The "Saltin-Grimby Physical Activity Level Scale" and its application to health research.

The use of a four-level questionnaire to assess leisure time physical activity (PA) and its validation is reviewed in this paper. This questionnaire was first published in 1968 and has then been used by more than 600,000 subjects, especially in different population studies in the Nordic countries. A number of modifications to the questionnaire have been published. These are mostly minor changes, such as adding practical examples of activities to illustrate the levels of PA. Some authors have also added duration requirements that were not included for all levels of PA in the original version. The concurrent validity, with respect to aerobic capacity and movement analysis using objective measurements has been shown to be good, as has the predictive validity with respect to various risk factors for health conditions and for morbidity and mortality.

Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice.

Atrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence increases with increasing age. In middle-aged men, endurance sport practice is associated with increased risk of AF but there are few studies among elderly people. The aim of this study was to investigate the role of long-term endurance sport practice as a risk factor for AF in elderly men. A cross-sectional study compared 509 men aged 65-90 years who participated in a long-distance cross-country ski race with 1768 men aged 65-87 years from the general population. Long-term endurance sport practice was the main exposure. Self-reported AF and covariates were assessed by questionnaires. Risk differences (RDs) for AF were estimated by using a linear regression model. After multivariable adjustment, a history of endurance sport practice gave an added risk for AF of 6.0 percent points (pp) (95% confidence interval 0.8-11.1). Light and moderate leisure-time physical activity during the last 12 months reduced the risk with 3.7 and 4.3 pp, respectively, but the RDs were not statistically significant. This study suggests that elderly men with a history of long-term endurance sport practice have an increased risk of AF compared with elderly men in the general population.

High incidence and prevalence of systemic lupus erythematosus in Norway.

Our aim was to identify all patients with systemic lupus erythematosus (SLE) within the city of Oslo from 1999-2008 and to estimate the incidence and prevalence of SLE according to age, sex and ethnicity. Adults (16 years and over) with SLE were identified from five different sources. Only patients fulfilling four or more of the updated 1997 American College of Rheumatology (ACR) criteria were included. The incidence was stable during the nine year study period, with a mean annual incidence rate of 3.0 per 100,000 at risk (95% confidence interval (CI) 2.4-3.5). Females exhibited a bimodal pattern in age specific incidence with the first peak at 16-29 years of age and the second at 50-59 years of age. The overall prevalence was 51.8 per 100,000 population (95% CI 45.2-58.4), with 91.0 (95% CI 78.8-103.1) for females and 10.7 (95% CI 6.4-15.0) for males. The prevalence proportions for European descendants were similar to those for Asians but statistically significant lower than those for individuals adopted from non-European countries. The findings indicate a higher prevalence in Norwegians compared to Caucasians in Denmark and England. The higher prevalence of SLE in foreign adopted individuals warrants further examination.

Low levels of antibodies for the oral bacterium Tannerella forsythia predict cardiovascular disease mortality in men with myocardial infarction: A prospective cohort study.

Antibody levels to periodontal pathogens in prediction of cardiovascular disease (CVD) mortality were explored using data from a health survey in Oslo in 2000 (Oslo II-study) with 12 1/2 years follow-up. IgG antibodies to four common periodontal pathogens; Tannerella forsythia (TF), Porphyromonas gingivalis (PG), and Treponema denticola (TD) all termed collectively the "red complex", and Aggregatibacter actinomycetemcomitans(AA) were analysed. The study sample consisted of 1172 men drawn from a cohort of 6,530 men who participated in the Oslo II-study, where they provided information on medical and dental history. Of the study sample, 548 men had reported prior myocardial infarction (MI) at baseline whereas the remaining 624 men were randomly drawn from the ostensibly healthy participants for comparative analyses. Dental anamnestic information included tooth extractions and oral infections. An inverse relation was found for trend by the quartile risk level of TF predicting CVD mortality, p-value for trend = 0.017. Comparison of the first to fourth quartile of TF antibodies resulted in hazard ratio (HR) = 1.82, 95% confidence interval 1.12-2.94, p = 0.015, adjusted for age, education, diabetes, daily smoking, and systolic blood pressure. Specificity comparing decile 1 to deciles 2-10 of TF predicting mortality was 92.3%. We found an increased HR by low levels of antibodies to the bacterium T. forsythia predicting CVD mortality in a 12 ½ years follow-up in persons who had experienced an MI but not among non-MI men. This novel finding constitutes a plausible causal link between oral infections and CVD mortality.

