A within-sibling pair analysis of lifestyle behaviours and BMI z-score in the multi-centre I.Family study.

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 adolescents. 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.

The impact of familial, behavioural and psychosocial factors on the SES gradient for childhood overweight in Europe. A longitudinal study.

BACKGROUND: In highly developed countries, childhood overweight and many overweight-related risk factors are negatively associated with socioeconomic status (SES). OBJECTIVE: The objective of this study is to investigate the longitudinal association between parental SES and childhood overweight, and to clarify whether familial, psychosocial or behavioural factors can explain any SES gradient. METHODS: The baseline and follow-up surveys of the identification and prevention of dietary and lifestyle induced health effects in children and infants (IDEFICS) study are used to investigate the longitudinal association between SES, familial, psychosocial and behavioural factors, and the prevalence of childhood overweight. A total of 5819 children (50.5% boys and 49.5% girls) were included. RESULTS: The risk for being overweight after 2 years at follow-up in children who were non-overweight at baseline increases with a lower SES. For children who were initially overweight, a lower parental SES carries a lower probability for a non-overweight weight status at follow-up. The effect of parental SES is only moderately attenuated by single familial, psychosocial or behavioural factors; however, it can be fully explained by their combined effect. Most influential of the investigated risk factors were feeding/eating practices, parental body mass index, physical activity behaviour and proportion of sedentary activity. CONCLUSION: Prevention strategies for childhood overweight should focus on actual behaviours, whereas acknowledging that these behaviours are more prevalent in lower SES families.

Usual energy and macronutrient intakes in 2-9-year-old European children.

OBJECTIVE: Valid estimates of population intakes are essential for monitoring trends as well as for nutritional interventions, but such data are rare in young children. In particular, the problem of misreporting in dietary data is usually not accounted for. Therefore, this study aims to provide accurate estimates of intake distributions in European children. DESIGN: Cross-sectional setting-based multi-centre study. SUBJECTS: A total of 9560 children aged 2-9 years from eight European countries with at least one 24-h dietary recall (24-HDR). METHODS: The 24-HDRs were classified in three reporting groups based on age- and sex-specific Goldberg cutoffs (underreports, plausible reports, overreports). Only plausible reports were considered in the final analysis (N=8611 children). The National Cancer Institute (NCI)-Method was applied to estimate population distributions of usual intakes correcting for the variance inflation in short-term dietary data. RESULTS: The prevalence of underreporting (9.5%) was higher compared with overreporting (3.4%). Exclusion of misreports resulted in a shift of the energy and absolute macronutrient intake distributions to the right, and further led to the exclusion of extreme values, that is, mean values and lower percentiles increased, whereas upper percentiles decreased. The distributions of relative macronutrient intakes (% energy intake from fat/carbohydrates/proteins) remained almost unchanged when excluding misreports. Application of the NCI-Method resulted in markedly narrower intake distributions compared with estimates based on single 24-HDRs. Mean percentages of usual energy intake from fat, carbohydrates and proteins were 32.2, 52.1 and 15.7%, respectively, suggesting the majority of European children are complying with common macronutrient intake recommendations. In contrast, total water intake (mean: 1216.7 ml per day) lay below the recommended value for >90% of the children. CONCLUSION: This study provides recent estimates of intake distributions of European children correcting for misreporting as well as for the daily variation in dietary data. These data may help to assess the adequacy of young children's diets in Europe.

Adherence to the obesity-related lifestyle intervention targets in the IDEFICS study.

