The Danish Aging and Cognition (DanACo) cohort.

BACKGROUND: With aging populations worldwide, identification of predictors of age-related cognitive decline is becoming increasingly important. The Danish Aging and Cognition Cohort (DanACo) including more than 5000 Danish men was established to investigate predictors of age-related cognitive decline from young adulthood to late mid-life. CONSTRUCTION AND CONTENT: The DanACo cohort was established through two separate data collections with identical designs involving a follow-up examination in late mid-life of men for whom intelligence test scores were available from their mandatory conscription board examination. The cohort consists of 5,183 men born from 1949 through 1961, with a mean age of 20.4 years at baseline and a mean age of 64.4 years at follow-up. The baseline measures consisted of height, weight, intelligence test score and educational level collected at the conscription board examination. The follow-up assessment consisted of a re-administration of the same intelligence test and a comprehensive questionnaire covering socio-demographic factors, lifestyle, and health-related factors. The data were collected in test sessions with up to 24 participants per session. Using the unique personal identification number assigned to all Danes, the cohort has been linked to data from national administrative and health registers for prospectively collected data on socioeconomic and health-related factors. UTILITY AND DISCUSSION: The DanACo cohort has some major strengths compared to existing cognitive aging cohorts such as a large sample size (n = 5,183 men), a validated global measure of cognitive ability, a long retest interval (mean 44.0 years) and the availability of prospectively collected data from registries as well as comprehensive questionnaire data. The main weakness is the low participation rate (14.3%) and that the cohort consists of men only. CONCLUSION: Cognitive decline is a result of a summary of factors across the life-course. The DanACo cohort is characterized by a long retest interval and contains data on a wealth of factors across adult life which is essential to establish evidence on predictors of cognitive decline. Moreover, the size of the cohort ensures sufficient statistical power to identify even relatively weak predictors of cognitive decline.

Mobile device screen time is associated with poorer language development among toddlers: results from a large-scale survey.

BACKGROUND: Despite young children's widespread use of mobile devices, little research exists on this use and its association with children's language development. The aim of this study was to examine the associations between mobile device screen time and language comprehension and expressive language skills. An additional aim was to examine whether three factors related to the domestic learning environment modify the associations. METHODS: The study uses data from the Danish large-scale survey TRACES among two- and three-year-old children (n = 31,125). Mobile device screen time was measured as time spent on mobile devices on a normal day. Measurement of language comprehension and expressive language skills was based on subscales from the Five to Fifteen Toddlers questionnaire. Multivariable linear regression was used to examine the association between child mobile device screen time and language development and logistic regression to examine the risk of experiencing significant language difficulties. Joint exposure analyses were used to examine the association between child mobile device screen time and language development difficulties in combination with three other factors related to the domestic learning environment: parental education, reading to the child and child TV/PC screen time. RESULTS: High mobile device screen time of one hour or more per day was significantly associated with poorer language development scores and higher odds for both language comprehension difficulties (1-2 h: AOR = 1.30; ≥ 2 h: AOR = 1.42) and expressive language skills difficulties (1-2 h: AOR = 1.19; ≥ 2 h: AOR = 1.46). The results suggest that reading frequently to the child partly buffers the negative effect of high mobile device screen time on language comprehension difficulties but not on expressive language skills difficulties. No modifying effect of parental education and time spent by the child on TV/PC was found. CONCLUSIONS: Mobile device screen time of one hour or more per day is associated with poorer language development among toddlers. Reading frequently to the child may have a buffering effect on language comprehension difficulties but not on expressive language skills difficulties.

Is vegetation cover in key behaviour settings important for early childhood socioemotional function? A preregistered, cross-sectional study.

The environmental influences on early childhood development are understudied. The association between vegetation cover (i.e., trees, shrubs, grassed areas) in four key behaviour settings and socioemotional functioning was investigated in 1196 young children (2-5 years). Emotional difficulties were inversely associated with vegetation cover in the home yard (OR: 0.81 [0.69-0.96]) and neighbourhood (OR: 0.79 [0.67-0.94]), but not in early childhood education and care (ECEC) centre outdoor areas or the ECEC neighbourhood. The higher odds of emotional difficulties associated with lower levels of maternal education was reduced with higher percentages of home yard vegetation cover. There was no evidence of mediation of the relationship between emotional difficulties and vegetation cover by time spent playing outside the home, day or nighttime sleep duration, or physical activity. We found no associations between vegetation cover and conduct, hyperactivity and inattention, peer difficulties, or prosocial behaviours. A video abstract of this article can be viewed at https://www.youtube.com/watch?v=J3HeEiIjVZc.