Intake of milk fat, reflected in adipose tissue fatty acids and risk of myocardial infarction: a case-control study.

OBJECTIVE: To study the association between content of fatty acids from milk fat (14:0, 15:0 and 17:0) in adipose tissue and risk of a first myocardial infarction (MI). DESIGN AND SUBJECTS: A case-control study with 99 patients and 98 population controls both men and postmenopausal women, age 45-75 year. Adipose tissue fatty acids were determined by gas-liquid chromatography. RESULTS: The content of 14:0, 14:1, 15:0, 17:0 and 17:1 were all significantly higher in adipose tissue of controls than of the patients. Age and sex adjusted odds ratios (OR) for MI were significantly reduced with increasing quartiles of 14:0, 14:1, 15:0 and 17:1 in adipose tissue, but except for 15:0 (OR = 0.36, 95% CI 0.13-0.99), the trend was no longer significant after further adjustment for waist-to-hip ratio, smoking and family history for coronary heart disease. Correlations between 14:0 and 15:0 in adipose tissue, and waist-to-hip ratio were significantly negative (r = -0.22 for both, P < 0.01). CONCLUSION: Our study suggests that intake of dairy fat or some other component of dairy products, as reflected by C15:0 as marker in adipose tissue, may protect persons at increased risk from having a first MI, and that the causal effects may rely on other factors than serum cholesterol. SPONSORSHIP: Throne Holst's foundation for Nutrition Research, Research Council of Norway, The Norwegian Association of Margarine Producers, DeNoFa Fabriker A/S, TINE BA.

Abstention from filtered coffee reduces the concentrations of plasma homocysteine and serum cholesterol--a randomized controlled trial.

BACKGROUND: Elevated concentrations of plasma total homocysteine (tHcy) and serum total cholesterol are risk factors for ischemic heart disease (IHD). Previous studies showed that the consumption of very high doses of unfiltered coffee increases tHcy and total cholesterol. OBJECTIVE: A prospective intervention study was performed to assess the effects of coffee consumption on the concentrations of tHcy and total cholesterol by using doses and brewing methods common in southeastern Norway. DESIGN: The study was an unblinded, controlled trial with 191 healthy, nonsmoking, coffee-drinking volunteers aged 24-69 y randomly assigned to 3 groups who were asked to consume for 6 consecutive weeks no coffee, 1-3 cups (approximately 175-525 mL)/d, or > or =4 cups (approximately 700 mL)/d prepared in the manner to which they were accustomed. Blood samples were drawn when the subjects were randomly assigned and at 3 and 6 wk of the trial. Dietary data were collected by questionnaire. RESULTS: Ninety-seven percent of the participants reported being regular consumers of caffeinated filtered coffee. Abstention from coffee for 6 wk was associated with a decrease in the tHcy concentration of 1.08 micromol/L and a decrease in the total cholesterol concentration of 0.28 mmol/L in participants who had been drinking on average 4 cups of filtered coffee daily for the past year. Adjustments for several possible confounders did not alter the results. CONCLUSION: Abstention from filtered coffee in doses that are commonly consumed was associated with lower concentrations of tHcy and total cholesterol.

Coffee and cholesterol in epidemiological and experimental studies.

Twenty-two cross-sectional studies involving 130,000 persons from 8 different countries have reported their findings on the association between coffee consumption and cholesterol levels. Results of these reports display a variety of trends in the association between coffee intake and serum cholesterol concentrations: 8 (36%) studies demonstrated a significant positive association in both sexes, and 5 (23%) studies showed no association in men or women. In 3 other reports where both sexes were included, significant positive association was observed only in women. The remaining 6 investigations examined only men with 4 (18%) reporting a significant correlation between coffee and cholesterol. This unexplained incongruity of cross-sectional data points to a relationship between coffee and cholesterol in some populations, which needs to be further explored. In addition, HDL cholesterol levels appeared unrelated to coffee intake in the 11 studies in which it was measured. The 7 available human experiments showed the same low level of agreement in the results among small numbers of volunteers. Experiments involving different brewing methods suggest that a major part of the cholesterol-increasing effect can be explained by different brewing methods. A critical assessment of the published reports leads to the conclusion that the data are insufficient to warrant public health admonitions against coffee drinking, but that it may be of clinical importance in some hypercholesterolemic individuals.

