Abhijit Sen

• Stangvaltaite-Mouhat, Lina; Skudutyte-Rysstad, Rasa; Steingrimsdóttir, Ólöf Anna & Sen, Abhijit (2026). Socioeconomic disparities in comorbidity of dental caries and metabolic syndrome in Norwegian adults: a cross-sectional study using HUNT4 survey data. Caries Research. ISSN 0008-6568. p. 17–17. doi: 10.1159/000553481. Full text in Research Archive Show summary

  Introduction. Dental caries is considered the most prevalent noncommunicable disease worldwide, while metabolic syndrome (MetS) is another noncommunicable condition with an increasing global burden. These conditions are caused by common risk factors, such as lifestyle and diet, which are shaped by overarching socioeconomic determinants. The aim of this study was to assess socioeconomic disparities in caries/MetS comorbidity. Methods. This cross-sectional study included data from adults participating in the population-based Trøndelag Health Study (HUNT4, 2017-2019). Inclusion criteria were dentate 35 years or older participants in Oral Health Examination having records of socioeconomic determinants. Socioeconomic determinants included self-reported educational level (3 categories) and household income (3 categories). The outcome was a comorbidity of untreated caries (number of teeth with clinically and radiographically detected cavitation in dentine, D3T) and MetS (defined by the Joint Interim Statement). A modified Poisson regression analyses with robust error variances was used to estimate the prevalence ratio (PR) and the corresponding 95% confidence interval (CI). Sensitivity analyses were performed. Results. Out of 7347, 3840 (52%) participants were included (55% women, the mean age of the participants 57.4 years (standard deviation (SD) 12.3). Neither dental caries nor MetS were recorded in 1052 (27%) participants, while 887 (23%) experienced caries/MetS comorbidity. Caries/MetS comorbidity was associated with the educational level in a gradient: basic and middle educational level (vs. higher), PR 1.47 (95% CI 1.22-1.79) and PR 1.29, (95% CI 1.15-1.47), respectively. Income gradient was also observed: lower and medium income level (vs. higher) PR 1.46 (95% CI 1.19-1.80) and PR 1.23 (95% CI 1.03-1.48), respectively. The sensitivity analyses yielded results of similar strength. Conclusions. A socioeconomic gradient was observed in caries/MetS comorbidity in adult Norwegian population. This finding supports integrated public health interventions targeting both health conditions simultaneously, particularly among populations with lower educational levels aiming to decrease overall burden of these conditions and reduce socioeconomic disparities. Oral health services should be a part of the Universal Health Coverage to reduce financial barriers to access. Further research in other contexts and longitudinal studies as well as public health intervention studies are warranted.

• Bhattarai, Sanju; Poudel, Lisasha; Mjølstad, Bente Prytz; Åsvold, Bjørn Olav; Skovlund, Eva & Shrestha, Archana [Show all 7 contributors for this article] (2026). Community health worker-facilitated home visits for hypertension management in urban Nepal: a mixed-methods process evaluation. BMJ Open. 16(3), p. 111093–111093. doi: 10.1136/bmjopen-2025-111093. Full text in Research Archive Show summary

  Objectives Hypertension remains poorly controlled globally, highlighting the need for scalable community-based strategies. Although community health worker (CHW)-facilitated interventions show promise, implementation evidence from low- and middle-income countries remains limited. This study assessed the implementation processes, mechanisms of impact and contextual factors influencing a CHW-facilitated home visit intervention for hypertension management. Design Mixed-methods process evaluation nested within a randomised cluster trial. Setting An urban municipality in Nepal. Participants Individuals with hypertension were surveyed at baseline (n=1252) and follow-up (n=1098). CHWs completed routine monitoring forms and home visits were observed (n=47). In-depth interviews were conducted with individuals with hypertension (n=20), spouses (n=7), adult children (n=13), CHWs (n=8) and public primary healthcare providers (n=5). Results Overall, 86% of participants completed all six planned home visits. Visits were generally delivered with fidelity, with minor adaptations to fit participant and family contexts. Participants reported high satisfaction and perceived benefits, including improved knowledge, family support and uptake of self-blood pressure monitoring. However, developed behavioural action plans often lacked specificity, limiting progress follow-up and accountability. Weak public primary care capacity, medication stockouts and preference for higher-level or private facilities constrained care linkage. Conclusion CHW-facilitated home visits addressed key individual and family-level barriers to hypertension management, but impact was limited by uneven behaviour uptake and constrained public primary healthcare capacity for medication supply and titration. Strengthened CHW training and mentorship are needed to support effective behaviour change. Integration of community interventions with functional primary care systems is essential for sustained hypertension control in low-resource urban settings. Trial Registration number NCT05292469 ; date of registration: 22 March 2022; URL: https://clinicaltrials.gov/ct2/show/NCT05292469?cntry=NP&draw=2&rank=6 .

• Reda, Mariam; Jensen, Knut Helge M.; Sen, Abhijit; Åstrøm, Anne N. & Mustafa, Manal (2026). Impact of a Culturally Adapted Intervention on Early Childhood Caries Among Immigrants—A Cluster‐Randomised Trial. Community Dentistry and Oral Epidemiology. ISSN 0301-5661. p. 1–13. doi: 10.1111/cdoe.70065. Full text in Research Archive Show summary

  ABSTRACT Objectives Early Childhood Caries (ECC) is reported to be more common among immigrant children than their native counterparts. There are no community‐based studies that assess the effectiveness of an intervention in reducing the risk of ECC among immigrant children in Norway. This study aimed to assess the effect of a culturally adapted intervention on ECC, plaque, feeding and oral hygiene habits in immigrant children, as well as on their parents' oral health behaviours. Methods Seven primary health centres in Bergen, Norway, were randomly assigned to either an intervention or a control group. Immigrant parents of newborns participated in the baseline study ( n  = 345). Self‐reported data were collected via questionnaires at baseline (infants aged 0–6 months) and at follow‐up (18–24 months following baseline). The intervention group received a culturally adapted intervention, which consisted of two one‐to‐one motivational interviews, MI‐informed counselling (MI), toothbrushing demonstrations and pamphlets in the participants' native languages at baseline and after 6 months. The control group received only the routine dental information provided at the primary health centres. Clinical oral examinations were performed to assess the presence or absence of ECC and plaque in the children at follow‐up. Differences in outcomes were assessed and compared between intervention and control groups using generalised linear mixed models. Odds ratios with corresponding 95% confidence intervals were reported. Results A lower prevalence of carious lesions was observed in the intervention group (7.7%) than in the control group (10.6%), while plaque accumulation was higher in the intervention group (19.2%) than in the control group (17.3%). The intervention group exhibited lower odds of night‐time feeding, not brushing day and night, or not using fluoride. Conversely, the intervention group showed higher odds of sugar intake in feeding bottles. Parents in the intervention group had higher odds of irregular flossing, mouthwash use and frequent sweet intake. However, none of the findings were statistically significant, indicating no true effect of the intervention. Conclusions The present study suggests that the intervention had no impact on ECC, plaque, feeding or oral hygiene habits of the immigrant children or on the parents' dietary and oral hygiene habits. These findings underscore the necessity for community‐based, comprehensive interventions with extended follow‐up periods to effectively address the needs of this diverse population. Trial Registration ClinicalTrials.gov Identifier: NCT05758454

• Abdallah, Mariam Mohamed Reda H H; Koldsland, Odd Carsten; Bhatta, Laxmi & Sen, Abhijit (2026). Body mass index, physical activity, and severe periodontitis– a cross-sectional HUNT4 Oral Health Study. BMC Oral Health. 26(1). doi: 10.1186/s12903-026-07882-x. Full text in Research Archive
• Morooka, Hikaru; Haug, Eirin Beate; Malmo, Vegard; Loennechen, Jan Pål; Ellekjær, Hanne & Sen, Abhijit [Show all 10 contributors for this article] (2025). Adverse pregnancy outcomes and risk of atrial fibrillation: findings from the HUNT study. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 32(10), p. 845–854. doi: 10.1093/eurjpc/zwaf233. Full text in Research Archive Show summary

  Abstract Aims Despite well-studied associations between hypertensive disorders of pregnancy (HDP) and atrial fibrillation (AF), the mechanisms of the excess risk of AF in women with history of HDP are not fully understood. Furthermore, little is known about associations between other adverse pregnancy outcomes (APOs) and AF, including preterm birth, small/large-for-gestational-age (SGA/LGA) offspring. Methods and results By linking the population-based HUNT study with the Medical Birth Registry of Norway (MBRN) and electronic patient administrative systems, 15 104 women ≥45 years with 34 674 births were followed and assessed for validated AF for a median of 12.9 years. Information on APOs was retrieved from the MBRN. We used Cox proportional hazards models to calculate hazard ratios (HRs) for associations of APOs with the risk of AF. By inverse odds ratio weighting, we assessed modifiable AF risk factors that could explain the associations. Among women aged 45–65, those with HDP had a higher risk of AF [HR 2.03, 95% confidence interval (CI) 1.27–3.24] as women without HDP, but not among women >65 years (HR 0.95, 95% CI 0.57–1.60). A history of LGA was associated with increased risk of AF (HR 1.38, 95% CI 1.03–1.84), but histories of preterm birth or SGA were not (HR 0.94, 95% CI 0.63–1.41, HR 0.90, 95% CI 0.66–1.23). Post-pregnancy body mass index might possibly explain ∼45% of the associations between HDP or LGA and AF. Conclusion Women with history of HDP or LGA offspring are at higher risk of AF.

• Myran, Lena; Sun, Yi-Qian; Dahllöf, Göran; Willumsen, Tiril; Rønneberg, Anne & Havnen, Audun [Show all 9 contributors for this article] (2025). Associations of adverse childhood experiences with dental fear, and the mediating role of dental fear on caries experience: the Young-HUNT4 Survey. BMC Oral Health. 25(1). doi: 10.1186/s12903-025-06486-1. Full text in Research Archive Show summary

  Abstract Background Adverse childhood experiences (ACEs) may contribute to dental fear, which can negatively affect long-term oral health. We aimed to examine associations between specific and cumulative ACEs and dental fear in adolescents, investigate possible sex differences, and explore the potential mediating role of dental fear in the relationship between ACEs and caries experience. Methods This cross-sectional study included 5882 Norwegian adolescents aged 13–17 years from the Young-HUNT4 Survey in Norway. Self-reported ACEs (i.e., physical and sexual abuse, witnessing violence, parental divorce, parental alcohol problems, and bully victimisation) and dental fear were combined with clinical measures of caries experience. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between ACEs and dental fear. Effect modification by sex was assessed using the likelihood ratio test. A counterfactual-based mediation analysis was conducted to estimate a potential mediating effect of dental fear on the relationship between ACEs and caries experience, with results presented as ratios of means (RMs) with bias-corrected 95% CIs. Results All specific ACEs were associated with higher odds of reporting dental fear, compared to those not reporting the given ACE. Adolescents reporting any ACE had a 74% higher likelihood of reporting dental fear compared to those without ACEs (OR 1.74, 95% CI 1.29–2.33). A dose-response relationship was observed, with a one-unit increase in ACE exposure associated with higher odds of reporting dental fear (OR 1.25, 95% CI 1.15–1.36). There was evidence of effect modification by sex, with the associations between any ACE and dental fear being more pronounced in females. Further, dental fear accounted for 5.9% of the total effect in the association between any ACE and caries experience. Conclusions Specific and cumulative ACEs were associated with dental fear among adolescents, with a stronger association in females. Our findings indicate a partial mediating role of dental fear in the association between ACEs and caries experience. This study highlights the value of incorporating ACEs and dental fear into patient assessment.

