Intake of different types of seafood and meat and risk of type 2 diabetes in women: a prospective study supported by a dietary intervention in mice.

Detailed knowledge regarding the associations between intake of different types of seafood and meat and the risk of type 2 diabetes (T2D), and insight into possible mechanisms are warranted. In this study we aimed to evaluate the associations between intake of different types of seafood and meat and the subsequent risk of T2D using the Norwegian Mother, Father, and Child Cohort Study (MoBa), and furthermore, by using a mouse model to gain further insight into possible molecular mechanisms contributing to the associated metabolic changes. Women in MoBa who were free of pharmacologically treated diabetes at baseline (n = 60,777) were prospectively evaluated for incident T2D, identified on the basis of medication usages > 90 days after delivery, ascertained by the Norwegian Prescription Database. Dietary intake was obtained with a validated 255-item food frequency questionnaire which assessed habitual diet during the first 4-5 months of pregnancy. Metabolic phenotypes and plasma metabolome were investigated in female mice fed isocaloric diets with different types of seafood and meat mimicking the dietary intake in the human cohort. During maximum 10-year and mean (SD) 7.2 (1.6) years follow-up time, 681 (1.1%) women developed pharmacologically treated T2D. All statistical models identified a higher risk of T2D with increased shellfish intake, whereas no associations were observed for total seafood, fatty fish, total meat and red meat in the adjusted models. In mice, the shellfish-based western diet induced reduced glucose tolerance and insulin secretion compared to the diet based on lean fish, and we identified a number of metabolites elevated in plasma from shellfish-fed mice that correlated with glucose intolerance. Mice fed a western diet based on meat also exhibited reduced glucose tolerance in comparison to lean fish fed mice, whereas mice fed fatty fish, total seafood or red meat did not differ from lean fish fed mice. We observed a diet-specific metabolic signature in plasma demonstrating five distinct metabolite profiles in mice fed shellfish, fatty fish, total seafood/lean fish, a mixed diet and meat. In conclusion, these findings demonstrate that different types of seafood have different outcome on T2D risk. In women, intake of shellfish was associated with higher risk of T2D. In female mice, a shellfish enriched diet reduced glucose tolerance and altered the abundance of several distinct plasma metabolites correlating with glucose tolerance.

Fetal Exposure to Preeclampsia and Later Risk of Cardiometabolic Disorders: A Population-Based Cohort Study.

BACKGROUND: Fetal preeclampsia exposure has been associated with later cardiometabolic disease. However, this association has been investigated in few large population-wide studies, and it is unknown whether the association represents a causal relationship or is the result of shared etiological factors. METHODS: To further investigate the relationship between preeclampsia exposure and later cardiometabolic disease, we identified 1 692 944 singleton infants born in Norway during 1967 to 1997, where 44 299 were exposed to preeclampsia in utero. The individuals were followed for hypertension, diabetes, and dyslipidemia as defined by dispensed medication. We used Cox regression models to calculate the association between preeclampsia exposure and cardiometabolic outcomes adjusting for measured confounders. We also used full sibling comparisons and stratified Cox regression to control for unmeasured familial confounders. RESULTS: On the population level, exposed individuals had increased risk of hypertension (adjusted hazard ratio [aHR] 1.51 [95% CI, 1.41-1.63]), diabetes (aHR 1.33 [95% CI, 1.24-1.43], and dyslipidemia (aHR 1.28 [95% CI, 1.13-1.45]) compared with unexposed individuals. In sibling data, individuals not exposed to preeclampsia, but with an exposed sibling, had higher risk of hypertension and diabetes than individuals where no siblings were exposed to preeclampsia. Moreover, when comparing siblings discordant on preeclampsia exposure, there were no associations between preeclampsia and hypertension (aHR 1.05 [95% CI, 0.88-1.26]), diabetes (aHR 0.96 [95% CI, 0.80-1.14]), and dyslipidemia (aHR 0.86 [95% CI, 0.62-1.20]). CONCLUSIONS: Fetal preeclampsia exposure was associated with adult life hypertension, diabetes, and dyslipidemia, but these associations were likely due to shared etiological factors, rather than exposure to the preeclamptic condition itself.

Intake of carbohydrates and SFA and risk of CHD in middle-age adults: the Hordaland Health Study (HUSK).