A longitudinal study of the biological variability of plasma lipoproteins in healthy young adults.

The fasting serum concentrations of total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total triglyceride and apoprotein A1 were measured at intervals of 12-18 weeks for 60 weeks in 17 male and 11 female healthy young adults in order to assess the variability of these risk factors for coronary disease. No statistically significant seasonal changes were detected in any variable in either sex, although a progressive rise in apoprotein A1 concentration was observed. The coefficients of variation for random fluctuations with time were in the rank order: total cholesterol less than HDL-C less than apoprotein A1 less than LDL-C less than triglyceride. These differences were attributable to biological, rather than to methodological, factors. Within subjects, HDL cholesterol concentration varied inversely with triglyceride concentration and directly with apoprotein A1 concentration. The marked differences which exist in the biological variability of lipid risk factors for atherosclerosis need to be taken into account when making comparisons in epidemiological studies of the predictive powers of single on-entry measurements for future disease. Fluctuations of HDL-C with time appear to be related in part to variations in triglyceride-rich lipoprotein metabolism.

Whole blood folate, homocysteine in serum, and risk of first acute myocardial infarction.

High level of total homocysteine (tHcy) is a risk factor for coronary artery disease (CAD), but the mechanism is not known. The serum concentration of tHcy, total cholesterol, high density lipoprotein cholesterol (HDL-C), and apolipoprotein A-I (apo A-I) and the concentration of folate in whole blood were measured in 107 patients with first acute myocardial infarction (MI) and 103 controls. The level of whole blood folate was lower and that of tHcy higher in cases than in controls. An increase of 50 nmol/l whole blood folate was associated with an OR for MI of 0.75, and an increase of 5 micromol/l tHcy with an OR for MI of 1.57. Correlations were observed between the levels of whole blood folate and tHcy and between whole blood folate and alcohol intake, and in MI cases, between tHcy, HDL-C, and apo A-I as well as between HDL-C and alcohol intake. The number of cigarette smokers was higher among cases than controls. In smokers, the level of tHcy was higher and that of whole blood folate lower than in non-smokers. After adjustment for smoking, the whole blood folate and tHcy-associated risks of MI became non-significant. We conclude that smoking may affect folate status and tHcy level adversely. The risk of MI in smokers may at least partly be attributed to hyperhomocysteinemia or low folate.

Legal drug use in a general population: association with gender, morbidity, health care utilization, and lifestyle characteristics.

Legal drug use was assessed by a questionnaire to 15,986 men and women participating in the Finnmark Health Survey 1987-1988. Logistic regression analysis was used to quantify the relationships between legal drug use and gender, morbidity, utilization of health services, and lifestyle and sociodemographic characteristics. Drug use was higher in women than men, but the gender difference decreased with age. Women used more drug groups than men, and the gender difference increased with number of drugs used. Participating in outdoor activities was associated with lower use of drugs in both men and women. The data support the notion that alcohol use plays a more important role in the prediction of drug use in men compared with women. A significant gender difference in the consumption of legal drugs do persist after adjusting for co-morbidity and utilization of health services. Overall, this analysis shows that drug use depends on need (morbidity), followed by use of health services and lifestyle. Sociodemographic variables were shown to have minor influence.

Differences in cardiovascular disease mortality and major risk factors between districts in Oslo. An ecological analysis.

BACKGROUND: The level of mortality from cardiovascular disease (CVD), coronary heart disease (CHD) and from all causes varies considerably within Oslo. The purpose of this study was to examine these differences according to cardiovascular risk factors and socioeconomic variables at the district level. METHODS: Total mortality rates and cardiovascular mortality rates for subjects aged 45-74 years in 1991-1995, and their relationship to cardiovascular risk factors and socioeconomic indicators in the 25 districts of Oslo were studied. Cardiovascular risk factors were based on data from 40 year olds in 1985-1988. The following variables were used as independent variables in the regression analyses to explain differences between the districts: daily smoking, cholesterol level, systolic blood pressure, education and income. RESULTS: Mortality rates were strongly related to cardiovascular risk factors and to socio-economic indicators, with correlation coefficients (Pearson) of 0.74 for smoking and CVD mortality, and -0.78 for high income and CHD mortality. Smoking explained 70% of the differences in mortality from all causes for men and 46% for women, and 61% and 49% of the differences in CVD mortality for men and women respectively. Diastolic blood pressure and total cholesterol were closely related to socioeconomic indicators and to smoking, but the relative strength of the cardiovascular risk factors in the multivariate analyses differed for males and females. CONCLUSION: diovascular risk factors and socioeconomic indicators at the population level were strongly related to mortality, and explained a large proportion of the differences in mortality between different districts of Oslo in the 1990s.

