The U.S. Supreme Court is considering a case involving penalties targeting involuntary homelessness. Enabling the criminalization of homelessness could undermine individual and population health.

Incidence rates for brain tumor subtypes by age and sex (1973-2010).

Adjusted incidence rate ratios for associations between perinatal or familial characteristics and primitive neuroectodermal tumors in 1973-2010.

The underrepresentation of individuals from minority and low-income backgrounds is a pressing and persistent issue in medicine. High school biomedical pipeline programs offer a promising strategy to diversify the medical pipeline by supporting underrepresented students towards successful transition into college and health careers. One of the most established university-based pipeline programs is the Stanford Medical Youth Science Program (SMYSP). For over thirty years, SMYSP has fostered the potential of low-income and under-represented high school students interested in careers in health and medicine through a 5-week summer program. We partnered with SMYSP to qualitatively explore the impact of their high school biomedical pipeline program on alumni at different stages of their educational and professional careers. We conducted a cross-sectional, qualitative study with alumni who participated in the SMYSP program from 1988-2019 who completed an online survey (n=83); a subset (n=21) who were working in or completing training in a clinical field were interviewed using a semi-structured, in-depth interview examining the perceived impact of SMYSP throughout different stages of their educational and professional careers. Interviews were audio-recorded, transcribed, and coded and thematic analysis was performed with input from SMYSP collaborators. Eighty-three alumni completed the survey, 45% had completed or were enrolled in an undergraduate degree program and 40% had completed or were enrolled in a graduate degree program. Twenty-one alumni were interviewed (66% men; ages 17-46 year; 43% Latino; 29% Asian; 14% Black; 5% Native; 5% White; 5% Mixed). The following themes emerged: (1) clinical experiences (hospital internships, anatomy laboratory practicums) were often described as the most impactful program component, (2) inspiration was gained by meeting students and professional mentors that "looked like me" during the program, (3) participation in the program at a young age was important in developing self-confidence to pursue higher education and (4) many alumni felt a sense of belonging in their school, work, and community despite challenging academic and career journeys. High school biomedical pipeline programs for underrepresented students can have a positive impact on alumni throughout different stages of their educational and professional careers. Established and evaluated programs like SMYSP should serve as a model to guide the development of future programs seeking to support under-represented students interested in health professions.

(Abstracted from JAMA 2019;322(16):1580–1588) More than 95% of preterm infants in developed countries now survive into adulthood. However, with a worldwide preterm birth rate of 10.6%, associated increased relative risks of cardiometabolic, respiratory, and neuropsychiatric disorders in adulthood prove concerning.

BACKGROUND:Breakthroughs in the treatment of preterm birth approximately 40 years ago have enabled a generation of preterm survivors to now reach mid-adulthood. Understanding their health sequelae is essential for guiding their long-term care. We did a study to examine preterm birth in relation to mortality into mid-adulthood. METHODS:A national cohort study was done of all 4 296 814 singleton livebirths in Sweden between 1973 and 2015, who were followed up for mortality through Dec 31, 2017 (maximum age 45 years). Cox regression was used to examine gestational age at birth in relation to all-cause and cause-specific mortality, and cosibling analyses assessed for potential confounding by shared familial (genetic or environmental) factors. FINDINGS:In 103·5 million person-years of follow-up, 43 916 (1·0%) deaths were reported. Gestational age at birth was inversely associated with mortality from infancy to mid-adulthood. Relative to full-term birth (39-41 weeks), the adjusted hazard ratios for mortality associated with gestational age at birth were: 66·14 (95% CI 63·09-69·34) for extremely preterm (22-27 weeks), 8·67 (8·32-9·03) for very preterm (28-33 weeks), 2·61 (2·52-2·71) for late preterm (34-36 weeks), and 1·34 (1·30-1·37) for early term (37-38 weeks), from birth to age 45 years; and 2·04 (0·92-4·55) for extremely preterm, 1·48 (1·17-1·87) for very preterm, 1·22 (1·07-1·39) for late preterm, and 1·16 (1·08-1·25) for early term, at ages 30-45 years. Preterm birth accounted for more deaths among males than females (additive interaction p<0·001). Multiple underlying causes were identified, including congenital anomalies; respiratory, endocrine, cardiovascular, and neurological diseases; cancer; and external causes. Cosibling analyses suggested that the observed associations were not due to shared genetic or environmental factors in families. INTERPRETATION:Preterm and early term birth should be recognised as chronic conditions that require long-term follow-up for adverse health sequelae in adulthood. FUNDING:National Heart, Lung, and Blood Institute at the National Institutes of Health.