Prospective associations between alcohol consumption and psychological well-being in midlife.

BACKGROUND: Alcohol consumption potentially influences psychological well-being in beneficial and harmful ways, but prospective studies on the association show mixed results. Our main purpose was to examine prospective associations between alcohol consumption and psychological well-being in middle-aged men and women. METHODS: The study sample included 4148 middle-aged individuals (80% men) from the Copenhagen Aging and Midlife Biobank who reported their alcohol consumption (average weekly consumption and frequency of binge drinking) at baseline in 2004 or 2006 and reported their psychological well-being (satisfaction with life and vitality) at follow-up in 2009-2011. Analyses were adjusted for sociodemographic factors, lifestyle, social relations, and morbidity. RESULTS: For satisfaction with life at follow-up, lower scores were observed in men and women who were alcohol abstinent at baseline as well as in men with heavy alcohol consumption compared with moderate alcohol consumption at baseline. Moreover, men with weekly binge drinking at baseline had lower satisfaction with life scores at follow-up than men with moderate frequency of binge drinking (1-3 times/month). In relation to vitality at follow-up, alcohol abstinence at baseline in men and women and heavy alcohol consumption at baseline in men were associated with lower scores compared with moderate alcohol consumption (yet in men these findings were not robust to adjustment for covariates). CONCLUSIONS: Alcohol abstinence seems to be prospectively associated with adverse psychological well-being (vitality and life satisfaction) in men and women, while heavy alcohol consumption seems to be prospectively associated with adverse satisfaction with life in men. Finally, a prospective association between weekly binge drinking and lower life satisfaction was observed in men.

Demographic factors and delay of treatment for alcohol use disorders among 6584 Danish men receiving alcohol treatment.

PURPOSE: This study aimed to investigate the time lag between onset and treatment (treatment delay) for alcohol use disorders (AUD) and associations between demographic factors and treatment delay for AUD. METHODS: The study included 6,584 men registered in the Copenhagen Alcohol Cohort, containing information on civil status, employment status, estimated age at onset of alcohol problems, and age at first outpatient AUD treatment. Data on year of birth, intelligence, and educational level were obtained from the Danish Conscription Database. Information on first hospital AUD treatment was retrieved from Danish national psychiatric registers. Associations between the demographic factors and treatment delay were analysed in separate linear regression models adjusted for year of birth and in a mutually adjusted model including all demographic factors. RESULTS: The mean treatment delay for AUD was 6.9 years (SD = 4.1). After mutual adjustment, an SD increase in intelligence score was associated with 0.17 years increase in treatment delay. Educational level was unrelated to treatment delay. Men with estimated age at onset of alcohol problems at age 20 years or younger had a 5.30 years longer treatment delay than men who had estimated age at onset of alcohol problems at age 51 years or older. Employed men had shorter treatment delays than unemployed men, especially among the oldest birth cohorts. CONCLUSIONS: The treatment delay of 6.9 years highlights the necessity to promote access to AUD treatment, perhaps in particular among adolescents and young individuals. Cognitive factors may affect treatment delay more than non-cognitive personal factors.

The Moderating Influence of School Achievement on Intelligence in Young Adulthood.

Education has been suggested to be possibly the most consistent, robust, and durable method available for raising intelligence, but little is known about the genetic and environmental interplay underlying this association. Therefore, we investigated how school achievement, as measured by grade point average in lower secondary school at 15 years of age, moderated intelligence variation in young adulthood. The sample consisted of all Danish male twin pairs who had left lower secondary school since 2002 and appeared, typically at age 18, before a draft board through 2015 (N = 2660). Shared environmental variance unique to intelligence (10% of total variance) was found to be greater among individuals with poor school achievement. However, school achievement did not moderate the genetic influences or the non-shared environmental influences on intelligence. We discuss the implications of this in light of the constraints imposed by the statistical models we used.

Satisfaction with life and SF-36 vitality predict risk of ischemic heart disease: a prospective cohort study.

