially on RCTs in animals and humans, epidemiology, population-based changes, and experiments of nature. Additionally, the distrust over dietary recommendations for fat quality may partly relate to an unclear understanding of the scientific method, especially as applied in nutrition research, including the process of developing dietary guidelines. We therefore also aimed to clarify this process. We discuss how we assess causality in nutrition research, and how we progress from scientific evidence to providing dietary recommendations.

• 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.

• Henriksen, Hege Berg; Berg, Hedda Beate; Andersen, Lene Frost; Weedon-Fekjær, Harald & Blomhoff, Rune (2023). Development of the Norwegian diet index and the Norwegian lifestyle index and evaluation in a national survey. Food & Nutrition Research (FNR). ISSN 1654-6628. 67. doi: 10.29219/fnr.v67.9217. Full text in Research Archive Show summary

  Background: Dietary and lifestyle indices are composite tools that are used to estimate risk of health outcomes. Objective: We aimed to develop a diet and a lifestyle index assessing adherence to the national guidelines in Norway, and to investigate adherence in a nationwide survey of healthy subjects (Norkost3). Design: Cut-off values for the indices were based on the Norwegian food based dietary guidelines and national lifestyle guidelines. Adherence was evaluated in the Norkost3 (n = 1,787). Results: Twelve dietary components were included in the diet index 1) fruit and berries, 2) vegetables, 3) whole grains, 4) unsalted nuts, 5) fish, 6) low-fat dairy products, 7) margarine/oils, 8) red meat, 9) processed meat, 10) foods rich in sugar and fat, 11) drinks with added sugar, and 12) dietary supplements. Each of the components was assigned a value of 0, 0.5 or 1 corresponding to low, intermediate and high adherence, except for plant-based foods, which were assigned a value of 0, 1.5 or 3, providing a composite diet index ranging from 0 to 20 points. The five components in the lifestyle index (i.e. diet, body mass index (BMI), physical activity, tobacco and alcohol) was assigned a value of 0, 0.5 or 1, giving a final score ranging from zero to five points. In Norkost3, 49% (95% CI: 47, 52) of the participants had low adherence to the diet component, whereas only 2% (95% CI: 2, 3) achieved high adherence, although most of the subjects had high educational level. High adherence to the recommendations of BMI, tobacco and alcohol intake was observed in 50% (95% CI: 47, 52), 72% (95% CI: 70, 74) and 68% (95% CI: 66, 70) of the participants, respectively. Due to the lack of data on physical activity, adherence to this component in the lifestyle index is not presented in this study. Conclusion: The new diet and lifestyle indices assess adherence to the Norwegian food-based dietary guidelines (FBDGs) and other national lifestyle guidelines. In this study, half of the subjects had low diet and lifestyle index scores. There is a need to implement interventions to improve this by focusing on the specific lifestyle components with low adherence.

• Alavi, Dena Helene; Sakinis, Tomas; Henriksen, Hege; Beichmann, Benedicte; Fløtten, Ann-Monica & Blomhoff, Rune [Show all 7 contributors for this article] (2022). Body composition assessment by artificial intelligence from routine computed tomography scans in colorectal cancer: Introducing BodySegAI. JCSM Clinical Reports. 7, p. 55–64. doi: 10.1002/crt2.53. Full text in Research Archive Show summary

  Background Body composition is of clinical importance in colorectal cancer patients, but is rarely assessed because of time-consuming manual segmentation. We developed and tested BodySegAI, a deep learning-based software for automated body composition quantification from routinely acquired computed tomography (CT) scans. Methods A two-dimensional U-Net convolutional network was trained on 2989 abdominal CT slices from L2 to S1 to segment skeletal muscle (SM), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intermuscular and intramuscular adipose tissue (IMAT). Human ground truth was established by combining segmentations from three human readers. BodySegAI was tested using 154 slices against the human ground truth and compared with a software named AutoMATiCA. Results Median Dice scores for BodySegAI against human ground truth were 0.969, 0.814, 0.986, and 0.990 for SM, IMAT, VAT, and SAT, respectively. The mean differences per slice for SM were −0.09 cm3, IMAT: −0.17 cm3, VAT: −0.12 cm3, and SAT: 0.67 cm3. Median absolute errors for SM, IMAT, VAT, and SAT were 1.35, 10.54, 0.91, and 1.07%, respectively. When analysing different anatomical levels separately, L3 and S1 demonstrated the overall highest and lowest Dice scores, respectively. On average, BodySegAI segmented 148 times faster than human readers (4.9 vs. 726.5 seconds, P < 0.001). Also, BodySegAI presented higher Dice scores for SM, IMAT, SAT, and VAT than AutoMATiCA (slices = 154). Conclusions BodySegAI rapidly generates excellent segmentation of SM, VAT, and SAT and good segmentation of IMAT in L2 to S1 among colorectal cancer patients and may replace semi-manual segmentation.

• 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.

• Bøhn, Siv Kjølsrud; Myhrstad, Mari; Thoresen, Magne; Erlund, Iris; Vasstrand, Ann Kristin & Marciuch, Anne [Show all 11 contributors for this article] (2021). Bilberry/red grape juice decreases plasma biomarkers of inflammation and tissue damage in aged men with subjective memory impairment –a randomized clinical trial. BMC Nutrition. 7(75). doi: 10.1186/s40795-021-00482-8. Full text in Research Archive Show summary

  Background: Few randomized clinical trials have explored the health effects of bilberries in humans. The aim was to test the effect of bilberry and red grape-juice consumption on visual memory, motor speed and dexterity as well as inflammatory and tissue damage biomarkers of plasma in aged men with subjective memory impairment. Methods: Nine-week double-blind, placebo-controlled, dietary intervention study of aged men (n = 60, age ≥ 67 years) with subjective memory impairment randomized to consume a 50/50 mix of bilberry/red grape-juice or an iso-caloric placebo juice. A selection of Cambridge Cognition Test Battery (CANTAB), Grooved Pegboard tests and blood-sampling for biomarker analysis were performed before and after the intervention. Results: Compared to placebo the selected memory and motor test scores were un-affected by the bilberry/red grape intervention. However, the plasma levels of tissue damage biomarkers decreased significantly more in the bilberry/red grape group. In particular lactate dehydrogenase (LDH) decreased from 362 U/L (median, baseline) to 346 U/L (median, post intervention) in the bilberry/red grape group. Also, several biomarkers of inflammation (EGF, IL6, IL9, IL10 and TNFα) decreased significantly more in the bilberry/red grape group. Furthermore, several plasma polyphenols; p-coumaric acid, hippuric acid, protocatechuic acid, 3HPAA and vanillic acid, increased significantly more in the bilberry/red grape group compared to placebo with the largest increase in p-coumaric acid with 116%; from 2.2 [1.0,5.5] to 4.7 [2.8,8.1] μM/L (median [95% CL]). Conclusions: The results indicate that a nine-week bilberry/red grape juice intervention has no measurable effects on the selected memory scores in aged men experiencing memory problems but decreases the level of biomarkers of inflammation and tissue damage. Whether the dampening effects on inflammation and tissue damage biomarkers have relevance for neuroinflammatory brain pathology remains to be established.

• Høyer, Anne; Christensen, Jacob J.; Arnesen, Erik Kristoffer; Andersen, Rikke; Eneroth, Hanna & Erkkola, Maijaliisa [Show all 13 contributors for this article] (2021). The Nordic Nutrition Recommendations 2022 – prioritisation of topics for de novo systematic reviews. Food & Nutrition Research (FNR). ISSN 1654-6628. 65. doi: 10.29219/fnr.v65.7828. Full text in Research Archive
• Henriksen, Hege; Alavi, Dena Helene & Blomhoff, Rune (2021). Precision of Lunar Dual-energy X-ray Absorptiometry (iDXA) in measuring body composition among colorectal cancer patients and healthy subjects. Clinical Nutrition ESPEN. ISSN 2405-4577. 44, p. 316–323. doi: 10.1016/j.clnesp.2021.05.025. Full text in Research Archive Show summary

  Background & aims High quality and precise methods are needed when monitoring changes in body composition among colorectal cancer (CRC) patients and healthy subjects. The aim of this study was to estimate precision of the Dual-energy X-ray absorptiometry (Lunar iDXA, GE Healthcare software enCORE version 16) in measuring body composition in CRC patients and healthy subjects. Methods Precision error of iDXA in measuring body composition was investigated in the current study. Thirty CRC patients and 30 healthy subjects, including both men and women underwent two consecutive whole-body DXA scan with repositioning. Precision estimates of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in the abdominal region, and total fat mass (FM), fat-free mass (FFM), lean mass (LM), bone mineral density (BMD) and bone mineral content (BMC) were calculated. Results Precision error expressed as coefficient of variation (% CV) of VAT and SAT were estimated to be 3.56% and 3.28% among CRC patients, and 5.30% and 3.46% among healthy subjects. Estimated precision errors for body masses in the total region ranged between 0.49-1.01% and 0.40–0.88% in CRC patients and healthy subjects, respectively. Least significant change (LSC) in VAT mass, SAT mass, FM and LM were 140.9 g, 121.4 g, 637.0 g and 701.0 g, respectively, among CRC patients. Among healthy subjects the LSC in VAT, SAT, FM and LM were 80.93 g, 98.90 g, 484.0 g and 618.0 g, respectively. Only minor and non-significant differences between the two consecutive measurements for each body compartment were observed within both populations, and we found no systematic bias in the distribution of the differences. Conclusion The Lunar iDXA demonstrated high precision in body composition measurements among both CRC patients and healthy subjects. Hence, iDXA is a useful tool in clinical following-up and interventions targeted towards changes in body composition.

• Henriksen, Christine; Paur, Ingvild; Pedersen, Astrid; Kværner, Ane Sørlie; Ræder, Hanna & Henriksen, Hege [Show all 9 contributors for this article] (2021). Agreement between GLIM and PG-SGA for diagnosis of malnutrition depends on the screening tool used in GLIM. Clinical Nutrition. ISSN 0261-5614. 41(2), p. 329–336. doi: 10.1016/j.clnu.2021.12.024. Full text in Research Archive Show summary

  Background & aim The Global Leadership Initiative on Malnutrition (GLIM) has suggested a process for the diagnosis of malnutrition. The process consists of applying an existing screening tool for malnutrition screening, followed by malnutrition diagnostics, and finally categorization of malnutrition severity (moderate or severe) according to specific GLIM criteria. However, it is not known how well the GLIM process agrees with other diagnostic tools used in the current clinical practice. The aim of this study was to validate the GLIM process against the Patient Generated-Subjective Global Assessment (PG-SGA) when different screening tools were applied in the screening step of the GLIM process. Methods Colorectal cancer (CRC) patients from the ongoing CRC-NORDIET study were included. For the GLIM process, the patients were first screened for malnutrition using either 1) Nutritional risk screening, first 4 questions (NRS-2002-4Q), 2) Malnutrition Screening Tool (MST), 3) Malnutrition Universal Screening Tool (MUST) or 4) the PG-SGA short form (PG-SGA-SF). The GLIM malnutrition diagnosis was then based on combining the result from each of the screening methods with the etiological and phenotypic GLIM-criteria including weight loss, BMI and fat free mass. In parallel, the patients were diagnosed using the PG-SGA methodology categorizing the patients into either A: well nourished, B: moderately malnourished or C: severely malnourished. The four different GLIM based diagnoses were then validated against the diagnosis obtained by the PG-SGA tool. Sensitivity, specificity and positive predictive value (PPV) were calculated to evaluate validity. Results In total, 426 patients were included (mean age: 66, ±8 years) at a mean time of 166 (±56) days after surgery. The GLIM diagnosis based on the four different screening tools identified 10–24% of the patients to be malnourished, of which 3–8% were severely malnourished. The PG-SGA method categorized 15% as moderately malnourished (PG-SGA: category B) and no patients as severely malnourished (PG-SGA: category C). The agreement between the PG-SGA and GLIM process was in general low, but differed according to the tools: PG-SGA SF (sensitivity 47%, PPV 71%), MST (sensitivity 56%, PPV 47%), NRS-2002-4Q (sensitivity 63%, PPV 53%) and MUST (sensitivity 53%, PPV 34%). Conclusion In this cross-sectional study of patients with CRC, the concordance between the GLIM-criteria and PG-SGA depended on the screening tool used in the GLIM process. Malnutrition frequency based on the GLIM process schould be reported with and without the use of a screening tool.