Dietary fat intake and risk of lung cancer: a prospective study of 51,452 Norwegian men and women.

The relationship between incidence of lung cancer and intake of dietary fats, high-fat foods, fish, and fish products was studied in 25,956 men and 25,496 women aged 16-56 years attending Norwegian health screening between 1977 and 1983. Linkage to the Cancer Registry of Norway and the Central Bureau of Statistics of Norway ensured a complete follow-up until 31 December 1991. Diet was recorded on a semiquantitative food-frequency questionnaire, and 153 cases of lung cancer were identified during follow-up. Mean age at diagnosis was 56 years. After adjusting for smoking status, gender, age at screening, and attained age, significant lower risks were found for cod liver oil supplement (incidence rate ratio (IRR) = 0.5, 95% CI = 0.3-1.0) and for skim milk compared to whole milk (IRR = 0.5, 95% CI = 0.3-0.9)). No association was found with dietary cholesterol and saturated fat. A threshold of increased risk starting at the second quartile was seen for mono- and polyunsaturated fat. The potential protective effect of cod liver oil, a supplement rich in preformed vitamin A, omega-3 fatty acids, and monounsaturated fat, has to our knowledge, not been reported before. Confounding from lifestyle is possible, but the result deserves further investigation.

Distribution of high-density lipoprotein cholesterol according to age, sex, and ethnic origin: cardiovascular disease study in Finnmark 1977.

As a part of a survey for cardiovascular risk factors high-density lipoprotein cholesterol (HDL-C) was determined in 15 942 men and women aged 20-53. Women had on average 0.24 mmol/l higher HDL-C concentration than men. The difference was of the same magnitude at all ages. For both sexes HDL-C increased with age. The increase was partly influenced by other variables affecting the HDL-C concentration. After adjusting for the effect of height, weight, cigarette-smoking, physical activity in leisure time, and ethnic origin the age-related change was more pronounced, 0.13 mmol/l and 0.16 mmol/l difference between the youngest and the oldest age group for men and women respectively. The population comprised three ethnic groups. HDL-C did not differ among the women of different ethnic origin, but among men those of Lappish origin had higher HDL-C concentrations than the other groups. This difference was reduced after adjusting for other variables and was probably due more to external factors influencing the HDL-C concentration than specific ethnic-genetic traits.

The Tromsø Heart Study: serum selenium and risk of myocardial infarction a nested case-control study.

The association between serum selenium concentration and the risk of myocardial infarction was studied in a nested case-control study. Altogether 59 men, initially free of disease, aged 28-54 at the time of blood sampling, died suddenly or experienced a fatal or non-fatal myocardial infarction during a six year follow-up period. Case-control pairs came from a population of 9364 persons examined in 1979-80 in the second Tromsø Heart Study. No significant difference was observed between serum selenium in cases and controls (p = 0.34). The major determinants of myocardial infarction and sudden death were raised levels of serum cholesterol and triglycerides (p less than or equal to 0.001) and high systolic blood pressure (p less than 0.05). Thus, in this population with intermediate selenium intake, low serum selenium is not associated with an excess risk of myocardial infarction.

Serum lipids and glucose concentrations in subjects using antihypertensive drugs: Finnmark 1977.

As a side project to a study of coronary risk factors 4878 men and women aged 20-53 were interviewed about present and previous use of antihypertensive drugs. Serum lipid and glucose concentrations were compared in 124 present users, 73 previous users, and 124 controls matched for age, sex, and systolic and diastolic blood pressure. Users of betablockers, thiazides, and other antihypertensive drugs had higher total cholesterol, triglycerides, and glucose and lower HDL-cholesterol than the other groups, but only the difference in HDL-cholesterol was statistically significant. Smokers had statistically significant lower HDL-cholesterol than non-smokers in drug users, whereas there were only minor differences between them in previous and never users. This indicates an interaction between smoking and current antihypertensive medication. The unfavourable serum lipid pattern may, if caused by drug use, explain the lack of influence that antihypertensive treatment has had on the incidence of coronary heart disease in intervention studies.