• Klimowicz, Thomas Richard; Feuerherm, Astrid Jullumstrø; Thorstensen, Wenche Moe; Berg, Lars Martin; Valen, Håkon & Becher, Rune [Show all 7 contributors for this article] (2025). Prevalence of oral mucosal lesions and associated risk factors in a Norwegian adult population – the HUNT4 Oral Health study. BMC Oral Health. 25. doi: 10.1186/s12903-025-06162-4. Full text in Research Archive Show summary

  Background Most studies on the prevalence of oral mucosal lesions (OMLs), including those from Norway, focus on patient populations. This study aimed to estimate the overall prevalence of OMLs and its types across different age groups and to examine their association with selected risk factors in a general adult population of Norway. Methods This cross-sectional study included a random sample of 4,909 individuals aged 19 years and older who completed questionnaires and underwent a standardized clinical examination for OMLs in the HUNT Oral Health Survey (2017–2019). The classification of OMLs was based on the World Health Organization and NHANES III guidelines. Odds Ratio (OR) with 95% confidence intervals (CI) were calculated using multivariable logistic regression to assess associations between OMLs and potential risk factors, adjusting for relevant confounders. Results The overall prevalence of OMLs was 7.5%, with a higher proportion observed in individuals aged 60 and older. The most prevalent oral lesions were exophytic lesions (3.1%) and white lesions (1.5%). Notably, individuals with a low/middle level of education had higher odds of having an OMLs than those with a higher level of education (OR, 1.27, 95% CI: 1.00-1.61) in the fully adjusted model. Exploratory analyses of lesion types found a positive association between smoking status and white lesions (OR, 1.77, 95% CI:1.05–2.97), as well as between a history of cancer and red-blue lesions (OR, 2.17, 95% CI, 1.14–4.11). Conclusion In this population-based study, 7.5% of Norwegian adults had one or more OMLs, with higher prevalence in participants aged 60 years and older. Further research is needed to confirm these findings in similar populations.

• Abdallah, Mariam Mohamed Reda H H; Sen, Abhijit; Åstrøm, Anne-Kristine N & Mustafa, Manal (2025). Effects of an intervention on immigrant parents' knowledge and attitudes toward their children's oral health: A cluster randomized trial in Norway. European Journal of Oral Sciences. ISSN 0909-8836. 133(1). doi: 10.1111/eos.13037. Full text in Research Archive Show summary

  There are no interventional studies on the oral health of immigrant children in Norway. This study aimed to assess the effectiveness of a culturally adapted oral health intervention for parental knowledge, attitude to oral hygiene, attitude to diet, and indulgence (permissiveness toward oral hygiene and sugar intake) concerning their children's oral health. A cluster randomized control trial, including immigrant parents of newborns, was conducted at seven health centers in Bergen (Norway) involving a 2-session one-to-one motivational interviews, toothbrushing demonstrations and pamphlets in the participants’ native languages at baseline and after 6 months. Mean differences in outcome scores were assessed and compared between intervention and control groups using generalized linear mixed model. In an intention-to-treat (ITT) analysis (n = 345), the estimated mean difference in parental attitude to diet and indulgence between the groups indicated more improvement in the control than in the intervention group in the adjusted models. For all outcomes within both groups, a slight positive change was observed in marginal mean scores from baseline to follow-up. The two culturally adapted intervention sessions had no impact on oral health-related knowledge, attitudes, and indulgence of immigrant parents. These findings suggest that more comprehensive interventions may be needed to improve parental knowledge and attitudes toward children's oral health.

• Jiang, Lin; Kordy, Neda; Myhr, Arnhild; Stangvaltaite-Mouhat, Lina; Skudutyte-Rysstad, Rasa & Bhatta, Laxmi [Show all 7 contributors for this article] (2025). Body mass index, physical activity and dental caries: cross-sectional HUNT4 oral health study. Scientific Reports. 15(1). doi: 10.1038/s41598-025-12282-2. Full text in Research Archive Show summary

  Studies on the association between body mass index (BMI) and dental caries among adults are limited. Moreover, individuals with a high BMI may be either physically active or inactive, but the impact of these combinations on dental caries remains unexplored. In this study, we aimed to investigate the associations between BMI, its combination with physical activity (PA), and dental caries in the adult population. We conducted a cross-sectional analysis using data from Norwegian HUNT4 Oral Health Survey (2017–2019). BMI was categorized as < 25.0 (normal), 25.0–29.9 (overweight), or ≥ 30.0 kg/m2 (obese). The combination of BMI and PA was classified into 4 groups: (1) normal weight and active; (2) normal weight and inactive; (3) overweight-obese and active; and (4) overweight-obese and inactive. Main outcomes included the total number of decayed, missing, and filled teeth (D3MFT) and decayed teeth (D3T), while missing and sound teeth were secondary outcomes. Ratios of means (RM) with 95% confidence intervals (CI) were calculated using negative binomial regression. Effect modification by age (< 65 vs. ≥ 65 years) was assessed via the likelihood ratio test. We included 4752 individuals with a mean age of 51.9 years (SD 15.9). Compared to individuals with BMI < 25 kg/m2, those with BMI ≥ 30.0 kg/m2 was associated with an increased mean number of D3MFT (adjusted RM: 1.10, 95% CI 1.07–1.13), D3T (1.19, 95% CI 1.07–1.32), and missing teeth (1.11, 95% CI 1.00–1.22), but inversely with sound teeth (0.96, 95% CI 0.92–0.99). No combined effect of BMI and PA was observed. The association between BMI and dental caries was modified by age, with an association observed in individuals under 65 years (Plikelihood ratio test < 0.001). We observed that a higher BMI was associated with a higher dental caries experience and missing teeth. However, there was no evidence of a combined effect between BMI and PA on dental caries.

• Høvik, Hedda; Jensen, Knut Helge; Børsting, Torunn; Eftedal, Randi Krog; Dahllöf, Göran & Hafell, Bjørnar [Show all 11 contributors for this article] (2025). Individual caries increments during adolescence in seven Norwegian cohorts born 1996–2002. BMC Oral Health. 25(1). doi: 10.1186/s12903-025-06136-6. Full text in Research Archive Show summary

  Background Caries increment during adolescence, including enamel caries, is rarely explored in detail. This study assessed the caries increment during the period from 12 to 18 years. The specific objectives were to examine time trends, increment variability between individuals, and whether baseline caries experience at 12 years or sex had an impact on the caries increment. Methods The sample included seven birth cohorts (1996–2002; n = 23,135) from a general adolescent population in Trøndelag County, Norway. Data was based on dental records from the Public Dental Service. Two caries increment thresholds were examined at the tooth level: the enamel caries increment (ΔD1–2T), and the caries increment at the dentin level, including missing and filled teeth (ΔD3–5MFT). Zero-inflated Poisson models were used to account for the skewed distribution with a high proportion of zero caries increment (31.1% with ΔD1–2T = 0 and 33.4% with ΔD3–5MFT=0). Results The mean caries increments for the seven cohorts were ΔD1–2T = 3.14 (95% CI: 3.09–3.19) and ΔD3–5MFT = 2.51 (95% CI: 2.47–2.55). A modest temporal trend of decreasing caries increment across cohorts was observed at both thresholds: ΔD1–2T = -0.31 (95% CI: ±0.13) and ΔD3–5MFT = -0.43 (95% CI: ±0.11). However, this decrease was small compared to the variation in caries increments between individuals. Females had slightly lower mean caries increment than males, but there was no effect of sex on the change across cohorts. Adolescents with high baseline caries experience at 12 years had higher mean caries increments compared to the intermediate or low baseline caries experience groups, and a reduction across cohorts was only seen in the two latter groups. Conclusions While there was a modest reduction in caries increment across cohorts, this reduction was small compared to the variation in caries increments between individuals. The change across cohorts was the same in females and males. Baseline caries experience at 12 years was a strong predictor of caries increment and the reduction across cohorts was only seen among those with lower baseline caries experience, incdicating an increased dental health disparity among Norwegian adolescents.

• Aune, Dagfinn; Vardaxis, Ioannis; Lindqvist, Bo Henry; Brumpton, Ben Michael; Strand, Linn B & Horn, Jens Wilhelm [Show all 12 contributors for this article] (2024). Dispensed prescription medications and short-term risk of pulmonary embolism in Norway and Sweden. Scientific Reports. 14(1). doi: 10.1038/s41598-024-69637-4. Full text in Research Archive Show summary

  Scandinavian electronic health-care registers provide a unique setting to investigate potential unidentified side effects of drugs. We analysed the association between prescription drugs dispensed in Norway and Sweden and the short-term risk of developing pulmonary embolism. A total of 12,104 pulmonary embolism cases were identified from patient- and cause-of-death registries in Norway (2004–2014) and 36,088 in Sweden (2005–2014). A case-crossover design was used to compare individual drugs dispensed 1–30 days before the date of pulmonary embolism diagnosis with dispensation in a 61–90 day time-window, while controlling for the receipt of other drugs. A BOLASSO approach was used to select drugs that were associated with short-term risk of pulmonary embolism. Thirty-eight drugs were associated with pulmonary embolism in the combined analysis of the Norwegian and Swedish data. Drugs associated with increased risk of pulmonary embolism included certain proton-pump inhibitors, antibiotics, antithrombotics, vasodilators, furosemide, anti-varicose medications, corticosteroids, immunostimulants (pegfilgrastim), opioids, analgesics, anxiolytics, antidepressants, antiprotozoals, and drugs for cough and colds. Mineral supplements, hydrochlorothiazide and potassium-sparing agents, beta-blockers, angiotensin 2 receptor blockers, statins, and methotrexate were associated with lower risk. Most associations persisted, and several additional drugs were associated, with pulmonary embolism when using a longer time window of 90 days instead of 30 days. These results provide exploratory, pharmacopeia-wide evidence of medications that may increase or decrease the risk of pulmonary embolism. Some of these findings were expected based on the drugs' indications, while others are novel and require further study as potentially modifiable precipitants of pulmonary embolism.

• Mustafa, Manal; Nasir, Elwalid Fadul; Sen, Abhijit & Åstrøm, Anne-Kristine N (2024). Immigrant Parents’ Knowledge and Attitudes: Sociodemographic Variation Related to Restriction of Children’s Sugar Intake. Oral Health & Preventive Dentistry. ISSN 1602-1622. 22, p. 557–566. doi: 10.3290/j.ohpd.b5816441. Full text in Research Archive Show summary

  Purpose: Focusing on immigrant parents with children aged 0–6 months, this study assessed whether awareness of and attitudes towards restricting children’s sugar consumption vary according to family sociodemographic background and parents’ oral-health–related behaviours. Materials and Methods: A cross-sectional study was conducted including immigrant parents attending child public health centers for vaccination of their children. The study included parents born in Asia, Africa, South America, Central America and Eastern Europe. Parents from Western Europe and North America were included if they were partners of the above-mentioned participants. Cross-tabulation and multiple variable logistic regression were used to assess associations of parental knowledge and attitudes with their child’s sugar intake and sociodemographic characteristics. Results: Overall, response rate was 72.6%. A total of 345 parents completed personal, structured interviews during their visit to the health centers. Attitudes and knowledge, but not indulgence, related to children’s sugar restriction were sociodemographically unequally distributed among immigrant parents. Employed mothers, mothers with immigrant background from North America or Western Europe as well as parents with less frequent own sugar intake were more likely to confirm positive attitudes towards restricting children’s sugar snacking. The corresponding odds ratios were OR=1.8 (95% CI 1.1–3.1) and OR=6.6 (95% CI 2.3–18.9). Employed mothers and parents having received dental care information were more likely than their counterparts to possess good oral-health–related knowledge. Conclusion: Parents from sociodemographically disadvantaged backgrounds were less inclined to express positive attitudes and demonstrate sufficient knowledge regarding the limitation of their children’s sugar snacking. Culturally adapted oral health intervention programs should be implemented for immigrants, with special reference to children’s dietary habits.