OBJECTIVE: Limiting SFA intake may minimise the risk of CHD. However, such reduction often leads to increased intake of carbohydrates. We aimed to evaluate associations and the interplay of carbohydrate and SFA intake on CHD risk. DESIGN: Prospective cohort study. SETTING: We followed participants in the Hordaland Health Study, Norway from 1997-1999 through 2009. Information on carbohydrate and SFA intake was obtained from a FFQ and analysed as continuous and categorical (quartiles) variables. Multivariable Cox regression estimated hazard ratios (HR) and 95 % CI. Theoretical substitution analyses modelled the substitution of carbohydrates with other nutrients. CHD was defined as fatal or non-fatal CHD (ICD9 codes 410-414 and ICD10 codes I20-I25). PARTICIPANTS: 2995 men and women, aged 46-49 years. RESULTS: Adjusting for age, sex, energy intake, physical activity and smoking, SFA was associated with lower risk (HRQ4 v. Q1 0·44, 95 % CI 0·26, 0·76, Ptrend = 0·002). For carbohydrates, the opposite pattern was observed (HRQ4 v. Q1 2·10, 95 % CI 1·22, 3·63, Ptrend = 0·003). SFA from cheese was associated with lower CHD risk (HRQ4 v. Q1 0·44, 95 % CI 0·24, 0·83, Ptrend = 0·006), while there were no associations between SFA from other food items and CHD. A 5 E% substitution of carbohydrates with total fat, but not SFA, was associated with lower CHD risk (HR 0·75, 95 % CI 0·62, 0·90). CONCLUSIONS: Higher intake of predominantly high glycaemic carbohydrates and lower intake of SFA, specifically lower intake from cheese, were associated with higher CHD risk. Substituting carbohydrates with total fat, but not SFA, was associated with significantly lower risk of CHD.

Intake of sucrose-sweetened beverages and risk of developing pharmacologically treated hypertension in women: cohort study.

Objective: To investigate the association between intake of sucrose-sweetened beverages (SSBs) and risk of developing pharmacologically treated hypertension in a population of Norwegian mothers followed up to 10 years after delivery. Design: Women without hypertension at baseline in the Norwegian Mother, Father and Child Cohort Study (n=60 027) who delivered between 2004 and 2009 were linked to the Norwegian Prescription Database to ascertain antihypertensive medication use after the first 90 days following delivery. Diet was assessed by a validated semiquantitative Food Frequency Questionnaire in mid pregnancy. Cox proportional hazard analyses evaluated HRs for the development of hypertension associated with SSB consumption as percent energy by quintiles in multivariable models. Supplemental analyses were stratified by gestational hypertension and by a low versus high sodium-to-potassium intake ratio (<0.78 compared with ≥0.78). Results: A total of 1480 women developed hypertension within 10 years of follow-up. The highest relative to the lowest quintile of SSB intake was associated with an elevated risk for hypertension after adjusting for numerous covariates in adjusted models (HR: 1.20 (95% CI: 1.02 to 1.42)). Consistency in results was observed in sensitivity analyses. In stratified analyses, the high SSB intake quintile associated with elevated hypertension risk among women who were normotensive during pregnancy (HR: 1.25 (95% CI: 1.03 to 1.52)), who had normal body mass index (HR: 1.49 (95% CI: 1.13 to 1.93)) and among women with low sodium to potassium ratio (HR: 1.33 (95% CI: 1.04 to 1.70)). Conclusions: This study provides strong evidence that SSB intake is associated with an increased risk of hypertension in women.

Intakes of Fish and Long-chain n-3 Polyunsaturated Fatty Acid Supplements During Pregnancy and Subsequent Risk of Type 2 Diabetes in a Large Prospective Cohort Study of Norwegian Women.

OBJECTIVE: To investigate associations between intakes of total fish, lean fish, fatty fish, and long-chain n-3 polyunsaturated fatty acid (LCn-3PUFA) supplements and risk of type 2 diabetes in women after pregnancy. Furthermore, we sought to compare the estimated intakes of methylmercury (MeHg) and sum of dioxins and dioxin-like polychlorinated biphenyls (dl-PCBs) with tolerable weekly intakes (TWI). RESEARCH DESIGN AND METHODS: Women free of diabetes at baseline (n = 60,831) who participated in the population-based Norwegian Mother, Father and Child Cohort Study (MoBa) were prospectively evaluated for incident type 2 diabetes, identified on the basis of medication usage >90 days after delivery, ascertained through the Norwegian Prescription Database. Dietary intake data were obtained with a validated 255-item food-frequency questionnaire (FFQ), which assessed habitual diet during the first 4-5 months of pregnancy. Intakes of MeHg and sum of dioxins and dl-PCBs were derived with use of a contaminant database and the FFQ. RESULTS: Median age was 31 years (interquartile range 27, 34) at time of delivery, and follow-up time was 7.5 years (6.5, 8.5). Type 2 diabetes occurred in 683 (1.1%) participants. Multivariable Cox regression analyses identified lower risk of type 2 diabetes with increasing energy-adjusted lean fish intake, 25 g/1,000 kcal (25 g/1,000 kcal: hazard ratio 0.71, 95% CI 0.53-0.95, P = 0.022). However, in stratified analyses, a lower risk was found only in women with prepregnancy BMI ≥25 kg/m2. There were no associations between intake of total fish, fatty fish, or LCn-3PUFA supplements and type 2 diabetes. MeHg intake was low, but the intake of the sum of dioxins and dl-PCBs (picograms of toxic equivalents/kilograms of body weight/week) exceeded the TWI set by the European Food Safety Authority (EFSA) for the majority of participants. CONCLUSIONS: Intake of lean fish, but not fatty fish or LCn-3PUFA supplements, was associated with lower risk of pharmacologically treated type 2 diabetes in Norwegian women who were overweight or obese. Fatty fish, which contain dioxins and dl-PCBs, did not increase the risk of type 2 diabetes, but the exceedance of the EFSA TWI for dioxins and dl-PCBs is a health concern.