• Selland, Mette; Skrede, Katrine; Lindemann, Kristina Yvonne Kathe; Skaali, Tone Margrethe Olsbu; Blomhoff, Rune & Bruheim, Kjersti [Show all 8 contributors for this article] (2021). Distress, problems and unmet rehabilitation needs after treatment for gynecological cancer. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. doi: 10.1111/aogs.14310. Full text in Research Archive Show summary

  Introduction - The prevalence of distress, problems and need for rehabilitation among women treated for gynecological cancer is largely unknown. The aims of this study were to examine the prevalence of distress, problems and unmet rehabilitation needs in the first years after treatment for gynecological cancer.<p> <p>Material and methods - Women treated for gynecological cancer within the last 2 years were invited. Participants responded to the National Comprehensive Cancer Network Distress Thermometer and Problem List measuring distress and problems. They also answered a questionnaire regarding physical endurance, muscle strength, and need for rehabilitation services.<p> <p>Results - Of 114 eligible women, 92 (81%) agreed to participate. Mean time since last treatment was 7.6 months (range 0–24.5 months). A total of 57% of the participants reported distress. The four most common problems reported were fatigue (58%), tingling in hands/feet (54%), worry (53%), and problems with memory/concentration (50%). Problems associated with distress were: dealing with partner, all emotional problems (i.e. depression, fears, nervousness, sadness, worry, and loss of interest in usual activities), appearance, memory/concentration, pain, sex, sleep, and problems with physical endurance and muscle strength. Fifty-two per cent reported unmet needs for rehabilitation services. Women with distress reported more unmet rehabilitation needs than those in the non-distressed group.<p> <p>Conclusions - The prevalence of distress in this population of women treated for gynecological cancer was high. Having a high number of problems and having unmet needs for rehabilitation services were both associated with distress. Hence, measurement of distress seems to be helpful when assessing the need for rehabilitation services.

• Larsen, Sunniva Veen; Holven, Kirsten B.; Christensen, Jacob J.; Flatberg, Arnar; Rundblad, Amanda & Leder, Lena [Show all 13 contributors for this article] (2021). Replacing Saturated Fat with Polyunsaturated Fat Modulates Peripheral Blood Mononuclear Cell Gene Expression and Pathways Related to Cardiovascular Disease Risk Using a Whole Transcriptome Approach. Molecular Nutrition & Food Research. ISSN 1613-4125. 65(24). doi: 10.1002/mnfr.202100633. Full text in Research Archive Show summary

  The aim of this study is to explore the molecular mechanisms underlying the effect of replacing dietary saturated fat (SFA) with polyunsaturated fat (PUFA) on cardiovascular disease (CVD) risk using a whole transcriptome approach. Methods and Results Healthy subjects with moderate hypercholesterolemia (n = 115) are randomly assigned to a control diet (C-diet) group or an experimental diet (Ex-diet) group receiving comparable food items with different fatty acid composition for 8 weeks. RNA isolated from peripheral blood mononuclear cells (PBMCs) at baseline and after 8 weeks of intervention is analyzed by microarray technology (n = 95). By use of a linear regression model (n = 92), 14 gene transcripts are differentially altered in the Ex-diet group compared to the C-diet group. These include transcripts related to vascular smooth muscle cell proliferation, low-density lipoprotein receptor folding, and regulation of blood pressure. Furthermore, pathways mainly related to immune response and inflammation, signal transduction, development, and cytoskeleton remodeling, gene expression and protein function, are differentially enriched between the groups. Conclusion Replacing dietary SFA with PUFA for 8 weeks modulates PBMC gene expression and pathways related to CVD risk in healthy subjects with moderate hypercholesterolemia.

• Carlsen, Harald; Ebihara, Kanae; Kuwata, Nobuyo H.; Kuwata, Kazuhisa; Aydemir, Gamze & Rühl, Ralph [Show all 7 contributors for this article] (2021). A transgenic reporter mouse model for in vivo assessment of retinoic acid receptor transcriptional activation. International Journal for Vitamin and Nutrition Research. ISSN 0300-9831. doi: 10.1024/0300-9831/a000705. Full text in Research Archive Show summary

  Abstract. Background: Vitamin A is essential for a wide range of life processes throughout embryogenesis to adult life. With the aim of developing an in vivo model to monitor retinoic acid receptor (RAR) transactivation real-time in intact animals, we generated transgenic mice carrying a luciferase (luc) reporter gene under the control of retinoic acid response elements (RAREs) consisting of three copies of a direct repeat with five spacing nucleotides (DR5). Methods: Transgenic mice carrying a RARE dependent luciferase reporter flanked with insulator sequence were generated by pronuclear injection. RARE dependent luciferase activity was detected by in vivo imaging or in tissue extracts following manipulations with RAR/retinoid X receptor (RXR) agonists, RAR antagonists or in vitamin A deficient mice. Results: We found a strong induction of luciferase activity in a time and dose dependent manner by retinoic acid as well as RAR agonists, but not by the RXR agonist (using n=4–6 per group; 94 mice). In addition, luciferase activity was strongly reduced in vitamin A-deficient mice (n=6–9; 30 mice). These observations confirm that luciferase activity was controlled by RAR activation in the RARE-luc mouse. Luciferase activity was detectable in various organs, with high activity especially in brain and testis, indicating strong retinoid signalling in these tissues. Conclusion: The RARE-luc transgenic mice, which enabled real-time in vivo assessment of RAR activation, will be useful in understanding the normal physiology of vitamin A, the role of retinoid signalling in pathologies as well as to evaluate pharmacological ligands for RARs.

• Alavi, Dena Helene; Henriksen, Hege; Lauritzen, Peter Mæhre; Kværner, Ane Sørlie; Sakinis, Tomas & Langleite, Torgrim Mikal [Show all 12 contributors for this article] (2021). Quantification of adipose tissues by Dual-Energy X-Ray Absorptiometry and Computed Tomography in colorectal cancer patients. Clinical Nutrition ESPEN. ISSN 2405-4577. 43, p. 360–368. doi: 10.1016/j.clnesp.2021.03.022. Full text in Research Archive Show summary

  Background & aims Excess adipose tissue may affect colorectal cancer (CRC) patients' disease progression and treatment. In contrast to the commonly used anthropometric measurements, Dual-Energy X-Ray Absorptiometry (DXA) and Computed Tomography (CT) can differentiate adipose tissues. However, these modalities are rarely used in the clinic despite providing high-quality estimates. This study aimed to compare DXA's measurement of abdominal visceral adipose tissue (VAT) and fat mass (FM) against a corresponding volume by CT in a CRC population. Secondly, we aimed to identify the best single lumbar CT slice for abdominal VAT. Lastly, we investigated the associations between anthropometric measurements and VAT estimated by DXA and CT. Methods Non-metastatic CRC patients between 50-80 years from the ongoing randomized controlled trial CRC-NORDIET were included in this cross-sectional study. Corresponding abdominal volumes were acquired by Lunar iDXA and from clinically acquired CT examinations. Also, single CT slices at L2-, L3-and L4-level were obtained. Agreement between the methods was investigated using univariate linear regression and Bland–Altman plots. Results Sixty-six CRC patients were included. Abdominal volumetric VAT and FM measured by DXA explained up to 91% and 96% of the variance in VAT and FM by CT, respectively. Bland–Altman plots demonstrated an overestimation of VAT by DXA compared to CT (mean difference of 76 cm3) concurrent with an underestimation of FM (mean difference of −319 cm3). A higher overestimation of VAT (p = 0.015) and underestimation of FM (p = 0.036) were observed in obese relative to normal weight subjects. VAT in a single slice at L3-level showed the highest explained variance against CT volume (R2 = 0.97), but a combination of three slices (L2, L3, L4) explained a significantly higher variance than L3 alone (R2 = 0.98, p < 0.006). The anthropometric measurements explained between 31-65% of the variance of volumetric VAT measured by DXA and CT. Conclusions DXA and the combined use of three CT slices (L2-L4) are valid to predict abdominal volumetric VAT and FM in CRC patients when using volumetric CT as a reference method. Due to the poor performance of anthropometric measurements we recommend exploring the added value of advanced body composition by DXA and CT integrated into CRC care.

• Arnesen, Erik Kristoffer; Christensen, Jacob Juel; Andersen, Rikke; Eneroth, Hanna; Erkkola, Maijaliisa & Høyer, Anne [Show all 13 contributors for this article] (2020). The Nordic Nutrition Recommendations 2022 – structure and rationale of qualified systematic reviews. Food & Nutrition Research (FNR). ISSN 1654-6628. 64, p. 1–11. doi: 10.29219/fnr.v64.4403. Full text in Research Archive Show summary

  Background: Qualified systematic reviews (SRs) will form the main basis for evaluating causal effects of nutrients or food groups on health outcomes in the sixth edition of Nordic Nutrition Recommendations to be published in 2022 (NNR2022). Objective: To describe rationale and structure of SRs used in NNR2022. Design: The SR methodologies of the previous edition of NNR were used as a starting point. Methodologies of recent SRs commissioned by leading national food and health authorities or international food and health organizations were examined and scrutinized. Methodologies for developing SRs were agreed by the NNR2022 Committee in a consensus-driven process. Results: Qualified SRs will be developed by a cross-disciplinary group of experts and reported according to the requirements of the EQUATOR network. A number of additional requirements must also be fulfilled, including 1) a clearly stated set of objectives and research questions with pre-defined eligibility criteria for the studies, 2) an explicit, reproducible methodology, 3) a systematic search that attempts to identify all studies that would meet the eligibility criteria, 4) an assessment of the validity of the findings of the included studies through an assessment of ‘risk of bias’ of the studies, 5) a systematic presentation and synthesis of the characteristics and findings of the included studies, and 6) a grading of the overall evidence. The complete definition and requirements of a qualified SR are described. Discussion: Most SRs published in scientific journals do not fulfill all criteria of the qualified SRs in the NNR2022 project. This article discusses the structure and rationale for requirements of qualified SRs in NNR2022. National food and health authorities have only recently begun to use qualified SRs as a basis for nutrition recommendations. Conclusion: Qualified SRs will be used to inform dietary reference values (DRVs) and food-based dietary guidelines (FBDGs) in the NNR2022 project.