The main objective of the current study was to investigate associations between two aspects of well-being - satisfaction with life and vitality - and incidence of and mortality from ischemic heart disease. Study design. The Copenhagen Aging and Midlife Biobank (CAMB) was conducted from 2009 to 2011 and was used as baseline data with 6750 individuals having complete information on The Satisfaction with Life Scale (SWLS) and 6652 individuals with complete information on the Short Form Health Survey (SF-36) vitality scale. Incidence of and mortality from ischemic heart disease were assessed using Danish register data and a total of 349 CAMB individuals were registered with either a diagnosis (n = 337) or had died (n = 12) from ischemic heart disease before the end of follow-up (31 December 2017). The hazard ratios of ischemic heart disease according to satisfaction with life and vitality scores were investigated using Cox proportional hazard regression adjusted for potential covariates. Results. A one standard deviation increase on the SWLS was associated with an 18% reduced risk of ischemic heart disease while a one standard deviation increase on the SF-36 vitality scale was associated with a 24% reduced risk of ischemic heart disease after adjustment for baseline socio-demographic factors. These associations remained when separately adjusting for lifestyle, objective health, and social factors, but became non-significant when adjusting for self-reported health. Conclusion. Our study indicates that both psychological and health-related components of wellbeing are important in relation to ischemic heart disease.

Does meaning protect against loneliness? Exploring empirical studies and theory.

Research indicates that meaning in life is a protective factor for physical and mental health. Although loneliness is increasingly recognized as an important public health concern, no studies have investigated the potential of meaning in life to protect against loneliness. Based on an explorative interdisciplinary research strategy that comprises data from a cohort study, a strategic review of empirical literature and a conceptual analysis of the concept of meaning in life we explore the support for potential links between meaning in life and the protection against loneliness. We propose three different explanatory mechanisms; (i) that meaning in life promotes a positive orientation toward others, (ii) that meaning in life enhances interpersonal appeal and (iii) that meaning in life promotes a better ability to cope with loneliness. Theoretically, we explore the idea that the value of meaning in life ultimately concerns a social need to contribute to the realization of value that, at least in principle, can be shared and recognized by others. When people realize the value of meaning in life, they partake in a community of shared values, which links them to a social world in a way that may protect against the feeling of loneliness. Jointly the analyses point to the need for prospective studies on the role of meaning in life as a protective factor against loneliness and a potential novel focus for loneliness interventions.

Birth weight and quality of life in midlife: a 50-year follow-up study of 2079 individuals in Denmark.

PURPOSE: Low birth weight has been associated with a higher risk of reduced quality of life (QoL) in children, adolescents, and young adults, but the influence seems to diminish over time. However, previous studies have mainly focused on health-related QoL and compared individuals with low birth weight with individuals without low birth weight. The purpose of the present cohort study was to investigate the influence of the entire range of birth weights on three distinct measures of QoL in midlife. METHODS: The study population consisted of all live-born singletons from the Copenhagen Perinatal Cohort (CPC, 1959-1961) who participated in a 50-year follow-up examination in 2009-2011 (N = 2079). Birth weight was measured by three pediatricians at birth. QoL was measured at the follow-up by the participants' scores on three QoL self-report measures: The Satisfaction With Life Scale, the Vitality Scale of the Medical Outcomes Study 36-Item Short-Form Health Survey, and a single-item QoL measure based on the question: "How is your quality of life at the moment?". General linear regression and binary logistic regression were used to estimate the association between birth weight and QoL in midlife. RESULTS: Small, curvilinear associations of birth weight with life satisfaction, vitality, and the single-item QoL measure were found, suggesting that both low and high birth weights increase the risk of low satisfaction with life, low vitality and low QoL. CONCLUSION: The study findings suggest that low and high-range birth weight exert a lasting influence on distinct, but complementary aspects of QoL in midlife.

Intelligence Test Scores Before and After Alcohol-Related Disorders-A Longitudinal Study of Danish Male Conscripts.

BACKGROUND: Existing studies on intellectual consequences of alcohol-related disorders are primarily cross-sectional and compare intelligence test scores of individuals with and without alcohol-related disorders, hence mixing the influence of alcohol-related disorders and predisposing factors such as premorbid intelligence. In this large-scale study, the primary aim was to estimate associations of alcohol-related disorders with changes in intelligence test scores from early adulthood to late midlife. METHODS: Data were drawn from a follow-up study on middle-aged men, which included a re-examination of the same intelligence test as completed in young adulthood at military conscription (total analytic sample = 2,499). Alcohol-related hospital diagnoses were obtained from national health registries, whereas treatment for alcohol problems was self-reported at follow-up. The analyses included adjustment for year of birth, retest interval, baseline intelligence quotient (IQ) score, education, smoking, alcohol consumption, and psychiatric and somatic comorbidity. RESULTS: Individuals with alcohol-related hospital diagnoses (8%) had a significantly lower baseline IQ score (95.0 vs. 100.5, p < 0.001) and a larger decline in IQ scores from baseline to follow-up (-8.5 vs. -4.8, p < 0.001) than individuals without such diagnoses. The larger decline in IQ scores with alcohol-related hospital diagnoses remained statistically significant after adjustment for all the covariates. Similar results were revealed when IQ scores before and after self-reported treatment for alcohol problems (10%) were examined. CONCLUSIONS: Individuals with alcohol-related disorders have a lower intelligence test score both in young adulthood and in late midlife, and these disorders, moreover, seem to be associated with more age-related decline in intelligence test scores. Thus, low mean intellectual ability observed in individuals with alcohol-related disorders is probably a result of both lower premorbid intelligence and more intellectual decline.

