The built environment correlates of objectively measured physical activity in Norwegian adults: A cross-sectional study.

BACKGROUND: Built environments that are designed to provide accessible, attractive, and convenient locales promote regular physical activity (PA). Norway has great variability in its geographic, natural, and built environment features. Urban areas have well-developed built environment features, whereas the rural areas are less walkable and this may influence the mode of transport. In general, active transport is more common in urban centers. Further, public transportation is more developed in urban areas, whereas motorized transport may be more widespread in the rural areas. Despite this, in Sogn & Fjordane, a rural county in western Norway, high PA levels are frequently observed. Thus, the aims of this study were to (1) explore perceived built environment features and characterize their associations with objectively measured PA levels in Norwegian adults and (2) explore the differences in these correlates between Sogn & Fjordane and the rest of Norway. METHODS: In this cross-sectional study, participants used questionnaires to rate perceptions of their built environments, and their PA was objectively measured for 7 consecutive days using the ActiGraph GT1M accelerometer. There were 972 Norwegian adults who were included in the study. The average age was 46.9 ± 6.5 years and 43.8% of participants were men. Data were analyzed using multiple linear regression. RESULTS: Total PA and moderate-to-vigorous physical activity (MVPA) were both associated with perceived walkability, the community perception score, and active transport for commuting (all p ≤ 0.004). We also observed geographic-area-specific associations: the community perception score was negatively associated with total PA and MVPA in the rest of Norway (p ≤ 0.012) but not in Sogn & Fjordane. Public transport for commuting was positively associated with MVPA in Sogn & Fjordane (p = 0.03) but not in the rest of Norway. CONCLUSION: Total PA level and MVPA were associated with built environment factors, such as perceptions of community, perceived walkability, and engaging in active transport for commuting. Geographic differences in the PA correlates were observed, and thus, locally customized environmental population approaches aimed at increasing PA levels may be essential complements to individual behavior and lifestyle strategies. Further, objective measures of Norwegian built environments, such as geographic information system data, and validated walk- and bike-scores would advance the field.

DHA reduces oxidative stress following hypoxia-ischemia in newborn piglets: a study of lipid peroxidation products in urine and plasma.

BACKGROUND: Lipid peroxidation mediated by reactive oxygen species is a major contributor to oxidative stress. Docosahexaenoic acid (DHA) has anti-oxidant and neuroprotective properties. Our objective was to assess how oxidative stress measured by lipid peroxidation was modified by DHA in a newborn piglet model of hypoxia-ischemia (HI). METHODS: Fifty-five piglets were randomized to (i) hypoxia, (ii) DHA, (iii) hypothermia, (iv) hypothermia+DHA or (v) sham. All groups but sham were subjected to hypoxia by breathing 8% O2. DHA was administered 210 min after end of hypoxia and the piglets were euthanized 9.5 h after end of hypoxia. Urine and blood were harvested at these two time points and analyzed for F4-neuroprostanes, F2-isoprostanes, neurofuranes and isofuranes using UPLC-MS/MS. RESULTS: F4-neuroprostanes in urine were significantly reduced (P=0.006) in groups receiving DHA. Hypoxia (median, IQR 1652 nM, 610-4557) vs. DHA (440 nM, 367-738, P=0.016) and hypothermia (median, IQR 1338 nM, 744-3085) vs. hypothermia+DHA (356 nM, 264-1180, P=0.006). The isoprostane compound 8-iso-PGF2α was significantly lower (P=0.011) in the DHA group compared to the hypoxia group. No significant differences were found between the groups in blood. CONCLUSION: DHA significantly reduces oxidative stress by measures of lipid peroxidation following HI in both normothermic and hypothermic piglets.

Helmet use and risk of head injuries in alpine skiers and snowboarders: changes after an interval of one decade.