Evaluation of incomplete maternal smoking data using machine learning algorithms: a study from the Medical Birth Registry of Norway.

BACKGROUND: The Medical Birth Registry of Norway (MBRN) provides national coverage of all births. While retrieval of most of the information in the birth records is mandatory, mothers may refrain to provide information on her smoking status. The proportion of women with unknown smoking status varied greatly over time, between hospitals, and by demographic groups. We investigated if incomplete data on smoking in the MBRN may have contributed to a biased smoking prevalence. METHODS: In a study population of all 904,982 viable and singleton births during 1999-2014, we investigated main predictor variables influencing the unknown smoking status of the mothers' using linear multivariable regression. Thereafter, we applied machine learning to predict annual smoking prevalence (95% CI) in the same group of unknown smoking status, assuming missing-not-at-random. RESULTS: Overall, the proportion of women with unknown smoking status was 14.4%. Compared to the Nordic country region of origin, women from Europe outside the Nordic region had 15% (95% CI 12-17%) increased adjusted risk to have unknown smoking status. Correspondingly, the increased risks for women from Asia was 17% (95% CI 15-19%) and Africa 26% (95% CI 23-29%). The most important machine learning prediction variables regarding maternal smoking were education, ethnic background, marital status and birth weight. We estimated a change from the annual observed smoking prevalence among the women with known smoking status in the range of - 5.5 to 1.1% when combining observed and predicted smoking prevalence. CONCLUSION: The predicted total smoking prevalence was only marginally modified compared to the observed prevalence in the group with known smoking status. This implies that MBRN-data may be trusted for health surveillance and research.

Association of dietary vitamin K and risk of coronary heart disease in middle-age adults: the Hordaland Health Study Cohort.

OBJECTIVE: The role of vitamin K in the regulation of vascular calcification is established. However, the association of dietary vitamins K1 and K2 with risk of coronary heart disease (CHD) is inconclusive. DESIGN: Prospective cohort study. SETTING: We followed participants in the community-based Hordaland Health Study from 1997 - 1999 through 2009 to evaluate associations between intake of vitamin K and incident (new onset) CHD. Baseline diet was assessed by a past-year food frequency questionnaire. Energy-adjusted residuals of vitamin K1 and vitamin K2 intakes were categorised into quartiles. PARTICIPANTS: 2987 Norwegian men and women, age 46-49 years. METHODS: Information on incident CHD events was obtained from the nationwide Cardiovascular Disease in Norway (CVDNOR) Project. Multivariable Cox regression estimated HRs and 95% CIs with test for linear trends across quartiles. Analyses were adjusted for age, sex, total energy intake, physical activity, smoking and education. A third model further adjusted K1 intake for energy-adjusted fibre and folate, while K2 intake was adjusted for energy-adjusted saturated fatty acids and calcium. RESULTS: During a median follow-up time of 11 years, we documented 112 incident CHD cases. In the adjusted analyses, there was no association between intake of vitamin K1 and CHD (HRQ4vsQ1 = 0.92 (95% CI 0.54 to 1.57), p for trend 0.64), while there was a lower risk of CHD associated with higher intake of energy-adjusted vitamin K2 (HRQ4vsQ1 = 0.52 (0.29 to 0.94), p for trend 0.03). Further adjustment for potential dietary confounders did not materially change the association for K1, while the association for K2 was slightly attenuated (HRQ4vsQ1 = 0.58 (0.28 to 1.19)). CONCLUSIONS: A higher intake of vitamin K2 was associated with lower risk of CHD, while there was no association between intake of vitamin K1 and CHD. TRIAL REGISTRATION NUMBER: NCT03013725.