• Zhou, Bin; Cesare, Mariachiara Di; Aguilar-Salinas, Carlos A; Ahmad, Nor Ani; Bovet, Pascal & Chen, Zhengming [Show all 51 contributors for this article] (2024). General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants. The Lancet. ISSN 0140-6736. 404(10455), p. 851–863. doi: 10.1016/S0140-6736(24)01405-3. Full text in Research Archive Show summary

  Background: Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hypertension. Methods: We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged 20–64 years in representative samples of the general population in eight world regions. We graphically compared the regional distributions of BMI and WHtR, and calculated Pearson's correlation coefficients between BMI and WHtR within each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies across regions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people who have hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminate between participants with and without hypertension using C-statistic and net reclassification improvement (NRI). Findings: The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjusting for age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbean and the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europe for both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve an equivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m2 (95% CI 2·31–3·28) lower for women and 1·28 kg/m2 (1·02–1·54) lower for men than in the high-income western region. In every region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adiposity metrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from 0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI and WHtR were used, performance improved only slightly compared with using either adiposity measure alone. Interpretation: BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominal adiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension. However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of central Asia, Middle East and north Africa, have higher WHtR than in the other regions. Funding: UK Medical Research Council and UK Research and Innovation (Innovate UK).

• Frutos, Javier Perez de; Helland, Ragnhild Holden; Desai, Shreya; Nymoen, Line Cathrine; Langø, Thomas & Remman, Theodor [Show all 7 contributors for this article] (2024). AI-Dentify: deep learning for proximal caries detection on bitewing x-ray - HUNT4 Oral Health Study. BMC Oral Health. 24(1). doi: 10.1186/s12903-024-04120-0. Full text in Research Archive Show summary

  Background: Dental caries diagnosis requires the manual inspection of diagnostic bitewing images of the patient, followed by a visual inspection and probing of the identified dental pieces with potential lesions. Yet the use of artificial intelligence, and in particular deep-learning, has the potential to aid in the diagnosis by providing a quick and informative analysis of the bitewing images. Methods: A dataset of 13,887 bitewings from the HUNT4 Oral Health Study were annotated individually by six different experts, and used to train three different object detection deep-learning architectures: RetinaNet (ResNet50), YOLOv5 (M size), and EfficientDet (D0 and D1 sizes). A consensus dataset of 197 images, annotated jointly by the same six dental clinicians, was used for evaluation. A five-fold cross validation scheme was used to evaluate the performance of the AI models. Results: The trained models show an increase in average precision and F1-score, and decrease of false negative rate, with respect to the dental clinicians. When compared against the dental clinicians, the YOLOv5 model shows the largest improvement, reporting 0.647 mean average precision, 0.548 mean F1-score, and 0.149 mean false negative rate. Whereas the best annotators on each of these metrics reported 0.299, 0.495, and 0.164 respectively. Conclusion: Deep-learning models have shown the potential to assist dental professionals in the diagnosis of caries. Yet, the task remains challenging due to the artifacts natural to the bitewing images.

• Zhou, Bin; Rayner, Archie W.; Gregg, Edvard W; Sheffer, Kate E.; Carrillo-Larco, Rodrigo M & Bennett, James E [Show all 49 contributors for this article] (2024). Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants. The Lancet. ISSN 0140-6736. 404(10467), p. 2077–2093. doi: 10.1016/S0140-6736(24)02317-1. Full text in Research Archive Show summary

  Background Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories. Methods We used data from 1108 population-representative studies with 141 million participants aged 18 years and older with measurements of fasting glucose and glycated haemoglobin (HbA1c), and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7·0 mmol/L or higher, having an HbA1c of 6·5% or higher, or taking medication for diabetes. We defined diabetes treatment as the proportion of people with diabetes who were taking medication for diabetes. We analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment. Findings In 2022, an estimated 828 million (95% credible interval [CrI] 757–908) adults (those aged 18 years and older) had diabetes, an increase of 630 million (554–713) from 1990. From 1990 to 2022, the age-standardised prevalence of diabetes increased in 131 countries for women and in 155 countries for men with a posterior probability of more than 0·80. The largest increases were in low-income and middle-income countries in southeast Asia (eg, Malaysia), south Asia (eg, Pakistan), the Middle East and north Africa (eg, Egypt), and Latin America and the Caribbean (eg, Jamaica, Trinidad and Tobago, and Costa Rica). Age-standardised prevalence neither increased nor decreased with a posterior probability of more than 0·80 in some countries in western and central Europe, sub-Saharan Africa, east Asia and the Pacific, Canada, and some Pacific island nations where prevalence was already high in 1990; it decreased with a posterior probability of more than 0·80 in women in Japan, Spain, and France, and in men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women, and the highest prevalence in the world in 2022 was in countries in Polynesia and Micronesia, some countries in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. In 2022, 445 million (95% CrI 401–496) adults aged 30 years or older with diabetes did not receive treatment (59% of adults aged 30 years or older with diabetes), 3·5 times the number in 1990. From 1990 to 2022, diabetes treatment coverage increased in 118 countries for women and 98 countries for men with a posterior probability of more than 0·80. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, and Costa Rica), Canada, South Korea, Russia, Seychelles, and Jordan. There was no increase in treatment coverage in most countries in sub-Saharan Africa; the Caribbean; Pacific island nations; and south, southeast, and central Asia. In 2022, age-standardised treatment coverage was lowest in countries in sub-Saharan Africa and south Asia, and treatment coverage was less than 10% in some African countries. Treatment coverage was 55% or higher in South Korea, many high-income western countries, and some countries in central and eastern Europe (eg, Poland, Czechia, and Russia), Latin America (eg, Costa Rica, Chile, and Mexico), and the Middle East and north Africa (eg, Jordan, Qatar, and Kuwait). Interpretation In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes.

• Bhattarai, Sanju; Skovlund, Eva; Shrestha, Archana; Mjølstad, Bente Prytz; Åsvold, Bjørn Olav & Sen, Abhijit (2024). Impact of a community health worker led intervention for improved blood pressure control in urban Nepal: an open-label cluster randomised controlled trial. The Lancet Regional Health – Southeast Asia. 29. doi: 10.1016/j.lansea.2024.100461. Full text in Research Archive Show summary

  Background: Effective control of hypertension remains challenging in low and middle-income countries. We tested the effectiveness of comprehensive approaches to hypertension management including six home visits by community health workers with regular follow up by a trained healthcare provider on blood pressure levels in Nepal. Methods: We implemented a non-blinded, open-label, parallel-group, two-arm cluster randomised controlled trial, with 1:1 allocation ratio in Budhanilakantha municipality, Kathmandu, Nepal. Ten public health facilities and their catchment area were randomly allocated to receive comprehensive intervention or only usual hypertension care. We recruited 1252 individuals aged 18 years and older with hypertension. The primary outcome was systolic blood pressure. Secondary outcomes were diastolic blood pressure, proportion with controlled blood pressure, waist to hip ratio, body mass index, physical activity, diet quality score, daily salt intake, adherence to antihypertensives, hypertension knowledge and perceived social support. Primary analysis was by intention-to-treat using a linear mixed model. Findings: Participants were, on average 57 years old, 60% females, 84% married, 54% Brahmin/Chettri ethnicity and 33% were illiterate. The decrease in mean systolic blood pressure (1.7 mm Hg, 95% CI −0.1, 3.4) and diastolic blood pressure (1.6 mm Hg, 95% CI 0.5, 2.6) was more in the intervention arm compared to the control. The proportion with blood pressure control (OR 1.5 95% CI 1.0, 2.1) and engaging in adequate physical activity (≥600 Metabolic equivalents of task per week) (OR 2.2, 95% CI 1.6, 3.1) were higher in the intervention arm compared to control. The change in hypertension knowledge score was higher and daily salt intake was lower in the intervention arm compared to control. Waist to hip ratio increased more and global dietary requirement scores decreased more in the intervention group and there was no effect on the body mass index and adherence to antihypertensives. Interpretation: Community health workers facilitated home support and routine follow-up care by healthcare providers was effective in controlling blood pressure in urban Nepal. These findings suggest comprehensive interventions targeting individual, community and health system barriers are feasible in low resource settings, but larger implementation trials are needed to inform future scale-up. Funding: This work was supported by Norwegian University of Science and Technology, Trondheim, Norway (Project number 981023100).

• Morooka, Hikaru; Haug, Eirin Beate; Malmo, Vegard; Loennechen, Jan Pål; Mukamal, Kenneth J. & Rich-Edwards, Janet Wilson [Show all 9 contributors for this article] (2024). Association of age at menarche, reproductive lifespan and age at menopause with the risk of atrial fibrillation: The HUNT study. Maturitas. ISSN 0378-5122. 185. doi: 10.1016/j.maturitas.2024.107979. Full text in Research Archive
• Morooka, Hikaru; Haug, Eirin Beate; Malmo, Vegard; Loennechen, Jan Pål; Mukamal, Kenneth J. & Sen, Abhijit [Show all 8 contributors for this article] (2024). Parity, infertility, age at first birth, and risk of atrial fibrillation: data from the HUNT study. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 31(13), p. 1645–1652. doi: 10.1093/eurjpc/zwae215. Full text in Research Archive
• Ostojic, Sergej; Phelps, Nowell H.; Singleton, Rosie K.; Zhou, Bin; Heap, Rachel & Mishra, Anu [Show all 54 contributors for this article] (2024). Worldwide trends in the underweight and obesity from 1990 to 2022: a pooled analysis of 3,633 population-representative studies with 222 million school-aged children, adolescents, and adults. The Lancet. ISSN 0140-6736. 403(10431), p. 1027–1050. doi: 10.1016/S0140-6736(23)02750-2. Full text in Research Archive Show summary

  Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.

• Bhattarai, Sanju; Wagle, Dikshya; Shrestha, Archana; Åsvold, Bjørn Olav; Skovlund, Eva & Sen, Abhijit (2024). Role of Perceived Social Support in Adherence to Antihypertensives and Controlled Hypertension: Findings of a Community Survey from Urban Nepal. Patient Preference and Adherence. 18, p. 767–777. doi: 10.2147/PPA.S455511. Full text in Research Archive Show summary

  Introduction: Social support is considered vital for effective management of chronic conditions, but its role in improving adherence to antihypertensive medication and control of hypertension in urban Nepal is unknown. We examined the role of social support in adherence to antihypertensives and controlled blood pressure to inform future interventions for hypertension management. Methods: We analyzed cross-sectional data collected at baseline of a cluster randomized trial of hypertension patients (n=1252) in the community between May and November 2022. Multidimensional scale of perceived social support was used to measure social support, adherence to antihypertensives was measured using the Morisky medication adherence scale − 8, and individuals with systolic- and diastolic- blood pressure less than 140 and 90 mmHg respectively were considered to have controlled hypertension. Modified Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals. Results: We found that 914 (73%) individuals received moderate to high social support. Participants receiving high social support had a numerically lower proportion of controlled hypertension (51%) however not statistically significant. The proportion of good adherence to antihypertensives did not differ between the social support categories. There was no association in overall, family, friends, and significant other sub-scales of social support with controlled hypertension and adherence to antihypertensives. Discussion: Further studies to understand the quality and mechanisms through which social support contributes to blood pressure control are needed for the health system to include social support in designing and implementing community-based interventions for hypertension management.