BACKGROUND: In a previous study, we concluded that a safety helmet can reduce the risk for head injury by 60%. Other studies reported similar effects, resulting in a general recommendation to wear a helmet while skiing or snowboarding. AIM: To determine the effect of the expected increased helmet wear on the risk of head injury one decade after the recommendation. METHODS: Ski patrols reported injury cases in major Norwegian alpine ski resorts. Injury type, helmet use and other risk factors were recorded. A multiple logistic regression analysis was used to assess the relation between individual risk factors and the risk of head injuries by comparing head injured skiers (cases) with skiers and snowboarders who reported other injuries (controls). RESULTS: Helmet use was associated with improved odds for head injuries (OR: 0.45, 95% CI 0.34 to 0.60; p<0.001) in 2002; this effect was attenuated in 2010 (OR: 0.79, 95% CI 0.63 to 0.98; p=0.02), and not significant in 2011 (OR: 0.80, 95% CI 0.60 to 1.06; p=0.12). For potentially severe head injuries, the protective effect of using a helmet was better sustained over the observation period, from an OR of 0.44 (95% CI 0.28 to 0.68, p<0.001) in 2002 to an OR of 0.74 (95% CI 0.57 to 0.97, p=0.02) in 2010 and 0.67 (95% CI 0.47 to 0.96; p=0.03) in 2011. CONCLUSIONS: We observed an unexpected reduction in the protective effect of a skiing helmet. This may be due to new skiing trends in the alpine resorts.

Effects of physical activity on schoolchildren's academic performance: The Active Smarter Kids (ASK) cluster-randomized controlled trial.

OBJECTIVE: To investigate the effect of a seven-month, school-based cluster-randomized controlled trial on academic performance in 10-year-old children. METHODS: In total, 1129 fifth-grade children from 57 elementary schools in Sogn og Fjordane County, Norway, were cluster-randomized by school either to the intervention group or to the control group. The children in the 28 intervention schools participated in a physical activity intervention between November 2014 and June 2015 consisting of three components: 1) 90min/week of physically active educational lessons mainly carried out in the school playground; 2) 5min/day of physical activity breaks during classroom lessons; 3) 10min/day physical activity homework. Academic performance in numeracy, reading and English was measured using standardized Norwegian national tests. Physical activity was measured objectively by accelerometry. RESULTS: We found no effect of the intervention on academic performance in primary analyses (standardized difference 0.01-0.06, p>0.358). Subgroup analyses, however, revealed a favorable intervention effect for those who performed the poorest at baseline (lowest tertile) for numeracy (p=0.005 for the subgroup∗group interaction), compared to controls (standardized difference 0.62, 95% CI 0.19-1.07). CONCLUSIONS: This large, rigorously conducted cluster RCT in 10-year-old children supports the notion that there is still inadequate evidence to conclude that increased physical activity in school enhances academic achievement in all children. Still, combining physical activity and learning seems a viable model to stimulate learning in those academically weakest schoolchildren.

Objectively Measured Physical Activity in Home Guard Soldiers During Military Service and Civilian Life.

Soldiers are encouraged to be physically active, and thereby maintain or increase their fitness level to meet job-related physical demands. However, studies on objectively measured physical activity (PA) in soldiers are scarce, particular for reserve soldiers. Hence, the aim of this study was to present PA data on Norwegian Home Guard (HG) soldiers. A total of 411 HG soldiers produced acceptable PA measurements (SenseWear Armband Pro2) during civilian life, of which 299 soldiers also produced acceptable data during HG military training. Reference data on total energy expenditure, metabolic equivalents, steps per day, and minutes of PA in three different metabolic equivalent categories are presented. The HG soldiers produced more minutes of moderate PA during HG military training compared to civilian life, but less vigorous and very vigorous PA. Furthermore, HG soldiers were more physically active during civilian week days compared to weekend days. The presented reference data can be used for comparisons against other groups of soldiers. Our data indicate that aerobic demands during HG military training were not very high. Promoting PA and exercise could still be important to ensure HG soldiers are physically prepared for more unforeseen job tasks.

The Vertical Drop Jump Is a Poor Screening Test for ACL Injuries in Female Elite Soccer and Handball Players: A Prospective Cohort Study of 710 Athletes.