BACKGROUND/OBJECTIVES: To address behaviours associated with childhood obesity, certain target values are recommended that should be met to improve children's health. In the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS) study such lifestyle recommendations were conveyed as six key messages. Here, we investigate the adherence of European children to these messages. METHODS: The IDEFICS intervention was based on the intervention mapping approach with the following six targets: increase water consumption (to replace sugar-containing beverages), increase fruit/vegetable consumption, reduce daily screen time, increase daily physical activity, improve the quality of family life and ensure adequate sleep duration. Internationally recommended target values were applied to determine the prevalence of children meeting these targets. RESULTS: In a cohort of 18,745 children participating in the IDEFICS baseline survey or newly recruited during follow-up, data on the above lifestyle behaviours were collected for a varying number of 8302 to 17,212 children. Information on all six behaviours was available for 5140 children. Although 52.5% of the cohort was classified in the highest category of water consumption, only 8.8% met the target of an intake of fruits/vegetables five times a day. The prevalence of children adhering to the recommendation regarding total screen time-below 1 h for pre-school children and 2 h for school children-was 51.1%. The recommended amount of at least 60 min of moderate-to-vigorous physical activity per day was fulfilled by 15.2%. Family life of the child measured by various indicators was considered as satisfactory in 22.8%. Nocturnal sleep duration of 11 (10) hours or more in pre-school (school) children was achieved by 37.9%. In general, children in northern countries and younger children showed better adherence to the recommendations. Only 1.1% of the children adhered to at least five of these recommendations. CONCLUSIONS: Current adherence of children to lifestyle recommendations to prevent childhood obesity is low where observed differences with respect to country, age and gender call for targeted intervention.

Metabolic syndrome in young children: definitions and results of the IDEFICS study.

OBJECTIVE: To estimate the prevalence of the metabolic syndrome (MetS) using reference standards obtained in European children and to develop a quantitative MetS score and describe its distribution in children. DESIGN AND METHODS: Population-based survey in eight European countries, including 18745 children 2.0 to 10.9 years, recruited during a second survey. Anthropometry (weight, height and waist circumference), blood pressure and serum-fasting triglycerides, HDL cholesterol, glucose and insulin were measured. We applied three widely accepted definitions of the pediatric MetS and we suggest a new definition, to guide pediatricians in decisions about close monitoring or even intervention (values of at least three of the MetS components exceeding the 90th or 95th percentile, respectively). We used a z-score standardisation to calculate a continuous score combining the MetS components. RESULTS: Among the various definitions of MetS, the highest prevalence (5.5%) was obtained with our new definition requiring close observation (monitoring level). Our more conservative definition, requiring pediatric intervention gives a prevalence of 1.8%. In general, prevalences were higher in girls than in boys. The prevalence of metabolic syndrome is highest among obese children. All definitions classify a small percentage of thin or normal weight children as being affected. The metabolic syndrome score shows a positive trend with age, particularly regarding the upper percentiles of the score. CONCLUSIONS: According to different definitions of pediatric MetS, a non-negligible proportion of mostly prepubertal children are classified as affected. We propose a new definition of MetS that should improve clinical guidance. The continuous score developed may also serve as a useful tool in pediatric obesity research. It has to be noted, however, that the proposed cutoffs are based on a statistical definition that does not yet allow to quantify the risk of subsequent disease.

Physical fitness reference standards in European children: the IDEFICS study.

BACKGROUND/OBJECTIVES: A low fitness status during childhood and adolescence is associated with important health-related outcomes, such as increased future risk for obesity and cardiovascular diseases, impaired skeletal health, reduced quality of life and poor mental health. Fitness reference values for adolescents from different countries have been published, but there is a scarcity of reference values for pre-pubertal children in Europe, using harmonised measures of fitness in the literature. The IDEFICS study offers a good opportunity to establish normative values of a large set of fitness components from eight European countries using common and well-standardised methods in a large sample of children. Therefore, the aim of this study is to report sex- and age-specific fitness reference standards in European children. SUBJECTS/METHODS: Children (10,302) aged 6-10.9 years (50.7% girls) were examined. The test battery included: the flamingo balance test, back-saver sit-and-reach test (flexibility), handgrip strength test, standing long jump test (lower-limb explosive strength) and 40-m sprint test (speed). Moreover, cardiorespiratory fitness was assessed by a 20-m shuttle run test. Percentile curves for the 1st, 3rd, 10th, 25th, 50th, 75th, 90th, 97th and 99th percentiles were calculated using the General Additive Model for Location Scale and Shape (GAMLSS). RESULTS: Our results show that boys performed better than girls in speed, lower- and upper-limb strength and cardiorespiratory fitness, and girls performed better in balance and flexibility. Older children performed better than younger children, except for cardiorespiratory fitness in boys and flexibility in girls. CONCLUSIONS: Our results provide for the first time sex- and age-specific physical fitness reference standards in European children aged 6-10.9 years.

