BACKGROUND:We examined the effect of adult weight change on risk for total hip replacement resulting from primary osteoarthritis, using a prospective study design.METHODS:We linked data on body mass index and body weight from 3 screening surveys in 3 Norwegian counties (mean ages at screenings 34, 43, and 47 y; n = 38,868) with follow-up data on total hip replacement (n = 572). Mean age at the start of follow up was 55 years, and mean duration of follow up was 9 years. For each participant we calculated a rate of weight change (weight slope) by linear regression of body weight versus time from the first through the third screening.RESULTS:Among men, mean weight change from first to last screening was +9.8 kg in the highest quartile and -3.7 kg in the lowest quartile. In women, the corresponding figures were +9.5 kg in the highest quartile and -5.2 kg in the lowest quartile. There was no association of weight slope, absolute weight change, or relative weight change between screenings with later total hip replacement resulting from primary osteoarthritis. We saw no change in the association between body mass index and later hip arthroplasty as the participants' age increased from 34 to 47 years at the 3 screenings.CONCLUSION:The risk for later total hip replacement resulting from primary osteoarthritis was unaffected by weight change during the fourth and fifth decades of life. The dose-response association between adult body mass index and later total hip replacement was similar across these age groups.

Background Two-thirds of the tuberculosis (TB) cases in Norway were discovered among immigrants. Some cases were discovered at arrival, but many develop the disease several years post- migration. Knowledge about how long after migration to Norway TB were discovered will enable us to better target preventive measures including preventive therapy. This study examines the long- term risk of TB among immigrants in Norway.Methods All non- Nordic immigrants who arrived in Norway between 1986 and 2002, as registered by the Norwegian Directorate of Immigration, were followed- up. Their TB status was determined from the National Tuberculosis Registry. Observation period for TB cases was calculated from the date of arrival in Norway to TB registration. For persons without TB, it was calculated from the date of arrival in Norway to the date of emigration from Norway, date of death, or until end of follow- up (December 31, 2002).Results For immigrants from Africa and Asia, the TB rates were 190 and 80 per 100 000 person- years (PY), respectively, at 7 years post- migration. For immigrants from Somalia, Pakistan, Vietnam, and the former Yugoslavia, the rates were 520, 160, 210, and 40 per 100 000 PY respectively, at 7 years post- migration. These rates were 7 to 90 times higher than the crude TB incidence for Norway. This increased risk applies to both genders, pulmonary and extra- pulmonary sites.Conclusion These results indicate the need for health personnel to be aware that immigrants remain at high risk of TB many years post- migration. Screening for TB on arrival should be strengthened, and preventive therapy for those with recent TB infection should be considered.

Objective: The aim of the present study was to examine the validity of local and national electronic databases using medical records as gold Standard.Study Design and Setting: All hospital admissions with ICD 9-code 820.X (hip fracture) in a 1-year period were identified in the electronic discharge registers of the hospitals in Oslo and in the national electronic database (The Norwegian Patient Register). Medical records for all patients identified by the discharge registers and the logbooks of the operating theater of the hospitals were retrieved, and the diagnosis was verified.Results: Compared with the total number of fractures confirmed in medical records, the electronic discharge register of one of the hospitals underestimated the number of fractures by 46%, whereas the two other overestimated the number by 17% and 19%. For the national electronic database, an overall overestimation of 19% was found.Conclusion: The present findings question the validity of electronic databases and thus have implications for epidemiologic studies. (C) 2005 Elsevier Inc. All rights reserved.

In Norwegian adult men, body mass index (BMI) increased from around 25 kg/m(2) in the late 1960s to around 26.5 kg/m(2) in the late 1990s, and the prevalence of obesity increased from about 5% to 15% in the same period. In women the prevalence of obesity actually decreased from around 13% in the late 1960s to 7% in the late 1980s. However, during the last years the prevalence has also increased reaching about 13% in the late 1990s. It is important to note that both mean and median BMI has increased with a shift in the distribution to the right. The proportion of normal weight individuals has thus decreased, whereas the proportion of obese has increased. The increase in BMI has occurred in different age groups. Although obesity is associated with low education and a sedentary lifestyle, the increase in BMI has also occurred in the more educated and physical active.