BACKGROUND: The evidence linking knee kinematics and kinetics during a vertical drop jump (VDJ) to anterior cruciate ligament (ACL) injury risk is restricted to a single small sample. Still, the VDJ test continues to be advocated for clinical screening purposes. PURPOSE: To test whether 5 selected kinematic and kinetic variables were associated with future ACL injuries in a large cohort of Norwegian female elite soccer and handball players. Furthermore, we wanted to assess whether the VDJ test can be recommended as a screening test to identify players with increased risk. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Elite female soccer and handball players participated in preseason screening tests from 2007 through 2014. The tests included marker-based 3-dimensional motion analysis of a drop-jump landing. We followed a predefined statistical protocol in which we included the following candidate risk factors in 5 separate logistic regression analyses, with new ACL injury as the outcome: (1) knee valgus angle at initial contact, (2) peak knee abduction moment, (3) peak knee flexion angle, (4) peak vertical ground-reaction force, and (5) medial knee displacement. RESULTS: A total of 782 players were tested (age, 21 ± 4 years; height, 170 ± 7 cm; body mass, 67 ± 8 kg), of which 710 were included in the analyses. We registered 42 new noncontact ACL injuries, including 12 in previously ACL-injured players. Previous ACL injury (relative risk, 3.8; 95% CI, 2.1-7.1) and medial knee displacement (odds ratio, 1.40; 95% CI, 1.12-1.74 per 1-SD change) were associated with increased risk for injury. However, among the 643 players without previous injury, we found no association with medial knee displacement. A receiver operating characteristic curve analysis of medial knee displacement showed an area under the curve of 0.6, indicating a poor-to-failed combined sensitivity and specificity of the test, even when including previously injured players. CONCLUSION: Of the 5 risk factors considered, medial knee displacement was the only factor associated with increased risk for ACL. However, receiver operating characteristic curve analysis indicated a poor combined sensitivity and specificity when medial knee displacement was used as a screening test for predicting ACL injury. For players with no previous injury, none of the VDJ variables were associated with increased injury risk. CLINICAL RELEVANCE: VDJ tests cannot predict ACL injuries in female elite soccer and handball players.

Association Between Paradoxical HDL Cholesterol Decrease and Risk of Major Adverse Cardiovascular Events in Patients Initiated on Statin Treatment in a Primary Care Setting.

BACKGROUND AND OBJECTIVES: Statin-induced changes in high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) are unrelated. Many patients initiated on statins experience a paradoxical decrease in HDL-C. The aim of this study was to evaluate the association between a decrease in HDL-C and risk of major adverse cardiovascular events (MACE). METHODS: Data from 15,357 primary care patients initiated on statins during 2004-2009 were linked with data from mandatory national hospital, drug-dispensing, and cause-of-death registers, and were grouped according to HDL-C change: decreased ≥0.1 mmol/L, unchanged ±0.1 or ≥0.1 mmol/L increased. To evaluate the association between decrease in HDL-C and risk of MACE, a sample of propensity score-matched patients from the decreased and unchanged groups was created, using the latter group as reference. MACE was defined as myocardial infarction, unstable angina pectoris, ischaemic stroke, or cardiovascular mortality. Cox proportional hazards models were used to estimate relative risks. RESULTS: HDL-C decreased in 20%, was unchanged in 58%, and increased in 22% of patients initiated on statin treatment (96% treated with simvastatin). The propensity score-matched sample comprised 5950 patients with mean baseline HDL-C and LDL-C of 1.69 and 4.53 mmol/L, respectively. HDL-C decrease was associated with 56% higher MACE risk (hazard ratio 1.56; 95% confidence interval 1.12-2.16; p < 0.01) compared with the unchanged HDL-C group. CONCLUSIONS: Paradoxical statin-induced reduction in HDL-C was relatively common and was associated with increased risk of MACE.

A pilot study testing the feasibility of skin temperature monitoring to reduce recurrent foot ulcers in patients with diabetes--a randomized controlled trial.