Cost and health consequences of reducing the population intake of salt.

STUDY OBJECTIVE: The aim was to estimate health and economic consequences of interventions aimed at reducing the daily intake of salt (sodium chloride) by 6 g per person in the Norwegian population. Health promotion (information campaigns), development of new industry food recipes, declaration of salt content in food and taxes on salty food/subsidies of products with less salt, were possible interventions. DESIGN: The study was a simulation model based on present age and sex specific mortality in Norway and estimated impact of blood pressure reductions on the risks of myocardial infarction and stroke as observed in Norwegian follow up studies. A reduction of 2 mm Hg systolic blood pressure (range 1-4) was assumed through the actual interventions. The cost of the interventions in themselves, welfare losses from taxation of salty food/subsidising of food products with little salt, cost of avoided myocardial infarction and stroke treatment, cost of avoided antihypertensive treatment, hospital costs in additional life years and productivity gains from reduced morbidity and mortality were included. RESULTS: The estimated increase in life expectancy was 1.8 months in men and 1.4 in women. The net discounted (5%) cost of the interventions was minus $118 millions (that is, cost saving) in the base case. Sensitivity analyses indicate that the interventions would be cost saving unless the systolic blood pressure reduction were less than 2 mm Hg, productivity gains were disregarded or the welfare losses from price interventions were high. CONCLUSION: Population interventions to reduce the intake of salt are likely to improve the population's health and save costs to society.

Disease activity and severity in patients with rheumatoid arthritis: relations to socioeconomic inequality.

The aim of this study was to investigate possible differences in measures on disease process, joint damage, health status and self-efficacy between patients with rheumatoid arthritis (RA) living in an affluent and in a less affluent area in the same city. We analyzed data collected on patients enrolled in a community-based register of patients with RA in Oslo, Norway. 246 patients were examined by questionnaire in 1994 and 133 patients were examined clinically in 1997. Measures on disease process, joint damage, health status and self-efficacy were compared between patients from two residential areas. There was no significant difference regarding joint counts, patients' or investigator's evaluation of disease severity, blood test results and number of joint replacements. Significant differences were observed for disability and for various dimensions of health measured by the arthritis impact measurement scales and the short form-36: patients in the less affluent area reported poorer health status. Patients in this area also showed significantly lower scores on the arthritis self-efficacy scale. Patients with RA in two socioeconomically different areas in Oslo thus were found to be equal regarding disease process and joint damage measures. However, in the measures reflecting physical and psychosocial health status, patients in the less affluent area seemed to be more seriously ill. They also showed less confidence in their ability to influence the disease. Even in a welfare society with universal access to health care the impact of a well-defined chronic disease seems to be closely linked to the patient's socioeconomic situation.

Filtered coffee raises serum cholesterol: results from a controlled study.

OBJECTIVE: Earlier studies and trials have shown a serum cholesterol raising effect of unfiltered coffee, which is reduced by about 80% in filtered coffee. Recent cross-sectional studies and trials, however, have indicated that filtered coffee may have a more pronounced serum cholesterol raising effect than previously anticipated. The objective of this controlled study was to assess the effects of the intake and abstention of filtered brewed coffee on blood lipids. DESIGN: A prospective, controlled study with four consecutive trial periods. The first and third periods were 3 weeks of total coffee abstention. The second and fourth periods consisted of 4 weeks with the subjects consuming 600 ml filter brewed coffee/day. SETTING: Free-living population. Volunteers. SUBJECTS: A total of 121 healthy, nonsmoking men and women aged 29-65 y. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Serum total cholesterol, serum HDL cholesterol, serum triglycerides, serum lipoprotein (a) (Lp(a)), blood pressure and heart rate. RESULTS: The two coffee abstention periods were associated with a decline in serum cholesterol of 0.22 mmol/l (95% CI -0.31, -0.13) and 0.36 mmol/l (95% CI -0.46, -0.26), respectively. Filtered coffee/day 600 ml increased serum cholesterol by 0.25 mmol/l (95% CI 0.15, 0.36) and 0.15 mmol/l (95% CI 0.04, 0.26) during the two coffee drinking periods. CONCLUSIONS: Coffee abstention for 3 weeks decreased total serum cholesterol by 0.22-0.36 mmol/l. A volume of 600 ml (about four cups) of filtered coffee/day during 4 weeks raised total serum cholesterol by 0.15-0.25 mmol/l.

