| 61. |
- Blair, SN, et al.
(författare)
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Body weight change, all-cause mortality, and cause-specific mortality in the Multiple Risk Factor Intervention Trial
- 1993
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Ingår i: Annals of Internal Medicine. ; 119, s. 749-757
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Tidskriftsartikel (refereegranskat)abstract
- Cooper Institute for Aerobics Research, Dallas, Texas. OBJECTIVE: To evaluate the relation between weight variability and death in high-risk, middle-aged men participating in the Multiple Risk Factor Intervention Trial (MRFIT). DESIGN: Cohort study with 3.8 years of follow-up. SETTING: Multicenter, collaborative, primary prevention trial conducted at 22 clinical centers in the United States. PARTICIPANTS: Men (n = 10,529) who were 35 to 57 years old at baseline and who were in the upper 10% to 15% of risk for coronary heart disease because of smoking, high blood pressure, and elevated cholesterol level. Participants were seen at least annually for 6 to 7 years for medical evaluations in study clinical centers. MEASUREMENTS: Death from cardiovascular disease (228 deaths) and from all causes (380 deaths). RESULTS: The primary measure of weight variability was the intrapersonal standard deviation of weight (ISD), which was calculated from measured weights obtained at clinic visits during a 6- to 7-year period. All-cause death rates per 1000 person-years of follow-up across ISD quartiles were 8.28, 8.25, 10.57, and 11.07 from the first to fourth quartiles, respectively. After adjusting for baseline risk factors associated with weight change, the relative risk for all-cause mortality in the fourth compared with the first quartile was 1.64 (95% CI, 1.21 to 2.23). Cardiovascular death and ISD showed a similar pattern. The association between weight change and death was not observed in the heaviest men. CONCLUSION: Greater weight variability was associated with a greater risk for cardiovascular disease and all-cause mortality in some types of high-risk men. PMID: 8363210 [PubMed - indexed for MEDLINE]
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| 62. |
- Blomstrand, Ann, et al.
(författare)
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Effects of leisure time physical activity on well-being among women in a 32-year perspective.
- 2009
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 37:7, s. 706-712
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To explore potential effects of physical activity on well-being in a population study. Results are from baseline and 32-year follow-ups. METHODS: In a population study of 1462 women in five age strata cross-sectional and prospective analysis were carried out. Activity levels were divided into low, intermediate and high. Well-being was based on self-reported well-being using a Likert-type 7-point scale. RESULTS: Cross-sectional analysis showed strong associations between level of physical activity and well-being. The odds ratio (OR) for poor well-being in women with low physical activity compared with physically more active women was, when studied cross-sectionally, after 12 years in 1980-81 3.94, 95% confidence interval (CI) 2.70-5.74, after 24 years in 1992-93 4.01, CI 2.61-6.17, and after 32 years in 2000-01 7.17, CI 3.56-14.44. Similar associations were observed when relating physical activity at baseline to subsequent well-being: after 12 years: OR 2.09, 95% CI 1.31-3.34, after 24 years: OR 2.74; 95% CI 1.56-4.83, and after 32 years: OR 1.49, 95% CI 0.77-2.88. There was a linear correlation between changes in the individual's physical activity level and her simultaneous changes in experience of well-being between 1980-81 and 1992-93 and between 1992-93 and 2000-01 as well as between 1980-81 and 2000-01. CONCLUSIONS: Strong associations were observed between leisure time physical activity level and reported experience of well-being cross-sectionally and prospectively. Well-being increased with concurrent changes in physical activity. Increased physical activity in sedentary individuals appears to promote not only health but also well-being.
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| 63. |
- Blomstrand, Ann, et al.