Heart failure in Norway, 2000-2014: analysing incident, total and readmission rates using data from the Cardiovascular Disease in Norway (CVDNOR) Project.

AIMS: To examine trends in heart failure (HF) hospitalization rates and risk of readmissions following an incident HF hospitalization. METHODS AND RESULTS: During 2000-2014, we identified in the Cardiovascular Disease in Norway Project 142 109 hospitalizations with HF as primary diagnosis. Trends of incident and total (incident and recurrent) HF hospitalization rates were analysed using negative binomial regression models. Changes over time in 30-day and 3-year risk of HF recurrences or cardiovascular disease (CVD)-related readmissions were analysed using Fine and Grey competing risk regression, with death as competing events. Age-standardized rates declined on average 1.9% per year in men and 1.8% per year in women for incident HF hospitalizations (both Ptrend < 0.001) but did not change significantly in either men or women for total HF hospitalizations. In men surviving the incident HF hospitalization, 30-day and 3-year risk of a HF recurrent event increased 1.7% and 1.2% per year, respectively. Similarly, 30-day and 3-year risk of a CVD-related hospitalization increased 1.5% and 1.0% per year, respectively (all Ptrend < 0.001). No statistically significant changes in the risk of HF recurrences or CVD-related readmissions were observed among women. In-hospital mortality for a first and recurrent HF episode declined over time in both men and women. CONCLUSIONS: Incident HF hospitalization rates declined in Norway during 2000-2014. An increase in the risk of recurrences in the context of reduced in-hospital mortality following an incident and recurrent HF hospitalization led to flat trends of total HF hospitalization rates.

Mortality following first-time hospitalization with acute myocardial infarction in Norway, 2001-2014: Time trends, underlying causes and place of death.

BACKGROUND: Trends on cause-specific mortality following acute myocardial infarction (AMI) are poorly described and no studies have analyzed where do AMI patients die. We analyzed trends in 28-day and one-year mortality following an incident AMI with focus on changes over time in the underlying cause and place of death. METHODS: We identified in the 'Cardiovascular Disease in Norway' Project all patients 25+ years, hospitalized with an incident AMI in Norway, 2001-2014. Information on date, underlying cause and place of death was obtained from the Cause of Death Registry. RESULTS: Of 144,473 patients included in the study, 11.4% died within first 28 days. The adjusted 28-day mortality declined by 5.2% per year (ptrend < 0.001). Of 118,881 patients surviving first 28 days, 10.1% died within one year. The adjusted one-year CVD mortality declined by 6.2% per year (ptrend < 0.001) while non-CVD mortality increased by 1.4% per year (ptrend < 0.001), mainly influenced by increased risk of dying from neoplasms. We observed a shift over time in the underlying cause of death toward more non-CVD deaths, and in the place of death toward more deaths occurring in nursing homes. CONCLUSIONS: We observed a decline in 28-day mortality following an incident AMI hospitalization. One-year CVD mortality declined while one-year risk of dying from non-CVD conditions increased. The resulting shift toward more non-CVD deaths and deaths occurring outside a hospital need to be considered when formulating priorities in treating and preventing adverse events among AMI survivors.

Forearm bone density is not elevated in Inuit women with impaired fasting glucose or type 2 diabetes mellitus.

Bone mineral density (BMD) and fracture risk are elevated in adults with impaired fasting glucose (IFG) or type 2 diabetes mellitus (T2D). This study aimed to compare bone health among Inuit women with IFG, T2D and normoglycemia. The study included Inuit women (≥40 y) with IFG (n = 57), T2D (n = 72) or normoglycemia (n = 340) from the International Polar Year Inuit Health Survey 2007-2008 in Canada. Distal one-third forearm BMD (FaBMD) was measured using a peripheral instantaneous x-ray imager. Anthropometry, fasting plasma glucose (FPG), serum adiponectin, leptin and 25-hydroxyvitamin D (25(OH)D) were measured. Traditional food intakes were surveyed. Data were analysed using mixed model ANOVA and regression models. The median age was 53 (IFG: IQR 48, 67) y and 56 (T2D: IQR 49, 63) y. Compared to normoglycemic women, FaBMD and T-scores were significantly lower in women with T2D, but not with IFG. Frequency of marine mammal intakes (ß = 0.145; 95%CI: 0.018, 0.053, p = 0.0001) positively related to FaBMD. The odds ratio of having a T-score consistent with osteoporosis was lower among women with T2D and higher BMI, while aging increased the risk. Although T2D associates with lower BMD among Inuit women, risk of osteoporosis is tempered, possibly by maintenance of a traditional lifestyle.

