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Background Colorectal cancer (CRC) is the third most common type of cancer worldwide, with Norwegian women having the highest incidence rate of colon cancer in 2022. The consumption of sweet beverages is a suggested modifiable risk factor for CRC; however, current evidence is limited and inconclusive. Objective To assess the associations between the intake of sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and juice and the risk of overall and subsite-specific CRC among Norwegian women. Methods In this prospective cohort study, we included 73,921 participants aged 41–61 years at baseline. Information on sweet beverage consumption was collected using self-reported food frequency questionnaires at two time points between 1998 and 2014. We used Cox proportional hazards models to estimate hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) for the associations between sweet beverage consumption and the risk of overall CRC, proximal colon cancer, distal colon cancer, and rectal cancer. Results During a mean follow-up time of 16.5 years from baseline, 1,187 women were diagnosed with CRC. Compared to no consumption, juice consumption was inversely associated with overall CRC risk (HR ≥ 7 glasses/wk = 0.81, 95% CI: 0.67–0.98; p -trend = 0.025), colon cancer (HR ≥ 7 glasses/wk = 0.73, 95% CI: 0.58–0.94; p -trend = 0.015) and proximal colon cancer (HR ≥ 7 glasses/wk = 0.71, 95% CI: 0.52–0.99; p -trend = 0.065) after adjusting for age, education, and diabetes status at baseline. No associations were observed between juice consumption and distal colon cancer or rectal cancer risk, or between the intake of SSBs or ASBs and CRC. Conclusion We observed no substantial association between the intake of SSBs or ASBs and the risk of CRC or cancer in colorectal subsites in our cohort of Norwegian women. Conversely, our results indicate that juice consumption is associated with a reduced risk of CRC, particularly in the colon. These results warrant further investigation in larger cohorts with power to detect possible differences in cancer risk across colorectal subsites, especially as patterns of sweet beverage consumption are changing.

Background Obesity is a serious childhood health problem today. Studies have shown that overweight and obesity tend to be stable (track) from birth, through childhood and adolescence, to adulthood. However, existing studies are heterogeneous; there is still no consensus on the strength of the association between high birth weight or high body mass index (BMI) early in life and overweight and obesity later in life, nor on the appropriate age or target group for intervention and prevention efforts. This study aimed to determine the presence and degree of tracking of overweight and obesity and development in BMI and BMI standard deviation scores (SDS) from childhood to adolescence in the Fit Futures cohort from North Norway. Methods Using a retrospective cohort design, data on 532 adolescents from the Fit Futures cohort were supplemented with height and weight data from childhood health records, and BMI was calculated at 2–4, 5–7, and 15–17 years of age. Participants were categorized into weight classes by BMI according to the International Obesity Taskforce’s age- and sex-specific cut-off values for children 2–18 years of age (thinness: adult BMI <18.5 kg/m 2 , normal weight: adult BMI ≥18.5- < 25 kg/m 2 , overweight: adult BMI ≥25- < 30 kg/m 2 , obesity: adult BMI ≥30 kg/m 2 ). Non-parametric tests, Cohen’s weighted Kappa statistic and logistic regression were used in the analyses. Results The prevalence of overweight and obesity combined, increased from 11.5 % at 2–4 years of age and 13.7 % at 5–7 years of age, to 20.1 % at 15–17 years of age. Children who were overweight/obese at 5–7 years of age had increased odds of being overweight/obese at 15–17 years of age, compared to thin/normal weight children (crude odds ratio: 11.1, 95 % confidence interval: 6.4–19.2). Six out of 10 children who were overweight/obese at 5–7 years of age were overweight/obese at 15–17 years of age. Conclusions The prevalence of overweight and obesity increased with age. We found a moderate indication of tracking of overweight/obesity from childhood to adolescence. Preventive and treatment initiatives among children at high risk of overweight and obesity should start before 5–7 years of age, but general preventive efforts targeting all children are most important.

Cereals and cereal products have traditionally been staple foods in many countries including in the Nordics and Baltics. Cereals can be consumed with their entire grain kernel and are then referred to as whole grains or can be consumed after removal of the bran or germ and are then referred to as refined grains. The terms cereals and grains are often used interchangeably. In this scoping review, we examine the associations between intake of cereals and cereal products and major health outcomes to contribute to up-to-date food-based dietary guidelines for the Nordic and Baltic countries in the Nordic Nutrition Recommendations 2023 project. Five qualified systematic reviews that covered non-communicable diseases, mortality, and risk factors were identified, and a supplementary literature search was performed in the MEDLINE and Cochrane databases for more recent studies and other endpoints. Compared to other high-income countries, the Nordic populations have a high consumption of whole grain foods. In some of the countries, rye constitutes a substantial fraction of the cereal consumption. However, few studies are available for specific cereals, and most of the research has been performed in predominantly wheat-consuming populations. The evidence suggests clear dose-response associations between a high intake of whole grains and lower risks of cardiovascular disease, colorectal cancer, type 2 diabetes, and premature mortality. The lowest risks of morbidity and mortality were observed for 3-7 servings of whole grains per day, equivalent of 90-210 g/day (fresh weight or ready-to-eat whole grain products, such as oatmeal or whole grain rye bread). Evidence from randomized trials indicates that a high intake of whole grains is beneficial for reducing weight gain. There is less evidence for refined grains, but the available evidence does not seem to indicate similar beneficial associations as for whole grains. It is suggested that replacing refined grains with whole grains would improve several important health outcomes. Cereals are plant foods that can be grown in most of the Nordic and Baltic regions.