Norway has a very high incidence of osteoporotic fractures, with substantial regional differences in fracture incidence. The present study evaluated whether there are differences in bone mineral density (BMD) between regions in Norway with differences in fracture incidence. The authors used data collected in four large, population-based, multipurpose studies performed in four regions of Norway during 1994-2001. Distal forearm BMD was measured by single energy x-ray absorptiometry in 10,667 participants aged 40-75 years. Cross-calibration was performed by using the European Forearm Phantom. Mean distal forearm BMD was lower in the urban populations of Tromso, Oslo, and Bergen compared with the rural county of Nord-Trondelag, whereas there was no difference between the rural part of Tromso and Nord-Trondelag. For women, body mass index explained some of these differences. The prevalence of low BMD (z score < or = -1) in Oslo, Bergen, and urban Tromso, compared with Nord-Trondelag, was 1.6-1.7 times higher in men and 1.5-2.0 times higher in women, whereas no significant difference was found between rural Tromso and Nord-Trondelag. In this study, higher BMD was found in rural compared with urban areas of Norway, which might help explain the differences in fracture incidence. There was no apparent north-south gradient in BMD.

We studied the prevalence of poor vitamin D status and the association with bone density in men and women born in Norway (quoted as Norwegians, n = 869) and Pakistan (quoted as Pakistanis, n = 177) in the population-based Oslo Health Study, 2000-2001.We measured 25-hydroxyvitamin D, iPTH and ionized calcium in serum and bone mineral density at the forearm site with single energy X-ray absorptiometry.Mean 25-hydroxyvitamin D was 74.8 +/- 23.7 nmol/l in the Norwegians and 25.0 +/- 13.6 nmol/l in the Pakistanis (P = 0.000). The prevalence of secondary hyperparathyroidism (iPTH greater than or equal to 8.5 pmol/l, 25-hydroxyvitamin D < 50 nmol/l and Ca2+ less than or equal to 1.35 mmol/l) was four times higher in Pakistani compared to Norwegian women. Also in Pakistani men, serious vitamin D deficiency defined as secondary hyperparathyroidism was prevalent, and five times as frequent as in Norwegian men. However, whereas BMD was significantly lower in Norwegian women with, compared to Norwegian women without, secondary hyperparathyroidism, there was no difference in BMD between Pakistani women with and without secondary hyperparathyroidism.In conclusion, vitamin D deficiency was prevalent among Pakistani immigrants, and in great contrast to the vitamin D replete Norwegians. Serious vitamin D deficiency was interestingly not associated with reduced forearm bone density among Pakistani women. (C) 2004 Elsevier Inc. All rights reserved.

Background. The aim of the study was to examine the associations between smoking habits, and dietary habits, physical activity and body mass index (BMI) in Norway in 1997-1999.Methods. The study was cross-sectional. Data on smoking habits, consumption of selected foods and physical activity were collected by questionnaire while body height and weight were measured in 59 361 subjects 40-42 years in 11 Norwegian counties.Results. In both genders, nearly twice as many never smokers than current smokers had fruit or vegetables at least twice a day; 25.5% versus 13.3% for women and 10.5% versus 4.6% for men. The proportion of non-smoking women with a high intake of fish and fruit/vegetables was considerably higher than that of non-smoking men. Mean BMI (95% confidence interval (Q) was higher for never smokers than for current smokers; 25.2 (25.1-25.3) versus 24.7 (24.6-24.8) kg/m(2) for women and 26.6 (26.5-26.7) versus 26.1 (26.0-26.2) kg/m(2) for men. The prevalence of obesity (BMI greater than or equal to30 kg/m(2)) (mean and 95% CI) was 12.5% (11.9-13.1%) and 14.4% (13.7-15.1%) among never-smoking women and men, respectively, whereas in smokers, the prevalence of obesity was 10.3% (9.8-10.8%) in women and 12.3% (11.7-12.9%) in men. The prevalence of performing strenuous physical activity at least 1 h a week was approximately 10% lower among current smokers than among non-smokers for both men and women.Conclusion. We found that non-smokers had healthier eating habits and higher levels of physical activity than did smokers, whereas the prevalence of obesity was lower in smokers. On the other hand, there were considerable gender differences, and female smokers' eating habits were as healthy as non-smoking males' eating habits. (C) 2003 American Health Foundation and Elsevier Inc. All rights reserved.