Prevalence of overweight and obesity in European children below the age of 10.

BACKGROUND: There is a lack of common surveillance systems providing comparable figures and temporal trends of the prevalence of overweight (OW), obesity and related risk factors among European preschool and school children. Comparability of available data is limited in terms of sampling design, methodological approaches and quality assurance. The IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS) study provides one of the largest European data sets of young children based on state-of-the-art methodology. OBJECTIVE: To assess the European distribution of weight status according to different classification systems based on body mass index (BMI) in children (2.0-9.9 years). To describe the prevalence of weight categories by region, sex, age and socioeconomic position. DESIGN: Between 2007 and 2010, 18,745 children from eight European countries participated in an extensive, highly standardised protocol including, among other measures, anthropometric examinations and parental reports on socio-demographic characteristics. RESULTS: The combined prevalence of OW/obesity ranges from more than 40% in southern Europe to less than 10% in northern Europe. Overall, the prevalence of OW was higher in girls (21.1%) as compared with boys (18.6%). The prevalence of OW shows a negative gradient with social position, with some variation of the strength and consistency of this association across Europe. Overall, population groups with low income and/or lower education levels show the highest prevalence of obesity. The use of different reference systems to classify OW results in substantial differences in prevalence estimates and can even reverse the reported difference between boys and girls. CONCLUSIONS: There is a higher prevalence of obesity in populations from southern Europe and in population groups with lower education and income levels. Our data confirm the need to develop and reinforce European public health policies to prevent early obesity and to reduce these health inequalities and regional disparities.

Adherence to a Mediterranean-like dietary pattern in children from eight European countries. The IDEFICS study.

BACKGROUND: Despite documented benefits of a Mediterranean-like dietary pattern, there is a lack of knowledge about how children from different European countries compare with each other in relation to the adherence to this pattern. In response to this need, we calculated the Mediterranean diet score (MDS) in 2-9-year-old children from the Identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) eight-country study. SUBJECTS AND METHODS: Using 24 h dietary recall data obtained during the IDEFICS study (n=7940), an MDS score was calculated based on the age- and sex-specific population median intakes of six food groups (vegetables and legumes, fruit and nuts, cereal grains and potatoes, meat products and dairy products) and the ratio of unsaturated to saturated fats. For fish and seafood, which was consumed by 10% of the population, one point was given to consumers. The percentages of children with high MDS levels (>3) were calculated and stratified by sex, age and by having at least one migrant parent or both native parents. Demographic (sex and age) and socioeconomic characteristics (parental education and income) of children showing high (>3) vs low (⩽3) MDS levels were examined. RESULTS: The highest prevalence of children with MDS>3 was found among the Italian pre-school boys (55.9%) and the lowest among the Spanish school-aged girls (26.0%). Higher adherence to a Mediterranean-like dietary pattern was not associated with living in a Mediterranean country or in a highly educated or high-income family, although with some exceptions. Differences in adherence between boys and girls or age groups varied between countries without any general pattern. CONCLUSIONS: With the exception of Italian pre-schoolers, similar adherence levels to a Mediterranean-like dietary pattern have been observed among European children.

Percentile reference values for anthropometric body composition indices in European children from the IDEFICS study.