• Christensen, Jacob Juel; Arnesen, Erik Kristoffer; Andersen, Rikke; Eneroth, Hanna; Erkkola, Maijaliisa & Høyer, Anne [Show all 13 contributors for this article] (2020). The Nordic Nutrition Recommendations 2022 – Principles and Methodologies. Food & Nutrition Research (FNR). ISSN 1654-6628. 64, p. 1–15. doi: 10.29219/fnr.v64.4402. Full text in Research Archive Show summary

  Background: The Nordic Nutrition Recommendations (NNRs) constitute the scientific basis for national dietary reference values (DRVs) and food-based dietary guidelines (FBDGs) in the Nordic and Baltic countries. Objective: To define principles and methodologies for the sixth edition of NNR to be published in 2022 (NNR2022). Design: The principles and methodologies of the previous edition of NNR were used as a starting point. Recent nutrition recommendations commissioned by other national food and health authorities or international food and health organizations were examined and dissected. Updated principles and methodologies were agreed by the NNR2022 Committee in a consensus-driven process. Results: An organizational model with ‘checks and balances’ was developed to minimize the influence of subjective biases of the committee members and experts. Individual chapters on all included nutrients and food groups will be updated as scoping reviews. Systematic reviews (SRs), which are the main basis for evaluating causal effects of nutrients or food groups on health outcomes, will be embedded in each chapter. A NNR SR Centre will be established for performing de novo SRs on prioritized topics. To avoid duplication and optimize the use of resources, qualified SRs commissioned by other national and international organizations and health authorities will also inform DRVs and FBDGs in NNR2022. Discussion: The evidence-based methods defined in the NNR2022 project are compatible with most contemporary methods used by leading national food and health authorities. Global harmonization of methodological approaches to nutrition recommendations is strongly encouraged. Conclusion: Evidence-informed principles and methodologies underpinned by SRs will ensure that DRVs and FBDGs defined in the NNR2022 project are based on the best available evidence and as far as possible free from overt bias.

• Arnesen, Erik Kristoffer; Christensen, Jacob J.; Andersen, Rikke; Eneroth, Hanna; Erkkola, Maijaliisa & Høyer, Anne [Show all 13 contributors for this article] (2020). The nordic nutrition recommendations 2022 – handbook for qualified systematic reviews. Food & Nutrition Research (FNR). ISSN 1654-6628. 64, p. 1–15. doi: 10.29219/fnr.v64.4404. Full text in Research Archive Show summary

  Background: Systematic reviews (SRs) constitute a major part of the Nordic Nutrition Recommendations (NNRs). The step-by-step procedure used to develop SRs has evolved considerably over time and is often tailored to fit the exposure and outcomes in focus. Objective: To describe a detailed procedure for developing qualified SRs commissioned by the NNR2022 project. Design: Scrutinizing procedures of recent SRs commissioned by leading national food and health authorities or international food and health organizations. Results: The following eight steps must be included when developing qualified SRs for the NNR2022 project: 1) define research question, 2) protocol development, 3) literature search, 4) screening and selection of studies, 5) data extraction, 6) assessing risk of bias, 7) synthesis and grading of total strength of evidence, and 8) reporting according to certain standards. Discussion: This guide is based on the guidelines developed for the fifth edition of NNR but includes some important new domains in order to adhere to more recent, authoritative standards. Conclusion: All qualified SRs in the NNR2022 project will follow the protocol described here.

• Bärebring, Linnea; Kværner, Ane Sørlie; Skotnes, Madeleine; Henriksen, Hege; Skjetne, Anne Juul & Henriksen, Christine [Show all 12 contributors for this article] (2020). Use of bioelectrical impedance analysis to monitor changes in fat-free mass during recovery from colorectal cancer– a validation study. Clinical Nutrition ESPEN. ISSN 2405-4577. 40, p. 201–207. doi: 10.1016/j.clnesp.2020.09.021. Full text in Research Archive Show summary

  Background & aims Although previous research show high correlation between fat-free mass (FFM) measured by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA), the validity of BIA to track longitudinal changes in FFM is uncertain. Thus, the aim of this study was to validate the ability of BIA to assess changes in FFM during 6 months of recovery from non-metastatic colorectal cancer (CRC). Methods A total of 136 women and men (50–80 years) with stage I-III CRC and a wide range of baseline FFM (35.7–73.5 kg) were included in the study. Body composition was measured at study baseline within 2–9 months of surgery and again 6 months later. Whole-body BIA FFM estimates (FFMBIA) were calculated using three different equations (manufacturer's, Schols' and Gray's) before comparison to FFM estimates obtained by DXA (FFMDXA). Results Correlation between changes in FFMBIA and FFMDXA was intermediate regardless of equation (r ≈ 0.6). The difference in change of FFMBIA was significant compared to FFMDXA, using all three equations and BIA overestimated both loss and gain. However, BIA showed 100% sensitivity and about 90% specificity to identify individuals with ≥5% loss in FFM, using all three equations. Sensitivity of FFMBIA to detect a smaller loss of FFM (60–76%) or a gain in FFM of ≥5% (33–62%) was poor. Conclusion In a well-nourished population of non-metastatic CRC patients, a single-frequency whole-body BIA device yielded imprecise data on changes in FFM, regardless of equation. BIA is thus not a valid option for quantifying changes in FFM in individuals. However, BIA could be used to identify patients with loss in FFM ≥5% in this population. The validity of BIA to monitor changes in FFM warrants further investigation before implementation in clinical praxis.

• Bemanian, Mitra; Mæland, Silje; Blomhoff, Rune; Rabben, Åsgeir Kjetland; Arnesen, Erik Kristoffer & Skogen, Jens Christoffer [Show all 7 contributors for this article] (2020). Emotional Eating in Relation to Worries and Psychological Distress Amid the COVID-19 Pandemic: A Population-Based Survey on Adults in Norway. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(1). doi: 10.3390/ijerph18010130. Full text in Research Archive Show summary

  Population-based studies have revealed a high occurrence of self-reported psychological distress symptoms during the early phases of the coronavirus disease 2019 (COVID-19) pandemic. Stress and negative affect can lead to emotional eating, which in turn can have negative outcomes on health. In this population-based study, 24,968 Norwegian inhabitants participated in an electronic questionnaire including structured questions on dietary habits, emotional eating, psychological distress symptoms, and COVID-19-related worries. The study took place during April 2020 after around six weeks of interventions to tackle the first wave of the COVID-19 pandemic. Overall, emotional eating was reported in 54% of the population and was markedly more frequent in female participants. Worries related to consequences of the pandemic were associated with increased emotional eating, and the association was stronger for worries related to personal economy—odds ratios (OR) 1.7 (95% confidence interval (CI95%) 1.5–1.9)—compared to worries related to health—OR 1.3 (CI95% 1.2–1.5). Psychological distress had a strong association with emotional eating—OR 4.2 (CI95% 3.9–4.4). Correspondingly, the intake of high-sugar foods and beverages was higher for those with substantial COVID-19-related worries and those with psychological distress compared to the overall population.

• Kværner, Ane Sørlie; Harnæs, Helene; Alavi, Dena Helene; Bärebring, Linnea; Henriksen, Hege & Guren, Marianne [Show all 11 contributors for this article] (2020). Bør beregning av cellegiftdose ved tarmkreft baseres på kroppssammensetning? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(8), p. 1–10. doi: 10.4045/tidsskr.19.0769. Full text in Research Archive
• Koivisto-Mørk, Anu; Paur, Ingvild; Paulsen, Gøran; Garthe, Ina; Raastad, Truls & Bastani, Nasser Ezzatkhah [Show all 8 contributors for this article] (2020). Dietary Adjustments to Altitude Training in Elite Endurance Athletes; Impact of a Randomized Clinical Trial With Antioxidant-Rich Foods. Frontiers in Sports and Active Living. 2. doi: 10.3389/fspor.2020.00106. Full text in Research Archive Show summary

  Background: Altitude training stresses several physiological and metabolic processes and alters the dietary needs of the athletes. International Olympic Committee (IOC)'s Nutrition Expert Group suggests that athletes should increase intake of energy, carbohydrate, iron, fluid, and antioxidant-rich foods while training at altitude. Objective: We investigated whether athletes adjust their dietary intake according to the IOC's altitude-specific dietary recommendations, and whether an in-between meal intervention with antioxidant-rich foods altered the athletes' dietary composition and nutrition-related blood parameters (mineral, vitamin, carotenoid, and hormone concentrations). Design: The dietary adjustments to altitude training (3 weeks at 2,320 m) were determined for 31 elite endurance athletes (23 ± 5 years, 23 males, 8 females) by six interviewer-administered 24-h dietary recalls on non-consecutive days; three before and during the altitude camp. The additional effect of in -between meal intervention with eucaloric antioxidant-rich or control snacks (1,000 kcal/day) was tested in a randomized controlled trial with parallel design. Results: At altitude the athletes increased their energy intake by 35% (1,430 ± 630 kcal/day, p < 0.001), the provided snacks accounting for 70% of this increase. Carbohydrate intake increased from 6.5 ± 1.8 g/kg body weight (BW) (50 E%) to 9.3 ± 2.1 g/kg BW (53 E%) (p < 0.001), with no difference between the antioxidant and control group. Dietary iron, fluid, and antioxidant-rich food intake increased by 37, 38, and 104%, respectively, in the whole cohort. The intervention group had larger increases in polyunsaturated fatty acids (PUFA), ω3 PUFA (n-3 fatty acids), ω6 PUFA (n-6 fatty acids), fiber, vitamin C, folic acid, and copper intake, while protein intake increased more among the controls, reflecting the nutritional content of the snacks. Changes in the measured blood minerals, vitamins, and hormones were not differentially affected by the intervention except for the carotenoid; zeaxanthin, which increased more in the intervention group (p < 0.001). Conclusions: Experienced elite endurance athletes increased their daily energy, carbohydrate, iron, fluid, and antioxidant-rich food intake during a 3-week training camp at moderate altitude meeting most of the altitude-specific dietary recommendations. The intervention with antioxidant-rich snacks improved the composition of the athletes' diets but had minimal impact on the measured nutrition-related blood parameters.