(författare)
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Forty-four-year longitudinal study of stroke incidence and risk factors - the Prospective Population Study of Women in Gothenburg
- 2022
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 40:1, s. 139-147
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess stroke incidence over 44 years and association with risk factors. To study total stroke incidence at 60-82 years of age and risk factors. Design Prospective population study. Setting Gothenburg, Sweden, with similar to 450,000 inhabitants. Subjects A representative sample of a general population of women (1462 in total) in 5 age strata aged 38-60 years in 1968-1969 (the Population Study of Women in Gothenburg, PSWG) were followed up to the ages of 82-104 years in 2012. Further, analysis was also performed for the age interval 60-82 years. Main outcome measures Incidence of total stroke (TS), ischaemic (IS), haemorrhagic (HS), non-specified (NS) and fatal (FS) strokes and association with baseline classic risk factors (such as hypertension, atrial fibrillation, low physical activity, diabetes, high waist-hip-ratio, hyperlipidaemia, smoking), low education, mental stress, pre-eclampsia and oral health as expressed by loss of teeth and bone score. Blood pressure in levels 1-3 according to modern guidelines. Associations with atrial fibrillation, diabetes and myocardial infarction shown in survival analyses. The five cohorts contributed to risk time data concerning associations with TS in the 60-82 age interval from the examination performed when they were 60. Results Three hundred and thirty-seven (23%) women had a first-ever stroke, 64 (19%) fatal. TS was associated with physical inactivity, high triglycerides and low education in multivariable analysis. The main sub-type IS was associated with systolic blood pressure, physical inactivity and low education. Pre-eclampsia showed association with IS only in the univariable analysis. FS was associated with systolic blood pressure and smoking. During 60-82 years of age, having <20 teeth (HR 1.74, CI 1.25-2.42), diabetes (HR 2.28 CI 1.09-4.76), WHR (HR 1.29 per 0.1 units CI 1.01-1.63), systolic blood pressure (HR 1.11 per 10 units CI 1.04-1.18) and smoking (HR 1.57, CI 1.14-2.16), were associated with TS in the combined five cohorts. Conclusions Several classic risk factors showed independent associations with stroke. Vulnerability factors as low education and oral health, reflected by loss of teeth, also showed association with stroke. All these factors are possible to target in primary care preventive interventions.
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| 64. |
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Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths
- 2007
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Ingår i: Lancet. ; 370:9602, s. 1829-39
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Age, sex, and blood pressure could modify the associations of total cholesterol (and its main two fractions, HDL and LDL cholesterol) with vascular mortality. This meta-analysis combined prospective studies of vascular mortality that recorded both blood pressure and total cholesterol at baseline, to determine the joint relevance of these two risk factors. METHODS: Information was obtained from 61 prospective observational studies, mostly in western Europe or North America, consisting of almost 900,000 adults without previous disease and with baseline measurements of total cholesterol and blood pressure. During nearly 12 million person years at risk between the ages of 40 and 89 years, there were more than 55,000 vascular deaths (34,000 ischaemic heart disease [IHD], 12,000 stroke, 10,000 other). Information about HDL cholesterol was available for 150,000 participants, among whom there were 5000 vascular deaths (3000 IHD, 1000 stroke, 1000 other). Reported associations are with usual cholesterol levels (ie, corrected for the regression dilution bias). FINDINGS: 1 mmol/L lower total cholesterol was associated with about a half (hazard ratio 0.44 [95% CI 0.42-0.48]), a third (0.66 [0.65-0.68]), and a sixth (0.83 [0.81-0.85]) lower IHD mortality in both sexes at ages 40-49, 50-69, and 70-89 years, respectively, throughout the main range of cholesterol in most developed countries, with no apparent threshold. The proportional risk reduction decreased with increasing blood pressure, since the absolute effects of cholesterol and blood pressure were approximately additive. Of various simple indices involving HDL cholesterol, the ratio total/HDL cholesterol was the strongest predictor of IHD mortality (40% more informative than non-HDL cholesterol and more than twice as informative as total cholesterol). Total cholesterol was weakly positively related to ischaemic and total stroke mortality in early middle age (40-59 years), but this finding could be largely or wholly accounted for by the association of cholesterol with blood pressure. Moreover, a positive relation was seen only in middle age and only in those with below-average blood pressure; at older ages (70-89 years) and, particularly, for those with systolic blood pressure over about 145 mm Hg, total cholesterol was negatively related to haemorrhagic and total stroke mortality. The results for other vascular mortality were intermediate between those for IHD and stroke. INTERPRETATION: Total cholesterol was positively associated with IHD mortality in both middle and old age and at all blood pressure levels. The absence of an independent positive association of cholesterol with stroke mortality, especially at older ages or higher blood pressures, is unexplained, and invites further research. Nevertheless, there is conclusive evidence from randomised trials that statins substantially reduce not only coronary event rates but also total stroke rates in patients with a wide range of ages and blood pressures.