INTRODUCTION: To characterise the nutritional status in children with obesity or wasting conditions, European anthropometric reference values for body composition measures beyond the body mass index (BMI) are needed. Differentiated assessment of body composition in children has long been hampered by the lack of appropriate references. OBJECTIVES: The aim of our study is to provide percentiles for body composition indices in normal weight European children, based on the IDEFICS cohort (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS). METHODS: Overall 18,745 2.0-10.9-year-old children from eight countries participated in the study. Children classified as overweight/obese or underweight according to IOTF (N=5915) were excluded from the analysis. Anthropometric measurements (BMI (N=12 830); triceps, subscapular, fat mass and fat mass index (N=11,845-11,901); biceps, suprailiac skinfolds, sum of skinfolds calculated from skinfold thicknesses (N=8129-8205), neck circumference (N=12,241); waist circumference and waist-to-height ratio (N=12,381)) were analysed stratified by sex and smoothed 1st, 3rd, 10th, 25th, 50th, 75th, 90th, 97th and 99th percentile curves were calculated using GAMLSS. RESULTS: Percentile values of the most important anthropometric measures related to the degree of adiposity are depicted for European girls and boys. Age- and sex-specific differences were investigated for all measures. As an example, the 50th and 99th percentile values of waist circumference ranged from 50.7-59.2 cm and from 51.3-58.7 cm in 4.5- to <5.0-year-old girls and boys, respectively, to 60.6-74.5 cm in girls and to 59.9-76.7 cm in boys at the age of 10.5-10.9 years. CONCLUSION: The presented percentile curves may aid a differentiated assessment of total and abdominal adiposity in European children.

The association between plasma homocysteine and coronary heart disease is modified by the MTHFR 677C>T polymorphism.

OBJECTIVE: An elevated level of total plasma homocysteine (tHcy) has been associated with risk of coronary heart disease (CHD). The level of tHcy is affected by lifestyle, in addition to genetic predisposition. The methylene tetrahydrofolate reductase (MTHFR) 677C>T polymorphism (rs1801133) is among the strongest genetic predictors of tHcy. We examined whether the association between tHcy and CHD is modified by the MTHFR 677C>T polymorphism. DESIGN AND SETTING: Data from two case-control studies of first-time myocardial infarction (MI), Stockholm Heart Epidemiology Programme (SHEEP), and for MI and unstable angina, INTERGENE, were analysed in parallel. PATIENTS: THcy was determined in a total of 1150 cases and 1753 controls. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The outcome comprised first-time MI and unstable angina, subsumed as CHD. Logistic regression was used to investigate the association between tHcy and CHD, and its modification by genotype. RESULTS: High tHcy was confirmed to be a risk factor for CHD in both studies. In SHEEP, the association between tHcy and MI was observed in MTHFR 677 C-homozygotes (OR=1.4, 95% CI 1.2 to 1.6, for a difference by 1 SD of log tHcy) and in heterozygotes (OR=1.3, 95% CI 1.1 to 1.6) but not in T-homozygotes, independent of smoking, physical activity and obesity. An effect modification of similar magnitude was observed but not statistically significant in the smaller INTERGENE study, and confirmed in a meta-analysis of both studies. CONCLUSIONS: Two Swedish case-control studies showed that the association between elevated tHcy and CHD was confined to carriers of the MTHFR 677 C-allele, which could have implications for the efficiency of tHcy-lowering treatment.

Multi-level influences on childhood obesity in Sweden: societal factors, parental determinants and child's lifestyle.

BACKGROUND: Swedish school children living in rural areas and in areas with low education are at excess risk of becoming overweight. This study examines influences of societal and individual characteristics (children and their parents) on prevalence of overweight and obesity, in a national sample of 7-9-year-old children. METHOD: Anthropometric and lifestyle data were collected in a nationally representative sample of 3636 Swedish children. Overweight and obesity (International Obesity Task Force (IOTF)) data were analyzed in relation to lifestyle factors, parental weight, education and breast-feeding. RESULTS: The prevalence of overweight was 15.6% including 2.6% obese. Urbanization level and parental characteristics (weight status and education) were related to risk of overweight. Overall less favorable lifestyle characteristics were observed in rural areas and for children of low/medium educated mothers. Boys had greater risk of obesity in semi-urban and rural areas but this was not true for girls. For children's overweight, the living area effect was attenuated in multivariate analysis, while there was an association with origin of parents, high parental weight and medium maternal education. For obesity, the living area effect remained in boys while having two non-Nordic parents predicted obesity in girls. Parental weight status was associated with obesity in both girls and boys. CONCLUSION: Individual and societal factors influence children's weight status, and parental weight status is a strong determinant. Including overweight and obese parents in future health promoting interventions could be a strategy to prevent children from becoming overweight, but identifying those parents may prove difficult. To ensure reaching children with the greatest needs, targeting high risk areas might be a more effective approach.