BACKGROUND: Although monitoring foot skin temperatures has been associated with diabetic foot ulcer recurrence, no studies have been carried out to test the feasibility among European Caucasians. Moreover, the educational and/or motivational models that promote cognitive or psychosocial processes in these studies are lacking. Thus, we conducted a pilot randomized controlled trial to test the feasibility of monitoring foot skin temperatures in combination with theory-based counselling to standard foot care to reduce diabetic foot ulcer recurrence. METHODS: In a single-blinded nurse-led 1-year controlled trial, conducted at a hospital setting in Norway, 41 patients with diabetic neuropathy and previous foot ulcer were randomized to the intervention (n = 21) or control groups (n = 20). All participants were instructed in foot care and recording observations daily. Additionally, the intervention group was taught how to monitor and record skin temperature at baseline, and received counselling every third month supporting them to use the new treatment. Subjects observing temperature differences > 2.0 °C between corresponding sites on the left and right foot on two consecutive days were asked to contact the study nurse and reduce physical activity. Fisher exact test was used to evaluate the effect of the intervention on the proportion of subjects with a foot ulcer. Kaplan-Meier survival analysis was performed to compare the two groups in regard to the time to development of a foot ulcer. RESULTS: In the intervention group, 67 % (n = 14/21) monitored and recorded skin temperatures ≥ 80 % of the time while 70 % (n = 14/20) of the controls recorded foot inspections. Foot ulcer incidence was 39 % (7/21) vs. 50 % (10/20) in the intervention and control groups, respectively (ns). CONCLUSIONS: This feasibility study showed that the addition of counselling to promote self-monitoring of skin temperature to standard care to prevent recurrence of foot ulcer is feasible in patients with diabetes in Norway. Home skin temperature monitoring was performed as frequently by the intervention group as usual foot observations in the controls despite the extra effort required. We did not detect a difference in foot ulcer recurrence between groups, but our study may inform future full scale studies. TRIAL REGISTRATION: Clinicaltrials.gov NCT01269502.

Long-term survival in the randomized trial of drug treatment in mild to moderate hypertension of the Oslo study 1972-3.

BACKGROUND: In the Oslo cardiovascular study of 1972-3 a 5-year randomized trial in mild to moderate hypertension was performed. Several changes in treatment practices have been recommended since that time. We followed the mortality patterns up to 40 years. METHODS: Invited to the Oslo study screening were 25,915 middle-aged men and 16,203 (63%) participated. Reexaminations were done to select suitable participants into the trial. Men had blood pressure 150-179/95-109 mm Hg and the active group (n=406) was treated with thiazides, alpha-methyldopa and propranolol versus untreated controls (n=379). Cox regression analysis was used for statistical analyses. RESULTS: There was no trend towards reduction in total mortality by treatment. A nominally significant increase in risk of death at first myocardial infarction was observed in the trial treatment group across the follow-up period, HR=1.51 (1.01-2.25); (P=0.042). The excess risk developed rapidly during the first 15 years, but the gap between the groups diminished to a large extent during the next 15 years, but the curves stayed at a certain distance for the last 10 years. Cerebrovascular death tended to be non-significantly reduced, HR=0.85 (0.52-1.41). CONCLUSIONS: Drug treatment of mild hypertensive men initiated in the 1970s did not reduce mortality at first MI or total mortality. However, during the period (late 1980s and whole 1990s), when large changes in hypertension treatment practices occurred into regimes with more use of combination therapies including metabolically neutral drugs at lower doses, beneficial effects on MI mortality could be observed.

Increased risk of all-cause mortality and renal graft loss in stable renal transplant recipients with hyperparathyroidism.

BACKGROUND: Hyperparathyroidism is reported in 10% to 66% of renal transplant recipients (RTR). The influence of persisting hyperparathyroidism on long-term clinical outcomes in RTR has not been examined in a large prospective study. METHODS: We investigated the association between baseline parathyroid hormone (PTH) levels and major cardiovascular events, renal graft loss, and all-cause mortality by Cox Proportional Hazard survival analyses in 1840 stable RTR derived from the Assessment of LEscol in Renal Transplantation trial. Patients were recruited in a mean of 5.1 years after transplantation, and follow-up time was 6 to 7 years. RESULTS: Significant associations between PTH and all 3 outcomes were found in univariate analyses. When adjusting for a range of plausible confounders, including measures of renal function and serum mineral levels, PTH remained significantly associated with all-cause mortality (4% increased risk per 10 units; P=0.004), and with graft loss (6% increased risk per 10 units; P<0.001), but not with major cardiovascular events. Parathyroid hormone above the upper limit of normal (65 pg/mL) indicated a 46% (P=0.006) higher risk of death and an 85% higher risk of graft loss (P<0.001) compared with low/normal values. CONCLUSIONS: Hyperparathyroidism is an independent, potentially remediable, risk factor for renal graft loss and all-cause mortality in RTR.