SummarySleep apnea is increasing in prevalence, and is an important cause of cardiometabolic diseases and mortality worldwide. Its only established modifiable risk factor is obesity; however, up to half of all sleep apnea cases may occur in non‐obese persons, and hence there is a pressing need to identify other modifiable risk factors to facilitate more effective prevention. We sought to examine, for the first time, cardiorespiratory fitness in relation to the risk of sleep apnea, independent of obesity. A national cohort study was conducted to examine cardiorespiratory fitness in all 1,547,478 Swedish military conscripts during 1969–1997 (97%–98% of all 18‐year‐old men) in relation to risk of sleep apnea through 2012 (maximum age 62 years). Cardiorespiratory fitness was measured as maximal aerobic workload in Watts, and sleep apnea was identified from nationwide outpatient and inpatient diagnoses. A total of 44,612 (2.9%) men were diagnosed with sleep apnea in 43.7 million person‐years of follow‐up. Adjusting for age, height, weight, socioeconomic factors and family history of sleep apnea, low cardiorespiratory fitness at age 18 years was associated with a significantly increased risk of sleep apnea in adulthood (lowest versus highest cardiorespiratory fitness tertile: incidence rate ratio, 1.44; 95% confidence interval, 1.40–1.49; p < 0.001; continuous cardiorespiratory fitness per 100 Watts: incidence rate ratio, 0.71; 95% confidence interval, 0.70–0.73; p < 0.001). An increased risk was observed even among men with normal body mass index (lowest versus highest cardiorespiratory fitness tertile: incidence rate ratio, 1.30; 95% confidence interval, 1.26–1.35; p < 0.001). These findings identify low cardiorespiratory fitness early in life as a new modifiable risk factor for development of sleep apnea in adulthood.

Patient counseling on physical fitness remains underutilized in primary care, despite its clinical and cost effectiveness. Most counseling interventions have focused on aerobic activity and neglected another vital component of physical fitness, muscle strengthening, which has recently been shown to be independently protective against cardiometabolic diseases and premature mortality. This article reviews the latest scientific evidence and makes recommendations toward a more comprehensive approach for promoting physical fitness in primary care. Given the high prevalence and wide-ranging health impacts of physical inactivity, counseling on physical fitness should be a standard part of wellness promotion and disease prevention and treatment for all patients. Interventions that include muscle strengthening will have a significantly greater impact on health outcomes than those focused on aerobic fitness alone. Counseling to promote both aerobic fitness and muscle strengthening is indicated for all patients, irrespective of body weight, and should begin early in life and continue across the life course.