• Cetrelli, Lena Elisabet; Lundestad, Anette; Gil, Elisabeth Grut; Fischer, Johannes Maria; Halbig, Josefine Mareile & Frid, Paula Hanna Therese [Show all 18 contributors for this article] (2024). Serum and salivary inflammatory biomarkers in juvenile idiopathic arthritis—an explorative cross-sectional study. Pediatric Rheumatology. 22(1). doi: 10.1186/s12969-024-00972-6. Full text in Research Archive Show summary

  Background Biomarkers may be useful in monitoring disease activity in juvenile idiopathic arthritis (JIA). With new treatment options and treatment goals in JIA, there is an urgent need for more sensitive and responsive biomarkers. Objective We aimed to investigate the patterns of 92 inflammation-related biomarkers in serum and saliva in a group of Norwegian children and adolescents with JIA and controls and in active and inactive JIA. In addition, we explored whether treatment with tumor necrosis factor inhibitors (TNFi) affected the biomarker levels. Methods This explorative, cross-sectional study comprised a subset of children and adolescents with non-systemic JIA and matched controls from the Norwegian juvenile idiopathic arthritis study (NorJIA Study). The JIA group included individuals with clinically active or inactive JIA. Serum and unstimulated saliva were analyzed using a multiplex assay of 92 inflammation-related biomarkers. Welch’s t-test and Mann–Whitney U-test were used to analyze the differences in biomarker levels between JIA and controls and between active and inactive disease. Results We included 42 participants with JIA and 30 controls, predominantly females, with a median age of 14 years. Of the 92 biomarkers, 87 were detected in serum, 73 in saliva, and 71 in both biofluids. A pronounced difference between serum and salivary biomarker patterns was found. Most biomarkers had higher levels in serum and lower levels in saliva in JIA versus controls, and in active versus inactive disease. In serum, TNF and S100A12 levels were notably higher in JIA and active disease. The TNF increase was less pronounced when excluding TNFi-treated individuals. In saliva, several biomarkers from the chemokine family were distinctly lower in the JIA group, and levels were even lower in active disease. Conclusion In this explorative study, the serum and salivary biomarker patterns differed markedly, suggesting that saliva may not be a suitable substitute for serum when assessing systemic inflammation in JIA. Increased TNF levels in serum may not be a reliable biomarker for inflammatory activity in TNFi-treated children and adolescents with JIA. The lower levels of chemokines in saliva in JIA compared to controls and in active compared to inactive disease, warrant further investigation.

• Sen, Abhijit; Gémes, Katalin; Svensén, Christer; Varmdal, Torunn; Jonsson, Magnus & Janszky, Imre [Show all 7 contributors for this article] (2023). Risk of myocardial infarction after invasive outpatient procedures. Heart. ISSN 1355-6037. 109(11), p. 839–845. doi: 10.1136/heartjnl-2022-321780. Full text in Research Archive Show summary

  Objective: To assess the short-term risk of acute myocardial infarction (AMI) associated with procedures performed at outpatient specialised hospital clinics. Methods: In this case-crossover, population-based study, we identified first-time AMI cases aged ≥40 years via patient registries and linked them to their surgical intervention in Norway (2008–2016) and Sweden (2001–2014), respectively. The number of individuals with AMI who underwent procedures 0–7 days (hazard period) prior to the AMI diagnosis was compared with cases who were exposed 29–36 days (control period) before the AMI. A total of 6176 patients with AMI who underwent a procedure either during the defined hazard or control period contributed to the analyses. ORs with 95% CIs were computed using conditional logistic regression. Results: The mean age of the total population was 74.7 years and 64.6% were male. The relative risk was higher following procedures performed under general/regional anaesthesia for gastrointestinal endoscopy (ORsummary, 4.23, 95% CI 1.58 to 11.31), vascular (ORsummary, 3.12, 95% CI 1.10 to 8.90), urological/gynaecological (ORsummary, 2.30, 95% CI 1.50 to 3.53) and orthopaedic (ORsummary,1.78, 95% CI 1.30 to 2.44) procedures, and for ENT (ear, nose and throat) and mouth procedures (ORsummary, 1.53, 95% CI 1.19 to 1.99) performed under local anaesthesia. Conclusion: This large population-based register study from two countries suggests that outpatient procedures are generally safe with regard to the postoperative risk of AMI. However, some procedures, such as gastrointestinal endoscopy, vascular procedures and urological/gynaecological procedures may increase the risk of AMI by twofold or threefold within the first 8 days after the procedures. Further studies are warranted to assess whether the effect is modified by cardiovascular medication or other clinical factors.

• Skeie, Marit Slåttelid; Sen, Abhijit; Dahllöf, Göran; Fagerhaug, Tone Natland; Høvik, Hedda & Klock, Kristin S. (2023). Karies på emalje- og dentinnivå blant europeiske ungdommer – en systematisk oversikt og metaanalyse En sekundærpublisering. Den norske tannlegeforenings Tidende. ISSN 0029-2303. 133(10), p. 768–786. doi: 10.56373/2023-10-4. Full text in Research Archive
• Baffour, Priscilla Kyei; Jahangiry, Leila; Jain, Shalu; Sen, Abhijit & Aune, Dagfinn (2023). Blood pressure, hypertension, and the risk of heart failure: a systematic review and meta-analysis of cohort studies. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 31(5), p. 529–556. doi: 10.1093/eurjpc/zwad344. Full text in Research Archive
• Mishra, Anu; Zhou, Bin; Rodriguez-Martinez, Andrea; Bixby, Honor; Singleton, Rosie K. & Carrillo-Larco, Rodrigo M. [Show all 1,626 contributors for this article] (2023). Diminishing benefits of urban living for children and adolescents’ growth and development. Nature. ISSN 0028-0836. 615(7954), p. 874–883. doi: 10.1038/s41586-023-05772-8. Full text in Research Archive Show summary

  Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1,2,3,4,5,6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

• Shakya, Pushpanjali; Shrestha, Archana; Bajracharya, Monish; Shrestha, Abha; Kulseng, Bård Eirik & Karmacharya, Biraj Man [Show all 13 contributors for this article] (2023). Effectiveness of a group-based Diabetes Prevention Education Program (DiPEP) in a population with pre-diabetes: a cluster randomised controlled trial in Nepal. BMJ Nutrition, Prevention and Health. 6(2). doi: 10.1136/bmjnph-2023-000702. Full text in Research Archive Show summary

  Background Although several lifestyle intervention studies have been conducted in low/middle-income countries, there were no such studies in Nepal. Therefore, a group-based culturally tailored Diabetes Prevention Education Program (DiPEP) was conducted recently. The study aimed to evaluate the effect of DiPEP in glycated haemoglobin (HbA1c), weight, waist circumference, physical activity and diet among population with pre-diabetes. Method A two-arm cluster randomised controlled trial was conducted in 12 clusters of two urban areas in Nepal. The DiPEP was a 6 month intervention (four 1-hour weekly educational sessions and 5 months of follow-up by community health workers/volunteers (CHW/Vs)). A postintervention assessment was done after 6 months. Linear mixed model was used to estimate the mean difference in primary outcome (HbA1c) and secondary outcomes (weight, waist circumference, physical activity and diet) between intervention and control arms, adjusted for baseline measure. Results In intention-to-treat analysis with a total of 291 participants, the estimated mean difference in HbA1c was found to be 0.015 percentage point (95% CI −0.074 to 0.104) between the intervention arm and the control arm, while it was −0.077 (95% CI −0.152 to −0.002) among those who attended at least 3 out of 4 educational sessions. The estimated mean difference in weight (in participants who attended ≥1 educational session) was −1.6 kg (95% CI −3.1 to −0.1). A significantly lower grain consumption was found in intervention arm (−39 g/day, 95% CI −65 to −14) compared with the control arm at postintervention assessment. Conclusion Although compliance was affected by COVID-19, individuals who participated in ≥3 educational sessions had significant reduction in HbA1c and those who attended ≥1 educational session had significant weight reduction. Grain intake was significantly reduced among the intervention arm than the control arm. Hence, group-based lifestyle intervention programmes involving CHW/vs is recommended for diabetes prevention

• Stødle, Ida Haukåen; Sen, Abhijit; Høvik, Hedda; Verket, Anders & Koldsland, Odd Carsten (2023). Association between periodontitis stages and self-reported diseases in a Norwegian population: the HUNT study. BMC Oral Health. 23(1), p. 1–10. doi: 10.1186/s12903-023-03743-z. Full text in Research Archive Show summary

  Background The relationships between periodontitis and non-communicable diseases (NCDs) have been investigated through several different case-definitions. The differences in methodology may have hindered the basis of comparison between these studies. The classification from the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions offers a unison platform that may facilitate future comparison of such research. The present study aimed to reproduce associations between periodontitis and other NCDs using the 2017 Classification, in the Trøndelag Health Study (HUNT). Material and methods The fourth HUNT-survey was carried out between 2017 and 2019. Clinical variables, blood samples and answers to questionnaires were collected from 4933 participants. Periodontal status was assessed based on the latest staging system, and its associations with NCDs were estimated by logistic regression models adjusted for potential confounders. Results Compared to no or Stage I periodontitis, participants with Stage III/IV periodontitis (radiographic bone loss exceeding 33%) were associated with cardiovascular disease, hyperglycemia in participants with diabetes and chronic obstructive pulmonary disease (COPD)/emphysema. Associations with hyperglycemia in participants with diabetes and COPD/emphysema were also observed in participants with Stage II periodontitis. The only observed association when considering never-smokers alone, was with COPD/emphysema. Conclusion Periodontitis Stage II and III/IV were associated with major NCDs. Effect sizes increased with increasing periodontitis stages, which implies greater occurrence of coincident comorbidities in patients with severe periodontitis.

• Shakya, Pushpanjali; Bajracharya, Monish; Skovlund, Eva; Shrestha, Abha; Karmacharya, Biraj Man & Kulseng, Bård Eirik [Show all 9 contributors for this article] (2023). How Did People with Prediabetes Who Attended the Diabetes Prevention Education Program (DiPEP) Experience Making Lifestyle Changes? A Qualitative Study in Nepal. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 20(6). doi: 10.3390/ijerph20065054. Full text in Research Archive Show summary

  Diabetes can be prevented through lifestyle modification in the prediabetic phase. A group-based lifestyle intervention called ‘Diabetes Prevention Education Program’ (DiPEP) was tested recently in Nepal. The present study aimed to explore experiences of making lifestyle changes among people with prediabetes participating in the DiPEP. This qualitative study, with semi-structured interviews of 20 participants, was conducted 4–7 months following DiPEP intervention. Data analysis was performed by thematic analysis. The results included four themes, understanding that diabetes could be prevented, lifestyle changes made, hurdles to overcome, and experiencing benefits leading to sustained change. Some participants said they felt relieved to know that they had a chance to prevent diabetes. The participants talked mostly about making changes in diet (reducing carbohydrate intake) and physical activity (starting exercises). Obstacles mentioned included a lack of motivation and a lack of family support to implement changes. Experiencing benefits such as weight loss and reduced blood sugar levels were reported to lead them to maintain the changes they had made. Understanding that diabetes could be prevented was a key motivator for implementing changes. The benefits and hurdles experienced by the participants of the present study can be taken into consideration while designing lifestyle intervention programs in similar settings.

• Reda, Mariam; Sen, Abhijit & Mustafa, Manal (2023). Prevention of caries and obesity in children with immigrant background in Norway- a study protocol for a cluster randomized controlled trial. BMC Oral Health. 23(1). doi: 10.1186/s12903-023-03329-9. Full text in Research Archive Show summary

  Background Immigrants are known to experience greater socioeconomic stress and poorer well-being and to suffer more from lifestyle- and diet-related disorders than native populations. There is also evidence that children of immigrant parents are at greater risk of diverse health problems than their host country cohorts. The aim of this study is to apply and evaluate the efficacy of an early life intervention program among parents/children with immigrant background to prevent childhood caries and obesity, thereby improving the children’s general health, oral health, and quality of life. Methods This is a study protocol for a cluster randomized controlled intervention follow-up study. In phase I of the study, the primary care health centers in the municipality of Bergen, Norway were randomly allocated to intervention or control groups. The intervention was carried out using the motivational interviewing technique and the common risk factor approach. The intervention group received guidance on diet/oral hygiene and the control group received standard care information. Parental knowledge and children at age 3 and 5 years old will be assessed in a prospective phase II follow-up study compared to native Norwegian controls. The primary outcome will be evaluation of change on parental oral health related knowledge and attitudes. The secondary outcome will assess the impact of the intervention on children’s caries -, body mass index- and oral health related quality of life. Discussion Collaboration between dental public health and primary health care personnel on the common risk approach motivational intervention offers opportunities to address key dietary behaviors that may prevent obesity and dental caries. Providing sustainable preventive measures decreases the burden of diseases and consequently reduces health inequalities, particularly among at-risk children.