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| 65. |
- Blundell, John E, et al.
(författare)
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Variations in the Prevalence of Obesity Among European Countries, and a Consideration of Possible Causes.
- 2017
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Ingår i: Obesity facts. - : S. Karger AG. - 1662-4033 .- 1662-4025. ; 10:1, s. 25-37
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Tidskriftsartikel (refereegranskat)abstract
- Over the last 10 years the prevalence of obesity across the European continent has in general been rising. With the exception of a few countries where a levelling-off can be perceived, albeit at a high level, this upward trend seems likely to continue. However, considerable country to country variation is noticeable, with the proportion of people with obesity varying by 10% or more. This variation is intriguing and suggests the existence of different profiles of risk or protection factors operating in different countries. The identification of such protection factors could indicate suitable targets for interventions to help manage the obesity epidemic in Europe. This report is the output of a 2-day workshop on the 'Diversity of Obesity in Europe'. The workshop included 14 delegates from 12 different European countries. This report contains the contributions and discussions of the materials and viewpoints provided by these 14 experts; it is not the output of a single mind. However, such is the nature of scientific analysis regarding obesity that it is possible that a different set of 14 experts may have come to a different set of conclusions. Therefore the report should not be seen as a definitive statement of a stable situation. Rather it is a focus for discussion and comment, and a vehicle to drive forward further understanding and management of obesity in Europe.
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| 66. |
- Boernhorst, C., et al.
(författare)
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Validity of 24-h recalls in (pre-)school aged children : Comparison of proxy-reported energy intakes with measured energy expenditure
- 2014
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Ingår i: Clinical Nutrition. - : CHURCHILL LIVINGSTONE. - 0261-5614 .- 1532-1983. ; 33:1, s. 79-84
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Tidskriftsartikel (refereegranskat)abstract
- Background & aims: Little is known about the validity of repeated 24-h dietary recalls (24-HDR) as a measure of total energy intake (El) in young children. This study aimed to evaluate the validity of proxy-reported El by comparison with total energy expenditure (TEE) measured by the doubly labeled water (DLW) technique. Methods: The agreement between El and TEE was investigated in 36 (47.2% boys) children aged 4-10 years from Belgium and Spain using subgroup analyses and Bland-Altman plots. Low-energy-reporters (LER), adequate-energy-reporters (AER) and high-energy-reporters (HER) were defined from the ratio of El over TEE by application of age- and sex-specific cut-off values. Results: There was good agreement between means of El (1500 kcal/day) and TEE (1523 kcal/day) at group level though in single children, i.e. at the individual level, large differences were observed. Almost perfect agreement between El and TEE was observed in thin/normal weight children (EI: 1511 kcal/day; TEE: 1513 kcal/day). Even in overweight/obese children the mean difference between El and TEE was only 86 kcal/day. Among the participants, 28(78%) were classified as AER, five (14%) as HER and three (8%) as LER. Conclusion: Two proxy-reported 24-HDRs were found to be a valid instrument to assess El on group level but not on the individual level. (C) 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
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| 67. |
- Bogl, L. H., et al.