The association between life satisfaction, vitality, self-rated health, and risk of cancer.

PURPOSE: Only few prospective studies have been conducted on the contribution of quality of life-related factors to the risk of cancer. The aim of this study was to investigate the prospective associations of three quality of life-related factors with the risk of cancer; life satisfaction, vitality, and self-rated health. METHODS: In 2009-2011, 7189 participants in the Copenhagen Aging and Midlife Biobank were asked to rate their life satisfaction, their vitality, and their health. The study population was followed until the end of 2015 for registration of cancer in the Danish National Patient Register. RESULTS: During the follow-up period, cancer was diagnosed in 312 individuals. Life satisfaction was not associated with the risk of cancer. Vitality was significantly associated with the risk of cancer, but the association became non-significant after adjustment for age, sex, socioeconomic position, and lifestyle factors. However, when additionally adjusting for life satisfaction, individuals who rated their vitality as low had a hazard ratio of 1.46 (95% confidence interval [CI] 1.04-2.07) for the development of cancer. Individuals who rated their health as poor had a hazard ratio of 1.70 (95% CI 1.27-2.26) for the development of cancer, compared with individuals with good, very good, or excellent self-rated health. The association remained significant after adjustment for basic confounders, life satisfaction, and vitality. CONCLUSION: A better grasp of the significance of quality of life-related factors for the risk of cancer may be of great importance to population-based cancer prevention that aims to target early risk factors for development of cancer across widespread cancer sites.

Adult-Life Alcohol Consumption and Age-Related Cognitive Decline from Early Adulthood to Late Midlife.

AIMS: Alcohol consumption is a modifiable and plausible risk factor for age-related cognitive decline but more longitudinal studies investigating the association are needed. Our aims were to estimate associations of adult-life alcohol consumption and consumption patterns with age-related cognitive decline. METHODS: We investigated the associations of self-reported adult-life weekly alcohol consumption and weekly extreme binge drinking (≥10 units on the same occasion) with changes in test scores on an identical validated test of intelligence completed in early adulthood and late midlife in 2498 Danish men from the Lifestyle and Cognition Follow-up study 2015. Analyses were adjusted for year of birth, retest interval, baseline IQ, education and smoking. RESULTS: Men with adult-life alcohol consumption of more than 28 units/week had a larger decline in IQ scores from early adulthood to late midlife than men consuming 1-14 units/week (B29-35units/week = -3.6; P < 0.001). Likewise, a 1-year increase in weekly extreme binge drinking was associated with a 0.12-point decline in IQ scores (P < 0.001). Weekly extreme binge drinking explained more variance in IQ changes than average weekly consumption. In analyses including mutual adjustment of weekly extreme binge drinking and average weekly alcohol consumption, the estimated IQ decline associated with extreme binge drinking was largely unaffected, whereas the association with weekly alcohol consumption became non-significant. CONCLUSIONS: Adult-life heavy alcohol consumption and extreme binge drinking appear to be associated with larger cognitive decline in men. Moreover, extreme binge drinking may be more important than weekly alcohol consumption in relation to cognitive decline.

Predictors of early life milestones: Results from the Copenhagen Perinatal Cohort.