• Myran, Lena; Sen, Abhijit; Willumsen, Tiril; Havnen, Audun; Kvist, Therese & Rønneberg, Anne [Show all 8 contributors for this article] (2023). Associations of adverse childhood experiences with caries and toothbrushing in adolescents. The Young-HUNT4 Survey. BMC Oral Health. 23(1). doi: 10.1186/s12903-023-03492-z. Full text in Research Archive Show summary

  Background Adverse childhood experiences (ACEs) are associated with poor oral health. Using a life course theoretical framework, this study explored the associations of specific and cumulative ACEs with caries and toothbrushing frequency in a Norwegian adolescent population. Methods Participants were adolescents (n = 6351) age 13–17 years from The Young-HUNT4 Survey. Clinical data were retrieved from dental health records. Oral health outcomes were toothbrushing frequency, dentine caries experience (Decayed, Missing, and Filled Teeth – DMFT), and enamel caries. ACE exposure variables were physical abuse, sexual abuse, witness to violence, parental separation/divorce, parental alcohol problems, and bully victimization. Negative binominal regression models (incident rate ratios, IRRs; 95% confidence intervals, CIs) were used to determine the associations of the various ACEs with caries; logistic regression analyses (odds ratios, ORs; 95% CIs) were used to estimate associations with toothbrushing frequency. Potential effect modification by age was assessed using likelihood ratio test. Results Adolescents exposed to physical abuse by others, sexual abuse by peers, parental separation/divorce, bullying, or who had witnessed violence, were more likely to report non-daily toothbrushing compared with those with no exposure to the given ACEs. Each cumulative increase in ACE exposure was associated with a 30% higher likelihood of non-daily toothbrushing (OR 1.30, 95% CI 1.19–1.42). Similarly, increasing number of adversities were associated with both higher dentine caries experience (IRR 1.06, 95% CI 1.02–1.09) and higher enamel caries (IRR 1.07, 95% CI 1.03–1.11). This effect was modified by age (13–15 vs. 16–17 years) for dentine caries experience. Furthermore, there was evidence of effect modification by age with bully victimization for both toothbrushing frequency (Pinteraction = 0.014) and dentine caries experience (Pinteraction < 0.001). Specifically, bully victimization was associated with a higher likelihood of non-daily toothbrushing (OR 2.59, 95% CI 1.80–3.72) and higher dentine caries experience (IRR 1.30, 95% CI 1.14–1.50) among 16–17-year-olds. Conclusions Several specific ACEs were associated with non-daily toothbrushing and a higher caries experience among Norwegian adolescents in the Young-HUNT4 Survey.

• Madsen, Helga; Sen, Abhijit & Aune, Dagfinn (2023). Fruit and vegetable consumption and the risk of hypertension: a systematic review and meta-analysis of prospective studies. European Journal of Nutrition. ISSN 1436-6207. 62, p. 1941–1955. doi: 10.1007/s00394-023-03145-5. Full text in Research Archive
• Reda, Mariam; Sen, Abhijit; Åstrøm, Anne-Kristine N & Mustafa, Manal (2023). Correction: Prevention of caries and obesity in children with immigrant background in Norway -a study protocol for a cluster randomized controlled trial. BMC Oral Health. Full text in Research Archive
• Bhattarai, Sanju Wagle; Shrestha, Archana; Skovlund, Eva; Åsvold, Bjørn Olav; Mjølstad, Bente Prytz & Sen, Abhijit (2023). Cluster randomised trial to evaluate comprehensive approach to hypertension management in Nepal: a study protocol. BMJ Open. 13(5). doi: 10.1136/bmjopen-2022-069898. Full text in Research Archive Show summary

  Introduction Despite having effective approaches for hypertension management including use of antihypertensive medication, monitoring of blood pressure and lifestyle modification many people with hypertension in Nepal remain undetected and untreated. A comprehensive intervention which provides personalised counselling on lifestyle modification, medication adherence together with support for regular monitoring of blood pressure is expected to achieve well controlled blood pressure. Methods and analysis This is a community-based, non-blinded, parallel group, two-arm cluster randomised controlled trial, with an allocation ratio of 1:1, conducted in Budhanilkantha municipality, Nepal. Ten health facilities and their catchment area are randomly allocated to either of the two arms. 1250 individuals aged 18 years and older with an established diagnosis of hypertension will be recruited. The intervention arm receives a comprehensive hypertension management package that includes blood pressure audit by health workers, home-based patient support by community health workers to engage patient and family members in providing tailored educational counselling on behavioural and lifestyle changes in addition to routine care. The control arm includes routine hypertension care. Trained enumerators will ensure consent and collect data. Outcome data on blood pressure, weight, waist and hip circumference will be measured and self-reported data on diet, lifestyle, medication adherence and hypertension knowledge will be registered at 11 months’ follow-up. The change in outcome measures will be compared by intention to treat, using a generalised linear mixed model. A formative assessment will be conducted using semistructured interviews and focus group discussions to explore factors affecting hypertension management. A mix-method approach will be applied for process evaluation to explore acceptability, adoption, fidelity, feasibility and coverage. Ethics and dissemination Ethics approval was obtained from Nepal Health Research Council (682/2021) and Regional Committee for Medical and Health Research Ethics, Norway (399479). The findings will be disseminated in peer-reviewed journal articles and with decision makers in Nepal.

• Parasuaraman, Ganeshkumar; Ayyasamy, Lavanya; Aune, Dagfinn; Sen, Abhijit; Nagarajan, Ramya & Rajkumar, Prabhu [Show all 9 contributors for this article] (2023). The association between body mass index, abdominal fatness, and weight change and the risk of adult asthma: a systematic review and meta-analysis of cohort studies. Scientific Reports. 13(1). doi: 10.1038/s41598-023-31373-6. Full text in Research Archive Show summary

  Obesity has been associated with increased risk of adult asthma, however, not all studies have found a clear association between overweight and the incidence of asthma, and data on other adiposity measures have been limited. Hence, we aimed to summarize evidence on association between adiposity and adult asthma. Relevant studies were retrieved through searches conducted in PubMed, and EMBASE up to March 2021. A total of sixteen studies (63,952 cases and 1,161,169 participants) were included in the quantitative synthesis. The summary RR was 1.32 (95% CI 1.21–1.44, I2 = 94.6%, pheterogeneity < 0.0001, n = 13) per 5 kg/m2 increase in BMI, 1.26 (95% CI 1.09–1.46, I2 = 88.6%, pheterogeneity < 0.0001, n = 5) per 10 cm increase in waist circumference and 1.33 (95% CI 1.22–1.44, I2 = 62.3%, pheterogeneity= 0.05, n = 4) per 10 kg increase in weight gain. Although the test for nonlinearity was significant for BMI (pnonlinearity < 0.00001), weight change (pnonlinearity = 0.002), and waist circumference (pnonlinearity = 0.02), there was a clear dose-response relationship between higher levels of adiposity and asthma risk. The magnitude of the associations and the consistency of the results across studies and adiposity measures provide strong evidence that overweight and obesity, waist circumference and weight gain increases asthma risk. These findings support policies to curb the global epidemic of overweight and obesity.

• Bhattarai, Sanju; Bajracharya, Swornim; Shrestha, Archana; Skovlund, Eva; Åsvold, Bjørn Olav & Mjølstad, Bente Prytz [Show all 7 contributors for this article] (2023). Facilitators and barriers to hypertension management in urban Nepal: Findings from a qualitative study. Open heart. 10(2). doi: 10.1136/openhrt-2023-002394. Full text in Research Archive Show summary

  Introduction In Nepal, one-fourth of the adult population has hypertension. Despite provision of comprehensive hypertension services through the primary healthcare system, huge gaps in treatment and control of hypertension exist. Our study explored the individual, interpersonal, health system and community-level barriers and facilitators affecting hypertension management in urban Nepal. Methods We used a qualitative methodology informed by Kaufman’s socioecological model, conducting focus group discussions with hypertension patients and their family members. In-depth interviews with hypertension patients, healthcare providers and municipal officials were also conducted. Results We found that inadequate knowledge about hypertension and harmful cultural beliefs hindered effective treatment of hypertension. Interrupted medical supply and distrust in primary healthcare providers affected the poor’s access to hypertension services. Poor communication between family members and gender norms affected adaptation of treatment measures. This study emphasised the role of family members in supporting patients in adhering to treatment measures and rebuilding community trust in primary healthcare providers for better access to hypertension services. The findings guided the development of a manual to be used by community health workers during home visits to support patients to control high blood pressure. Conclusion The study highlights the importance of integrating various aspects of care to overcome the multiple barriers to hypertension management in urban settings in low-resource countries. Participatory home visits have the potential to empower individuals and families to develop and implement feasible and acceptable actions for home management of hypertension through improved adherence to antihypertensive medication, and behaviour change.

• Cetrelli, Lena Elisabet; Bletsa, Athanasia; Lundestad, Anette; Gil, Elisabeth Grut; Fischer, Johannes Maria & Halbig, Josefine Mareile [Show all 18 contributors for this article] (2022). Vitamin D, oral health, and disease characteristics in juvenile idiopathic arthritis: a multicenter cross-sectional study. BMC Oral Health. 22(1). doi: 10.1186/s12903-022-02349-1. Full text in Research Archive Show summary

  Background Vitamin D deficiency has been associated with autoimmune diseases and oral health. Knowledge about the association between vitamin D status and oral conditions in JIA is limited. We aimed to investigate vitamin D status in a cohort of Norwegian children and adolescents with JIA and possible associations between serum vitamin D levels, clinical indicators of oral health, and JIA disease characteristics. Methods This multi-center, cross-sectional study, included individuals with JIA aged 4–16 years from three geographically spread regions in Norway. Demographic data, age at disease onset, disease duration, JIA category, disease status, medication, and vitamin D intake were registered. One blood sample per individual was analyzed for 25(OH) vitamin D, and the level of insufficiency was defined as < 50 nmol/L. A clinical oral examination was performed applying commonly used indices in epidemiological studies of dental caries, dental erosion, enamel defects, gingival bleeding, and oral hygiene. Serum vitamin D was used as exposure variable in multivariable regression analyses to estimate the associations between insufficient vitamin D level, JIA disease status, and oral conditions, with adjustments for age, sex, geographical region, BMI, seasonal blood sampling, and parental education. Results Among the 223 participants with JIA, 97.3% were Caucasians, 59.2% were girls, and median age was 12.6 years. Median disease duration was 4.6 years, and 44.4% had oligoarticular JIA. Mean serum vitamin D level was 61.4 nmol/L and 29.6% had insufficient levels. Vitamin D levels did not differ between sexes, but between regions, iso-BMI categories, age groups, and seasons for blood sampling. Insufficient vitamin D levels were associated with dentin caries (adjusted OR 2.89, 95% CI 1.43–5.86) and gingival bleeding (adjusted OR 2.36, 95% CI 1.10–5.01). No associations were found with active JIA disease or more severe disease characteristics. Conclusion In our study, nearly 30% had vitamin D insufficiency, with a particularly high prevalence among adolescents. Vitamin D insufficiency was associated with dentin caries and gingival bleeding, but not with JIA disease activity. These results point to the need for a multidisciplinary approach in the follow-up of children with JIA, including an increased focus on vitamin D status and oral health.