BACKGROUND:Low socioeconomic status is an established risk factor for coronary heart disease. Yet relatively few studies have examined whether wives' socioeconomic status may influence men's coronary heart disease (CHD) risk factors and mortality. We examined whether wives' education was associated with men's risk of CHD after taking into account the men's own educational level.METHODS:Married men were identified in a population-based cohort recruited for a cardiovascular disease screening conducted 1977-1983 in three Norwegian counties. Differences in baseline risk factors and subsequent CHD mortality by men's and their wives' education were examined. The cohort was followed through 1992.RESULTS:Wives' education was inversely related to the prevalence of men's sedentary behaviour, being overweight, having a high diastolic blood pressure, blood pressure treatment, and high total cholesterol and smoking in logistic regression analyses adjusting for men's age and education. For smoking and obesity, we observed a significant men's by wives' education interaction, with stronger inverse trends observed by wives' education among the higher-educated men. In prospective analyses, men's age-adjusted CHD mortality rates decreased with increasing level of wives' education within each stratum of men's education, with the exception of men in the lowest (7 years) education category where no trend by wives' education was observed. In additional multivariate analyses, adjusting for numerous baseline risk factors, the inverse trend in men's CHD mortality by wives' educational level remained significant only among men in the highest education category (>or=11 years of education).CONCLUSIONS:The data suggest that a partner's educational level could add valuable information to studies designed to characterize and measure the influence of socioeconomic status. Also, our data do not support other studies reporting that educated wives are hazardous for men's hearts.

Objectives. To investigate the association between composition of serum free fatty acid (FFA) fraction and risk of a first myocardial infarction (MI).Design. A case-control design.Setting. The patients were recruited from Ulleval Hospital in Oslo and Ostfold Central Hospital in Fredrikstad and Sarpsborg, Norway.Subjects. A total of 103 patients with first MI and 104 population controls, both men and postmenopausal women, age 45-75 years.Results. The mean molar percentage content of docosahexaenoic (DHA), eicosapentaenoic (EPA), stearic and myristic acid in the serum FFA fraction was significantly lower in cases than in controls, whereas that of oleic and linoleic acid was higher in cases. Increased percentage content of total very long-chain omega-3 fatty acids (VLC n-3) in serum FFA was associated with decreased risk of MI. Multivariate odds ratio (OR), adjusted for age, sex, waist-hip ratio, smoking, family history of coronary heart disease (CHD) and years of education was 0.20 (95% CI 0.06-0.63) for the highest vs. lowest quartile. Also increased content of stearic acid was associated with decreased risk. Multivariate OR adjusted as above was 0.38 (95% CI 0.14-1.04) for the highest versus lowest quartile. After adjustment for oleic acid, however, the inverse linear trend was no longer significant.Conclusions. The percentage content of VLC n-3 as well as of stearic acid in serum FFA was inversely associated with risk of myocardial infarction. That of VLC n-3 may reflect diet. but additionally these free fatty acids might in some way be related to the pathogenetic process and not only reflect their content in adipose tissue.

Randomized controlled trials have shown that a combination of vitamin D and calcium can prevent fragility fractures in the elderly. Whether this effect is attributed to the combination of vitamin D and calcium or to one of these nutrients alone is not known. We studied if an intervention with 10 μg of vitamin D3 per day could prevent hip fracture and other osteoporotic fractures in a double‐blinded randomized controlled trial. Residents from 51 nursing homes were allocated randomly to receive 5 ml of ordinary cod liver oil (n = 569) or 5 ml of cod liver oil where vitamin D was removed (n = 575). During the study period of 2 years, fractures and deaths were registered, and the principal analysis was performed on the intention‐to‐treat basis. Biochemical markers were measured at baseline and after 1 year in a subsample. Forty‐seven persons in the control group and 50 persons in the vitamin D group suffered a hip fracture. The corresponding figures for all nonvertebral fractures were 76 persons (control group) and 69 persons (vitamin D group). There was no difference in the incidence of hip fracture (p = 0.66, log‐rank test), or in the incidence of all nonvertebral fractures (p = 0.60, log‐rank test) in the vitamin D group compared with the control group. Compared with the control group, persons in the vitamin D group increased their serum 25‐hydroxyvitamin D concentration with 22 nmol/liter (p = 0.001). In conclusion, we found that an intervention with 10 μg of vitamin D3 alone produced no fracture‐preventing effect in a nursing home population of frail elderly people.