Red blood cell folate levels in Canadian Inuit women of childbearing years: influence of food security, body mass index, smoking, education, and vitamin use.

BACKGROUND: The benefits of folic acid for prevention of congenital anomalies are well known. For the Inuit of Canada, where vitamin use is low and access to folate-rich foods limited, fortification is likely a major source of intake. We sought to determine whether red blood cell folate (RBCF) levels of Inuit women reached accepted target levels. METHODS: The Inuit Health Survey, 2007-2008, included evaluation of RBCF levels among 249 randomly selected non-pregnant women of reproductive age. Using descriptive statistics and linear regression analyses, RBCF levels were assessed and compared across several socio-demographic variables to evaluate the characteristics associated with RBCF status. RESULTS: Mean (SD) RBCF levels of 935.5 nmol/L (± 192) reached proposed target levels (> 906 nmol/L); however, 47% of women had lower than target levels. In bivariate analysis, non-smoking, higher education, higher income, food security, increased body mass index, and vitamin use were each significantly associated with higher RBCF. Increased levels of smoking had a negative association with RBCF levels (- 5.8 nmol/L per cigarette smoked per day (p = 0.001)). A total of 6.8% of women reported taking vitamin supplements, resulting in a 226 nmol/L higher RBCF level on average compared to non-users (p < 0.001). CONCLUSION: While mean levels of folate reached target levels, this was largely driven by the small number of women taking vitamin supplements. Our results suggest that folate status is often too low in Inuit women of childbearing years. Initiatives to improve food security, culturally relevant education on folate-rich traditional foods, vitamin supplements, and smoking cessation/reduction programs may benefit Inuit women and improve birth outcomes.

Trends in incident acute myocardial infarction in Norway: An updated analysis to 2014 using national data from the CVDNOR project.

Background We updated the information on trends of incident acute myocardial infarction in Norway, focusing on whether the observed trends during 2001-2009 continued throughout 2014. Methods All incident (first) acute myocardial infarctions in Norwegian residents age 25 years and older were identified in the Cardiovascular Disease in Norway 1994-2014 project. We analysed overall and age group-specific (25-64 years, 65-84 years and 85 + years) trends by gender using Poisson regression analyses and report the average annual changes in rates with their 95% confidence intervals. Results During 2001-2014, 221,684 incident acute myocardial infarctions (59.4% men) were identified. Hospitalised cases accounted for 79.9% of all incident acute myocardial infarctions. Overall, incident acute myocardial infarction rates declined on average 2.6% per year (incidence rate ratio 0.974, 95% confidence interval 0.972-0.977) in men and 2.8% per year (incidence rate ratio 0.972, 95% confidence interval 0.971-0.974) in women, contributed by declining rates of hospitalisations (1.8% and 1.9% per year in men and women, respectively) and deaths (6.0% and 5.8% per year in men and women, respectively). Declining rates were observed in all three age groups. The overall acute myocardial infarction incidence rates continued to decline from 2009 onwards, with a steeper decline compared to 2001-2009. During 2009-2014, gender-adjusted acute myocardial infarction incidence among adults age 25-44 years declined 5.3% per year, contributed mostly by declines in hospitalisation rates (5.1% per year). Conclusion Acute myocardial infarction incidence rates continued to decline after 2009 in Norway in both men and women. The decline started to involve individuals aged 25-44 years, marking a turning point in the previously reported stagnation of rates during 2001-2009.

Pregnancy-Related Risk Factors Are Associated With a Significant Burden of Treated Hypertension Within 10 Years of Delivery: Findings From a Population-Based Norwegian Cohort.

BACKGROUND: The association between pregnancy complications and women's later cardiovascular disease has, primarily, been evaluated in studies lacking information on important covariates. This report evaluates the prospective associations between pregnancy-related risk factors (preeclampsia/eclampsia, gestational hypertension, pregestational and gestational diabetes mellitus, preterm delivery, and fetal growth restriction) and pharmacologically treated hypertension within 10 years after pregnancy, while adjusting for a wide range of covariates. METHODS AND RESULTS: Prepregnancy normotensive women participating in the MoBa (Norwegian Mother and Child Cohort Study) from January 2004 through July 2009 were linked to the Norwegian Prescription Database to identify women with pharmacologically treated hypertension beyond the postpartum period of 3 months. The burden of hypertension associated with pregnancy-related risk factors was evaluated using an attributable fraction method. A total of 1480 women developed pharmacologically treated hypertension within the follow-up among 60 027 women (rate of hypertension, 3.6/1000 person-years). The proportion of hypertension associated with a history of preeclampsia/eclampsia, gestational hypertension, preterm delivery, and pregestational or gestational diabetes mellitus was 28.6% (95% confidence interval, 25.5%-31.6%) on the basis of multivariable analyses adjusting for numerous covariates. The proportion was similar for women with a healthy prepregnancy body mass index (18.5-24.9 kg/m2; attributable fraction (AF)% 25.9%; 95% confidence interval, 21.3%-30.3%), but considerably higher for nulliparous women at baseline within the first 5 years of follow-up. Small-for-gestational age, however, did not increase subsequent hypertension risk in multivariable analyses. CONCLUSIONS: A structured postpartum follow-up of high-risk women identified through pregnancy-related risk factors would facilitate personalized preventive strategies to postpone or avoid onset of premature cardiovascular events.