Folic acid supplement decreases the homocysteine increasing effect of filtered coffee. A randomised placebo-controlled study.

OBJECTIVE: Elevated levels of plasma total homocysteine (tHcy) are identified as independent risk factors for coronary heart disease and for fetal neural tube defects. tHcy levels are negatively associated with folic acid, pyridoxine and cobalamine, and positively associated with coffee consumption and smoking. A total of 600 ml of filtered coffee results in a tHcy increase that 200 mug of folic acid or 40 mg of pyridoxine supplementation might eliminate. DESIGN: Randomised, blinded study with two consecutive trial periods. SETTING: Free living population. Volunteers. SUBJECTS: A total of 121 healthy, nonsmoking men and women (78%) aged 29-65 y. INTERVENTIONS: (1) A coffee-free period of 3 weeks, (2) 600 ml coffee/day and a supplement of 200 mug folic acid/day or placebo for 4 weeks, (3) 3-week coffee-free period, (4) 600 ml coffee/day and 40 mg pyridoxine/day or placebo for 4 weeks. MAIN OUTCOME MEASURES: The difference between the change in tHcy in the supplement group and the change in tHcy in the placebo group during the 4-week trial period. RESULTS: Coffee abstention resulted in a tHcy decrease of 1.04 mumol/l for the whole group. In the subsequent coffee period, a further decrease of 0.17 mumol/l was observed in the folic acid group whereas an increase of 1.26 mumol/l was observed in the placebo group, the difference was 1.43 mumol/l (95% CI: 0.80, 2.07). Pyridoxine supplement had no impact on tHcy levels. CONCLUSIONS: Supplementation of 200 mug folic acid/day eliminates the tHcy increasing effect of 600 ml filtered coffee in subjects not already on folic acid supplements. A supplement of 40 mg pyridoxine/day does not have the same effect.

Adipose tissue fatty acids and risk of myocardial infarction--a case-control study.

OBJECTIVES: To study the association between content in adipose tissue of very long-chain n-3 fatty acids, trans fatty acids, linoleic acid and alpha-linolenic acid and risk of a first myocardial infarction. DESIGN AND SUBJECTS: A case-control design among 100 patients and 98 population controls both men and postmenopausal women, age 45-75 y. Adipose tissue fatty acids were determined by gas-liquid chromatography. Intake data were obtained through interview using a validated food frequency questionnaire. RESULTS: Dietary intake and adipose tissue content of the fatty acids studied correlated significantly. Adipose tissue contents of eicosapentaenoic acid (20:5n-3), docosapentaenoic acid (22:5n-3) and docosahexaenoic acid (22:6n-3) were significantly lower while those of trans fatty acids, linoleic and alpha-linolenic acid were significantly higher in patients than in controls. Age and sex adjusted odds ratios (OR) were significantly reduced with increasing quintiles of very long-chain n-3 fatty acids, thus the OR in the fifth compared to the first quintile was 0.23 (95% CI 0.08-0.70). After further adjustment for waist-to-hip ratio, smoking, family history of CHD and content of trans fatty acids, the OR in the highest quintile was 0.17 (95% CI 0.04-0.76) and the P for trend 0. 016. Age and sex adjusted OR was increased in the fifth compared to the first quintile of trans fatty acids (OR 2.81, 95% CI 1.16-6.84), linoleic acid (OR 2.10, 95% CI 0.87-5.07) and alpha-linolenic acid (OR 1.96, 95% CI 0.83-4.61), and P for trend was 0.002, 0.005 and 0. 020, respectively. The trends remained significant after adjustment for waist-to-hip ratio, smoking, and family history of coronary heart disease. Trans fatty acids, linoleic acid and alpha-linolenic acid in adipose tissue were strongly correlated, indicating a common source, most likely margarine. When each of these fatty acid species were adjusted for the two others the trends were no longer significant. CONCLUSION: Intake of very long-chain n-3 fatty acids as reflected in adipose tissue content is inversely associated with risk of myocardial infarction. Trans fatty acids, linoleic and alpha-linolenic acid were intercorrelated and associated with increased risk. It is suggested that the increased risk may be connected to trans fatty acids or to some other factor associated with margarine consumption. European Journal of Clinical Nutrition 54, 618-625.