Malmö Diet and Cancer - MDC

The MDC study was led by the professor of internal medicine, Göran Berglund, and the professor of epidemiology, Lars Janzon. Between 1991 and 1996, 17,000 women were recruited (born 1923-1950) and 11,000 men (born 1923-1945), which corresponded to a participation of 40 percent. The recruitment is described in detail in several references. MDC is part of EPIC, The European Prospective Investigation into Diet and Cancer. This collaboration involves 20 similar cohorts in ten European countries. In total, there is data and biological material from about 550,000 people.

MDC baseline survey (1991-1996)

The baseline survey consisted of a questionnaire relating to lifestyle, socio-economic factors, medications and previous illnesses. An important part of the baseline survey was dietary measurements. The participants had to keep a diary for a week and write down what they ate, then supplementary individual interviews were done with each. The body constitution was investigated in several ways; length, weight and hip and waist circumference were measured. Fat percentage was calculated with an impedance method. All participants provided blood samples that were separated and saved in minus 80°C or minus 140°C. DNA was extracted from individuals and from almost everyone there is also GWAS data.

MDC Cardiovascular section (1992-1999)

Early on, the study was expanded with additional issues. In a cardiovascular section, about 6,000 men and women were examined. The participants provided supplementary blood samples, this time fasting, as well as investigated the carotid intima-media thickness, the thickness of the neck vessels, with ultrasound technology. Another supplementary study was the bone density measurements that were carried out on most of the participants. Finally, the so-called "Neck-Shoulder-Project" studied factors related to chronic pain.

MDC 5-year re-examination (1997-2001)

Five years after the baseline survey, all participants who were alive were contacted and asked to fill in the questionnaire a second time. In total, more than 22,000 individuals responded and filled in the form.

MDC re-examination Cardiovascular section (2007-2012)

Between 2007 and 2012, a re-examination of the cardiovascular section was underway. More than 3,700 individuals participated. The re-examination consisted of a questionnaire, measurements of body constitution, blood pressure, sugar load (OGTT), carotid ultrasound, artery stiffness and blood sampling.

The Multi-Generation Register linked to Malmö Diet and Cancer (MDC)

The Swedish Multi-Generation Register (Flergenerationsregistret, FGR) provides the opportunity to map first-degree relatives of an index individual (participant in a population study) based on social security number. The degree of coverage is extensive and with this register it will be possible to obtain data on diseases within families after ethical approval, which has been granted, and carried out within the population cohort Malmö Diet and Cancer (MDC) with its 30,000 examined individuals at baseline in the years 1991–1996. The ethics permit provided the opportunity to link MDC with FGR to be able to identify parents, siblings and children of the index individuals. The medical history of these relatives could then be mapped via the National Board of Health and Welfare's national registers. They were then linked to the registered individuals in the MDC, but only in the form of data within these categories: parents, siblings or children. They were not registered at an individual level and the relatives' social security numbers were removed by the National Board of Health and Welfare. From first-degree relatives, data through 2019 are available from the National Cancer Registry, National Patient Register, National Cause of Death Register and National Prescribed Drug Register, from Index individuals, current data are available up to 2022.

All in all, this means that we within MDC have the opportunity to make prediction studies of future disease conditions in the MDC Index individuals, taking into account: 

• objective family history for defined medical conditions via FGR
• subjective family history via responses to questionnaires at MDC baseline
• genetic risk markers
• MDC subjects' own health examination data at baseline

Previous studies, for example, have shown that both family history of cardiovascular disease and genetic risk markers for coronary disease can predict future incidence of coronary events/myocardial infarction in index individuals from MDC, but independently of each other. This suggests that both family history and genetic risk can predict future events, but because these are factors independent of each other (to a large extent), it means that family history includes a number of risk mechanisms that go beyond pure genetics, i.e. epigenetics, shared family social factors and lifestyle, microbiota patterns within families, as well as the influence of factors during pregnancy and the first years of life which link generations to each other.

Further information can be obtained from senior professor/expert Peter M Nilsson, Department of Clinical Studies Malmö, peter [dot] nilsson [at] med [dot] lu [dot] se (peter[dot]nilsson[at]med[dot]lu[dot]se).

Link to the Multi-Generation Register (only in Swedish): Flergenerationsregistret.

Malmö Offspring Study (2013-2021)

In the Malmö Offspring Study, MOS, children and grandchildren to the previous population study Malmö Diet Cancer are invited to participate. The children are today in their 50-55 years and the grandchildren are about 20-30 years old. MOS started in 2013 and finished 2021. A total of 5 260 children and grandchildren participated in the study of about 15 000 potential subjects.

• Data collection - MDC
• EPIC
• MDC dietary method
• Follow-up - MDC
• References - MDC