• Olsen, Thomas & Blomhoff, Rune (2019). Retinol, Retinoic Acid, and Retinol-Binding Protein 4 are Differentially Associated with Cardiovascular Disease, Type 2 Diabetes, and Obesity: An Overview of Human Studies. Advances in Nutrition. ISSN 2161-8313. doi: 10.1093/advances/nmz131. Full text in Research Archive Show summary

  Vitamin A is a fat-soluble essential nutrient obtained from plant- and animal-based sources that has roles in growth, vision, and metabolism. Vitamin A circulates mainly as retinol bound to retinol-binding protein 4 (RBP4), and is delivered to tissues and converted to retinoic acid, which is a ligand for several nuclear receptors. In recent years, aspects of vitamin A metabolism have been under scrutiny with regards to the development of metabolic and lifestyle diseases including cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), and overweight and obesity in humans. Studies have mainly focused on RBP4 in this context, whereas the major circulating form, retinol, and the major bioactive form, retinoic acid, have been overlooked in this regard until recently. As one of the main roles of RBP4 is to deliver retinol to tissues for biological action, the associations of retinol and retinoic acid with these diseases must also be considered. In this review, we summarize and discuss recent and available evidence from human studies with focus on retinol, retinoic acid, and RBP4 and provide an overview of these crucial components of vitamin A metabolism in CVD, T2DM, and obesity. In summary, retinol was found to be both inversely and positively associated with CVD whereas the associations with T2DM and obesity were less clear. Although only a few studies have been published on retinoic acid, it was inversely associated with CVD. In contrast, serum RBP4 was mostly found to be positively associated with CVD, T2DM, and obesity. At present, it is difficult to ascertain why the reported associations differ depending on the compound under study, but there is a clear imbalance in the literature in disfavor of retinol and retinoic acid, which needs to be considered in future human studies.

• Henriksen, Hege Berg; Henriksen, Christine; Ræder, Hanna; Kværner, Ane Sørlie; Skjetne, Anne Juul & Bøhn, Siv Kjølsrud [Show all 11 contributors for this article] (2019). Hvilke kostråd skal man gi til pasienter behandlet for tarmkreft? Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. p. 32–36. Full text in Research Archive
• Koivisto, Anu; Olsen, Thomas; Paur, Ingvild; Paulsen, Gøran; Bastani, Nasser Ezzatkhah & Garthe, Ina [Show all 10 contributors for this article] (2019). Effects of antioxidant-rich foods on altitude-induced oxidative stress and inflammation in elite endurance athletes: A randomized controlled trial. PLOS ONE. 14(6). doi: 10.1371/journal.pone.0217895. Full text in Research Archive Show summary

  Background Various altitude training regimes, systematically used to improve oxygen carrying capacity and sports performance, have been associated with increased oxidative stress and inflammation. We investigated whether increased intake of common antioxidant-rich foods attenuates these processes. Methods In a randomized controlled trial, 31 elite endurance athletes (23 ± 5 years), ingested antioxidant-rich foods (n = 16), (> doubling their usual intake), or eucaloric control foods (n = 15) during a 3-week altitude training camp (2320 m). Fasting blood and urine samples were collected 7 days pre-altitude, after 5 and 18 days at altitude, and 7 days post-altitude. Change over time was compared between the groups using mixed models for antioxidant capacity [uric acid-free (ferric reducing ability of plasma (FRAP)], oxidative stress (8-epi-PGF2α) and inflammatory biomarkers (IFNγ, IL1α, IL1RA, IL1β, IL2, IL5, IL6, IL7, IL10, IL12p70, IL13, IL17, TNFα, MCP-1 and micro-CRP). The cytokine response to a stress-test (VO2max ramp test or 100 m swimming) was assessed at pre- and post-altitude. Results FRAP increased more in the antioxidant compared to the control group (p = 0.034). IL13 decreased in the antioxidant group, while increasing in the controls (p = 0.006). A similar trend was seen for IL6 (p = 0.062). A larger decrease in micro-CRP was detected in the antioxidant group compared to controls (β: -0.62, p = 0.02). We found no group differences for the remaining cytokines. 8-epi-PGF2α increased significantly in the whole population (p = 0.033), regardless group allocation. The stress response was significantly larger post-altitude compared with pre-altitude for IL1β, IL6, IL7, IL13, IL12p70 and TNFα, but we found no group differences. Conclusions Increased intake of antioxidant-rich foods elevated the antioxidant capacity and attenuated some of the altitude-induced systemic inflammatory biomarkers in elite athletes. The antioxidant intervention had no impact on the altitude-induced oxidative stress or changes in acute cytokine responses to exercise stress-tests.

• Olsen, Thomas; Vinknes, Kathrine; Blomhoff, Rune; Lysne, Vegard; Midttun, Øivind & Dhar, Indu [Show all 12 contributors for this article] (2019). Creatinine, total cysteine and uric acid are associated with serum retinol in patients with cardiovascular disease. European Journal of Nutrition. ISSN 1436-6207. doi: 10.1007/s00394-019-02086-2. Full text in Research Archive Show summary

  Purpose: We hypothesized that biomarkers and dietary factors related to cardiovascular disease risk were associated with serum retinol and evaluated these potential associations in patients with suspected coronary artery disease (CAD). Methods: We used cross-sectional data from 4116 patients hospitalised for suspected CAD. Dietary data were obtained from a subgroup of 1962 patients using a food frequency questionnaire. Potential biomarkers and dietary factors were explored using linear regression modelling adjusted for age and sex. Regression coefficients and corresponding confidence intervals (CI) are given as % change in serum retinol per unit change in the predictors. Analyses were performed in the total population and in strata of serum retinol tertiles. Results: In age- and sex-adjusted models, serum creatinine (standardized β: 0.38, 95% CI [0.35, 0.42]), plasma total cysteine (0.26, [0.23, 0.29]), serum uric acid (0.30, [0.26, 0.33]) and plasma neopterin (0.22, [0.18, 0.25]) were positively associated, whereas plasma serine (− 0.15, [− 0.18, − 0.12]) and serum C-reactive protein (− 0.15, [− 0.18, − 0.12]) were inversely associated with serum retinol. When we included the significant biomarkers in a multivariate model, the model explained 33% of the variability (R2 = 0.33) in serum retinol. The results were similar in the lower and upper tertiles of serum retinol. Weak or no associations were observed for dietary factors. Conclusions: In patients with suspected CAD, concentrations of creatinine, cysteine and uric acid were positively associated with serum retinol. Future studies should assess whether retinol concentrations are influenced by metabolic alterations in patients at risk of cardiovascular disease.

• Kværner, Ane Sørlie; Minaguchi, Jun; Yamani, Naouale El; Henriksen, Christine; Ræder, Hanna & Paur, Ingvild [Show all 12 contributors for this article] (2018). DNA damage in blood cells in relation to chemotherapy and nutritional status in colorectal cancer patients — A pilot study. DNA Repair. ISSN 1568-7864. 63, p. 16–24. doi: 10.1016/j.dnarep.2018.01.005. Full text in Research Archive
• Travis, Ruth C; Perez-Cornago, Aurora; Appleby, Paul N; Albanes, Demetrius; Joshu, Corinne E & Lutsey, Pamela [Show all 66 contributors for this article] (2018). A collaborative analysis of individual participant data from 19 prospective studies assesses circulating Vitamin D and prostate cancer risk. Cancer Research. ISSN 0008-5472. 79(1), p. 274–285. doi: 10.1158/0008-5472.CAN-18-2318. Full text in Research Archive Show summary

  Previous prospective studies assessing the relationship between circulating concentrations of vitamin D and prostate cancer risk have shown inconclusive results, particularly for risk of aggressive disease. In this study, we examine the association between prediagnostic concentrations of 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] and the risk of prostate cancer overall and by tumor characteristics. Principal investigators of 19 prospective studies provided individual participant data on circulating 25(OH)D and 1,25(OH)2D for up to 13,462 men with incident prostate cancer and 20,261 control participants. ORs for prostate cancer by study-specific fifths of season-standardized vitamin D concentration were estimated using multivariable-adjusted conditional logistic regression. 25(OH)D concentration was positively associated with risk for total prostate cancer (multivariable-adjusted OR comparing highest vs. lowest study-specific fifth was 1.22; 95% confidence interval, 1.13–1.31; P trend < 0.001). However, this association varied by disease aggressiveness (Pheterogeneity = 0.014); higher circulating 25(OH)D was associated with a higher risk of nonaggressive disease (OR per 80 percentile increase = 1.24, 1.13–1.36) but not with aggressive disease (defined as stage 4, metastases, or prostate cancer death, 0.95, 0.78–1.15). 1,25(OH)2D concentration was not associated with risk for prostate cancer overall or by tumor characteristics. The absence of an association of vitamin D with aggressive disease does not support the hypothesis that vitamin D deficiency increases prostate cancer risk. Rather, the association of high circulating 25(OH)D concentration with a higher risk of nonaggressive prostate cancer may be influenced by detection bias.

• Ræder, Hanna; Henriksen, Christine; Bøhn, Siv Kjølsrud; Vilbo, Anne-Rikke; Henriksen, Hege & Kværner, Ane Sørlie [Show all 10 contributors for this article] (2018). Agreement between PG-SGA category and fat-free mass in colorectal cancer patients. Clinical Nutrition ESPEN. ISSN 2405-4577. 27, p. 24–31. doi: 10.1016/j.clnesp.2018.07.005. Full text in Research Archive Show summary

  Background and aims Low fat-free mass (FFM) is associated with adverse outcomes in colorectal cancer (CRC) patients. Patient-Generated Subjective Global Assessment (PG-SGA) is a widely used tool developed to detect patients with malnutrition or at risk of malnutrition. The aim of this study was to investigate the agreement between PG-SGA category and FFM in patients with non-metastatic CRC. Methods Ninety-seven patients were included and categorized as well nourished (PG-SGA:A, n = 67) or malnourished (PG-SGA:B, n = 30). No patients were severely malnourished (PG-SGA: C). Bioelectrical impedance analysis (BIA) was used to assess FFM. Low FFM was defined as low fat-free mass index (FFMI) according to cut-off values recently proposed by The European Society for Clinical Nutrition and Metabolism (ESPEN). Results Twenty-nine percent of the patients were identified with low FFMI. The proportion with low FFMI was significantly higher among patients classified as malnourished by PG-SGA compared to well nourished (p = 0.015). The sensitivity was however low, as the PG-SGA categorization classified only 50.0% of the patients with low FFMI as malnourished (PG-SGA B). Using the PG-SGA scores (cut-off point > 4), the sensitivity increased to 60.7%. Physical examination in the PG-SGA identified only 64.3% of the patients with low FFMI as muscle depleted. Conclusion Our results indicate a low agreement between PG-SGA category and low FFMI among patients with non-metastatic CRC. In clinical practice, PG-SGA should be supplemented by muscle mass assessments by BIA or other methods in order to detect low FFM in this patient group.