The objective of this study was to investigate the pattern of serum non-esterified fatty acid (NEFA) fraction in association with atherosclerosis development. We have studied possible relationships between eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and arachidonic acid (AA) in the NEFA fraction and biochemical markers of endothelial activation or dysfunction. The study population consisted of 152 elderly men with high risk for coronary heart disease. The composition of fasting serum NEFA was analysed by gas–liquid chromatography. Endothelial activation was evaluated using biochemical analyses of some markers of endothelial function. A significant inverse linear association was found between serum non-esterified EPA and DHA, and soluble vascular cell adhesion molecule-1 (sVCAM-1) (P=0.02 and 0.001, respectively). An inverse linear association was found between serum non-esterified AA and sVCAM-1 (P=0.001) and von Willebrand Factor (P=0.005). The significant inverse associations for DHA and AA were independent from the serum content of other NEFAs. Taken together, negative associations were found between sVCAM-1 and the serum levels of non-esterified DHA, EPA and AA. The inverse relation between the levels of sVCAM-1 and very long-chain n-3 fatty acids might indicate an anti-inflammatory effect of the latter.

PURPOSE:To study the association between body mass index (BMI) and mortality, and to evaluate the effect of physical activity during leisure time and smoking on this association in a general male population.METHODS:During 1974-1978, all men aged 35-49 yr living in three Norwegian counties were invited to a cardiovascular screening, and 87.1% attended and had their weight and height measured. Men with recognized cardiovascular diseases, diabetes mellitus, or cancer at screening were excluded. The cohort (N = 22,304) was followed for an average of 16.3 yr with respect to total and cause-specific mortality.RESULTS:During follow-up, 1909 men died. We found a J-shaped association between BMI and total mortality, and the form of association was similar for death from cardiovascular diseases. Although not statistically significant, a J-shaped association was also suggested in never-smokers. Irrespective of BMI level, ex- and never-smokers had lower mortality than current smokers. Obese smoking men had a relative risk of dying of 2.01 (95% CI: 1.29-3.11) compared with obese never-smokers, and a relative risk of 4.55 (95% CI: 3.34-6.20) compared with normal weight never-smokers (BMI 22-24.9 kg x m(-2)). Within each category of physical activity during leisure time, obese men had a similar increased relative risk of death compared with normal-weight individuals. However, the U- to J-shaped association between BMI and mortality seemed to disappear by increasing level of physical activity, but this finding was not significant.CONCLUSION:This study suggests a J-shaped association between BMI and total mortality, also when stratified on smoking habits and physical activity. The suggested linear trend in the most physical active men needs to be reassessed.

Despite several studies showing a higher incidence of peri-implant femoral fractures with the Gamma nail than with a sliding screw plate (SSP), the Gamma nail has remained the standard implant for trochanteric fractures in many hospitals. We recorded 921 trochanteric fractures in the city of Oslo during 2 years and compared the reoperation frequency in patients treated with the Gamma nail (n 379) and SSP (n 542). The distribution of age and gender in the two treatment groups was the same. 65 patients were reoperated on, several of them more than once. The only significant difference between the two surgical methods in complications leading to a reoperation was the frequency of femoral shaft fractures. 17 of the patients treated with the Gamma nail had a new femoral fracture postoperatively, compared to 3 of those with a SSP. The relative risk of another femoral fracture after surgery was 12 (95% CI: 2.7-52) if the surgical device was a Gamma nail compared to a SSP.The Gamma nail therefore can not be recommended as the standard implant for trochanteric fractures.