Measures of birth size in relation to risk of prostate cancer: the Malmö Diet and Cancer Study, Sweden.

There is some evidence that perinatal factors, specifically birth weight (BW), may be related to the onset of prostate cancer (PRCA). This case-control study, nested within the Malmö Diet and Cancer Cohort Study, used archived birth record data from 308 incident PRCA cases diagnosed between 1991 and 2005, and 637 age-matched controls among 4781 men born (1923-1945) in Malmö and Lund, Sweden. We applied conditional logistic regression to examine the birth size-PRCA association, including tumour subtypes, adjusting for perinatal and adult factors. Compared with controls, cases had a non-significantly higher mean BW and were more likely to have high (>4000 g) BW (21% v. 18%), but did not differ in other birth size measures, nor in mean adult body mass index . We observed a non-linear association between BW and PRCA risk. Compared with BWs between 3000 and 3500 g (reference), the fully adjusted odds ratios (OR, 95% CI) were 0.55 (0.33-0.91) for <3000 g, 0.86 (0.61-1.22) for 3500-4000 g and 0.98 (0.64-1.50) for >4000 g. Among men with aggressive tumours, the reduction in risk for those with BWs <3000 g (OR 0.26, 95% CI 0.09-0.72) was stronger than the rate of risk for PRCA overall. Crude risk estimates were minimally attenuated when adjusted for gestational age, maternal age, birth order and adult factors. Birth length, head circumference and placental weight were not associated with prostate cancer. Our results indicate a protective effect of lower BW on risk of total and aggressive prostate cancer, rather than any direct effect of larger birth size.

Beer consumption and the 'beer belly': scientific basis or common belief?

BACKGROUND/OBJECTIVES: The term 'beer belly' expresses the common belief that beer consumption is a major determinant of waist circumference (WC). We studied the gender-specific associations between beer consumption and WC (partially in relation to body weight and hip circumference (HC) change). PARTICIPANTS/METHODS: Within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study (7876 men, 12 749 women), cross-sectional associations were investigated applying general linear models. Prospective analyses of baseline beer consumption and an 8.5-year WC change were assessed using multivariate general linear models and polytomous logistic regression. To test the site-specific effect of beer consumption on WC, an adjustment for concurrent changes in body weight and HC was carried out. In addition, the relationship between change in beer consumption and change in WC was studied. RESULTS: A positive association in men and no association in women were seen between beer consumption and WC at baseline. Men consuming 1000 ml/d beer were at 17% higher risk for WC gain compared with very light consumers. Significantly lower odds for WC gain (odds ratio=0.88; 95% confidence interval 0.81, 0.96) were found in beer-abstaining women than in very-light-drinking women. The adjustment for concurrent body weight and HC change diminished effect estimates notably, explaining most of the association between beer and change in WC. Decreasing beer consumption was related to higher relative odds for WC loss, although not statistically significant. CONCLUSIONS: Beer consumption leads to WC gain, which is closely related to concurrent overall weight gain. This study does not support the common belief of a site-specific effect of beer on the abdomen, the beer belly.

Psychosocial profile in men and women with unexplained chest pain.

OBJECTIVE: The aim of this study was to compare men and women with unexplained chest pain (UCP) to a randomly selected population sample free of clinical heart disease with regard to sleep problems, mental strain at work, stress at home, negative life events and health-related quality of life (HRQOL). DESIGN AND SUBJECTS: The study was conducted at a university hospital in Sweden including 231 patients aged 25-69 without any organic cause for chest pain. As a reference group, 1069 participants, were recruited from the INTERGENE population-based study. RESULTS: Patients with UCP had more sleep problems (OR = 1.8, P < 0.0001), were almost three times more worried about stress at work (OR = 2.9, P < 0.0001), or had more stress at home (OR = 2.8, P < 0.0001), and were twice as likely to have negative life events (OR = 2.1, P < 0.0001). Women, but not men, with UCP, had a higher prevalence of cardiovascular risk factors (obesity, smoking, diabetes and hypertension) compared with references. With regard to HRQOL, UCP patients scored significantly lower than references in all dimensions of the SF-36. CONCLUSIONS: In comparison with a healthy reference group, patients with UCP reported more sleep problems, mental strain at work, stress at home and negative life events and had lower health-related quality of life. Aside from immigration the strongest independent psychosocial factors were mental strain at work and negative life events last year in men and stress at home in women.