• Henriksen, Hege; Berntsen, Sveinung; Paur, Ingvild; Zucknick, Manuela; Skjetne, Anne Juul & Bøhn, Siv Kjølsrud [Show all 10 contributors for this article] (2018). Validation of two short questionnaires assessing physical activity in colorectal cancer patients. BMC sports science, medicine and rehabilitation. 10:8(8), p. 1–12. doi: 10.1186/s13102-018-0096-2. Full text in Research Archive Show summary

  Background In order to investigate the impact of adherence to recommendations of physical activity and sedentary time on health outcomes in clinical trials, there is a need for feasible tools such as questionnaires that can give representative estimates of these measures. The primary aim of the present study was to validate two such questionnaires and their ability to estimate adherence to the recommendations of physical activity defined as moderate-to- vigorous physical activity or moderate physical activity of at least 150 min/week in colorectal cancer patients. Secondarily, self-reported sedentary time from the HUNT-PAQ was also evaluated. Methods Participants from 'The Norwegian dietary guidelines and colorectal cancer survival-study’ (CRC-NORDIET study) completed two short questionnaires; the NORDIET-FFQ (n = 78) and the HUNT-PAQ (n = 77). The physical activity monitor SenseWear Armband Mini was used as the reference method during seven consecutive days. Results The NORDIET-FFQ provided better estimates of time in moderate-to- vigorous physical activity and moderate physical activity than the HUNT-PAQ. The NORDIET-FFQ was unable to rank individual time in moderate-to- vigorous physical activity and moderate physical activity (Spearman’s rho = 0.08, p = 0.509 and Spearman’s rho rho = 0.01, p = 0.402, respectively). All intensities were under-reported by the HUNT-PAQ, but ranking of individual time in moderate physical activity and sedentary time were acceptable among women only (Spearman’s rho = 0.37, p = 0.027 and Spearman’s rho = 0.36, p = 0.035, respectively). The HUNT-PAQ correctly classified 71% of those not meeting the recommendations (sensitivity), and the NORDIET-FFQ correctly classified 63% of those who met the recommendations (specificity). About 67% and 33% reported to meet the recommendation of moderate-to- vigorous physical activity with the NORDIET-FFQ and HUNT-PAQ, respectively, whereas 55% actually met the moderate-to- vigorous physical activity according to the SenseWear Armband Mini. Conclusions The NORDIET-FFQ provided better specificity and better estimates of PA than the HUNT-PAQ. The HUNT-PAQ provided better sensitivity, and provided better ranking of PA and sedentary time among women than NORDIET-FFQ. It is important to be aware of the limitations documented in the present study. Trial registration The study is registered on the National Institutes of Health Clinical Trials (Identifier: NCT01570010). Registered 4 April 2012.

• Koivisto, Anu; Paulsen, Gøran; Paur, Ingvild; Garthe, Ina; Tønnessen, Espen & Raastad, Truls [Show all 10 contributors for this article] (2018). Antioxidant-rich foods and response to altitude training: A randomized controlled trial in elite endurance athletes. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 28(9), p. 1982–1995. doi: 10.1111/sms.13212. Full text in Research Archive Show summary

  High doses of isolated antioxidant supplements such as vitamin C and E have demonstrated the potential to blunt cellular adaptations to training. It is, however, unknown whether intake of high doses of antioxidants from foods has similar effects. Hence, the aim of the study was to investigate whether intake of antioxidant‐rich foods affects adaptations to altitude training in elite athletes. In a randomized controlled trial, 31 national team endurance athletes (23 ± 5 years) ingested antioxidant‐rich foods (n = 16) or eucaloric control foods (n = 15) daily during a 3‐week altitude training camp (2320 m). Changes from baseline to post‐altitude in hemoglobin mass (Hbmass; optimized CO rebreathing), maximal oxygen uptake (VO2max; n = 16) or 100 m swimming performance (n = 10), and blood parameters were compared between the groups. The antioxidant group significantly increased total intake of antioxidant‐rich foods (~118%) compared to the control group during the intervention. The total study population improved VO2max by 2.5% (1.7 mL/kg/min, P = .006) and Hbmass by 4.7% (48 g, P < .001), but not 100 m swimming performance. No difference was found between the groups regarding changes in Hbmass, VO2max or swimming performance. However, hemoglobin concentration increased more in the antioxidant group (effect size = 0.7; P = .045) with a concomitantly larger decrease in plasma and blood volumes compared to control group. Changes in ferritin and erythropoietin from pre‐ to post‐altitude did not differ between the groups. Doubling the intake of antioxidant‐rich foods was well tolerated and did not negatively influence the adaptive response to altitude training in elite endurance athletes.

• Henriksen, Hege; Carlsen, Monica Hauger; Paur, Ingvild; Berntsen, Sveinung; Bøhn, Siv Kjølsrud & Skjetne, Anne Juul [Show all 11 contributors for this article] (2018). Relative validity of a short food frequency questionnaire assessing adherence to the Norwegian dietary guidelines among colorectal cancer patients. Food & Nutrition Research (FNR). ISSN 1654-6628. 62:1306, p. 1–15. doi: 10.29219/fnr.v62.1306. Full text in Research Archive
• Olsen, Thomas; Vinknes, Kathrine; Svingen, Gard Frodahl Tveitevåg; Pedersen, Eva Ringdal; Dhar, Indu & Tell, Grethe S. [Show all 11 contributors for this article] (2018). The risk association of plasma total homocysteine with acute myocardial infarction is modified by serum vitamin A. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 25(15), p. 1612–1620. doi: 10.1177/2047487318788587. Full text in Research Archive Show summary

  Background. Plasma total homocysteine (tHcy) has been implicated in the development of cardiovascular disease, but the mechanisms remain unclear. Vitamin A (Vit-A) is involved in homocysteine metabolism and we therefore explored the potential interaction between plasma tHcy and serum Vit-A in relation to incident acute myocardial infarction. Methods. Cox proportional hazards models were used to assess the prospective relationships between tHcy and acute myocardial infarction in 2205 patients from Western Norway undergoing elective coronary angiography for suspected stable angina pectoris. Results are reported as hazard ratio per standard deviation increase in log-transformed tHcy. An interaction term for tHcy × Vit-A was added to multivariate models including age, sex, smoking, apolipoprotein B fasting, statin and aspirin prescription and estimated glomerular filtration rate.  Results. Geometric mean (geometric standard deviation) age of the participants (64.3% men) was 62.3 (1.24) years. Plasma tHcy was higher among participants in the upper versus lower Vit-A tertile. During 7 (2.4) years of follow-up, 15.1% suffered an AMI. A significant association of plasma tHcy with AMI in the total study population was observed. When we stratified the population according to Vit-A tertiles, plasma tHcy was associated with acute myocardial infarction only in the upper Vit-A tertile (hazard ratio per SD: 1.25, 95% confidence interval: 1.04–1.53, pinteraction = 0.03). Conclusions. The risk relationship between plasma tHcy and acute myocardial infarction was modified by serum concentrations of Vit-A in patients with suspected stable angina pectoris. This finding may clarify the relationship between tHcy and cardiovascular disease.

• Holm, Maia Blomhoff; Kristiansen, Oddrun; Holme, Ane Moe; Bastani, Nasser Ezzatkhah; Horne, Hildegunn & Blomhoff, Rune [Show all 9 contributors for this article] (2018). Placental release of taurine to both the maternal and fetal circulations in human term pregnancies. Amino Acids. ISSN 0939-4451. 50(9), p. 1205–1214. doi: 10.1007/s00726-018-2576-9. Full text in Research Archive Show summary

  Taurine is regarded as an essential amino acid in utero, and fetal taurine supply is believed to rely solely on placental transfer from maternal plasma. Despite its potential role in intrauterine growth restriction and other developmental disturbances, human in vivo studies of taurine transfer between the maternal, placental, and fetal compartments are scarce. We studied placental transfer of taurine in uncomplicated human term pregnancies in vivo in a cross-sectional study of 179 mother-fetus pairs. During cesarean section, we obtained placental tissue and plasma from incoming and outgoing vessels on the maternal and fetal sides of the placenta. Taurine was measured by liquid chromatography–tandem mass spectrometry. We calculated paired arteriovenous differences, and measured placental expression of the taurine biosynthetic enzyme cysteine sulfinic acid decarboxylase (CSAD) with quantitative real-time polymerase chain reaction and western blot. We observed a fetal uptake (p < 0.001), an uteroplacental release (p < 0.001), and a negative placental consumption of taurine (p = 0.001), demonstrating a bilateral placental release to the maternal and fetal compartments. Increasing umbilical vein concentrations and fetal uptake was associated with the uteroplacental release to the maternal circulation (rs = − 0.19, p = 0.01/rs = − 0.24, p = 0.003), but not with taurine concentrations in placental tissue. CSAD-mRNA was expressed in placental tissue, suggesting a potential for placental taurine synthesis. Our observations show that the placenta has the capacity to a bilateral taurine release, indicating a fundamental role of taurine in the human placental homeostasis beyond the supply to the fetus.

• Olsen, Thomas; Vinknes, Kathrine; Svingen, Gard Frodahl Tveitevåg; Pedersen, Eva Ringdal; Tell, Grethe S. & Blomhoff, Rune [Show all 11 contributors for this article] (2017). Cardiovascular disease risk associated with serum apolipoprotein B is modified by serum vitamin A. Atherosclerosis. ISSN 0021-9150. p. 325–330. doi: 10.1016/j.atherosclerosis.2017.07.020. Full text in Research Archive
• Henriksen, Christine; Gjelstad, Ingrid Merethe Fange; Nilssen, Hugo & Blomhoff, Rune (2017). A low proportion of malnourished patients receive nutrition treatment - results from nutritionDay. Food & Nutrition Research (FNR). ISSN 1654-6628. 61:1391667, p. 1–9. doi: 10.1080/16546628.2017.1391667. Full text in Research Archive Show summary

  NutritionDay is a yearly point-prevalence study of malnutrition in hospitals from more than 50 countries. The aim of the present study was to quantify the frequency of malnutrition and the proportion of malnourished patients receiving nutritional treatment in two university hospitals in Norway using data from nutritionDay. All units at Oslo University Hospital (OUH) and University Hospital of Northern Norway (UNN) were invited to participate in nutritionDay 2014, and 28 out of 85 eligible units agreed to take part. Malnutrition was diagnosed based on body mass index (BMI), weight reduction and food intake in the previous week, according to national guidelines and ESPEN criteria. Data from 488 patients were available, representing 90.1% of occupied beds in participating units. Thirty percent of the patients were diagnosed malnourished when national criteria were used, and only 41% of these patients received nutritional treatment. The estimated malnutrition rate was 11% when the ESPEN consensus criteria were used. Data on weight or height were frequently missing in the patient records, and BMI could only be calculated in two-thirds of the patients. The frequency of low BMI (<18.5 kg/m 2 ) was only 5%. Involuntary weight loss was present in 37% of the patients, and 60% had eaten less than normal in the previous week. Oncology units had the highest frequency of patients with low BMI, and the highest weight loss and overall malnutrition rate. Surgery and geriatric units had the highest rate of patients with low food intake. In this study, nearly 60% of the malnourished patients did not receive any nutritional treatment, and this indicates a potential for improved nutritional care and cost savings. Low food intake and weight loss were frequent at these two Norwegian hospitals, and in line with previous reports from nutritionDay in other countries.