(författare)
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A within-sibling pair analysis of lifestyle behaviours and BMI z-score in the multi-centre I.Family study
- 2019
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Ingår i: Nutrition Metabolism and Cardiovascular Diseases. - : Elsevier BV. - 0939-4753. ; 29:6, s. 580-589
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: By investigating differences in lifestyle behaviours and BMI in sibling pairs, family-level confounding is minimized and causal inference is improved, compared to cross-sectional studies of unrelated children. Thus, we aimed to investigate within-sibling pair differences in different lifestyle behaviours and differences in BMI z-scores in children and adolesents. Methods and results: We examined three groups of sibling pairs 1) all same-sex sibling pairs with maximum 4 years age difference (n = 1209 pairs from 1072 families in 8 countries, mean age 10.7 years, standard deviation 2.4 years), 2) sibling pairs discordant for overweight (n = 262) and 3) twin pairs (n = 85). Usual dietary intake was estimated by 24-h recalls and time spent in light (LPA) and moderate-to-vigorous physical activity (MVPA) was measured by accelerometers. Screen time, sleep and dieting for weight loss were assessed by questionnaires. Within all 3 groups of sibling pairs, more time in MVPA was associated with lower BMI z-score. Higher energy intake was associated with higher BMI z-score within twin pairs and within all sibling pairs who were not currently dieting for weight loss. Regarding LPA, screen time or sleep duration, no or inconsistent associations were observed for the three groups of sibling pairs. Conclusions: MVPA and energy intake were associated with BMI differences within sibling and twin pairs growing up in the same home, thus independent of family-level confounding factors. Future studies should explore whether genetic variants regulating appetite or energy expenditure behaviours account for weight differences in sibling pairs. (C) 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
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| 68. |
- Bogl, Leonie H, et al.
(författare)
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Like me, like you - relative importance of peers and siblings on children's fast food consumption and screen time but not sports club participation depends on age.
- 2020
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Ingår i: The international journal of behavioral nutrition and physical activity. - : Springer Science and Business Media LLC. - 1479-5868. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Lifestyle interventions to prevent paediatric obesity often target family and peer settings; their success is likely to depend on the influence that peers and families exert on children's lifestyle behaviors at different developmental stages.First, to determine whether children's lifestyle behavior more closely resembles their peers' or siblings' behaviors. Secondly, to investigate longitudinally whether children's behavioral change is predicted by that of their peers or their siblings as they grow older.The European prospective IDEFICS/I.Family cohort (baseline survey: 2007/2008, first follow-up: 2009/2010, and second follow-up: 2013/2014) aims at investigating risk factors for overweight and related behaviors during childhood and adolescence. The present investigation includes 2694 observations of children and their siblings aged 2 to 18 years. Peers were defined as same-sex, same-age children in the same community and identified from the full cohort. The longitudinal analysis (mean follow-up time: 3.7 years) includes 525 sibling pairs. Children's lifestyle behaviors including fast food consumption (frequency/week), screen time (hours/week) and sports club participation (hours/week) were assessed by questionnaire. Data were analyzed using multilevel linear models.Children's lifestyle behavior was associated with the respective behavior of their peers and sibling for all 3 behaviors. For fast food consumption, the peer resemblance was more than 6-fold higher than the sibling resemblance and the peer resemblance surpassed the sibling resemblance by the age of 9-10 years. The similarities with peers for fast food consumption and screen time steadily increased, while the similarities with siblings steadily decreased with increasing age of the children (Pinteraction < 0.001). In contrast, the relative importance of peers and siblings on sports club duration did not vary by the age of the children. Longitudinal results showed that children's changes in fast food consumption were more strongly associated with those in their peer group than their sibling, in particular if the age gap between siblings was large.In conclusion, our results support the implementation of multi-setting interventions for improving lifestyle behaviors in children. Our findings might also guide future intervention studies in the choice of timing and setting in which interventions are likely to be most effective. From the ages of 9-10 years onwards, family- or home-based interventions targeting children's fast food intake and screen time behavior may become less effective than school- or community-based interventions aimed at peer groups.
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| 69. |
- Bornhorst, C., et al.