Long-term survival in pre-specified groups at risk in the Oslo Study, 1972-1973.

AIMS: Using the Oslo Study of 1972-1973, we wished to compare the long-term mortality pattern up to 40 years, in both the healthy cardiovascular groups at supposedly high and low risk, and in some groups having cardiovascular disease at screening. METHODS: At the screening, 16,203 (63% of those invited) men aged 40-49 years participated. Study groups were identified by means of questionnaires regarding diseases, blood pressure and measurements of total cholesterol, triglycerides and glucose. We identified six groups: very high cholesterol, very high blood pressure, very high glucose, non-smoking with non-elevated such risk factors, from a randomized diet and antismoking trial, and a randomized drug treatment in mild-to-moderate hypertension. Statistical analyses were by Cox regression analysis, with Kaplan-Meier graphs. RESULTS: The supposedly low-risk group had a total mortality of one-third of other groups, such as: men with hypertension, diabetes or hypercholesterolemia, or those whom participated in the two trials. Between these latter groups, we found 2-5 years of difference in their median survival time, but their absolute risk stayed at rather high levels through all the years, with the median remaining a lifetime that was 3-8 years shorter than the men whom were free of known cardiovascular disease, diabetes or hypertension. CONCLUSIONS: The long-term preventive effects on total mortality seem large, if the levels of the classical risk factors of blood pressure, total cholesterol and glucose can be adequately controlled, concurrently with a non-smoking behavior. The study indicated that non-smoking and a low total cholesterol value were the most important contributors to extended survival.

Long-Term Correlates of Objectively Measured Physical Activity and Sedentary Time in Norwegian Men and Women.

BACKGROUND: Sex, age, body mass index (BMI), perceived health and health behavior are correlates known to affect physical activity and sedentary time. However, studies have often been cross-sectional, and less is known about long-term correlates. Thus, the aims were to investigate 1) the associations between a set of characteristics (demographic, biological, psychological, and behavioral) and objectively measured physical activity and sedentary time at 13-year follow-up, and 2) the association between changes in these characteristics over time and physical activity and sedentary time. METHODS: Baseline characteristics were collected in 40-year-olds in 1996, and follow-up data on objectively measured physical activity and sedentary time were obtained in 2009 (n = 240). Data were analyzed by multiple linear regressions. RESULTS: Self-reported physical activity (P < .001) and improved perceived health (P = .046) were positively associated with moderate-to-vigorous physical activity (MVPA) whereas BMI (P = .034) and increased BMI (P = .014) were negatively associated with MVPA at follow-up. Women spent less time being sedentary than men (P = .019). Education (P < .001) was positively associated and improved perceived health (P = .010) was negatively associated with sedentary time at follow-up. CONCLUSIONS: MVPA and sedentary time at follow-up were associated with behavioral, biological and demographic correlates. However, the nature of our analyses prevents us from inferring causality.

A prospective cohort study of depression in pregnancy, prevalence and risk factors in a multi-ethnic population.