• Mezaki, Yoshihiro; Nagatsuma, Keisuke; Yokoyama, Hiroshi; Park, Joon Hyuk; Nakamura, Mariko & Masaki, Takahiro [Show all 9 contributors for this article] (2017). Biochemical and histochemical analyses of lecithin:retinol acyltransferase from polar bear (Ursus maritimus) livers. Polar Biology. ISSN 0722-4060. p. 1–11. doi: 10.1007/s00300-017-2241-x. Full text in Research Archive
• Holm, Maia Blomhoff; Bastani, Nasser Ezzatkhah; Holme, Ane Moe; Zucknick, Manuela; Jansson, Thomas & Refsum, Helga [Show all 10 contributors for this article] (2017). Uptake and release of amino acids in the fetal-placental unit in human pregnancies. PLOS ONE. 12(10). doi: 10.1371/journal.pone.0185760. Full text in Research Archive Show summary

  Objectives: The current concepts of human fetal-placental amino acid exchange and metabolism are mainly based on animal-, in vitro- and ex vivo models. We aimed to determine and assess the paired relationships between concentrations and arteriovenous differences of 19 amino acids on the maternal and fetal sides of the human placenta in a large study sample. Methods: This cross-sectional in vivo study included 179 healthy women with uncomplicated term pregnancies. During planned cesarean section, we sampled blood from incoming and outgoing vessels on the maternal (radial artery and uterine vein) and fetal (umbilical vein and artery) sides of the placenta. Amino acid concentrations were measured by liquid chromatography—tandem mass spectrometry. We calculated paired arteriovenous differences and performed Wilcoxon signed-rank tests and Spearman’s correlations. Results: In the umbilical circulation, we observed a positive venoarterial difference (fetal uptake) for 14 amino acids and a negative venoarterial difference (fetal release) for glutamic acid (p<0.001). In the maternal circulation, we observed a positive arteriovenous difference (uteroplacental uptake) for leucine (p = 0.005), isoleucine (p = 0.01), glutamic acid (p<0.001) and arginine (p = 0.04) and a negative arteriovenous difference (uteroplacental release) for tyrosine (p = 0.002), glycine (p = 0.01) and glutamine (p = 0.02). The concentrations in the maternal artery and umbilical vein were correlated for all amino acids except tryptophan, but we observed no correlations between the uteroplacental uptake and the fetal uptake or the umbilical vein concentration. Two amino acids showed a correlation between the maternal artery concentration and the fetal uptake. Conclusions: Our human in vivo study expands the current insight into fetal-placental amino acid exchange, and discloses some differences from what has been previously described in animals. Our findings are consistent with the concept that the fetal supply of amino acids in the human is the result of a dynamic interplay between fetal and placental amino acid metabolism and interconversions.

• Ræder, Hanna; Kværner, Ane Sørlie; Henriksen, Christine; Florholmen, Geir; Henriksen, Hege & Bøhn, Siv Kjølsrud [Show all 9 contributors for this article] (2017). Validity of bioelectrical impedance analysis in estimation of fat-free mass in colorectal cancer patients. Clinical Nutrition. ISSN 0261-5614. 37(1), p. 292–300. doi: 10.1016/j.clnu.2016.12.028. Full text in Research Archive Show summary

  Background & aims: Bioelectrical impedance analysis (BIA) is an accessible and cheap method to measure fat-free mass (FFM). However, BIA estimates are subject to uncertainty in patient populations with altered body composition and hydration. The aim of the current study was to validate a whole-body and a segmental BIA device against dual-energy X-ray absorptiometry (DXA) in colorectal cancer (CRC) patients, and to investigate the ability of different empiric equations for BIA to predict DXA FFM (FFMDXA). Methods: Forty-three non-metastatic CRC patients (aged 50–80 years) were enrolled in this study. Whole-body and segmental BIA FFM estimates (FFMwhole-bodyBIA, FFMsegmentalBIA) were calculated using 14 empiric equations, including the equations from the manufacturers, before comparison to FFMDXA estimates. Results: Strong linear relationships were observed between FFMBIA and FFMDXA estimates for all equations (R2 = 0.94–0.98 for both devices). However, there were large discrepancies in FFM estimates depending on the equations used with mean differences in the ranges −6.5–6.8 kg and −11.0–3.4 kg for whole-body and segmental BIA, respectively. For whole-body BIA, 77% of BIA derived FFM estimates were significantly different from FFMDXA, whereas for segmental BIA, 85% were significantly different. For whole-body BIA, the Schols* equation gave the highest agreement with FFMDXA with mean difference ±SD of −0.16 ± 1.94 kg (p = 0.582). The manufacturer's equation gave a small overestimation of FFM with 1.46 ± 2.16 kg (p < 0.001) with a tendency towards proportional bias (r = 0.28, p = 0.066). For segmental BIA, the Heitmann* equation gave the highest agreement with FFMDXA (0.17 ± 1.83 kg (p = 0.546)). Using the manufacturer's equation, no difference in FFM estimates was observed (−0.34 ± 2.06 kg (p = 0.292)), however, a clear proportional bias was detected (r = 0.69, p < 0.001). Both devices demonstrated acceptable ability to detect low FFM compared to DXA using the optimal equation. Conclusion: In a population of non-metastatic CRC patients, mostly consisting of Caucasian adults and with a wide range of body composition measures, both the whole-body BIA and segmental BIA device provide FFM estimates that are comparable to FFMDXA on a group level when the appropriate equations are applied. At the individual level (i.e. in clinical practice) BIA may be a valuable tool to identify patients with low FFM as part of a malnutrition diagnosis.

• Henriksen, Hege; Ræder, Hanna; Bøhn, Siv Kjølsrud; Paur, Ingvild; Kværner, Ane Sørlie & Billington, Siv Åshild [Show all 14 contributors for this article] (2017). The Norwegian dietary guidelines and colorectal cancer survival (CRC-NORDIET) study: A food-based multicentre randomized controlled trial. BMC Cancer. 17(1). doi: 10.1186/s12885-017-3072-4. Full text in Research Archive Show summary

  Background Colorectal cancer survivors are not only at risk for recurrent disease but also at increased risk of comorbidities such as other cancers, cardiovascular disease, diabetes, hypertension and functional decline. In this trial, we aim at investigating whether a diet in accordance with the Norwegian food-based dietary guidelines and focusing at dampening inflammation and oxidative stress will improve long-term disease outcomes and survival in colorectal cancer patients. Methods/design This paper presents the study protocol of the Norwegian Dietary Guidelines and Colorectal Cancer Survival study. Men and women aged 50–80 years diagnosed with primary invasive colorectal cancer (Stage I-III) are invited to this randomized controlled, parallel two-arm trial 2–9 months after curative surgery. The intervention group (n = 250) receives an intensive dietary intervention lasting for 12 months and a subsequent maintenance intervention for 14 years. The control group (n = 250) receives no dietary intervention other than standard clinical care. Both groups are offered equal general advice of physical activity. Patients are followed-up at 6 months and 1, 3, 5, 7, 10 and 15 years after baseline. The study center is located at the Department of Nutrition, University of Oslo, and patients are recruited from two hospitals within the South-Eastern Norway Regional Health Authority. Primary outcomes are disease-free survival and overall survival. Secondary outcomes are time to recurrence, cardiovascular disease-free survival, compliance to the dietary recommendations and the effects of the intervention on new comorbidities, intermediate biomarkers, nutrition status, physical activity, physical function and quality of life. Discussion The current study is designed to gain a better understanding of the role of a healthy diet aimed at dampening inflammation and oxidative stress on long-term disease outcomes and survival in colorectal cancer patients. Since previous research on the role of diet for colorectal cancer survivors is limited, the study may be of great importance for this cancer population. Trial registration ClinicalTrials.gov Identifier: NCT01570010 .

• Paur, Ingvild; Lilleby, Wolfgang; Bøhn, Siv Kjølsrud; Hulander, Erik; Klein, Willibrord & Vlatkovic, Ljiljana [Show all 19 contributors for this article] (2016). Tomato-based randomized controlled trial in prostate cancer patients: Effect on PSA. Clinical Nutrition. ISSN 0261-5614. 36(3), p. 672–679. doi: 10.1016/j.clnu.2016.06.014. Full text in Research Archive Show summary

  Background & aims: The effect of lycopene-containing foods in prostate cancer development remains undetermined. We tested whether a lycopene-rich tomato intervention could reduce the levels of prostate specific antigen (PSA) in prostate cancer patients. Methods: Prior to their curative treatment, 79 patients with prostate cancer were randomized to a nutritional intervention with either 1) tomato products containing 30 mg lycopene per day; 2) tomato products plus selenium, omega-3 fatty acids, soy isoflavones, grape/pomegranate juice, and green/black tea (tomato-plus); or 3) control diet for 3 weeks. Results: The main analysis, which included patients in all risk categories, did not reveal differences in changes of PSA-values between the intervention and control groups. Post-hoc, exploratory analyses within intermediate risk (n = 41) patients based on tumor classification and Gleason score post-surgery, revealed that median PSA decreased significantly in the tomato group as compared to controls (−2.9% and +6.5% respectively, p = 0.016). In separate post-hoc analyses, we observed that median PSA-values decreased by 1% in patients with the highest increases in plasma lycopene, selenium and C20:5 n-3 fatty acid, compared to an 8.5% increase in the patients with the lowest increase in lycopene, selenium and C20:5 n-3 fatty acid (p = 0.003). Also, PSA decreased in patients with the highest increase in lycopene alone (p = 0.009). Conclusions: Three week nutritional interventions with tomato-products alone or in combination with selenium and n-3 fatty acids lower PSA in patients with non-metastatic prostate cancer. Our observation suggests that the effect may depend on both aggressiveness of the disease and the blood levels of lycopene, selenium and omega-3 fatty acids.

• Kolberg, Marit; Pedersen, Sigrid; Mitake, Maiko; Holm, Kristine Lillebø; Bøhn, Siv Kjølsrud & Blomhoff, Heidi Kiil [Show all 9 contributors for this article] (2016). Coffee inhibits nuclear factor-kappa B in prostate cancer cells and xenografts. Journal of Nutritional Biochemistry. ISSN 0955-2863. 27, p. 153–163. doi: 10.1016/j.jnutbio.2015.08.028. Full text in Research Archive
• Stea, Tonje Holte; Berntsen, Solvor; Berntsen, Sveinung; Bastani, Nasser Ezzatkhah; Paulsen, Gøran & Seiler, Hilde Lohne [Show all 9 contributors for this article] (2016). Effect of Omega-3 and Vitamins e + C Supplements on the Concentration of Serum B-Vitamins and Plasma Redox Aminothiol Antioxidant Status in Elderly Men after Strength Training for Three Months. Annals of Nutrition and Metabolism. ISSN 0250-6807. 68(2), p. 145–155. doi: 10.1159/000443847. Full text in Research Archive
• Meyer, Haakon E; Støer, Nathalie; Samuelsen, Sven Ove; Blomhoff, Rune; Robsahm, Trude Eid & Brustad, Magritt [Show all 8 contributors for this article] (2016). Long Term Association between Serum 25-Hydroxyvitamin D and Mortality in a Cohort of 4379 Men. PLOS ONE. 11(3). doi: 10.1371/journal.pone.0151441. Full text in Research Archive Show summary

  Objective A number of observational studies have shown an inverse association between circulating 25-hydroxyvitamin D and total mortality, but a reverse J-shaped association has also been reported. In a large nested case-control study, serum-25-hydroxyvitamin D (s-25(OH)D) was positively associated with incident prostate cancer. Based on the same study population, the primary aim of the present study was to investigate the association between s-25 (OH)D and total mortality. Methods Men participating in population based health screenings during 1981–1991 and enrolled in a nested case-control study were followed throughout 2007 with respect to all-cause and cause-specific mortality. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox proportional hazards regression. Results In men with prostate cancer (n = 2282), there was a significant inverse association between s-25(OH)D and total mortality after controlling for potential confounders (HR = 1.25 (95% CI 1.05–1.50), s-25(OH)D < 50 nmol/l versus s-25(OH)D > 50 nmol/l). The corresponding figure among controls (n = 2147) was HR = 1.15 (95% CI 0.88–1.50) and in the total study.population HR = 1.19 (95% CI 1.03–1.38). For cause-specific deaths, we found no significant associations. Conclusions In this study population, s-25(OH)D was inversely associated with total mortality during more than two decades of follow-up, despite, as previous reported, high s-25(OH)D was associated with increased risk of prostate cancer.