Alcoholic beverages and incidence of dementia: 34-year follow-up of the prospective population study of women in Goteborg.

The objective of this study was to assess the association between different types of alcoholic beverages and 34-year incidence of dementia. Among a random sample of 1,462 women aged 38-60 years and living in Göteborg, Sweden, in 1968-1969, 164 cases of dementia were diagnosed by 2002. At baseline as well as in 1974-1975, 1980-1981, and 1992-1993, the frequency of alcohol intake, as well as other lifestyle and health factors, was recorded and related to dementia with Cox proportional hazard regression, by use of both baseline and updated covariates. Wine was protective for dementia (hazard ratio (HR) = 0.6, 95% confidence interval (CI): 0.4, 0.8) in the updated model, and the association was strongest among women who consumed wine only (HR = 0.3, 95% CI: 0.1, 0.8). After stratification by smoking, the protective association of wine was stronger among smokers. In contrast, consumption of spirits at baseline was associated with slightly increased risk of dementia (HR = 1.5, 95% CI: 1.0, 2.2). Results show that wine and spirits displayed opposing associations with dementia. Because a protective effect was not seen for the other beverages, at least part of the association for wine may be explained by components other than ethanol.

Health Hunters--an intervention to prevent overweight and obesity in young high-risk women.

AIM: The aim of the study was to develop and implement an obesity and weight gain prevention program targeted to a high-risk group. METHOD: Women, 18-28 years old, with at least one severely obese parent, were randomized to the intervention or control group of the 'Health Hunters' program. During 1 year of follow-up, the intervention group received an individualized behavioral program focusing on food choice, physical activity and other lifestyle factors. Anthropometric measures, DXA-based body composition and fitness levels were measured at baseline and after 1 year. Self-reported changes in obesity-related behaviors were also assessed. RESULTS: Baseline examinations were conducted in 40 women, of whom 30 completed follow-up examinations 1 year later. Pregnancy was the most common reason for failure to complete the study. Compared to the control group (which gained weight), the intervention group displayed significant improvements in body weight, body mass index, waist circumference, waist-to-hip ratio and self-reported physical activity. Changes in body composition, although not significant, suggested that the intervention tended to be associated with improved body composition. Further analysis of changes in diet and fitness in relation to concurrent weight changes indicated that the strongest 'protective' associations were for energy percent protein, fiber density and fitness. CONCLUSION: Pilot data from the Health Hunters obesity prevention program indicates that it is effective in high-risk young women with familial predisposition for obesity.

Obesity in 70-year-old Swedes: secular changes over 30 years.

OBJECTIVE: Secular increases in obesity have been widely reported in middle-aged adults, but less is known about such trends among the elderly. The primary purpose of this paper is to document the most recent wave of the obesity epidemic in population-based samples of 70-y-old men and women from Göteborg. Additionally, we will investigate the influences of physical activity, smoking and education on these secular trends. POPULATIONS AND METHODS: Five population-based samples of 3702 70-y-olds (1669 men and 2033 women) in Göteborg, Sweden, born between 1901 and 1930, were examined in the Gerontological and Geriatric Population Studies (H70) between 1971 and 2000. Cohort differences in anthropometric measures were the main outcomes studied. Physical activity, smoking habits and education were assessed by comparable methods in all cohorts. Subsamples of the women in the latest two cohorts (birth years 1922 and 1930) were also part of the Prospective Population Study of Women in Göteborg. In these women, it was possible to examine body mass index (BMI) and waist-to-hip circumference ratio (WHR) longitudinally since 1968. RESULTS AND CONCLUSIONS: Significant upward trends were found for height, weight, BMI, waist circumference (WC), WHR, prevalence of overweight (BMI> or =25 kg/m(2)) and obesity (BMI> or =30 kg/m(2)) across cohorts in both sexes. In 2000, 20% of the 70-y-old men born in 1930 were obese, and the largest increment (almost doubling) had occurred between the early 1980s and the early 1990s. In 70-y-old women the prevalence of obesity was 24% in 2000, a 50% increase compared to the cohort born 8 y earlier. BMI increased over time in all physical activity, smoking and education groups, with the exception of never-smoking men. Although 70-y-old women in 2000 were heavier than cohorts examined 8 y previously, data from the women studied longitudinally revealed that these differences were already present in earlier adulthood. In conclusion, the elderly population is very much part of the obesity epidemic, although secular trends in BMI were detected slightly earlier in men than in women. The health implications of these secular trends should be focused on in future gerontological research.

