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  • 1.
    Butwicka, Agnieszka
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden;.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden .
    Frisén, Louise
    Child and Adolescent Psychiatry Research Center, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Child and Adolescent Psychiatry Research Center, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, United States.
    Celiac disease is associated with childhood psychiatric disorders: A Population-Based Study2017In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 184, p. 87-93.e1, article id S0022-3476(17)30153-1Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To determine the risk of future childhood psychiatric disorders in celiac disease, assess the association between previous psychiatric disorders and celiac disease in children, and investigate the risk of childhood psychiatric disorders in siblings of celiac disease probands.

    STUDY DESIGN: This was a nationwide registry-based matched cohort study in Sweden with 10 903 children (aged <18 years) with celiac disease and 12 710 of their siblings. We assessed the risk of childhood psychiatric disorders (any psychiatric disorder, psychotic disorder, mood disorder, anxiety disorder, eating disorder, psychoactive substance misuse, behavioral disorder, attention-deficit hyperactivity disorder [ADHD], autism spectrum disorder [ASD], and intellectual disability). HRs of future psychiatric disorders in children with celiac disease and their siblings was estimated by Cox regression. The association between previous diagnosis of a psychiatric disorder and current celiac disease was assessed using logistic regression.

    RESULTS: Compared with the general population, children with celiac disease had a 1.4-fold greater risk of future psychiatric disorders. Childhood celiac disease was identified as a risk factor for mood disorders, anxiety disorders, eating disorders, behavioral disorders, ADHD, ASD, and intellectual disability. In addition, a previous diagnosis of a mood, eating, or behavioral disorder was more common before the diagnosis of celiac disease. In contrast, siblings of celiac disease probands were at no increased risk of any of the investigated psychiatric disorders.

    CONCLUSIONS: Children with celiac disease are at increased risk for most psychiatric disorders, apparently owing to the biological and/or psychological effects of celiac disease.

  • 2.
    Cuenca-Garcia, Magdalena
    et al.
    Granada University, Granada, Spain.
    Ortega, Francisco B.
    Granada University, Granada, Spain; Karolinska Institutet, Huddinge, Sweden.
    Ruiz, Jonatan R.
    Granada University, Granada, Spain; Karolinska Institutet, Huddinge, Sweden.
    Labayen, Idoia
    Basque Country University, Vitoria, Spain.
    Moreno, Luis A.
    Zaragoza University, Zaragoza, Spain.
    Patterson, Emma
    Karolinska Institutet, Huddinge, Sweden.
    Vicente-Rodriguez, German
    Zaragoza University, Zaragoza, Spain.
    Gonzalez-Gross, Marcela
    Madrid Technical University, Madrid, Spain.
    Marcos, Ascension
    Spanish National Research Council, Madrid, Spain.
    Polito, Angela
    National Research Institute for Food and Nutrition, Rome, Italy.
    Manios, Yannis
    Harokopio University, Athens, Greece.
    Beghin, Laurent
    Health and Medical Research National Institute-University Hospital, Lille, France.
    Huybrechts, Inge
    International Agency for Research on Cancer, Lyon, France; Ghent University, Ghent, Belgium.
    Wästlund, Acki
    Karolinska Institutet, Huddinge, Sweden.
    Hurtig-Wennlöf, Anita
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Karolinska Institutet, Huddinge, Sweden.
    Hagströmer, Maria
    Karolinska Institutet, Huddinge, Sweden.
    Molnar, Denes
    Pécs University, Pécs, Hungary.
    Widhalm, Kurt
    Private Medical University, Salzburg, Austria.
    Kafatos, Anthony
    Crete University, Crete, Greece.
    De Henauw, Stefaan
    Ghent University, Ghent, Belgium.
    Castillo, Manuel J.
    Granada University, Granada, Spain.
    Gutin, Bernard
    Georgia Regents University, Augusta, GA.
    Sjöström, Michael
    Karolinska Institutet, Huddinge, Sweden.
    More Physically Active and Leaner Adolescents Have Higher Energy Intake2014In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 164, no 1, p. 159-166Article in journal (Refereed)
    Abstract [en]

    Objective To test whether youths who engage in vigorous physical activity are more likely to have lean bodies while ingesting relatively large amounts of energy. For this purpose, we studied the associations of both physical activity and adiposity with energy intake in adolescents.