• Russnes, Kjell Magne; Möller, Elisabeth; Wilson, Kathryn M.; Carlsen, Monica Hauger; Blomhoff, Rune & Smeland, Sigbjørn [Show all 10 contributors for this article] (2016). Total antioxidant intake and prostate cancer in the Cancer of the Prostate in Sweden (CAPS) study. A case control study. BMC Cancer. 16:438, p. 1–12. doi: 10.1186/s12885-016-2486-8. Full text in Research Archive Show summary

  Background The total intake of dietary antioxidants may reduce prostate cancer risk but available data are sparse and the possible role of supplements unclear. We investigated the potential association between total and dietary antioxidant intake and prostate cancer in a Swedish population. Methods We used FFQ data from 1499 cases and 1112 controls in the population based case–control study Cancer of the Prostate in Sweden (CAPS). The ferric reducing antioxidant potential (FRAP) assay was used to assess the total antioxidant capacity (TAC) of diet and supplements. We calculated odds ratios (ORs) for the risk of prostate cancer across quintiles of antioxidant intake from all foods, from fruit and vegetables only, and from dietary supplements using unconditional logistic regression. Results Coffee comprised 62 % of the dietary antioxidant intake, tea 4 %, berries 4 %, chocolate 2 %, and boiled potatoes 2 %. In total 19 % and 13 % of the population took multivitamins and supplemental Vitamin C respectively, on a regular basis. Antioxidant intake from all foods and from fruits and vegetables separately measured by the FRAP assay was not associated with prostate cancer risk. For antioxidant intake from supplements we found a positive association with total, advanced, localized, high grade and low grade prostate cancer in those above median supplemental TAC intake of users compared to non-users (Adjusted ORs for total prostate cancer: 1.37, 95 % CI 1.08–1.73, advanced: 1.51, 95 % CI 1.11–2.06, localized: 1.36. 95 % CI 1.06–1.76, high grade 1.60, 95 % CI 1.06–2.40, low grade 1.36, 95 % CI 1.03–1.81). A high intake of coffee (≥6 cups/day) was associated with a possible risk reduction of fatal and significantly with reduced risk for high grade prostate cancer, adjusted OR: 0.45 (95 % CI: 0.22–0.90), whereas a high intake of chocolate was positively associated with risk of total, advanced, localized and low grade disease (adjusted OR for total: 1.43, 95 % CI 1.12–1.82, advanced: 1.40, 95 % CI 1.01–1.96, localized: 1.43, 95 % CI 1.08–1.88, low-grade: 1.41, 95 % CI 1.03–1.93). Conclusions Total antioxidant intake from diet was not associated with prostate cancer risk. Supplement use may be associated with greater risk of disease.

• Finnes, Trine Elisabeth; Lofthus, Cathrine Marie; Meyer, Haakon E; Søgaard, Anne-Johanne; Tell, Grethe Seppola & Apalset, Ellen M [Show all 12 contributors for this article] (2016). A combination of low serum concentrations of vitamins K1 and D is associated with increased risk of hip fractures in elderly Norwegians: a NOREPOS study. Osteoporosis International. ISSN 0937-941X. 27(4), p. 1645–1652. doi: 10.1007/s00198-015-3435-0. Full text in Research Archive
• Tjelle, Torunn Elisabeth; Holtung, Linda; Bøhn, Siv Kjølsrud; Aaby, Kjersti; Thoresen, Magne & Wiik, Siv Åshild [Show all 11 contributors for this article] (2015). Polyphenol-rich juices reduce blood pressure measures in a randomised controlled trial in high normal and hypertensive volunteers. British Journal of Nutrition. ISSN 0007-1145. 114(7), p. 1054–1063. doi: 10.1017/S0007114515000562. Full text in Research Archive Show summary

  Intake of fruits and berries may lower blood pressure (BP), most probably due to the high content of polyphenols. In the present study, we tested whether consumption of two polyphenol-rich juices could lower BP. In a randomised, double-blinded, placebo-controlled trial of 12 weeks, 134 healthy individuals, aged 50–70 years, with high normal range BP (130/85–139/89 mmHg, seventy-two subjects) or stage 1-2 hypertension (140/90–179/109 mmHg, sixty-two subjects), were included. They consumed 500 ml/d of one of either (1) a commercially available polyphenol-rich juice based on red grapes, cherries, chokeberries and bilberries; (2) a juice similar to (1) but enriched With polyphenol-rich extracts from blackcurrant press-residue or (3) a placebo juice (polyphenol contents 245·5, 305·2 and 76 mg/100 g, respectively). Resting BP was measured three times, with a 1 min interval, at baseline and after 6 and 12 weeks of intervention. Systolic BP significantly reduced over time (6 and 12 weeks, respectively) in the pooled juice group compared with the placebo group in the first of the three measurements, both for the whole study group (6·9 and 3·4 mmHg; P¼0·01) and even more pronounced in the hypertensive subjects when analysed separately (7·3 and 6·8 mmHg; P¼0·04). The variation in the BP measurements was significantly reduced in the pooled juice group compared with the placebo group (1·4 and 1·7 mmHg; P¼0·03). In conclusion, the present findings suggest that polyphenol-rich berry juice may contribute to a BP- and BP variability lowering effect, being more pronounced in hypertensive than in normotensive subjects.

• Bjørnsen, Thomas; Salvesen, Svein; Berntsen, Sveinung; Hetlelid, Ken Joar; Stea, Tonje Holte & Seiler, Hilde Lohne [Show all 17 contributors for this article] (2015). Vitamin C and E supplementation blunts increases in total lean body mass in elderly men after strength training. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 26(7), p. 755–755. doi: 10.1111/sms.12506. Full text in Research Archive Show summary

  The aim of this study was to investigate the effects of vitamin C and E supplementation on changes in muscle mass (lean mass and muscle thickness) and strength during 12 weeks of strength training in elderly men. Thirty-four elderly males (60–81 years) were randomized to either an antioxidant group (500 mg of vitamin C and 117.5 mg vitamin E before and after training) or a placebo group following the same strength training program (three sessions per week). Body composition was assessed with dual-energy X-ray absorptiometry and muscle thickness by ultrasound imaging. Muscle strength was measured as one-repetition maximum (1RM). Total lean mass increased by 3.9% (95% confidence intervals: 3.0, 5.2) and 1.4% (0, 5.4) in the placebo and antioxidant groups, respectively, revealing larger gains in the placebo group (P = 0.04). Similarly, the thickness of m. rectus femoris increased more in the placebo group [16.2% (12.8, 24.1)] than in the antioxidant group [10.9% (9.8, 13.5); P = 0.01]. Increases of lean mass in trunk and arms, and muscle thickness of elbow flexors, did not differ significantly between groups. With no group differences, 1RM improved in the range of 15–21% (P < 0.001). In conclusion, high-dosage vitamin C and E supplementation blunted certain muscular adaptations to strength training in elderly men.

• Kolberg, Marit; Pedersen, Sigrid; Bastani, Nasser Ezzatkhah; Carlsen, Harald; Blomhoff, Rune & Paur, Ingvild (2015). Tomato Paste Alters NF-κB and Cancer-Related mRNA Expression in Prostate Cancer Cells, Xenografts, and Xenograft Microenvironment. Nutrition and Cancer. ISSN 0163-5581. 67(2), p. 305–315. doi: 10.1080/01635581.2015.990575. Full text in Research Archive
• Iversen, Per Ole; Ha, Lisa Ah Fung; Blomhoff, Rune; Hauge, Truls & Veierød, Marit Bragelien (2015). Baseline oxidative defense and survival after 5-7 years among elderly stroke patients at nutritional risk: Follow-up of a randomized, nutritional intervention trial. Clinical Nutrition. ISSN 0261-5614. 34(4), p. 775–778. doi: 10.1016/j.clnu.2014.07.002. Full text in Research Archive
• Indrevær, Randi Larsen; Moskaug, Jan Øivind; Paur, Ingvild; Bøhn, Siv Kjølsrud; Jørgensen, Silje Fjellgård & Blomhoff, Rune [Show all 9 contributors for this article] (2015). IRF4 is a critical gene in retinoic acid-mediated plasma cell formation and is deregulated in common variable immunodeficiency-derived B cells. Journal of Immunology. ISSN 0022-1767. 195(6), p. 2601–2611. doi: 10.4049/jimmunol.1500250. Full text in Research Archive
• Cabo, Rona; Hernes, Sigrunn; Slettan, Audun; Haugen, Margaretha; Ye, Shu & Blomhoff, Rune [Show all 7 contributors for this article] (2015). Effect of genetic polymorphisms involved in folate metabolism on the concentration of serum folate and plasma total homocysteine (p-tHcy) in healthy subjects after short-term folic acid supplementation: a randomized, double blind, crossover study. Genes & Nutrition. ISSN 1555-8932. 10. doi: 10.1007/s12263-015-0456-4. Full text in Research Archive
• Svendsen, Mette; Tonstad, Serena; Heggen, Eli; Pedersen, Terje Rolf; Seljeflot, Ingebjørg & Bøhn, Siv Kjølsrud [Show all 10 contributors for this article] (2015). The effect of kiwifruit consumption on blood pressure in subjects with moderately elevated blood pressure: A randomized, controlled study. Blood Pressure. ISSN 0803-7051. 24(1), p. 48–54. doi: 10.3109/08037051.2014.976979. Full text in Research Archive
• Holvik, Kristin; Ahmed, Luai Awad; Forsmo, Siri; Gjesdal, Clara Gram; Grimnes, Guri & Samuelsen, Sven Ove [Show all 10 contributors for this article] (2015). No increase in risk of hip fracture at high serum retinol concentrations in community-dwelling older Norwegians: the Norwegian Epidemiologic Osteoporosis Studies. American Journal of Clinical Nutrition. ISSN 0002-9165. 102(5), p. 1289–1296. doi: 10.3945/ajcn.115.110528. Full text in Research Archive
• Cabo, Rona; Hernes, Sigrunn; Slettan, Audun; Haugen, Margaretha; Ye, Shu & Blomhoff, Rune [Show all 7 contributors for this article] (2015). Effects of polymorphisms in endothelial nitric oxide synthase and folate metabolizing genes on the concentration of serum nitrate, folate, and plasma total homocysteine after folic acid supplementation: A double-blind crossover study. Nutrition - The International Journal of Applied and Basic Nutritional Sciences. ISSN 0899-9007. 31(2), p. 337–344. doi: 10.1016/j.nut.2014.08.009. Full text in Research Archive
• Sakhi, Amrit Kaur; Bastani, Nasser Ezzatkhah; Ellingjord-Dale, Merete; Gundersen, Thomas Erik; Blomhoff, Rune & Ursin, Giske (2015). Feasibility of self-sampled dried blood spot and saliva samples sent by mail in a population-based study. BMC Cancer. 15(1). doi: 10.1186/s12885-015-1275-0. Full text in Research Archive Show summary