• Skeie, Marit Slåttelid; Sen, Abhijit; Dahllöf, Göran; Fagerhaug, Tone Natland; Høvik, Hedda & Klock, Kristin S. (2022). Dental caries at enamel and dentine level among European adolescents – a systematic review and meta-analysis. BMC Oral Health. 22(1). doi: 10.1186/s12903-022-02631-2. Full text in Research Archive Show summary

  Background: In contrast with the last century, caries epidemiology has begun integrating enamel caries into determinations of caries prevalence and experience. The objective of the present systematic review and meta-analysis was to assess the caries status including estimations of enamel caries, of European adolescents. Method: Four databases (Medline Ovid, Embase, CINAHL, and SweMed+) were systematically searched from 1 January 2000 through 20 September 2021 for peer-reviewed publications on caries prevalence and caries experience in 12–19-year-olds; that also included evaluations of enamel lesions. Summary estimates were calculated using random effect model. Results: Overall, 30 publications were selected for the systematic review covering 25 observational studies. Not all studies could be used in the meta-analyses. Caries prevalence was 77% (n = 22 studies). Highest prevalence was reported in the age groups 16–19 years, and in studies where caries examinations were done before 2010. The overall mean DMFS score was 5.93 (n = 14 studies) and it was significantly lower among Scandinavian adolescents than among other European adolescents (4.43 vs. 8.89). The proportion of enamel caries (n = 7 studies) was 50%, and highest in the lowest age group (12–15 years). Results from the present systematic review reflected the caries distribution to be skewed at individual-, tooth- and surface levels; at tooth and surface level, also changed according to age. Conclusions: Although studies in which the caries examinations had been done in 2010 or later documented a reduction in caries prevalence, caries during adolescence still constitutes a burden. Thus, the potential for preventing development of more severe caries lesions, as seen in the substantial volume of enamel caries during early adolescence, should be fully exploited. For this to happen, enamel caries should be a part of epidemiological reporting in national registers.

• Shakya, Pushpanjali; Shrestha, Archana; Karmacharya, Biraj Man; Shrestha, Abha; Kulseng, Bård Eirik & Skovlund, Eva [Show all 7 contributors for this article] (2022). Prevalence of prediabetes and associated factors of prediabetic stages: a cross-sectional study among adults in Nepal. BMJ Open. 12(12). doi: 10.1136/bmjopen-2022-064516. Full text in Research Archive Show summary

  Objectives To estimate the prevalence of prediabetes and to assess the association of prediabetic stages with sociodemographic, lifestyle and clinical factors Design Cross-sectional study at the screening and inclusion stage of a Diabetes Prevention Education Program (DiPEP) trial Setting The study was conducted in two urban communities in Nepal (October 2019–March 2020). Participants A total of 6222 residents of two study sites, aged 18–64 years and without a history of diabetes, were eligible for prediabetes screening. Exclusion criteria were pregnancy, history of diabetes and critical illness. A total of 291 participants with prediabetes were included in this study. Primary and secondary outcome measures Prevalence of prediabetes based on glycated haemoglobin (HbA1c) criteria (5.7%–6.4%) was the primary outcome of the study. Odds Ratio and 95% CI were estimated to assess the associations between the outcome prediabetic stages (5.7%–5.9% vs 6.0%–6.4%) and sociodemographic, lifestyle and clinical factors in both unadjusted and adjusted models. Results Out of 6222 screened participants, 308 (5%, 95% CI: 4.4% to 5.5%) individuals were detected with prediabetes based on HbA1c. The mean age of 291 responded participants was 50.3±7.6 years and 67% were females. Among them, 78% aged 45–64 years, 97% had central obesity, 90% had high waist–hip ratio, 63% were hypertensive and 66% had no family history of diabetes. Approximately, 54% and 46% of individuals with prediabetes had HbA1c of 5.7%–5.9% and 6.0%–6.4%, respectively. Female gender was associated with prediabetes with HbA1c 6.0%–6.4% (OR, 1.98, 95% CI: 1.07 to 3.67) in the adjusted model. Conclusion The estimated prevalence of prediabetes was 5% among screened participants, and female gender was associated with the prediabetic stage. As a large proportion of the population with prediabetes were not aware of their status, this study demonstrates a need for regular community screening programmes to detect individuals with prediabetes and provide them a comprehensive lifestyle intervention for diabetes prevention.

• Rustand, Kristin; Aass, Anne Merete; Sen, Abhijit & Koldsland, Odd Carsten (2022). Oral health-related quality of life following peri-implantitis surgery: A prospective study. Clinical Oral Implants Research. ISSN 0905-7161. 33(8), p. 858–867. doi: 10.1111/clr.13967. Full text in Research Archive Show summary

  Aim The aim of this prospective study was to describe long-term patient-reported outcomes following surgical treatment of peri-implantitis. Methods Oral health-related quality of life (OHRQoL) of 43 patients diagnosed with peri-implantitis was recorded using the short form of the Oral Health Impact Profile (OHIP-14), where low scores indicate low impact. A Norwegian version of the OHIP-14 form was filled out 1 week before and 6-, 18- and 36 months after the peri-implant surgery. The mean and median OHIP-14 scores were calculated for its seven domains (i.e., Functional limitation, Physical pain, Psychological discomfort, Physical disability, Psychological disability, Social disability, and Handicap) across four different time points. The dataset was analyzed to find correlations between independent variables and the OHIP-scores. Results The OHIP-14 scores were at a low level from baseline to 36 months post-surgery. The mean scores at specific time points were at baseline 7.2 (SD 7.3), 6 months post-surgery 6.0 (SD 6.9), 18 months post-surgery 6.8 (SD 9.7), and 3 years post-surgery 7.0 (SD 9.4). None of these changes were statistically significant. Specific domains of OHRQoL did not significantly differ across different time points (pre- and post-surgery) in males (except for domain “Handicap”) or females (except for domain “Functional limitation”). Conclusions The reported OHIP-14 measures were initially low and stayed low up to 3 years after peri-implant surgery. This may indicate that neither the disease nor the treatment deteriorated or improved the OHRQoL.

• Sen, Abhijit; Gemes, Katalin; Stålhammar, Gustav; Svensén, Christer; Tornvall, Per & Jonsson, Magnus [Show all 10 contributors for this article] (2022). Risk for Acute Myocardial Infarction After Ophthalmologic Procedures. Annals of Internal Medicine. ISSN 0003-4819. 175(5), p. 6–63. doi: 10.7326/M20-6618. Full text in Research Archive Show summary

  Background: Preoperative cardiovascular evaluations are frequently done before ambulatory ophthalmologic procedures. However, whether these procedures can trigger an acute myocardial infarction (AMI) is unknown. Objective: To assess the short-term risk for AMI associated with ophthalmologic procedures. Design: Case-crossover design. Setting: Population-based nationwide study from Norway and Sweden. Participants: First-time patients with AMI, aged 40 years and older, identified via inpatient registries and linked to outpatient surgical procedures in Norway (2008 to 2014) and Sweden (2001 to 2014), respectively. Measurements: Using self-matching, for each participant, exposure to ophthalmologic procedures in the 0 to 7 days before AMI diagnosis (hazard period) was compared with an 8-day period 30 days earlier, that is, days 29 to 36 before AMI (control period) to estimate the relative risk for an AMI the week after an ophthalmologic procedure. The odds ratios (ORs) with 95% CIs were calculated, using conditional logistic regression. Only patients who had a procedure of interest during either the hazard or control period were included. Results: For the 806 patients with AMI included in this study, there was a lower likelihood of AMI in the week after an ophthalmologic procedure than during the control week (OR, 0.83; 95% CI, 0.75 to 0.91). Furthermore, there was no evidence of increased risk for AMI when analyses were stratified by surgery subtype, anesthesia (local or general), duration, invasiveness (low, intermediate, or high), patient's age (<65 years or ≥65 years), or comorbidity (none vs. any). Limitation: Potential bias from time-varying confounders between the hazard and the control periods. Conclusion: Ophthalmologic procedures done in an outpatient setting did not seem to be associated with an increased risk for AMI.

• Bhattarai, Sanju Wagle; Larsen, Rikke Nerhus; Shrestha, Archana; Karmacharya, Biraj & Sen, Abhijit (2022). Association between socioeconomic positions and overweight/obesity in rural Nepal. Frontiers in Nutrition. 9. doi: 10.3389/fnut.2022.952665. Full text in Research Archive Show summary

  Introduction: Obesity and its association with socioeconomic factors are well-established. However, the gradient of this relationship among rural populations in low- and middle-income countries such as Nepal is not fully understood. We sought to assess the association of socioeconomic factors (education, income, and employment status) with overweight/obesity. Methods: This cross-sectional study analyzed data from 260 participants aged ≥18 years and attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors was collected, and weight and height were measured for all the study participants. Those with a body mass index of <25 kg/m2 were regarded as non-overweight/obese and those with ≥25 kg/m2 were regarded as overweight/obese. Poisson regression models were used to estimate prevalence ratios and corresponding 95% confidence intervals to assess the association between socioeconomic factors and overweight/obesity. In addition, we assessed the effect of modification by age and gender to study the effect of socioeconomic factors on overweight/obesity. Results: The age-standardized prevalence of overweight/obesity was higher for individuals with higher education (23%) and high-income (32%) and those who were unemployed (42%). Compared to the low-income and no formal education groups, the prevalence ratio of overweight/ obesity was 1.69 and 2.27 times more for those belonging to the high-income and high school and above groups, respectively. No evidence of effect modification by gender and age was observed. Conclusions: Socioeconomic factors, education, and income were positively associated with overweight/obesity prevalence in rural Nepal. Further large studies using longitudinal settings are necessary to replicate our findings.

• Lyshol, Heidi; Grøtvedt, Liv; Fagerhaug, Tone Natland; Feuerherm, Astrid Jullumstrø; Jakhelln, Gry & Sen, Abhijit (2022). A study of socio‑economic inequalities in self‑reported oral and general health in South‑East Norway. Scientific Reports. 12. doi: 10.1038/s41598-022-18055-5. Full text in Research Archive Show summary

  This study assesses the association between socioeconomic determinants and self-reported health using data from a regional Norwegian health survey. We included 9,068 participants ≥ 25 years. Survey data were linked to registry data on education and income. Self-reported oral and general health were separately assessed and categorized into ‘good’/‘poor’. Exposures were educational level, personal income, and economic security. Prevalence ratios (PR) were computed to assess the associations between socioeconomic determinants and self-reported health using Poisson regression models. Participants with low education or income had poorer oral and general health than those with more education or higher income. Comparing the highest and lowest education levels, adjusted PRs for poor oral and general health were 1.27 (95%CI, 1.11–1.46) and 1.43 (95%CI, 1.29–1.59), respectively. Correspondingly, PRs for lowest income quintiles compared to highest quintile were 1.34 (95%CI, 1.17–1.55) and 2.10 (95%CI, 1.82–2.43). Low economic security was also significantly associated with poor oral and general health. There were socioeconomic gradients and positive linear trends between levels of education and income in relation to both outcomes (P-linear trends

• Iurilli, Maria Laura Caminia; Zhou, Bin; Bennett, James E.; Carrillo-Larco, Rodrigo M.; Sophiea, Marisa K. & Rodriguez-Martinez, Andrea [Show all 77 contributors for this article] (2021). Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight. eLIFE. 10. doi: 10.7554/eLife.60060. Full text in Research Archive Show summary

  From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.

• Børsting, Torunn; Venkatraman, Vishwesh; Fagerhaug, Tone Natland; Skeie, Marit Slåttelid; Stafne, Signe Nilssen & Feuerherm, Astrid Jullumstrø [Show all 7 contributors for this article] (2021). Systematic assessment of salivary inflammatory markers and dental caries in children: an exploratory study. Acta Odontologica Scandinavica. ISSN 0001-6357. doi: 10.1080/00016357.2021.2011400. Full text in Research Archive Show summary

  Objective: To investigate associations between a wide panel of salivary inflammatory markers and the presence of dental caries among children. Material and methods: In this exploratory, cross-sectional study, 176 children, aged 7-9, underwent a dental examination. Information on the children's oral health habits and lifestyles was collected from their mothers. In addition, saliva samples were collected and analyzed using a multiplex immunoassay. Of 92 inflammatory markers measured, 56 were included in the statistical analyses. To identify potential inflammatory markers associated with caries, we applied low to advanced statistical analyses. First, we performed traditional logistic regression analysis followed by Bonferroni corrections. Thereafter, a more robust and less conservative statistical approach, i.e. Least Absolute Shrinkage and Selection Operator (LASSO), was applied. The models were adjusted for potential confounders. Results: Of the 176 children in the study, 22.2% were affected by caries. Among the 56 salivary inflammatory markers, only macrophage colony-stimulating factor 1 (CSF1) was selected by the LASSO and found to be positively associated with the presence of caries. Conclusions: The observed association between CSF1 and the presence of caries may be of clinical value in caries risk management and early diagnosis. Larger studies are warranted to assess the replicability of our findings.