Key PointsQuestionWhat is the prevalence of survival without major comorbidities in adulthood among persons born prematurely? FindingsIn this population-based cohort study of more than 2.5 million persons born in Sweden from 1973 to 1997, 54.6% of those born preterm (gestational age <37 weeks) and 22.3% of those born extremely preterm (22-27 weeks) were alive with no major comorbidities at ages 18 to 43 years, compared with 63.0% of those born full-term. The prevalences were statistically significantly lower in those born at earlier gestational ages vs full-term. MeaningAmong Swedish persons born prematurely, a large percentage survived into adulthood and had no major comorbidities. ImportancePreterm birth has been associated with cardiometabolic, respiratory, and neuropsychiatric disorders in adulthood. However, the prevalence of survival without any major comorbidities is unknown. ObjectiveTo determine the prevalence of survival without major comorbidities in adulthood among persons born preterm vs full-term. Design, Setting, and ParticipantsNational cohort study of all 2566699 persons born in Sweden from January 1, 1973, through December 31, 1997, who had gestational age data and who were followed up for survival and comorbidities through December 31, 2015 (ages 18-43 years). ExposuresGestational age at birth. Main Outcomes and MeasuresSurvival without major comorbidities among persons born extremely preterm (22-27 weeks), very preterm (28-33 weeks), late preterm (34-36 weeks), or early term (37-38 weeks), compared with full-term (39-41 weeks). Comorbidities were defined using the Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) Comorbidity Index, which includes conditions that commonly manifest in adolescence or young adulthood, including neuropsychiatric disorders; and the Charlson Comorbidity Index (CCI), which includes major chronic disorders predictive of mortality in adulthood. Poisson regression was used to determine prevalence ratios and differences, adjusted for potential confounders. ResultsIn this study population, 48.6% were female, 5.8% were born preterm, and the median age at end of follow-up was 29.8 years (interquartile range, 12.6 years). Of all persons born preterm, 54.6% were alive with no AYA HOPE comorbidities at the end of follow-up. Further stratified, this prevalence was 22.3% for those born extremely preterm, 48.5% for very preterm, 58.0% for late preterm, 61.2% for early term, and 63.0% for full-term. These prevalences were significantly lower for earlier gestational ages vs full-term (eg, adjusted prevalence ratios: extremely preterm, 0.35 [95% CI, 0.33 to 0.36; P<.001]; all preterm, 0.86 [95% CI, 0.85 to 0.86; P<.001]; adjusted prevalence differences: extremely preterm, -0.41 [95% CI, -0.42 to -0.40; P<.001]; all preterm, -0.09 [95% CI, -0.09 to -0.09; P<.001]). Using the CCI, the corresponding prevalences were 73.1% (all preterm), 32.5% (extremely preterm), 66.4% (very preterm), 77.1% (late preterm), 80.4% (early term), and 81.8% (full-term) (adjusted prevalence ratios: extremely preterm, 0.39 [95% CI, 0.38 to 0.41; P<.001]; all preterm, 0.89 [95% CI, 0.89 to 0.89; P<.001]; adjusted prevalence differences: extremely preterm, -0.50 [95% CI, -0.51 to -0.49; P<.001]; all preterm, -0.09 [95% CI, -0.09 to -0.09; P<.001]). Conclusions and RelevanceAmong persons born preterm in Sweden between 1973 and 1997, the majority survived to early to mid-adulthood without major comorbidities. However, outcomes were worse for those born extremely preterm. This cohort study uses data from the Swedish Birth Registry to determine the prevalence of survival without major comorbidities in adulthood among persons born preterm vs full-term in Sweden between 1973 and 1997.

OBJECTIVE To investigate the relation between preterm birth (gestational age <37 weeks) and risk of CKD from childhood into mid-adulthood. DESIGN National cohort study. SETTING Sweden. PARTICIPANTS 4 186 615 singleton live births in Sweden during 1973-2014. EXPOSURES Gestational age at birth, identified from nationwide birth records in the Swedish birth registry. MAIN OUTCOME MEASURES CKD, identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth and risk of CKD while adjusting for potential confounders, and co-sibling analyses assessed the influence of unmeasured shared familial (genetic or environmental) factors. RESULTS 4305 (0.1%) participants had a diagnosis of CKD during 87.0 million person years of follow-up. Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95% confidence interval 1.74 to 2.16; P<0.001; 3.01, 1.67 to 5.45; P<0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P<0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P<0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P<0.001) and 20-43 years (1.34, 1.15 to 1.57; P<0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families. CONCLUSIONS Preterm and early term birth are strong risk factors for the development of CKD from childhood into midadulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.

Objective Low physical fitness and obesity have been associated with higher risk of developing heart failure (HF), but their interactive effects are unknown. Elucidation of interactions among these common modifiable factors may help facilitate more effective primary prevention. Methods We conducted a national cohort study to examine the interactive effects of aerobic fitness, muscular strength and body mass index (BMI) among 1 330 610 military conscripts in Sweden during 1969–1997 (97%–98% of all 18-year-old men) on risk of HF identified from inpatient and outpatient diagnoses through 2012 (maximum age 62 years). Results There were 11 711 men diagnosed with HF in 37.8 million person-years of follow-up. Low aerobic fitness, low muscular strength and obesity were independently associated with higher risk of HF, after adjusting for each other, socioeconomic factors, other chronic diseases and family history of HF. The combination of low aerobic fitness and low muscular strength (lowest vs highest tertiles) was associated with a 1.7-fold risk of HF (95% CI 1.6 to 1.9; p<0.001; incidence rates per 100 000 person-years, 43.2 vs 10.8). These factors had positive additive and multiplicative interactions (p<0.001) and were associated with increased risk of HF even among men with normal BMI. Conclusions Low aerobic fitness, low muscular strength and obesity at the age of 18 years were independently associated with higher risk of HF in adulthood, with interactive effects between aerobic fitness and muscular strength. These findings suggest that early-life interventions may help reduce the long-term risk of HF and should include both aerobic fitness and muscular strength, even among persons with normal BMI.