  Background In large epidemiological studies it is often challenging to obtain biological samples. Self-sampling by study participants using dried blood spots (DBS) technique has been suggested to overcome this challenge. DBS is a type of biosampling where blood samples are obtained by a finger-prick lancet, blotted and dried on filter paper. However, the feasibility and efficacy of collecting DBS samples from study participants in large-scale epidemiological studies is not known. The aim of the present study was to test the feasibility and response rate of collecting self-sampled DBS and saliva samples in a population–based study of women above 50 years of age. Methods We determined response proportions, number of phone calls to the study center with questions about sampling, and quality of the DBS. We recruited women through a study conducted within the Norwegian Breast Cancer Screening Program. Invitations, instructions and materials were sent to 4,597 women. The data collection took place over a 3 month period in the spring of 2009. Results Response proportions for the collection of DBS and saliva samples were 71.0% (3,263) and 70.9% (3,258), respectively. We received 312 phone calls (7% of the 4,597 women) with questions regarding sampling. Of the 3,263 individuals that returned DBS cards, 3,038 (93.1%) had been packaged and shipped according to instructions. A total of 3,032 DBS samples were sufficient for at least one biomarker analysis (i.e. 92.9% of DBS samples received by the laboratory). 2,418 (74.1%) of the DBS cards received by the laboratory were filled with blood according to the instructions (i.e. 10 completely filled spots with up to 7 punches per spot for up to 70 separate analyses). To assess the quality of the samples, we selected and measured two biomarkers (carotenoids and vitamin D). The biomarker levels were consistent with previous reports. Conclusion Collecting self-sampled DBS and saliva samples through the postal services provides a low cost, effective and feasible alternative in epidemiological studies.

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• Retterstøl, Kjetil; Drevon, Christian A & Blomhoff, Rune (2019). Kapittel 28: Hjerte-karsykdommer. Cappelen Damm Akademisk. ISBN 9788202643904. 540 p. Full text in Research Archive

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• Blomhoff, Rune; Arnesen, Erik Kristoffer & Christensen, Jacob J. (2024). De nye nordiske kostrådene bygger på solide systematiske kunnskapsoppsummeringer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(1), p. 1–4. doi: 10.4045/tidsskr.23.0814. Full text in Research Archive
• Anandavadivelan, Poorna; Cardinale, Daniele; Blomhoff, Rune; Sunde, Berit; Lassen, Kristoffer & Kleive, Dyre [Show all 10 contributors for this article] (2024). Blood flow restriction Exercise in the perioperative setting to Prevent loss of muscle mass in patients with pancreatic, biliary tract, and liver cancer: study protocol for the PREV-Ex randomized controlled trial. Trials. 25(1). doi: 10.1186/s13063-024-08207-5. Full text in Research Archive Show summary

  Background Patients diagnosed with pancreatic, biliary tract, and liver cancer often suffer from a progressive loss of muscle mass. Given the considerable functional impairments in these patients, high musculoskeletal weight loads may not be well tolerated by all individuals. The use of blood-flow restricted resistance training (BFR-T) which only requires low training loads may allow for a faster recovery of muscle due to avoidance of high levels of mechanical muscle stress associated with high-load resistance exercise. This study aims to investigate whether BFR-T can prevent or slow down the loss of skeletal muscle mass and enhance the functional capacity and mental health of patients with pancreatic, biliary tract, and liver cancer. Methods The PREV-Ex exercise trial is a multicenter two-armed randomized controlled trial. Patients will be randomized to an exercise program consisting of home-based low-load BFR-T during a combined pre- and postoperative period for a total of 6–10 weeks (prehabilitation and rehabilitation), or to a control group. Protein supplementation will be given to both groups to ensure adequate protein intake. The primary outcomes, skeletal muscle thickness and muscle cross-sectional area, will be assessed by ultrasound. Secondary outcomes include the following: (i) muscle catabolism-related and inflammatory bio-markers (molecular characteristics will be assessed from a vastus lateralis biopsy and blood samples will be obtained from a sub-sample of patients); (ii) patient-reported outcome measures (self-reported fatigue, health-related quality of life, and nutritional status will be assessed through validated questionnaires); (iii) physical fitness/performance/activity (validated tests will be used to evaluate physical function, cardiorespiratory fitness and maximal isometric muscle strength. Physical activity and sedentary behavior (assessed using an activity monitor); (iv) clinical outcomes: hospitalization rates and blood status will be recorded from the patients’ medical records; (v) explorative outcomes of patients’ experience of the exercise program which will be evaluated using focus group/individual interviews. Discussion It is worthwhile to investigate new strategies that have the potential to counteract the deterioration of skeletal muscle mass, muscle function, strength, and physical function, all of which have debilitating consequences for patients with pancreatic, biliary tract, and liver cancer. The expected findings could improve prognosis, help patients stay independent for longer, and possibly reduce treatment-related costs. Trial registration ClinicalTrials.gov NCT05044065. Registered on September 14, 2021.

• Christensen, Jacob Juel; Blomhoff, Rune & Arnesen, Erik Kristoffer (2023). Rødt kjøtt i NNR2023: hvorfor 350 gram per uke? doi: 10.18261/ntfe.21.4.5. 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
• Fadnes, Lars T.; Furulund, Einar; Druckrey-Fiskaaen, Karl Trygve; Madebo, Tesfaye; Vold, Jørn Henrik & Olsvold, Maria [Show all 10 contributors for this article] (2022). Effect of fruit smoothie supplementation on psychological distress among people with substance use disorders receiving opioid agonist therapy: protocol for a randomised controlled trial (FruktBAR). BMC Nutrition. 8. doi: 10.1186/s40795-022-00582-z. Full text in Research Archive Show summary

  Background: People with substance use disorders generally have unhealthy diets, including limited intake of fruit and vegetables. Evidence shows substantial health benefits from increasing fruit and vegetable consumption on various indicators and possibly also psychological distress. A pilot study has indicated that supplementation with fruit smoothie could be promising also among people receiving opioid agonist therapy for opioid dependence. FruktBAR will compare the efficacy of added fruit smoothie supplementation to people receiving opioid agonist therapy compared to standard treatment without added supplementation. Methods: FruktBAR is a multicentre, randomised controlled trial. The trial will aim to recruit 302 patients receiving opioid agonist therapy. The intervention involves daily supplementation with 250 ml fruit smoothie including a variety of fruits such as apple, pineapple, mango, bananas, orange, blueberries, passion fruit, coconut, lime, and blackcurrant. The main endpoints are 16 weeks after intervention initiation. Participants will be included and followed up during and after the intervention. The target group will be patients with opioid dependence receiving opioid agonist therapy from involved outpatient clinics in Bergen and Stavanger, two of the largest cities in Norway. The main outcome is psychological distress assessed with Hopkins Symptom Checklist (SCL-10) at the end of the intervention period 16 weeks after initiation, and will be compared between the intervention and control arms. Secondary outcome measures are changes in fatigue, physical functioning assessed with a 4-minute step-test, health-related quality of life, biochemical indicators of inflammation, and biochemical indicators of fruit intake. Discussion: This study will inform on the relative advantages or disadvantages of fruit supplementation in addition to the current medically and psychologically oriented treatment of people receiving opioid agonist therapy. If the supplementation is efficacious, it can be considered for further scale-up.

• Paur, Ingvild; Henriksen, Christine; Kværner, Ane Sørlie; Bøhn, Siv Kjølsrud & Blomhoff, Rune (2022). Reply – Letter to the Editor by FM Silva on “Agreement between GLIM and PG-SGA for diagnosis of malnutrition depends on the screening tool used in GLIM”. Clinical Nutrition. ISSN 0261-5614. 41(10), p. 2414–2415. doi: 10.1016/j.clnu.2022.07.019. Full text in Research Archive
• Nordengen, Anne Lene; Zheng, Congying; Raastad, Truls; Collins, Andrew Richard; Blomhoff, Rune & Shaposhnikov, Sergey (2022). Diet as a potential moderator for DNA stability in colorectal cancer survivors - a randomized controlled trial. 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
• Larsen, Sunniva Veen; Holven, Kirsten Bjørklund; Flatberg, Arnar; Christensen, Jacob J.; Leder, Lena & Blomhoff, Rune [Show all 11 contributors for this article] (2018). Effects of replacing saturated fatty acids with polyunsaturated fatty acids on gene expression profiles of human peripheral blood mononuclear cells: a double-blind randomised controlled trial. Full text in Research Archive
• Kværner, Ane Sørlie; Minaguchi, Jun; Yamani, Naouale El; Henriksen, Christine; Ræder, Hanna & Paur, Ingvild [Show all 12 contributors for this article] (2017). DNA damage in blood cells in relation to chemotherapy and nutritional status in colorectal cancer patients. Full text in Research Archive
• Rangel-Huerta, Oscar Daniel; Paur, Ingvild; Bastani, Nasser Ezzatkhah; Bøhn, Siv Kjølsrud; Lilleby, Wolfgang & Smeland, Sigbjørn [Show all 8 contributors for this article] (2017). Association between amino acids, biomarkers of prostate cancer and inflammation in Norwegian prostate cancer patients. Full text in Research Archive
• Ræder, Hanna; Henriksen, Christine; Bøhn, Siv Kjølsrud; Vilbo, Anne Rikke O`de Fey; Henriksen, Hege & Kværner, Ane Sørlie [Show all 9 contributors for this article] (2016). A high proportion of cachectic cancer patients are not identified by the Patient-Generated Subjective Global Assessment tool. Full text in Research Archive
• Olausen, Hans Robert; Bøhn, Siv Kjølsrud; Carlsen, Harald & Blomhoff, Rune (2015). Activation of p53 and antioxidant relevant transcriptional response by broccoli in colon cancer cells. Full text in Research Archive
• Bøhn, Siv Kjølsrud; Kværner, Ane Sørlie; Henriksen, Hege; Ræder, Hanna; Paur, Ingvild & Blomhoff, Rune (2015). The nutrigenomic response to a 12 months dietary RCT in CRC patients. Full text in Research Archive
• Kværner, Ane Sørlie; Bøhn, Siv Kjølsrud; Henriksen, Hege; Paur, Ingvild; Ræder, Hanna & Blomhoff, Rune (2015). Kjøttkonsum og kreftrisiko – hva sier forskningen? Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. p. 18–22. Full text in Research Archive
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