    Study design The study subjects were adolescents who participated in 1 of 2 cross-sectional studies, the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study (n = 1450; mean age, 14.6 years) or the European Youth Heart Study (EYHS; n = 321; mean age, 15.6 years). Physical activity was measured by accelerometry, and energy intake was measured by 24-hour recall. In the HELENA study, body composition was assessed by 2 or more of the following methods: skinfold thickness, bioelectrical impedance analysis, plus dual-energy X-ray absorptiometry or air-displacement plethysmography in a subsample. In the EYHS, body composition was assessed by skinfold thickness.

    Results Fat mass was inversely associated with energy intake in both studies and using 4 different measurement methods (P <=.006). Overall, fat-free mass was positively associated with energy intake in both studies, yet the results were not consistent across measurement methods in the HELENA study. Vigorous physical activity in the HELENA study (P<.05) and moderate physical activity in the EYHS (P<.01) were positively associated with energy intake. Overall, results remained unchanged after adjustment for potential confounding factors, after mutual adjustment among the main exposures (physical activity and fat mass), and after the elimination of obese subjects, who might tend to under-report energy intake, from the analyses.

    Conclusion Our data are consistent with the hypothesis that more physically active and leaner adolescents have higher energy intake than less active adolescents with larger amounts of fat mass.

  • 3.
    Mårild, Karl
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Astrid Lindgren Children's Hospital, Solna, Sweden.
    Stephansson, Olof
    Clinical Epidemiology Unit, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden.
    Grahnquist, Lena
    Astrid Lindgren Children's Hospital, Solna, Sweden.
    Cnattingius, Sven
    Clinical Epidemiology Unit, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden.
    Söderman, Gabriella
    Danderyd's Hospital, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro University Hospital. School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Down syndrome is associated with elevated risk of celiac disease: a nationwide case-control study2013In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 163, no 1, p. 237-242Article in journal (Refereed)
    Abstract [en]

    Objective: To provide risk estimates for celiac disease (CD) in Down syndrome (DS) compared with the general population.

    Study design: In this nationwide Swedish case-control study, we examined the risk of CD in individuals with DS born between 1973 and 2008. Study participants consisted of 2 populations: 11 749 patients with biopsy-verified CD (villous atrophy [VA], equivalent to Marsh grade III) who were identified through histopathology reports from the 28 pathology departments in Sweden and 53 887 population-based controls matched for sex, age, calendar year of birth, and county of residence. We used prospectively recorded data from Swedish health registers to identify individuals with DS. ORs were calculated using conditional logistic regression.

    Results: Of the 11 749 individuals with CD, 165 had a diagnosis of DS (1.4%) compared with 55/53 887 controls (0.1%). This corresponded to an OR of 6.15 (95% CI = 5.09-7.43) for subsequent CD in individuals with DS compared with the general population. The association between DS and CD was not affected by maternal age at delivery, infant sex, or presence of type 1 diabetes mellitus in the child.

    Conclusions: We found a sixfold increased risk of CD in individuals with DS. This study adds precision to the previously reported association between DS and CD.

  • 4. Rizzo, Nico S.
    et al.
    Ruiz, Jonatan R.
    Hurtig-Wennlöf, Anita
    Örebro University, Department of Clinical Medicine.
    Ortega, Francisco B.
    Sjöström, Michael
    Relationship of physical activity, fitness, and fatness with clustered metabolic risk in children and adolescents: the European youth heart study2007In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 150, no 4, p. 388-394Article in journal (Refereed)
    Abstract [en]

    Objectives To examine the associations of physical activity (PA) at different levels and intensities and cardiorespiratory fitness (CRF) with a clustering of metabolic risk factors in children and adolescents with special consideration of body fat. Study design Total PA and intensity levels were measured by accelerometry in children (9 years, n = 273) and adolescents (15 years, n = 256). CRF was measured with a maximal ergometer bike test. Measured outcomes included fasting insulin, glucose, triglycerides, total and high-density lipoprotein cholesterol, blood pressure, and body fat. A metabolic risk score (MRS) was computed as the mean of the standardized outcome scores. A “non-obesity-MRS” was computed omitting body fat from the MRS. Analysis of variance and multiple regressions were used in the analysis. Results Total and vigorous PA was inversely significantly associated with MRS in adolescent girls, the group with lowest PA, becoming insignificant when CRF was introduced in the analysis. Significant regression coefficients of total PA and CRF on non-obesity–MRS diminished when body fat was entered in the analysis. Conclusions CRF is more strongly correlated to metabolic risk than total PA, whereas body fat appears to have a pivotal role in the association of CRF with metabolic risk.