Association between pregravid physical activity and family history of stroke and risk of stillbirth: population-based cohort study.

OBJECTIVES: To evaluate whether family history of disease and pregravid lifestyle and cardiovascular risk factors are associated with subsequent stillbirth delivery. DESIGN: Prepregnancy cohort study. SETTING: Cohort Norway regional health surveys (1994-2003) linked to Medical Birth Registry of Norway for deliveries through 2012. PARTICIPANTS: 13 497 singleton births (> 22 weeks gestation) in 8478 women. MAIN OUTCOME MEASURE: Risk of stillbirth evaluated by Poisson regression. RESULTS: Mean (SD) length of follow-up was 5.5 (3.5) years. In analyses adjusting for baseline age and length of follow-up, ≥3 hours of baseline past-year vigorous physical activity per week (resulting in shortness of breath/sweating) was associated with increased risk of stillbirth compared with <1 hour/week of vigorous activity (incidence rate ratio, IRR 2.46; 95% CI 1.23 to 4.90). In contrast, baseline past-year light physical activity of ≥3 hours per week associated with reduced risk of stillbirth compared with <3 hours of light physical activity per week (IRR 0.53; 95% CI 0.30 to 0.93). A family history of stroke associated with increased risk of stillbirth delivery (IRR 2.53; 95% CI 1.06 to 6.01). Because overweight/obese women may experience shortness of breath and sweating with less physical exertion than normal weight women, a sensitivity analysis was conducted limited to women with a normal BMI (> 18.5 and <25 kg/m2). Vigorous activity of ≥3 hours per week (IRR of 4.50; 95% CI 1.72 to 11.79) and a family history of stroke (IRR of 3.81; 95% CI 1.31 to 11.07) were more strongly related to stillbirth risk among women with a normal BMI than that observed for all women combined. Established risk factors also associated with stillbirth risk. CONCLUSIONS: The study identified physical activity and family history of stroke as potential new risk factors for stillbirth delivery.

Low Calcium Intake in Midpregnancy Is Associated with Hypertension Development within 10 Years after Pregnancy: The Norwegian Mother and Child Cohort Study.

Background: Low dietary calcium intake may be a risk factor for hypertension, but studies conflict.Objective: We evaluated the ability to predict hypertension within 10 y after delivery based on calcium intake during midpregnancy.Methods: The Norwegian Mother and Child Cohort Study of women delivering in 2004-2009 was linked to the Norwegian Prescription Database (2004-2013) to ascertain antihypertensive medication usage >90 d after delivery. Women with hypertension before pregnancy were excluded, leaving 60,027 mothers for analyses. Age and energy-adjusted cubic splines evaluated dose-response curves, and Cox proportional hazard analyses evaluated HR and 95% CIs by calcium quartiles adjusting for 7 covariates. Analyses were stratified by gestational hypertension and by sodium-to-potassium intake ratio (<0.76 compared with ≥0.76).Results: Participants had a mean ± SD age of 30.5 ± 4.6 y, a body mass index (in kg/m2) of 24.0 ± 4.3 before pregnancy, and a mean follow-up duration of 7.1 ± 1.6 y. Cubic spline graphs identified a threshold effect of low calcium intake only within the range of dietary inadequacy related to increased risk. The lowest calcium quartile (≤738 mg/d; median: 588 mg/d), relative to the highest quartile (≥1254 mg/d), had an HR for hypertension of 1.34 (95% CI: 1.05, 1.70) among women who were normotensive during pregnancy, and an HR of 1.62 (95% CI: 1.14, 2.35) among women who had gestational hypertension, after adjusting for covariates. Women with gestational hypertension, who were in the lowest quartile of calcium intake, and who had a high sodium-to-potassium intake ratio had a risk of hypertension more than double that of their counterparts with a calcium intake in the highest quartile. Results were attenuated by adjusting for covariates (HR: 1.92; 95% CI: 1.09, 3.39).Conclusions: The results suggest that low dietary calcium intake may be a risk factor or risk marker for the development of hypertension, particularly for women with a history of gestational hypertension.