Background Food systems contribute significantly to environmental degradation. The interplay of sociodemographic factors influences food choices and thus, the environmental impacts of diet. This study investigated the environmental impact of food consumption in Northern Norway, focusing on intersectional dynamics. Methods A cross-sectional design was employed using data from the Tromsø Study. The diet was assessed using a food frequency questionnaire, and the environmental impacts of the diet were estimated for greenhouse gas emissions, water use, land use, acidification, and eutrophication using a Norwegian life cycle analysis food database. Multiple linear regression analyses were performed to examine the associations with sociodemographic variables using three-way interactions with sex, education, and income in an inter-categorical intersectionality framework. Pairwise contrasts were calculated to assess the mean differences between interacting groups. Results The typical diet in Northern Norway substantially impacts the environment, with dairy products being the primary contributor. When controlling for energy intake, age was inversely linked to the environmental impact, whereas a higher body mass index corresponded to a greater environmental impact. No clear association with sex was observed, and the associations among environmental impact, education, and income varied. Including intersectional analyses did not significantly improve the explanatory power of the models. Although a few pairwise comparisons were statistically significant, the effect sizes were generally small. Conclusion The study underscores the complex dynamics of dietary habits and sociodemographic factors in shaping the environmental impact of food consumption. The findings are important to develop approaches that balance sustainability perspectives and the diverse needs of the population in Northern Norway. Graphical Abstract

Background Metabolomics is a promising molecular tool to identify novel etiologic pathways leading to cancer. Using a targeted approach, we prospectively investigated the associations between metabolite concentrations in plasma and breast cancer risk. Methods A nested case-control study was established within the European Prospective Investigation into Cancer cohort, which included 1624 first primary incident invasive breast cancer cases (with known estrogen and progesterone receptor and HER2 status) and 1624 matched controls. Metabolites ( n  = 127, acylcarnitines, amino acids, biogenic amines, glycerophospholipids, hexose, sphingolipids) were measured by mass spectrometry in pre-diagnostic plasma samples and tested for associations with breast cancer incidence using multivariable conditional logistic regression. Results Among women not using hormones at baseline ( n  = 2248), and after control for multiple tests, concentrations of arginine (odds ratio [OR] per SD = 0.79, 95% confidence interval [CI] = 0.70–0.90), asparagine (OR = 0.83 (0.74–0.92)), and phosphatidylcholines (PCs) ae C36:3 (OR = 0.83 (0.76–0.90)), aa C36:3 (OR = 0.84 (0.77–0.93)), ae C34:2 (OR = 0.85 (0.78–0.94)), ae C36:2 (OR = 0.85 (0.78–0.88)), and ae C38:2 (OR = 0.84 (0.76–0.93)) were inversely associated with breast cancer risk, while the acylcarnitine C2 (OR = 1.23 (1.11–1.35)) was positively associated with disease risk. In the overall population, C2 (OR = 1.15 (1.06–1.24)) and PC ae C36:3 (OR = 0.88 (0.82–0.95)) were associated with risk of breast cancer, and these relationships did not differ by breast cancer subtype, age at diagnosis, fasting status, menopausal status, or adiposity. Conclusions These findings point to potentially novel pathways and biomarkers of breast cancer development. Results warrant replication in other epidemiological studies.