Tall stature and obesity have been associated with a higher risk of atrial fibrillation (AF), but there have been conflicting reports of the effects of aerobic fitness. We conducted a national cohort study to examine interactions between height or weight and level of aerobic fitness among 1,547,478 Swedish military conscripts during 1969-1997 (97%-98% of all 18-year-old men) in relation to AF identified from nationwide inpatient and outpatient diagnoses through 2012 (maximal age, 62 years). Increased height, weight, and aerobic fitness level (but not muscular strength) at age 18 years were all associated with a higher AF risk in adulthood. Positive additive and multiplicative interactions were found between height or weight and aerobic fitness level (for the highest tertiles of height and aerobic fitness level vs. the lowest, relative excess risk = 0.51, 95% confidence interval (CI): 0.40, 0.62; ratio of hazard ratios = 1.50, 95% CI: 1.34, 1.65). High aerobic fitness levels were associated with higher risk among men who were at least 186 cm (6 feet, 1 inch) tall but were protective among shorter men. Men with the combination of tall stature and high aerobic fitness level had the highest risk (for the highest tertiles vs. the lowest, adjusted hazard ratio = 1.70, 95% CI: 1.61, 1.80). These findings suggest important interactions between body size and aerobic fitness level in relation to AF and may help identify high-risk subgroups.

INTRODUCTION:Low aerobic fitness, low muscular strength, and obesity have been associated with premature mortality, but their interactive effects are unknown. This study examined interactions among these common, modifiable factors, to help inform more-effective preventive interventions. METHODS:This national cohort study included all 1,547,478 military conscripts in Sweden during 1969-1997 (97%-98% of all men aged 18 years each year). Aerobic fitness, muscular strength, and BMI measurements were examined in relation to all-cause and cardiovascular mortality through 2012 (maximum age, 62 years). Data were collected/analyzed in 2015-2016. RESULTS:Low aerobic fitness, low muscular strength, and obesity at age 18 years were independently associated with higher all-cause and cardiovascular mortality in adulthood. The combination of low aerobic fitness and muscular strength (lowest versus highest tertiles) was associated with twofold all-cause mortality (adjusted hazard ratio=2.01; 95% CI=1.93, 2.08; p<0.001; mortality rates per 100,000 person years, 247.2 vs 73.8), and 2.6-fold cardiovascular mortality (2.63; 95% CI=2.38, 2.91; p<0.001; 43.9 vs 8.3). These factors also had positive additive and multiplicative interactions in relation to all-cause mortality (their combined effect exceeded the sum or product of their separate effects; p<0.001), and were associated with higher mortality even among men with normal BMI. CONCLUSIONS:Low aerobic fitness, low muscular strength, and obesity at age 18 years were associated with increased mortality in adulthood, with interactive effects between aerobic fitness and muscular strength. Preventive interventions should begin early in life and include both aerobic fitness and muscular strength, even among those with normal BMI.