Associations between omega-3 fatty acids and 25(OH)D and psychological distress among Inuit in Canada.

BACKGROUND: Inuit in Canada have experienced dietary changes over recent generations, but how this relates to psychological distress has not been investigated. OBJECTIVE: To evaluate how nutritional biomarkers are related to psychological distress. DESIGN: A total of 36 communities in northern Canada participated in the International Polar Year Inuit Health Survey (2007-2008). Of 2796 households, 1901 (68%) participated; 1699 Inuit adults gave blood samples for biomarker analysis and answered the Kessler 6-item psychological distress questionnaire (K6). Biomarkers included n-3 fatty acids and 25-hydroxyvitamin D (25(OH)D). The K6 screens for psychological distress over the last 30 days with six items scored on a 4-point scale. A total score of 13 or more indicates serious psychological distress (SPD). Logistic regression models were used to investigate any associations between SPD and biomarkers while controlling for age, gender, marital status, days spent out on the land, feeling of being alone, income and smoking. RESULTS: The 30-day SPD prevalence was 11.2%, with women below 30 years having the highest and men 50 years and more having the lowest SPD prevalence at 16.1% and 2.6%, respectively. SPD was associated with being female, younger age, not being married or with a common-law partner, spending few days out on the land, feelings of being alone, smoking and low income. Low levels of both 25(OH)D and long-chain n-3 FAs were associated with higher odds for SPD in both unadjusted and adjusted logistic regression models. CONCLUSION: In this cross-sectional analysis, low levels of 25(OH)D and long-chain n-3 FAs were associated with higher odds ratios for SPD, which highlights the potential impact of traditional foods on mental health and wellbeing. Cultural practices are also important for mental health and it may be that the biomarkers serve as proxies for cultural activities related to food collection, sharing and consumption that increase both biomarker levels and psychological well-being. ABBREVIATIONS: n-3 FAs: omega-3 fatty acids; PUFAs: polyunsaturated fatty acids; 25(OH)D: 25-hydroxyvitamin D; IPY: International Polar Year; IHS : Inuit Health Survey; RBC: red blood cell; OR: odds ratio; K6: Kessler 6-item screening scale; SPD: serious psychological distress; EPA: eicosapentaenoic acid (20:5 n-3); DHA: docosahexaenoic acid (22:6 n-3); DPA n-3: docosapentaenoic acid (22:5 n-3); n-3 LC-PUFAs: EPA (20:5 n-3) + DHA (22:6 n-3) + DPA (22:5 n-3); BMI: body mass index (kg m-2).

Trends in the risk of early and late-onset heart failure as an adverse outcome of acute myocardial infarction: A Cardiovascular Disease in Norway project.

Aims Heart failure is a serious complication of acute myocardial infarction, leading to a poor prognosis. We explored trends in the risk of heart failure among patients hospitalised with an incident acute myocardial infarction in Norway during 2001-2009. Methods and results A total of 69,372 patients were followed for an episode of heart failure occurring either during (early-onset heart failure) or within one year of discharge from the incident acute myocardial infarction hospitalisation (late-onset heart failure). Logistic regression and competing risk regression models were used to explore trends in early and late-onset heart failure respectively. Overall, 17.1% of patients had early-onset heart failure. The odds of heart failure increased by 2.3% per year (odds ratio = 1.023; 95% confidence interval: 1.015-1.031), influenced by an increase of 5.9% per year among younger (25-69 years) patients while no statistically significant changes occurred among older (70-84 years) patients. Among 47,673 patients discharged alive, without early-onset heart failure, 5.4% experienced late-onset heart failure. The risk of heart failure declined by 6.3% per year (subhazard ratio = 0.937; 95% confidence interval: 0.921-0.954). The decline was statistically significant in both age groups (6.8% per year and 5.9% per year respectively). Overall, the risk of heart failure occurring at any time during the follow up did not change significantly. However, it increased by 3.3% per year in younger patients and declined by 1.5% per year in older patients. Conclusions Heart failure occurring during acute myocardial infarction hospitalisation accounts for the majority of heart failure cases and is characterised by unfavourable trends, while heart failure rates following acute myocardial infarction discharge declined over the study period.

Development of Social and Demographic Differences in Maternal Smoking Between 1999 and 2014 in Norway.