Despite development in cancer treatment and prevention options during the past few years, cancer of the pancreas remains a diagnosis associated with poor prognosis and limited options for prevention. Diet has proven to be an important risk factor for development of many types of cancer, particularly for cancers of the digestive system. Still, evidence regarding its relation to pancreatic cancer remains ambiguous. To investigate the relationship between diet and pancreatic cancer, an analysis of dietary patterns in participants from the Norwegian Women and Cancer Study (n = 89,156; 305 pancreatic cancer cases) was performed. Cox regression analysis was used for studying possible associations between dietary patterns, derived from principal component analysis, and pancreatic cancer incidence. The four most prominent dietary patterns were identified and described: European pattern, animal food consumers' dietary pattern, traditional Norwegian pattern, and alcohol-abstaining dietary pattern. In analysis without adjustment for confounders, being in the highest tertile of the abstaining dietary pattern was associated with lower risk of pancreatic cancer in comparison to the lowest tertile (hazard ratios [HR]: 0.66, 95% confidence interval [CI]: 0.49-0.89). After additional adjustment for height and smoking status, no dietary pattern was associated with increased pancreatic cancer risk, nor was there any difference in effect estimates between strata of smokers and non-smokers. The results of our current analysis do not support the role of major dietary patterns in the development of pancreatic cancer.Despite development in cancer treatment and prevention options during the past few years, cancer of the pancreas remains a diagnosis associated with poor prognosis and limited options for prevention. Diet has proven to be an important risk factor for development of many types of cancer, particularly for cancers of the digestive system. Still, evidence regarding its relation to pancreatic cancer remains ambiguous. To investigate the relationship between diet and pancreatic cancer, an analysis of dietary patterns in participants from the Norwegian Women and Cancer Study (n = 89,156; 305 pancreatic cancer cases) was performed. Cox regression analysis was used for studying possible associations between dietary patterns, derived from principal component analysis, and pancreatic cancer incidence. The four most prominent dietary patterns were identified and described: European pattern, animal food consumers' dietary pattern, traditional Norwegian pattern, and alcohol-abstaining dietary pattern. In analysis without adjustment for confounders, being in the highest tertile of the abstaining dietary pattern was associated with lower risk of pancreatic cancer in comparison to the lowest tertile (hazard ratios [HR]: 0.66, 95% confidence interval [CI]: 0.49-0.89). After additional adjustment for height and smoking status, no dietary pattern was associated with increased pancreatic cancer risk, nor was there any difference in effect estimates between strata of smokers and non-smokers. The results of our current analysis do not support the role of major dietary patterns in the development of pancreatic cancer.

Earlier analyses within the EPIC study showed that dietary fibre intake was inversely associated with colorectal cancer risk, but results from some large cohort studies do not support this finding. We explored whether the association remained after longer follow-up with a near threefold increase in colorectal cancer cases, and if the association varied by gender and tumour location. After a mean follow-up of 11.0 years, 4,517 incident cases of colorectal cancer were documented. Total, cereal, fruit, and vegetable fibre intakes were estimated from dietary questionnaires at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models stratified by age, sex, and centre, and adjusted for total energy intake, body mass index, physical activity, smoking, education, menopausal status, hormone replacement therapy, oral contraceptive use, and intakes of alcohol, folate, red and processed meats, and calcium. After multivariable adjustments, total dietary fibre was inversely associated with colorectal cancer (HR per 10 g/day increase in fibre 0.87, 95% CI: 0.79-0.96). Similar linear associations were observed for colon and rectal cancers. The association between total dietary fibre and risk of colorectal cancer risk did not differ by age, sex, or anthropometric, lifestyle, and dietary variables. Fibre from cereals and fibre from fruit and vegetables were similarly associated with colon cancer; but for rectal cancer, the inverse association was only evident for fibre from cereals. Our results strengthen the evidence for the role of high dietary fibre intake in colorectal cancer prevention.

High intake of sugar-sweetened beverages (SSB) has been associated with weight gain and chronic disease. The objective of this paper was to study the intake of SSB and characteristics associated with SSB intake in adolescents from Troms, Norway. We present results from a cross-sectional analysis from the Tromsø Study: Fit Futures, with 426 female and 444 male students aged 15–17 years (93% participation rate). Descriptive statistics and logistic regression analyses were performed. Among females, 31.8% drank at least one glass of SSB per day on average, compared to 61.0% among males. The adjusted OR (odds ratio) of daily SSB drinking for males vs. females was 3.74 (95% CI (confidence interval) 2.68–5.22). Other dietary habits such as eating snacks, drinking artificially sweetened beverages, fruit juice, and seldom eating breakfast were associated with higher odds for daily SSB drinking, as was daily snuffing. Weight class was not associated with daily SSB drinking. Students in vocational studies, particularly males tended to be more likely to be daily SSB drinkers. The prevalence of participants who on average were daily drinkers was higher than in national studies. We have identified several possible targets for interventions. Clustering of unhealthy behaviours and tendencies to socioeconomic differences are of particular concern.

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

Background Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors are individually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of this study was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factors - healthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore the association of this index with CRC incidence using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Methods In the EPIC cohort, a total of 347,237 men and women, 25- to 70-years old, provided dietary and lifestyle information at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC cases were identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazards regression models and population attributable risks (PARs) have been calculated. Results After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors, the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70 to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors; P -trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; P for trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P -trend <0.0001) for rectal cancer, respectively ( P -difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) were attributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index. Conclusions Combined lifestyle factors are associated with a lower incidence of CRC in European populations characterized by western lifestyles. Prevention strategies considering complex targeting of multiple lifestyle factors may provide practical means for improved CRC prevention.