(författare)
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Early Life Factors and Inter-Country Heterogeneity in BMI Growth Trajectories of European Children: The IDEFICS Study
- 2016
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Ingår i: Plos One. - San Francisco : Public Library of Science (PLoS). - 1932-6203. ; 11:2
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Tidskriftsartikel (refereegranskat)abstract
- Background Starting from birth, this explorative study aimed to investigate between-country differences in body mass index (BMI) trajectories and whether early life factors explain these differences. The sample included 7,644 children from seven European countries (Belgium, Cyprus, Germany, Hungary, Italy, Spain, Sweden) participating in the multi-centre IDEFICS study. Information on early life factors and in total 53,409 repeated measurements of height and weight from 0 to <12 years of age were collected during the baseline (2007/2008) and follow-up examination (2009/2010) supplemented by records of routine child health visits. Country-specific BMI growth curves were estimated using fractional polynomial mixed effects models. Several covariates focussing on early life factors were added to the models to investigate their role in the between-countries differences. Large between-country differences were observed with Italian children showing significantly higher mean BMI values at all ages >= 3 years compared to the other countries. For instance, at age 11 years mean BMI values in Italian boys and girls were 22.3 [21.9; 22.8; 99% confidence interval] and 22.0 [21.5; 22.4], respectively, compared to a range of 18.4 [18.1; 18.8] to 20.3 [19.8; 20.7] in boys and 18.2 [17.8; 18.6] to 20.3 [19.8; 20.7] in girls in the other countries. After adjustment for early life factors, differences between country-specific BMI curves became smaller. Maternal BMI was the factor being most strongly associated with BMI growth (p<0.01 in all countries) with associations increasing during childhood. Gestational weight gain (GWG) was weakly associated with BMI at birth in all countries. In some countries, positive associations between BMI growth and children not being breastfed, mothers' smoking during pregnancy and low educational level of parents were found. Early life factors seem to explain only some of the inter-country variation in growth. Maternal BMI showed the strongest association with children's BMI growth.
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| 70. |
- Bornhorst, C., et al.
(författare)
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The effects of hypothetical behavioral interventions on the 13-year incidence of overweight/obesity in children and adolescents
- 2023
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Ingår i: International Journal of Behavioral Nutrition and Physical Activity. - 1479-5868. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background In view of the high burden of childhood overweight/obesity (OW/OB), it is important to identify targets for interventions that may have the greatest effects on preventing OW/OB in early life. Using methods of causal inference, we studied the effects of sustained behavioral interventions on the long-term risk of developing OW/OB based on a large European cohort.Methods Our sample comprised 10 877 children aged 2 to < 10 years at baseline who participated in the well-phenotyped IDEFICS/I.Family cohort. Children were followed from 2007/08 to 2020/21. Applying the parametric g-formula, the 13-year risk of developing OW/OB was estimated under various sustained hypothetical interventions on physical activity, screen time, dietary intake and sleep duration. Interventions imposing adherence to recommendations (e.g. maximum 2 h/day screen time) as well as interventions 'shifting' the behavior by a specified amount (e.g. decreasing screen time by 30 min/day) were compared to 'no intervention' (i.e. maintaining the usual or so-called natural behavior). Separately, the effectiveness of these interventions in vulnerable groups was assessed.Results The 13-year risk of developing OW/OB was 30.7% under no intervention and 25.4% when multiple interventions were imposed jointly. Meeting screen time and moderate-to-vigorous physical activity (MVPA) recommendations were found to be most effective, reducing the incidence of OW/OB by -2.2 [-4.4;-0.7] and -2.1 [-3.7;-0.8] percentage points (risk difference [95% confidence interval]), respectively. Meeting sleep recommendations (-0.6 [-1.1;-0.3]) had a similar effect as increasing sleep duration by 30 min/day (-0.6 [-0.9;-0.3]). The most effective intervention in children of parents with low/medium educational level was being member in a sports club; for children of mothers with OW/OB, meeting screen time recommendations and membership in a sports club had the largest effects.Conclusions While the effects of single behavioral interventions sustained over 13 years were rather small, a joint intervention on multiple behaviors resulted in a relative reduction of the 13-year OW/OB risk by between 10 to 26%. Individually, meeting MVPA and screen time recommendations were most effective. Nevertheless, even under the joint intervention the absolute OW/OB risk remained at a high level of 25.4% suggesting that further strategies to better prevent OW/OB are required.
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