INTRODUCTION: The Medical Birth Registry of Norway provides national coverage of all births in Norway. In this study trends of smoking at the beginning of pregnancy and the variation of these trends across different sociodemographic groups are analyzed. This knowledge is important for planning interventions both in the general population and specifically among pregnant women. METHODS: All births registered in Medical Birth Registry of Norway 1999-2014 with information on mothers' smoking status were included in the overall analyses of the smoking trends (806 298). Records from 210 268 births in two time periods 1999-2000 and 2013-2014 were selected, and for the multivariate analyses we used general linear models to provide adjusted risk ratios. RESULTS: The prevalence of maternal smoking at the beginning of pregnancy decreased from 25% to 8% over the 15-year period. Mothers with low, medium, and high education, respectively, had a 46% (RR 0.54, CI 0.52-0.55), 62% (RR 0.38, CI 0.37-0.40), and 80% (RR 0.20, CI 0.19-0.22) reduction in maternal smoking between the two time periods. Similarly, the decline in smoking was greater for mothers who were married or living together (64%; RR 0.36, CI 0.35-0.37) than for single mothers (39%; RR 0.61, CI 0.58-0.64). Immigrants had a lower smoking prevalence than Norwegians in the entire period 1999-2014. CONCLUSION: The prevalence of smoking during pregnancy in Norway decreased in all population groups, but the relative differences between the educational groups increased from 1999-2000 to 2013-2014. This is a public health concern and a strong contributor to health disparities. IMPLICATIONS: Women with low and medium education level and single mothers had the highest smoking prevalence and the lowest decline over the two time periods. These groups constitute 45% of our study population, the relatively high maternal smoking in these groups continues to be of public health concern for maternal and child health.

Prognostic Impact of In-Hospital and Postdischarge Heart Failure in Patients With Acute Myocardial Infarction: A Nationwide Analysis Using Data From the Cardiovascular Disease in Norway (CVDNOR) Project.

BACKGROUND: Heart failure (HF) is a serious complication of acute myocardial infarction (AMI). We explored the excess mortality associated with HF as an early or late complication of AMI and describe changes over time in such excess mortality. METHODS AND RESULTS: All patients hospitalized with an incident AMI and without history of prior HF hospitalization were followed up to 1 year after AMI discharge for episodes of HF. New HF episodes were classified as in-hospital HF if diagnosed during the AMI hospitalization or postdischarge HF if diagnosed within 1 year after discharge from the incident AMI. Logistic and Cox regression models were used to explore the excess mortality associated with HF categories. Changes over time in the excess mortality were assessed by testing the interaction between HF status and study year. In-hospital HF increased in-hospital mortality 1.79 times (odds ratio [OR], 1.79; 95% CI: 1.68-1.91). The excess mortality associated with HF increased by 4.3 times from 2001 to 2009 (P interaction<0.001) as a consequence of a greater decline of in-hospital mortality among AMI patients without (9% per year) compared to those with in-hospital HF (3% per year). Postdischarge HF increased all-cause and CVD mortality 5.98 times (hazard ratio, 5.98; 95% CI: 5.39-6.64) and 7.93 times (subhazard ratio, 7.93; 95% CI: 6.84 -9.19), respectively. The relative excess 1-year mortality associated with HF did not change significantly over time. CONCLUSIONS: Development of HF-either as an early or late complication of AMI-has a negative impact on patients' survival. Changes in the excess mortality associated with HF are driven by modest improvements in survival among AMI patients with HF as compared to those without HF.

Educational inequalities in mortality of patients with atrial fibrillation in Norway.

OBJECTIVES: We explored the educational gradient in mortality in atrial fibrillation (AF) patients. DESIGN: We prospectively followed patients hospitalized with AF as primary discharge diagnosis in the Cardiovascular Disease in Norway 2008-2012 project. The average length of follow-up was 2.4 years. Mortality by educational level was assessed by Cox proportional hazard models. Population attributable fractions (PAF) were calculated. Analyses stratified by age (≤75 and >75 years of age), and adjusted for age, gender, medical intervention, and Charlson Comorbidity Index. RESULTS: Of 42,138 AF patients, 16% died by end of 2012. Among younger patients, those with low education (≤10 years) had a HR of 2.3 (95% confidence interval 2.0, 2.6) for all-cause mortality relative to those with any college or university education. Similar results were observed for cardiovascular mortality. Disparities in mortality were greater among younger than older patients. A PAF of 35.9% (95% confidence interval 27.9, 43.1) was observed for an educational level of high school/vocational school or less versus higher education in younger patients. CONCLUSIONS: Increasing educational level associated with better prognosis suggesting underlying education-related behavioral and medical determinants of mortality. A considerable proportion of mortality within 5 years following hospital discharge could be prevented.