IMPORTANCE:High body mass index (BMI) and low physical fitness are risk factors for hypertension, but their interactive effects are unknown. Elucidation of interactions between these modifiable risk factors may help inform more effective interventions in susceptible subgroups.OBJECTIVE:To determine the interactive effects of BMI and physical fitness on the risk of hypertension in a large national cohort.DESIGN, SETTING, AND PARTICIPANTS:This cohort study included all 1,547,189 military conscripts in Sweden from January 1, 1969, through December 31, 1997 (97%-98% of all 18-year-old men nationwide each year), who were followed up through December 31, 2012 (maximum age, 62 years). Data analysis was conducted August 1 through August 15, 2015.EXPOSURES:Standardized aerobic capacity, muscular strength, and BMI measurements obtained at a military conscription examination.MAIN OUTCOMES AND MEASURES:Hypertension identified from outpatient and inpatient diagnoses.RESULTS:A total of 93,035 men (6.0%) were diagnosed with hypertension in 39.7 million person-years of follow-up. High BMI and low aerobic capacity (but not muscular strength) were associated with increased risk of hypertension, independent of family history and socioeconomic factors (BMI, overweight or obese vs normal: incidence rate ratio, 2.51; 95% CI, 2.46-2.55; P < .001; aerobic capacity, lowest vs highest tertile: incidence rate ratio, 1.50; 95% CI, 1.47-1.54; P < .001). Aerobic capacity was inversely associated with hypertension across its full distribution (incidence rate ratio per 100 W, 0.70; 95% CI, 0.69-0.71; P < .001). A combination of high BMI (overweight or obese vs normal) and low aerobic capacity (lowest vs highest tertile) was associated with the highest risk of hypertension (incidence rate ratio, 3.53; 95% CI, 3.41-3.66; P < .001) and had a negative additive and multiplicative interaction (P < .001). Although high BMI was a significant risk factor for hypertension, low aerobic capacity also was a significant risk factor among those with normal BMI.CONCLUSIONS AND RELEVANCE:In this large national cohort study, high BMI and low aerobic capacity in late adolescence were associated with higher risk of hypertension in adulthood. If confirmed, our findings suggest that interventions to prevent hypertension should begin early in life and include not only weight control but aerobic fitness, even among persons with normal BMI.

OBJECTIVE:Greater blood pressure reactivity to psychological stress has been associated with higher risk of developing hypertension. We hypothesised that low stress resilience based on psychological assessment early in life is associated with hypertension in adulthood.METHODS:National cohort study of 1,547,182 military conscripts in Sweden during 1969-1997 (97-98% of all 18-year-old males) without prior history of hypertension, who underwent standardised psychological assessment by trained psychologists for stress resilience (1-9 scale), and were followed up for hypertension identified from outpatient and inpatient diagnoses during 1969-2012 (maximum age 62).RESULTS:93,028 men were diagnosed with hypertension in 39.4 million person-years of follow-up. Adjusting for body mass index (BMI), family history and socioeconomic factors, low stress resilience at age 18 was associated with increased risk of hypertension in adulthood (lowest vs highest quintile: HR 1.43; 95% CI 1.40 to 1.46; p < 0.001; incidence rates, 278.7 vs 180.0 per 100,000 person-years), including a strong linear trend across the full range of stress resilience (p(trend) < 0.0001). We also found a positive additive interaction between stress resilience and BMI (p < 0.001), indicating that low stress resilience accounted for more hypertension cases among those with high BMI. Men with a combination of low stress resilience and high BMI had a more than threefold risk of hypertension.CONCLUSIONS:These findings suggest that low stress resilience may contribute to etiological pathways for hypertension and accounts for more cases among those with high BMI. If confirmed, this knowledge may help inform better preventive interventions by addressing psychosocial risk factors and stress management across the lifespan.

Psychosocial stress in adulthood is associated with a higher risk of type 2 diabetes, possibly mediated by behavioural and physiological factors. However, it is unknown whether low stress resilience earlier in life is related to subsequent development of type 2 diabetes. We examined whether low stress resilience in late adolescence is associated with an increased risk of type 2 diabetes in adulthood.