BACKGROUND: Depression in pregnancy increases the risk of complications for mother and child. Few studies are done in ethnic minorities. We wanted to identify the prevalence of depression in pregnancy and associations with ethnicity and other risk factors. METHOD: Population-based, prospective cohort of 749 pregnant women (59% ethnic minorities) attending primary antenatal care during early pregnancy in Oslo between 2008 and 2010. Questionnaires covering demographics, health problems and psychosocial factors were collected through interviews. Depression in pregnancy was defined as a sum score ≥ 10 by the Edinburgh Postnatal Depression Scale (EPDS) at gestational week 28. RESULTS: The crude prevalence of depression was; Western Europeans: 8.6% (95% CI: 5.45-11.75), Middle Easterners: 19.5% (12.19-26.81), South Asians: 17.5% (12.08-22.92), and other groups: 11.3% (6.09-16.51). Median EPDS score was 6 in Middle Easterners and 3 in all other groups. Middle Easterners (OR = 2.81; 95% CI (1.29-6.15)) and South Asians (2.72 (1.35-5.48)) had significantly higher risk for depression than other minorities and Western Europeans in logistic regression models. When adjusting for socioeconomic position and family structure, the ORs were reduced by 16-18% (OR = 2.44 (1.07-5.57) and 2.25 (1.07-4.72). Other significant risk factors were the number of recent adverse life events, self-reported history of depression and poor subjective health three months before conception. CONCLUSION: The prevalence of depression in pregnancy was higher in ethnic minorities from the Middle East and South Asia. The increased risk persisted after adjustment for risk factors.

Survival in elderly men in relation to midlife and current BMI.

BACKGROUND: the relationship between BMI and mortality is U-shaped in the elderly but may be modified by midlife BMI and change in weight. OBJECTIVE: to elucidate mortality prediction by BMI trajectory in older men. SUBJECTS: the Oslo cohort of men born in 1923-32 were screened for BMI and cardiovascular risk in 1972-73. Survivors were rescreened at ages of 68-77 years, and all-cause mortality was followed from 2000 to 2011. METHODS: we calculated Cox regression proportional hazards for 11-year mortality rates in relation to BMI change among 5,240 men with no reported disease in 1972-73 and complete data. Models were adjusted for demographics, medications and disease. Men with BMI < 25 kg/m(2) in midlife (1972-73) and in 2000 were the reference group. RESULTS: men whose BMI changed from <25 kg/m(2) in midlife to 25-29.9 kg/m(2) in 2000 carried the lowest mortality risk (hazard ratio [HR] 0.84; 95% confidence interval [CI] 0.75-0.94). Men with BMI ≥ 30 kg/m(2) in midlife were at highest risk (HR 1.79; 95% CI 1.12-2.88 if reclassified to 25-29.9 kg/m(2) in 2000 and HR 1.39; 95% CI 1.05-1.85 if BMI remained ≥30 kg/m(2) in 2000). Men with BMI 25-29.9 kg/m(2) in midlife that reclassified to <25 kg/m(2) in 2000 had increased risk. Findings were similar when percentage change in BMI was the outcome. CONCLUSION: survival in older men with normal weight at midlife was associated with BMI gain after midlife while midlife obesity increased risk regardless of subsequent change.

The effect of kiwifruit consumption on blood pressure in subjects with moderately elevated blood pressure: a randomized, controlled study.

BACKGROUND AND AIMS: Kiwifruit contains bioactive substances that may lower blood pressure (BP) and improve endothelial function. We examined the effects of adding kiwifruit to the usual diet on 24-h ambulatory BP, office BP and endothelial function. METHODS: In a parallel-groups study, 118 subjects with high normal BP or stage 1 hypertension (systolic BP 130-159 mmHg and/or diastolic BP 85-99 mmHg) were randomized to intake of three kiwifruits (intervention) or one apple (control) a day for 8 weeks. Office and 24-h ambulatory BP was measured along with biomarkers of endothelial function including metabolites of nitric oxide (NO) formation and finger photo-plethysmography. RESULTS: At randomization, mean 24-h ambulatory systolic/diastolic BP was 133 ± 13/82 ± 9 mmHg (n = 106). After 8 weeks, BP was lower in the group assigned to kiwifruit versus apple intake (between group difference, - 3.6 mmHg [95% CI - 6.5 to - 0.7], p = 0.017 and - 1.9 mmHg [95% CI - 3.6 to - 0.3]; p = 0.040, for systolic and diastolic BP, respectively). Changes in office BP and endothelial function did not differ between the groups. CONCLUSIONS: Among men and women with moderately elevated BP, intake of three kiwifruits was associated with lower systolic and diastolic 24-h BP compared with one apple a day. The effect may be regulated by mechanisms other than improvement of endothelial function.

