We studied the relations between body height, body mass index (BMI), and fatal hip fractures prospectively in a large, representative population. During the years 1963-1975, a nationwide compulsory mass x-ray examination including standardized height and weight measurements took place in Norway covering all persons age 15 years and older. In the study presented here, we selected women (N = 357,807) and men (N = 316,041) age 50-89 years at screening. We matched the file to the national death register containing causes of death throughout 1991; we defined cases as persons with hip fracture mentioned on their death certificates. During an average follow-up of 16.4 years, we identified a total of 6,087 fatal hip fractures in the study population. There was a distinct inverse relation between BMI and fatal hip fracture, with an age-adjusted relative risk (RR) in the three highest vs the low quartile of 0.68 [95% confidence interval (CI) = 0.63-0.72] in women and 0.57 (95% CI = 0.52-0.62) in men. The risk of fatal hip fractures increased slightly with increasing body height [RR = 1.10 (95% CI = 1.04-1.16) in women and RR = 1.08 (95% CI = 1.01-1.16) in men per 10-cm increase in body height]. This study indicates that low BMI is an important risk factor for fatal hip fractures and that body height has a weak, positive association.
STUDY OBJECTIVE--The study investigated the joint effect of body mass index and systolic blood pressure on cardiovascular and total mortality. DESIGN--This was a prospective cohort study. The main outcome measures were age adjusted mortality and relative risks estimated from survival models. SETTING--The population of the city of Bergen, Norway. PARTICIPANTS--Subjects were 21,145 men and 30,330 women aged 30-79 years at the time of examination in 1963. MAIN RESULTS--Both cause specific and all cause mortality increased with systolic blood pressure within each category of body mass index. Stroke mortality was not significantly associated with body mass index when adjusted for systolic blood pressure in either age group of men or women. Coronary heart disease mortality increased on average 30% per 5 kg/m2 increase in body mass index in men and women aged 30-59 years at baseline. Adjusted for systolic blood pressure, the relative risks were reduced to 1.20 (95% confidence interval (CI) 1.12, 1.29) in men and 1.10 (95% CI 1.03, 1.18) in women. They were similar at each level of systolic blood pressure. For coronary heart disease mortality in men and women aged 60-79 years at measurement a negative interaction between body mass index and systolic blood pressure was suggested in the first five years. Excluding the first five years, adjusted relative risks per 5 kg/m2, were 1.05 (95% CI 0.96, 1.15) in men and 1.11 (95% CI 1.04, 1.17) in women in the older age group. There was an upturn in cardiovascular mortality at low levels of body mass index in both age groups of women, but not in men. CONCLUSIONS--Hypertension is an important risk factor for cardiovascular and all cause mortality even in the obese. Body mass index is generally a weak predictor of cardiovascular mortality in this population. It is a stronger risk factor of coronary death in men when measured at a younger age. Thin people with hypertension are not at particularly high risk of death from coronary heart disease compared with their obese counterparts, except possibly in the first few years after measurement in the elderly. Being underweight is associated with increased risk of death from all cardiovascular causes in women, but not in men.
The objective of the present study was to quantify the relationship between body mass index (BMI; in kilogrammes per metre squared) and asthma in middle-aged males and females, and to evaluate change in BMI as a risk factor for asthma. Asthma incidence was estimated from data on redeemed prescriptions of anti-asthmatic drugs during the period 2004-2007, retrieved from the nationwide Norwegian Prescription Database. BMI was measured during health surveys in 1994-1999 in >100,000 individuals born during 1952-1959. Change in BMI was based on self-report. Relative risks were estimated using Poisson regression. The relative risk associated with a 3-unit increase in BMI ranged from 1.14 (95% confidence interval 1.10-1.18) in current smokers to 1.27 (1.22-1.32) in never-smokers after adjusting for confounders. The relative risk associated with a 3-unit increase in BMI was 1.21 (1.16-1.26) after adjusting for confounders, including sex, smoking and BMI. Asthma incidence, as measured by anti-asthmatic drug use, was positively related to both BMI and change in BMI. For BMI, the association was stronger for never-smokers than for ex-smokers and current smokers.