Obesity and low physical fitness are known risk factors for ischemic heart disease (IHD), but their interactive effects are unclear. Elucidation of interactions between these common, modifiable risk factors may help inform more effective preventive strategies. We examined interactive effects of obesity, aerobic fitness and muscular strength in late adolescence on risk of IHD in adulthood in a large national cohort. We conducted a national cohort study of all 1 547 407 military conscripts in Sweden during 1969–1997 (97–98% of all 18-year-old males each year). Aerobic fitness, muscular strength and body mass index (BMI) measurements were examined in relation to IHD identified from outpatient and inpatient diagnoses through 2012 (maximum age 62 years). There were 38 142 men diagnosed with IHD in 39.7 million person years of follow-up. High BMI or low aerobic fitness (but not muscular strength) was associated with higher risk of IHD, adjusting for family history and socioeconomic factors. The combination of high BMI (overweight/obese vs normal) and low aerobic fitness (lowest vs highest tertile) was associated with highest IHD risk (incidence rate ratio, 3.11; 95% confidence interval (CI), 2.91–3.31; P<0.001). These exposures had no additive and a negative multiplicative interaction (that is, their combined effect was less than the product of their separate effects). Low aerobic fitness was a strong risk factor even among those with normal BMI. In this large cohort study, low aerobic fitness or high BMI at age 18 was associated with higher risk of IHD in adulthood, with a negative multiplicative interaction. Low aerobic fitness appeared to account for a similar number of IHD cases among those with normal vs high BMI (that is, no additive interaction). These findings suggest that interventions to prevent IHD should begin early in life and include not only weight control but aerobic fitness, even among persons of normal weight.

Background: Gender stereotypes in science impede supportive environments for women. Research suggests that women's perceptions of these environments are influenced by stereotype threat (ST): anxiety faced in situations where one may be evaluated using negative stereotypes. This study developed and tested ST metrics for first time use with junior faculty in academic medicine. Methods: Under a 2012 National Institutes of Health Pathfinder Award, Stanford School of Medicine's Office of Diversity and Leadership, working with experienced clinicians, social scientists, and epidemiologists, developed and administered ST measures to a representative group of junior faculty. Results: 174 School of Medicine junior faculty were recruited (62% women, 38% men; 75% assistant professors, 25% instructors; 50% white, 40% Asian, 10% underrepresented minority). Women reported greater susceptibility to ST than did men across all items including ST vulnerability (p < 0.001); rejection sensitivity (p = 0.001); gender identification (p < 0.001); perceptions of relative potential (p = 0.048); and, sense of belonging (p = 0.049). Results of career-related consequences of ST were more nuanced. Compared with men, women reported lower beliefs in advancement (p = 0.021); however, they had similar career interest and identification, felt just as connected to colleagues, and were equally likely to pursue careers outside academia (all p > 0.42). Conclusions: Innovative ST metrics can provide a more complete picture of academic medical center environments. While junior women faculty are susceptible to ST, they may not yet experience all of its consequences in their early careers. As such, ST metrics offer a tool for evaluating institutional initiatives to increase supportive environments for women in academic medicine.

Background: Early-life physical fitness has rarely been examined in relation to type 2 diabetes mellitus (DM) in adulthood because of the lengthy follow-up required. Elucidation of modifiable risk factors at young ages may help facilitate earlier and more effective interventions.Objective: To examine aerobic capacity and muscle strength at age 18 years in relation to risk for type 2 DM in adulthood.Design: National cohort study.Setting: Sweden.Participants: 1 534 425 military conscripts from 1969 to 1997 (97% to 98% of all men aged 18 years nationwide) without prior type 2 DM.Measurements: Aerobic capacity and muscle strength (measured in watts and newtons per kilogram of body weight, respectively) were examined in relation to type 2 DM identified from outpatient and inpatient diagnoses from 1987 to 2012 (maximum age, 62 years).Results: 34 008 men were diagnosed with type 2 DM in 39.4 million person-years of follow-up. Low aerobic capacity and muscle strength were independently associated with increased risk for type 2 DM. The absolute difference in cumulative incidence of type 2 DM between the lowest and highest tertiles of both aerobic capacity and strength was 0.22% at 20 years of follow-up (95% CI, 0.20% to 0.25%), 0.76% at 30 years (CI, 0.71% to 0.81%), and 3.97% at 40 years (CI, 3.87% to 4.06%). Overall, the combination of low aerobic capacity and muscle strength was associated with a 3-fold risk for type 2 DM(adjusted hazard ratio, 3.07 [CI, 2.88 to 3.27]; P < 0.001), with a positive additive interaction (P < 0.001). These associations were seen even among men with normal body mass index.Limitation: This cohort did not include women and did not measure physical fitness at older ages.Conclusion: In this large cohort of Swedish male military conscripts, low aerobic capacity and muscle strength at age 18 years were associated with increased long-term risk for type 2 DM, even among those with normal body mass index.