[Physical activity, smoking and mortality among men who participated in the Oslo studies of 1972 and 2000]. / Fysisk aktivitet, røyking og dødelighet hos menn som deltok i Oslo-undersøkelsene i 1972 og 2000.

BACKGROUND: Few Norwegian data are available on the importance of physical activity with regard to mortality. Our objective was to study mortality in light of leisure time physical activity and smoking. MATERIAL AND METHOD: Men born in the period 1923-1932 were included in the Oslo Study in 1972-1973 and then investigated again in 2000. A total of 5738 men were included in the analyses. Physical activity was registered as self-reported number of hours at low and high intensity, as well by the Gothenburg question on the degree of leisure activity (sedentary, low, moderate, high). Cox regression analysis was used for statistical computation. RESULTS: After 12 years, men who reported a moderate amount of activity (approximately 30 minutes per day six times per week of low or high activity) in the year 2000 had a 40% lower mortality rate than the physically inactive (the reference group). A change in activity level in older age was independently associated with a risk of death. The Gothenburg question on amount of activity gave the same predictive information value as smoking. INTERPRETATION: Our data indicate that there is a dose-response relationship between the degree of physical activity and early death. An increase in activity was just as strongly associated with reduced mortality as quitting smoking. Based on these data, physical activity should be recommended as a daily habit.

Increased predictive ability of BMI but not other risk factors with time in men: 39-year follow-up of total mortality in the Oslo Study.

OBJECTIVE: Risk factor associations to mortality may change, in part due to removal of high-risk persons. We compared strengths of association and ability of risk factors to predict total mortality across short (<15 years), medium (15-29 years) and long (30-39 years) follow-up. METHODS: Cardiovascular risk factors were measured in 1972-1973 in the Oslo Study among 14,846 men born in 1923-1932. Relationships of risk factors to mortality (to 2011) were analyzed using Cox regression models, and receiver operating characteristics (ROC) were estimated. RESULTS: BMI was the only factor that increased strength of association with elapsed time (hazard ratio for ≥35 kg/m(2) vs. 22.5-24.9 kg/m(2): 1.25 (95% CI 0.73-2.17), 1.51 (95% CI 1.06-2.16) and 3.73 (95% CI 2.33-5.98) for <15, 15-29 and 30-39 years, respectively). Other factors lost predictive ability with time. Cigarette smoking was the strongest predictor in all periods. Serum lipids and systolic blood pressure increased risk in most periods, and moderate physical activity was protective to 29 years, but these factors and BMI contributed minimally to ROC. DISCUSSION: Risk factors differed in association strengths and ability to predict mortality over four decades. BMI strengthened its association with time, while cigarette smoking was strongest in all periods.

Uric acid and clinical correlates of endothelial function in kidney transplant recipients.

UNLABELLED: Uric acid is associated with increased mortality in kidney transplant recipients (KTRs), but it is uncertain if this involves endothelial dysfunction. We hypothesized, first, that there was an association between uric acid and endothelial function, and second, that there were associations between endothelial function and cardiac and mortality risk scores. METHODS: One hundred and fifty-two patients were examined 10 wk after kidney transplantation by two measures of endothelial function, the brachial artery flow-mediated dilatation (FMD) expressed as percent dilatation (FMD%), and fingertip peripheral arterial tone (PAT) expressed as log-reactive hyperemia index (LnRHI). Risk scores were calculated from a recently validated formula. Other clinical correlates of endothelial function were described in stepwise linear regression models. RESULTS: Uric acid was associated negatively with FMD% in an age- and gender-adjusted model, while not in the multivariable model. No association was shown between uric acid and LnRHI. FMD% was associated negatively with risk scores in both crude and age- and gender-adjusted models (p < 0.01). LnRHI was associated negatively with risk scores in the latter model only (p < 0.05). CONCLUSIONS: Uric acid was neither associated with FMD% nor LnRHI in KTRs. There were significant associations between endothelial function indices and cardiac and mortality risk scores.