• Aune, Dagfinn; Sen, Abhijit; Norat, Teresa; Riboli, Elio & Folseraas, Trine (2021). Primary sclerosing cholangitis and the risk of cancer, cardiovascular disease, and all-cause mortality: a systematic review and meta-analysis of cohort studies. Scientific Reports. 11. doi: 10.1038/s41598-021-90175-w. Full text in Research Archive Show summary

  Abstract A diagnosis of primary sclerosing cholangitis (PSC) has been associated with increased risk of hepatobiliary cancers, colorectal cancer and all-cause mortality in several studies, while associations with cardiovascular disease have been inconsistent. We conducted a systematic review and meta-analysis of published cohort studies on the topic to summarize these associations. PubMed and Embase databases were searched up to January 13th, 2020. Cohort studies on PSC and risk of cancer, cardiovascular disease, or mortality were included. Summary relative risks (RRs) and 95% confidence intervals (95% CIs) were estimated using random effects models. The summary RR (95% CI) comparing persons with PSC to persons without PSC was 584.37 (269.42–1267.51, I 2  = 89%, n = 4) for cholangiocarcinoma (CCA), 155.54 (125.34–193.02, I 2  = 0%, n = 3) for hepatobiliary cancer, 30.22 (11.99–76.17, I 2  = 0%, n = 2) for liver cancer, 16.92 (8.73–32.78, I 2  = 88%, n = 4) for gastrointestinal cancer, 7.56 (2.42–23.62, I 2  = 0%, n = 3) for pancreatic cancer, 6.10 (4.19–8.87, I 2  = 14%, n = 7) for colorectal cancer (CRC), 4.13 (2.99–5.71, I 2  = 80%, n = 5) for total cancer, 3.55 (2.94–4.28, I 2  = 46%, n = 5) for all-cause mortality, and 1.57 (0.25–9.69, I 2  = 79%, n = 2) for cardiovascular disease. Strong positive associations were observed between PSC and risk of CCA, hepatobiliary cancer, liver cancer, gastrointestinal cancer, pancreatic cancer, CRC, total cancer, and all-cause mortality, but not for cardiovascular disease.

• Jordal, Kristin; Skudutyte-Rysstad, Rasa; Sen, Abhijit; Torgersen, Gerald; Ørstavik, Dag & Sunde, Pia Titterud (2021). Effects of an individualized training course on technical quality and periapical status of teeth treated endodontically by dentists in the Public Dental Service in Norway. An observational intervention study. International Endodontic Journal. ISSN 0143-2885. doi: 10.1111/iej.13669. Full text in Research Archive Show summary

  Aim: To investigate the effect of a continuing education course on technical quality and treatment outcome for root filled permanent teeth in Møre and Romsdal County, Norway. Methodology: Fifty-two dentists employed in the Public Dental Service in Møre and Romsdal county, Norway, completed a two-day continuing education course in root canal treatment. Periapical radiographs of root filled teeth treated before and after the course, with at least one-year follow-up were identified and scored for technical quality and periapical status. Technical root filling quality was assessed by density and length and the treatment outcome by PAI scores. Treatment information was achieved from the county's electronic dental record system. Information regarding the dental practitioners' background and treatment procedure routines was collected by a questionnaire. Descriptive statistics analyses and mixed-effect logistic regression analyses were performed to evaluate the effect of the course. Results: Radiographs were available for 224 teeth root filled before and for 221 teeth after the course. The proportion of teeth with adequate root filling quality was significantly lower after the course (p =0.006), associated mainly with short root fillings (p 18 years. Conclusions: A two-day continuing education course in root canal treatment attended by Public Dental Service dentists in Norway did not improve the technical quality of root fillings or periapical status associated with root filled teeth. Keywords: apical periodontitis; continuing education; endodontics; general dental practitioner; reciprocating technique; root filling quality.

• Stødle, Ida Haukåen; Verket, Anders; Høvik, Hedda; Sen, Abhijit & Koldsland, Odd Carsten (2021). Prevalence of periodontitis based on the 2017 classification in a Norwegian population. The HUNT Study. Journal of Clinical Periodontology. ISSN 0303-6979. doi: 10.1111/jcpe.13507. Full text in Research Archive Show summary

  Aim This cross-sectional study assesses the prevalence of periodontitis in a large Norwegian population, based on the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. The prevalence of periodontitis was determined by bone loss recorded on radiographs (orthopantomogram [OPG] and bitewing [BW]) and by clinical examination. Materials and methods As part of a large population health study (The HUNT Study), 7347 participants aged 19 years and older were invited to the HUNT4 Oral Health Study. Radiographic bone loss (RBL) and periodontal stage and grade were assessed in 4863 participants. Results Periodontal examination was performed in 4863 participants. RBL and clinical registrations corresponding to periodontitis as defined were observed in 72.4%. The prevalence of periodontitis increased after 40 years of age, with severe forms occurring primarily after 60 years of age. Stage I was observed in 13.8%, Stage II in 41.1%, Stage III in 15.3%, and Stage IV in 2.3% of the population. Grade A, B, and C was observed in 5.7%, 60.2%, and 6.2%, respectively. Conclusion Periodontitis was frequently observed in the investigated population. The prevalence of periodontitis Stage III and Stage IV combined was observed in 17.6% of the study population.

• Jordal, Kristin; Sen, Abhijit; Skudutyte-Rysstad, Rasa; Ørstavik, Dag & Sunde, Pia Titterud (2021). Effects of an individualised training course in endodontics on the knowledge and insights of dentists in Public Dental Service in Norway. Acta Odontologica Scandinavica. ISSN 0001-6357. doi: 10.1080/00016357.2021.1876915. Full text in Research Archive Show summary

  Objective To evaluate the knowledge and insights of general dental practitioners regarding endodontic diagnosis and treatment principles before and after attending a 2-days continuing education course. Materials and methods Sixty-seven dentists employed in the Public Dental Service in Møre and Romsdal county, Norway, were invited to a continuing education course in endodontics. Before and after the course, they answered a questionnaire weighing the importance of factors influencing the prognosis of endodontic treatment. The same questionnaire was answered by specialists in endodontics (n = 56; Spec Group) and a reference group consisting of general dental practitioners from both private and public practice (n = 21; Ref Group). The Test Group answered both before and after the course, while the Spec and Ref Groups completed the questionnaire once. The responses were compared using the Wilcoxon Sign test and Mann–Whitey U test. Results Of the 67 dentists in the Test Group, 49 (73%) completed the course and answered both questionnaires. Before attending the course, the Test Group differed significantly from the Spec Group in 18 out of 27 prognostic factors (p ≤ .05). After the course, there was only moderate improvement in the Test Group responses. On only three factors, they agreed significantly more with the specialists than before attending the course (p ≤ .05). After the Test Group participants had attended the course, their responses were comparable to the responses of the Ref Group.

• Shakya, Pushpanjali; Shrestha, Archana; Kamacharya, Biraj; Shrestha, Abha; Kulseng, Bård Eirik & Skovlund, Eva [Show all 7 contributors for this article] (2021). Diabetes Prevention Education Program in a population with pre-diabetes in Nepal: a study protocol of a cluster randomised controlled trial (DiPEP). BMJ Open. 11(11). doi: 10.1136/bmjopen-2020-047067. Full text in Research Archive Show summary

  Introduction Evidence suggests that diabetes burden can be reduced by implementing early lifestyle intervention programmes in population with pre-diabetes in high-income countries. However, little is known in developing nations like Nepal. This study aims to assess effectiveness of community-based Diabetes Prevention Education Program (DiPEP) on haemoglobin A1c (HbA1c) level, proportion of pre-diabetes reverting to normoglycaemia, diet, physical activity, weight reduction, diabetes knowledge and health literacy after 6 months of follow-up. Furthermore, we will also conduct qualitative studies to explore experiences of participants of intervention sessions and perception of healthcare workers/volunteers about DiPEP. Methods and analyses This is a community-based two-arm, open-label, cluster randomised controlled trial. We will randomise 14 clusters into intervention arm and control arm. Estimated total sample size is 448. We will screen individuals without diabetes, aged 18–64 years, and permanent residents of study sites. HbA1c test will be only performed if both Indian Diabetes Risk Score and random blood sugar value are ≥60 and 140–250 mg/dL, respectively. At baseline, participants in intervention arm will receive DiPEP package (including intensive intervention classes, diabetes prevention brochure, exercise calendar and food record booklet), and participants in control arm will be provided only with diabetes prevention brochure. The change in outcome measures will be compared between intervention to control arm after 6 months of follow-up by linear mixed models. Also, we will conduct individual interviews among participants and healthcare workers as part of a qualitative study. We will use thematic analysis to analyse qualitative data. Ethics and dissemination Regional Committee for Medical and Health Research Ethics, Norway; Nepal Health Research Council, Nepal and Institutional Review Committee, Kathmandu University School of Medical Sciences have approved the study. The DiPEP package can be implemented in other communities of Nepal if it is effective in preventing diabetes. Trial registration number NCT04074148, 2019/783.

• Janszky, Imre; Vardaxis, Ioannis; Lindqvist, Bo Henry; Horn, Jens; Brumpton, Ben Michael & Strand, Linn Beate [Show all 12 contributors for this article] (2021). Assessing short-term risk of ischemic stroke in relation to all prescribed medications. Scientific Reports. 11. doi: 10.1038/s41598-021-01115-7. Full text in Research Archive Show summary

  We examined the short-term risk of stroke associated with drugs prescribed in Norway or Sweden in a comprehensive, hypothesis-free manner using comprehensive nation-wide data. We identified 27,680 and 92,561 cases with a first ischemic stroke via the patient- and the cause-of-death registers in Norway (2004–2014) and Sweden (2005–2014), respectively, and linked these data to prescription databases. A case-crossover design was used that compares the drugs dispensed within 1 to 14 days before the date of ischemic stroke occurrence with those dispensed 29 to 42 days before the index event. A Bolasso approach, a version of the Lasso regression algorithm, was used to select drugs that acutely either increase or decrease the apparent risk of ischemic stroke. Application of the Bolasso regression algorithm selected 19 drugs which were associated with increased risk for ischemic stroke and 11 drugs with decreased risk in both countries. Morphine in combination with antispasmodics was associated with a particularly high risk of stroke (odds ratio 7.09, 95% confidence intervals 4.81–10.47). Several potentially intriguing associations, both within and across pharmacological classes, merit further investigation in focused, follow-up studies.

• Vårum, Vegard Berg; Mavragani, Maria; Skeie, Marit Slåttelid; Pedersen, Sindre Andre & Sen, Abhijit (2021). Uønskede effekter ved kjeveortopediske retainere. En systematisk litteraturoversikt og kliniske sjekkpunkter for allmenntannlegen. Den norske tannlegeforenings Tidende. ISSN 0029-2303. 131(12), p. 1106–1119. Full text in Research Archive Show summary

  Hovedbudskap Faste kjeveortopediske retainere er tråder som brukes etter kjeveortopedisk behandling, ofte i kombinasjon med avtakbare plater eller skinner. Selv om bruken er utstrakt, med klar indikasjon om å motvirke residiv, er oppfølgingsrutinene uklare. Retensjonstråd kan gi uønskede effekter, hovedsakelig plakkakumulering og i sjeldne tilfeller utilsiktet tannforflytning. Kliniske sjekkpunkter bør omfatte regelmessig kontroll av støttevev og slimhinner, samt tannstilling, tråd og limingspunkter. Individuell risikoanalyse og tett samarbeid mellom kjeveortoped, tannlege og pasient er avgjørende.