The objective was to study the association between smoking habits and mortality from coronary heart disease among men and women aged 35-49 years. Almost 45000 individuals (50% women) from three counties in Norway attended a screening programme during 1974-1978. The participation rate was almost 90% of the population. These individuals have been followed for an average of 18 years through the Norwegian death register. There were 1021 and 193 deaths from coronary heart disease among men and women, respectively. The mortality rate among current smokers was three times higher than that among those who had never smoked cigarettes. The relative risk between low-dose smokers and non-smokers was higher than that between high- and low-dose smokers. Among men, the relative risk between smokers and non-smokers was lower in the age group 45-49 years than in the two younger 5-year age groups. Among women, the relative risks did not vary significantly across the age groups. The relative risk between smokers and non-smokers remained the same in the first and second half of the observation period in men. A stronger association in the second half of the observation period was suggested among women (P = 0.08). The duration of smoking was an independent predictor of coronary heart disease among men, but not among women. Duration of smoking and length of follow-up seemed to have a different relationship with mortality from coronary heart disease in men and women. The dose-response relationship was the same in men and women, on the relative scale. Age affected the magnitude of relative risk between smokers and non-smokers among men, but not among women.
We analyzed data from 4,905 women aged 20-39 and 14,803 aged 40-49 who attended a health survey in Norway 1985-88, to study cardiovascular risk factors in users of oral contraceptives, all types and specifically by formulation. In age group 20-39, users of low-dose estrogen/ progestin regimens were younger, had lower body mass index (BMI), less often reported coronary heart disease in relatives, and less often used saturated fat on bread than did non-users. In age group 40-49, smoking was more prevalent in users of low-dose estrogen/progestin than in non-users. In both age groups the mean ratio of total/HDL cholesterol, the mean level of non-fasting triglycerides, and the mean systolic and diastolic blood pressures were higher in oral contraceptive users than in non-users. Among the users, a more favorable pattern was found in women using progestin-only oral contraceptives, as blood pressure levels were equal to those of non-users and total cholesterol and triglycerides were both 0.1-0.2 mmol/l below the non-users, in both age groups. However, users of low-dose estrogen formulations containing desogestrel 0.15 mg, norethisterone (norethindrone) 0.5 mg or lynestrenol 2.5 mg had the highest levels of HDL, even higher than the non-users. A pattern of higher triglycerides and higher ratio of total/ HDL cholesterol was found in smokers, compared with non-smokers, among users of any type of contraceptives, and in non-users.
OBJECTIVE--To study the association between number of cups of coffee consumed per day and coronary death when taking other major coronary risk factors into account. DESIGN--Men and women attending screening and followed up for a mean of 6.4 years. SETTING--Cardiovascular survey performed by ambulatory teams from the National Health Screening Service in Norway. PARTICIPANTS--All middle aged people in three counties: 19,398 men and 19,166 women aged 35-54 years who reported neither cardiovascular disease or diabetes nor symptoms of angina pectoris or intermittent claudication. MAIN OUTCOME MEASURE--Predictive value of number of cups of coffee consumed per day. RESULTS--At initial screening total serum cholesterol concentration, high density lipoprotein cholesterol concentration, blood pressure, height, and weight were measured and self reported information about smoking history, physical activity, and coffee drinking habits was recorded. Altogether 168 men and 16 women died of coronary heart disease during follow up. Mean cholesterol concentrations for men and women were almost identical and increased from the lowest to highest coffee consumption group (13.1% and 10.9% respectively). With the proportional hazards model and adjustment for age, total serum and high density lipoprotein cholesterol concentrations, systolic blood pressure, and number of cigarettes per day the coefficient for coffee corresponded to a relative risk between nine or more cups of coffee and less than one cup of 2.2 (95% confidence interval 1.1 to 4.5) for men and 5.1 (0.4 to 60.3) for women. For men the relative risk varied among the three counties. CONCLUSIONS--Coffee may affect mortality from coronary heart disease over and above its effect in raising cholesterol concentrations.