BACKGROUND: Pre- and postnatal factors have been found to be predictors of age at attaining milestones in infancy; however, the degree to which such factors are predictors of milestones in the subsequent years is less investigated. The aim was to conduct a systematic evaluation of a broad range of possible predictors of milestone attainment during the second and third years to identify factors that explain significant inter-individual variance. METHODS: Mothers of 4009 children from the Copenhagen Perinatal Cohort (1959-61) were interviewed by a physician about 20 developmental milestones at a three-year examination. Milestones were related to: Language, Walking, Eating, Dressing, Social interaction, and Toilet training. Information on possible predictors was collected during pregnancy and at a 1- and 3-year follow-up. RESULTS: Several pre- and postnatal factors were significantly associated with the timing of milestone attainment; especially parental social status, paternal age, sex, gestational age, birth weight, birth length, weight increase in the first year of life, and motor development during the first year of life. The significant predictors explained 16.2% of the variance in the Overall mean of milestones and 20.3% of the variance in milestones related to Walking. The most influential individual factor for the timing of milestone attainment was previous motor development during the first year of life. Additionally, sex was an important factor as girls were generally faster at attaining milestones. Parental social status was a consistent, but relatively week predictor. CONCLUSION: A notable amount of variance in the timing of milestones during the first three years of life can be explained by perinatal and early postnatal factors. The study provides evidence of developmental continuity as the main predictor of milestones in the second and third years was the speed of development during the first year.

Parental socioeconomic position and risk of ADHD in offspring: a cohort study of 9648 individuals in Denmark 1976-2013.

The strength of the association between parental socioeconomic position (SEP) and risk of attention-deficit/hyperactivity disorder (ADHD) in offspring is found to vary substantially, perhaps due to the negligence of possible changes in parental life course SEP. The present study investigated the association between parental SEP in adulthood and risk of ADHD diagnosis in offspring and whether parental childhood SEP modified this association. The study population included 9648 live-born singletons followed in the Psychiatric Central Register from birth in 1976-1996 until 2013. Cox regression was used to estimate hazard ratios for ADHD diagnosis according to parental SEP in adulthood. The results showed that low parental SEP in adulthood was associated with higher risk of ADHD diagnosis in offspring, also after adjustment for possible confounders. Thus, offspring of parents with low SEP in adulthood had 4.52 (95% CI 2.81-7.26) times higher hazard of ADHD diagnosis compared with offspring of parents with high SEP in adulthood. Further, parental childhood SEP was found to modify the observed association. Thus, offspring of parents with downward social mobility from childhood to adulthood and offspring of parents with stable low SEP experienced the highest risk of ADHD diagnosis, followed by offspring of parents with upward social mobility, compared with offspring of parents with stable high SEP. The results suggest that it is important to take into account the possibility of social mobility as changes in parental life course SEP from childhood to adulthood seem to influence the risk of ADHD diagnosis in offspring.

Associations of Early Developmental Milestones With Adult Intelligence.

The study investigated whether age at attainment of 20 developmental milestones within the areas of language, walking, eating, dressing, social interaction, and toilet training was associated with adult intelligence. Mothers of 821 children of the Copenhagen Perinatal Cohort recorded 20 developmental milestones at a 3-year examination, and all children were administered the Wechsler Adult Intelligence Scale when they were 20-34 years old. Later attainment of a number of milestones was associated with lower adult IQ with the strongest associations found for those related to language and social interaction. The adjusted full-scale IQ means were 107.0, 101.8, and 100.6 for being able to form a sentence at less than 24 months, at 24 months, and later than 24 months.

Parental socioeconomic position and midlife allostatic load: a study of potential mediators.

BACKGROUND: The mechanisms underlying the association of parental socioeconomic position with later life allostatic load remain unclear. The present study aims to examine potential pathways underlying this association: personality, social relations, intelligence and education. METHODS: The study comprised 361 members of the Copenhagen Perinatal Cohort who participated in two subsequent follow-ups: the Prenatal Development Project (mean age 27 years) and the Copenhagen Aging and Midlife Biobank study (mean age 50 years). Allostatic load was based on 14 biomarkers representing the inflammatory, metabolic and cardiovascular system measured at midlife. Information on potential mediators was collected in young adulthood, and their role in the association of parental socioeconomic position with midlife allostatic load were examined in linear regression path analyses. RESULTS: Parental socioeconomic position at one year was inversely associated with midlife allostatic load (ß = - 0.238, p < .001). No mediation effects were found for personality or social relations. In a model including intelligence and education, a significant indirect effect was found for education (ß = - 0.151, p < .001). A significant direct effect remained (ß = - 0.111, p = .040). CONCLUSIONS: Parental socioeconomic position was inversely associated with allostatic load in midlife. Results suggest that part of this association was mediated by education. A better understanding of the non-cognitive pathways related to education is an important prerequisite for the development of effective intervention strategies.

Predictors of motor developmental milestones during the first year of life.