  • 5.
    Welander, Adina
    et al.
    Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Ludvigsson, Johnny
    Division of Pediatrics, Linköping University, Östergötland County Council, Linköping, Sweden; Division of Pediatrics, University Hospital, Östergötland County Council, Linköping, Sweden.
    Ludvigsson, Jonas F.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Medical Epidemiology and Biostatistics, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Infectious Disease at Gluten Introduction and Risk of Childhood Diabetes Mellitus2014In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 165, no 2, p. 326-U160Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the risk of future diabetes mellitus type 1 (T1D) in children who suffered from infection at time of gluten introduction.

    Study design: Population-based prospective study. Parents filled out a diary at home. We hereby obtained data on date of gluten introduction, breastfeeding duration, and infections in 9414 children born in the southeast of Sweden from October 1, 1997, through October 1, 1999 (the All Babies in Southeast Sweden cohort). The Cox proportional hazards model was used to investigate the risk of future T1D until February 1, 2012, among children with infection at time of gluten introduction.

    Results: Forty-six children (0.5%) developed T1D and were compared with 9368 reference children from the general population. Some 10 of 46 children with later T1D had an infection at time of gluten introduction (22%) compared with 2520 reference children (27%, P = .43). Later T1D was not associated with age at end of breastfeeding, age at any infection, or age at gluten introduction. Breastfeeding at time of gluten introduction was not protective against future T1D (hazard ratio 1.2; 95% CI, 0.5-2.7). In our final model, when we adjusted for age at gluten introduction, age at infection, and breastfeeding duration, infection at time of gluten introduction did not influence the risk of future T1D (hazard ratio 0.8; 95% CI, 0.3-1.6).

    Conclusion: Infection at time of gluten introduction is not a major risk factor for future T1D in nonselected children.

  • 6.
    Wettergren, Björn
    et al.
    Pediatric Department, Region Gävleborg, Gävle, Sweden.
    Blennow, Margareta
    Institutionen för klinisk forskning och utbildning, Södersjukhuset, Stockholm, Sweden.
    Hjern, Anders
    Center for Health Equity Studies, Stockholm University, Stockholm, Sweden; Center for Health Equity Studies, Karolinska Institutet, Stockholm, Sweden.
    Söder, Olle
    Department of Women's and Children's Health, Paediatric Endocrinology Unit, Karolinska Institute, Stockholm, Sweden; Department of Women's and Children's Health, Paediatric Endocrinology Unit, Karolinska University Hospital, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro University, School of Medical Sciences. Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Child Health Systems in Sweden2016In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 177, no Suppl., p. S187-S202Article in journal (Refereed)
    Abstract [en]

    On a national level, several factors are responsible for Sweden's leading position in achieving the excellent health of children because Sweden has experienced a long history of peace and success in establishing a parliamentary democracy throughout the 20th century. Among the different sectors of society, Sweden has been able to focus on prevention and health promotion. The Swedish health care system is publicly financed based on local taxation. Pediatricians working in secondary and tertiary care are employed by the public sector, whereas family physicians are employed by both the private and public sectors. The pediatric departments at county and university levels provide a high quality of inpatient care for neonates and children. The county hospital pediatric departments typically include one neonatal ward and one ward for older children. Subspecialization exists even at the county level, and there is close cooperation between the county level and subspecialist units at the university level. Within the primary care sector, most children receive care from family physicians. The majority of family physicians have completed 3 months of pediatrics in their basic training program. In the more densely populated areas there are also pediatric ambulatory care centers working mostly with referrals from the family physicians. Preventive care is carried out at midwife-led maternity health centers, nurse-led Child Health Centers, and nurse-led school health care settings and reach almost everyone (99%). All health care for children and adolescents is free of charge up to 18 years of age.

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