Trends in overweight and obesity from 1985 to 2002 in Göteborg, West Sweden.

OBJECTIVE: To study secular trends in overweight and selected correlates in men and women in Göteborg, Sweden. DESIGN: Cross-sequential population-based surveys. SUBJECTS: A total of 2931 female and 2691 male subjects aged 25-64 y participated in WHO MONICA surveys (1985, 1990, 1995) and the INTERGENE study (2002). MEASUREMENTS: Body mass index (BMI), waist-to-hip ratio (WHR), prevalence of overweight (BMI> or =25 kg/m(2)), and obesity (BMI> or =30 kg/m(2)). RESULTS: Mean body weight increased by 3.3 kg for women and 5 kg for men, with a significant upward trend for BMI in men but not women over the 17-y observation period. The prevalence of overweight and obesity increased significantly in both sexes over the period. The largest increase was observed in men, and in women aged 25-34 y. In 2002, the prevalence of overweight was 38% in women and 58% in men, and the prevalence of obesity was 11% in women and 15% in men. No significant secular trends were observed for WHR, but there was an upward trend in prevalence of WHR>0.85 in women. A decreased prevalence of smoking in both sexes was observed together with an increase in reported leisure time physical activity. No significant secular trends were observed in rates of self-reported diabetes, although the risk of diabetes attributable to obesity was 24%. CONCLUSION: The results indicate that 25-64-y-olds in the recent survey were more overweight and obese than earlier studied MONICA participants. The increase in BMI was more pronounced in men while abdominal obesity increased principally in women. Although obesity and overweight are clearly important risk factors for type 2 diabetes, the number of diabetics remains low and any secular increase is not yet apparent.

A 24-year follow-up of body mass index and cerebral atrophy.

OBJECTIVE: To investigate the longitudinal relationship between body mass index (BMI), a major vascular risk factor, and cerebral atrophy, a marker of neurodegeneration, in a population-based sample of middle-aged women. METHODS: A representative sample of 290 women born in 1908, 1914, 1918, and 1922 was examined in 1968 to 1969, 1974 to 1975, 1980 to 1981, and 1992 to 1993 as part of the Population Study of Women in Göteborg, Sweden. At each examination, women completed a survey on a variety of health and lifestyle factors and underwent anthropometric, clinical, and neuropsychiatric assessments and blood collection. Atrophy of the temporal, frontal, occipital, and parietal lobes was measured on CT in 1992 when participants were age 70 to 84. Univariate and multivariate regression analyses were used to assess the relationship between BMI and brain measures. RESULTS: Women with atrophy of the temporal lobe were, on average, 1.1 to 1.5 kg/m2 higher in BMI at all examinations than women without temporal atrophy (p < 0.05). Multivariate analyses showed that age and BMI were the only significant predictors of temporal atrophy. Risk of temporal atrophy increased 13 to 16% per 1.0-kg/m2 increase in BMI (p < 0.05). There were no associations between BMI and atrophy measured at three other brain locations. CONCLUSION: Overweight and obesity throughout adult life may contribute to the development of temporal atrophy in women.

Birth weight is associated with postmenopausal breast cancer risk in Swedish women.

There is some evidence that birth weight is associated with breast cancer. Whether this association differs between premenopausal and postmenopausal ages is still unclear. The results from this study suggest that higher birth weight is a risk factor for postmenopausal breast cancer (OR 1.06, CI 1.00-1.12, per 100 g), independent of selected early-life and adult factors.