Studies suggest that both pre- and postnatal factors are predictors of age of attaining milestones in infancy. However, no studies evaluate the comparative strength of these predictors and the amount of the variance in development they explain. This study aimed to conduct a systematic evaluation of a broad selection of possible predictors of age at milestone attainment and to identify factors that explain significant inter-individual variance. Mothers of 5765 children of the Copenhagen Perinatal Cohort (1959-61) recorded 12 developmental milestones prospectively during the child's first year of life. Information on possible predictors was collected during pregnancy and at follow-up and was categorized into the domains: Family background, Pregnancy and delivery, Postnatal influences, and Postnatal growth. The domain Pregnancy and delivery contributed most of the explained variance in Overall mean of milestones (14.4%), with especially gestational age (ß = -0.15; p ≤ 0.001) and birth weight (ß = -0.16; p ≤ 0.001) being important predictors. CONCLUSION: Several individual factors, especially gestational age, birth weight, breastfeeding, having lived in a full-time institution, and weight and head increase in the first year, were significantly associated with milestone attainment in the first year of life. Variables within the domain of Pregnancy and delivery explained the largest proportion of variance in milestone attainment compared to the other domains. What is known: • Younger age at attainment of motor developmental milestones positively predicts cognitive outcomes in adulthood. • Both pre- and postnatal factors have been associated with age of attaining milestones in infancy. What is new: • First study to provide a systematic evaluation of a broad selection of predictors of infant milestone attainment. • Variables within the domain of Pregnancy and delivery, especially gestational age and birth weight, explained the largest proportion of variance in milestone attainment. • The variance explained by the predictors decreased time-dependently with later milestones.

Social network as predictor for onset of alcohol use disorder: A prospective cohort study.

OBJECTIVE: Social network has been linked to alcohol use disorder in several studies. However, since the majority of such findings are cross-sectional, causal interpretation is difficult. The aim of the present study was to test if social network characteristics predict alcohol use disorder in a prospective design. METHODS: Information on social network and covariates was obtained from 9589 men and women aged 21-99 years in the Copenhagen City Heart Study, followed for registration of alcohol use disorder in the Danish National Patient Registry and the WINALCO database. RESULTS: Men who lived alone, were separated or divorced or widowers had a higher risk of developing alcohol use disorder: HR among men living alone vs. men not living alone was 2.28 (95% CI: 1.59-3.27), and HR among separated/divorced men vs. married men was 2.55 (95% CI: 1.33-4.89). No such associations were found among women. Frequency of contact with friends was associated with risk of developing alcohol use disorder among both sexes. For example, the HRs were 1.72 (CI 95%: 0.99-3.01) and 2.59 (95% CI: 1.42-4.71) among women who had contact with friends a couple of times per week and daily, respectively, compared with more rarely. Frequency of contact with family was not associated with risk of developing alcohol use disorder among either sex. CONCLUSION: Living alone and not being married or cohabiting with a partner were predictors of developing alcohol use disorder among men. Further, frequent contact with friends was associated with higher risk of alcohol use disorder among both sexes.

Physical activity and risk of alcohol use disorders: results from a prospective cohort study.

AIMS: To examine the effect of physical activity on risk of developing alcohol use disorders in a large prospective cohort study with focus on leisure-time physical activity. METHODS: Data came from the four examinations of the Copenhagen City Heart Study (CCHS), performed in 1976-1978, 1981-1983, 1991-1994 and 2001-2003. Information on physical activity (classified as Moderate/high, low or sedentary) and covariates was obtained through self-administered questionnaires, and information on alcohol use disorders was obtained from the Danish Hospital Discharge Register, the Danish Psychiatric Central Research Register and the Winalco database. In total, 18,359 people participated in the study, a mean follow-up time of 20.9 years. Cox proportional hazards model with delayed entry was used. Models were adjusted for available covariates (age, smoking habits, alcohol intake, education, income and cohabitation status) including updated time-dependent variables whenever possible. RESULTS: A low or moderate/high leisure-time physical activity was associated with almost half the risk of developing alcohol use disorder compared with a sedentary leisure-time physical activity. This translates into a 1.5- to 2-fold increased risk of developing alcohol use disorder (Hazard ratios for men 1.64; 95% CI 1.29-2.10 and women 1.45; 1.01-2.09) in individuals with a sedentary leisure-time physical activity, compared with a moderate to high level. However, when stratifying by presence of other psychiatric disorders, no association was observed in women with psychiatric comorbidity. Residual confounding may have been present in this study, especially according to rough measures of income and education. CONCLUSIONS: In both men and women, being sedentary in leisure time was a risk factor for developing an alcohol use disorder.