• Zhou, Bin; Carrillo-Larco, Rodrigo M.; Danaei, Goodarz; Riley, Leanne M.; Paciorek, Christopher J. & Stevens, Gretchen A. [Show all 100 contributors for this article] (2021). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet. ISSN 0140-6736. 398(10304), p. 957–980. doi: 10.1016/S0140-6736(21)01330-1. Full text in Research Archive Show summary

  Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Funding WHO.

• Bhattarai, Sanju; Tandstad, Birgit; Shrestha, Archana; Kamacharya, Biraj; Karmacharya, Biraj & Sen, Abhijit (2021). Socioeconomic Status and Its Relation to Hypertension in Rural Nepal. International Journal of Hypertension. ISSN 2090-0384. 2021. doi: 10.1155/2021/5542438. Full text in Research Archive Show summary

  Introduction. Hypertension and its association with socioeconomic positions are well established. However, the gradient of these relationships and the mediating role of lifestyle factors among rural population in low- and middle-income countries such as Nepal are not fully understood. We sought to assess the association between socioeconomic factors (education, income, and employment status) and hypertension. Also, we assessed whether the effect of education and income level on hypertension was mediated by lifestyle factors. Methods. This cross-sectional study was conducted among 260 participants aged ≥18 years attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors were collected, and blood pressure, weight, and height were measured for all study participants. Those with systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or administrating high blood pressure-lowering medicines were regarded as hypertensives. Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals to assess the association between socioeconomic factors and hypertension. We explored mediation, using the medeff command in Stata for causal mediation analysis of nonlinear models. Results. Of the 50 hypertensive participants, sixty percent were aware of their status. The age-standardized prevalence of hypertension was two times higher for those with higher education or high-income category. Compared to low-income and unemployed groups, the prevalence ratio of hypertension was 1.33 and 2.26 times more for those belonging to the high-income and employed groups, respectively. No evidence of mediation by lifestyle factors was observed between socioeconomic status and hypertension. Conclusions. Socioeconomic positions were positively associated with hypertension prevalence in rural Nepal. Further studies using longitudinal settings are necessary to validate our findings especially in low- and middle-income countries such as Nepal.

• Sen, Abhijit; Bakken, Inger Johanne Landsjøåsen; Govatsmark, Ragna Elise Støre; Varmdal, Torunn; Bønaa, Kaare Harald & Mukamal, Kenneth Jay [Show all 8 contributors for this article] (2021). Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study. BMC Cardiovascular Disorders. 21(31). doi: 10.1186/s12872-020-01836-z. Full text in Research Archive Show summary

  Background US and European guidelines diverge on whether to vaccinate adults who are not at high risk for cardiovascular events against influenza. Here, we investigated the associations between influenza vaccination and risk for acute myocardial infarction, stroke and pulmonary embolism during the 2009 pandemic in Norway, when vaccination was recommended to all adults. Methods Using national registers, we studied all vaccinated Norwegian individuals who suffered AMI, stroke, or pulmonary embolism from May 1, 2009 through September 30, 2010. We defined higher-risk individuals as those using anti-diabetic, anti-obesity, anti-thrombotic, pulmonary or cardiovascular medications (i.e. individuals to whom vaccination was routinely recommended); all other individuals were regarded as having lower-risk. We estimated incidence rate ratios with 95% CI using conditional Poisson regression in the pre-defined risk periods up to 180 days following vaccination compared to an unexposed time-period, with adjustment for season or daily temperature. Results Overall, we observed lower risk for cardiovascular events following influenza vaccination. When stratified by baseline risk, we observed lower risk across all three outcomes in association with vaccination among higher-risk individuals. In this subgroup, relative risks were 0.72 (0.59–0.88) for AMI, 0.77 (0.59–0.99) for stroke, and 0.73 (0.45–1.19) for pulmonary embolism in the period 1–14 days following vaccination when compared to the background period. These associations remained essentially the same up to 180 days after vaccination. In contrast, the corresponding relative risks among subjects not using medications were 4.19 (2.69–6.52), 1.73 (0.91–3.31) and 2.35 (0.78–7.06). Conclusion In this nationwide study, influenza vaccination was associated with overall cardiovascular benefit. This benefit was concentrated among those at higher cardiovascular risk as defined by medication use. In contrast, our results demonstrate no comparable inverse association with thrombosis-related cardiovascular events following vaccination among those free of cardiovascular medications at baseline. These results may inform the risk–benefit balance for universal influenza vaccination.

• Taddei, Cristina; Jackson, Rod; Zhou, Bin; Bixby, Honor; Danaei, Goodarz & Cesare, Mariachiara Di [Show all 361 contributors for this article] (2020). National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio: A pooled analysis of 458 population-based studies in Asian and Western countries. International Journal of Epidemiology. ISSN 0300-5771. 49(1), p. 173–192. doi: 10.1093/ije/dyz099. Full text in Research Archive
• Aune, Dagfinn; Sen, Abhijit; Kobeissi, Elsa; Hamer, Mark; Norat, Teresa & Riboli, Eilo (2020). Physical activity and the risk of abdominal aortic aneurysm: a systematic review and meta-analysis of prospective studies. Scientific Reports. 10, p. 1–10. doi: 10.1038/s41598-020-76306-9. Full text in Research Archive Show summary

  The association between physical activity and risk of abdominal aortic aneurysm has been inconsistent with some studies reporting a reduced risk while others have found no association. We conducted a systematic review and meta-analysis of prospective studies to quantify the association. PubMed and Embase databases were searched up to 3 October 2020. Prospective studies were included if they reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) of abdominal aortic aneurysm associated with physical activity. Summary RRs (95% CIs) were estimated using a random effects model. Nine prospective studies (2073 cases, 409,732 participants) were included. The summary RR for high vs. low physical activity was 0.70 (95% CI: 0.56–0.87, I2 = 58%) and per 20 metabolic equivalent task (MET)-hours/week increase of activity was 0.84 (95% CI: 0.74–0.95, I2 = 59%, n = 6). Although the test for nonlinearity was not significant (p = 0.09) the association appeared to be stronger when increasing the physical activity level from 0 to around 20–25 MET-hours/week than at higher levels. The current meta-analysis suggest that higher physical activity may reduce the risk of abdominal aortic aneurysm, however, further studies are needed to clarify the dose–response relationship between different subtypes and intensities of activity and abdominal aortic aneurysm risk.

• Rodriguez-Martinez, Andrea; Zhou, Bin; Sophiea, Marisa K.; Bentham, James; Paciorek, Christopher J. & Turilli, Maria L.C. [Show all 54 contributors for this article] (2020). Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants. The Lancet. ISSN 0140-6736. 396(10261), p. 1511–1524. doi: 10.1016/S0140-6736(20)31859-6. Full text in Research Archive Show summary

  Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m². In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in subSaharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks. Funding Wellcome Trust, AstraZeneca Young Health Programme, EU.

• Aune, Dagfinn; Sen, Abhijit; Kobeissi, Elsa; Hamer, Mark; Norat, Teresa & Riboli, Elio (2020). Physical activity and the risk of abdominal aortic aneurysm: a systematic review and meta-analysis of prospective studies. Scientific Reports. doi: 10.1038/s41598-020-76306-9. Full text in Research Archive Show summary

  The association between physical activity and risk of abdominal aortic aneurysm has been inconsistent with some studies reporting a reduced risk while others have found no association. We conducted a systematic review and meta-analysis of prospective studies to quantify the association. PubMed and Embase databases were searched up to 3 October 2020. Prospective studies were included if they reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) of abdominal aortic aneurysm associated with physical activity. Summary RRs (95% CIs) were estimated using a random effects model. Nine prospective studies (2073 cases, 409,732 participants) were included. The summary RR for high vs. low physical activity was 0.70 (95% CI: 0.56–0.87, I2 = 58%) and per 20 metabolic equivalent task (MET)-hours/week increase of activity was 0.84 (95% CI: 0.74–0.95, I2 = 59%, n = 6). Although the test for nonlinearity was not significant (p = 0.09) the association appeared to be stronger when increasing the physical activity level from 0 to around 20–25 MET-hours/week than at higher levels. The current meta-analysis suggest that higher physical activity may reduce the risk of abdominal aortic aneurysm, however, further studies are needed to clarify the dose–response relationship between different subtypes and intensities of activity and abdominal aortic aneurysm risk.

• Taddei, Cristina; Zhou, Bin; Bixby, Honor; Carrillo-Larco, Rodrigo M.; Danaei, Goodarz & Jackson, Rod T. [Show all 55 contributors for this article] (2020). Repositioning of the global epicentre of non-optimal cholesterol. Nature. ISSN 0028-0836. 582(7810), p. 73–77. doi: 10.1038/s41586-020-2338-1. Full text in Research Archive Show summary

  High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.

• Sen, Abhijit; Vardaxis, Ioannis; Lindqvist, Bo Henry; Brumpton, Ben Michael; Strand, Linn B & Bakken, Inger Johanne Landsjøåsen [Show all 11 contributors for this article] (2019). Systematic assessment of prescribed medications and short-term risk of myocardial infarction - a pharmacopeia-wide association study from Norway and Sweden. Scientific Reports. 9. doi: 10.1038/s41598-019-44641-1. Full text in Research Archive Show summary

  Wholesale, unbiased assessment of Scandinavian electronic health-care databases offer a unique opportunity to reveal potentially important undiscovered drug side effects. We examined the short-term risk of acute myocardial infarction (AMI) associated with drugs prescribed in Norway or Sweden. We identified 24,584 and 97,068 AMI patients via the patient- and the cause-of-death registers and linked to prescription databases in Norway (2004–2014) and Sweden (2005–2014), respectively. A case-crossover design was used to compare the drugs dispensed 1–7 days before the date of AMI diagnosis with 15–21 days’ time -window for all the drug individually while controlling the receipt of other drugs. A BOLASSO approach was used to select drugs that acutely either increase or decrease the apparent risk of AMI. We found 48 drugs to be associated with AMI in both countries. Some antithrombotics, antibiotics, opioid analgesics, adrenergics, proton-pump inhibitors, nitroglycerin, diazepam, metoclopramide, acetylcysteine were associated with higher risk for AMI; whereas angiotensin-II-antagonists, calcium-channel blockers, angiotensin-converting-enzyme inhibitors, serotonin-specific reuptake inhibitors, allopurinol, mometasone, metformin, simvastatin, levothyroxine were inversely associated. The results were generally robust in different sensitivity analyses. This study confirms previous findings for certain drugs. Based on the known effects or indications, some other associations could be anticipated. However, inverse associations of hydroxocobalamin, levothyroxine and mometasone were unexpected and needs further investigation. This pharmacopeia-wide association study demonstrates the feasibility of a systematic, unbiased approach to pharmacological triggers of AMI and other diseases with acute, identifiable onsets.

• Bixby, Honor; Bentham, James; Zhou, Bin; Cesare, Mariachiara Di; Paciorek, Christopher J. & Bennett, James E. [Show all 51 contributors for this article] (2019). Rising rural body-mass index is the main driver of the global obesity epidemic in adults. Nature. ISSN 0028-0836. 569, p. 260–264. doi: 10.1038/s41586-019-1171-x. Full text in Research Archive Show summary

  Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3,4,5,6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

• Skeie, Marit Slåttelid; Gil, Elisabeth Grut; Cetrelli, Lena Elisabet; Rosén, Annika; Fischer, Johannes Maria & Åstrøm, Anne Nordrehaug [Show all 13 contributors for this article] (2019). Oral health in children and adolescents with juvenile idiopathic arthritis - a systematic review and meta-analysis. BMC Oral Health. 19:285, p. 1–16. doi: 10.1186/s12903-019-0965-4. Full text in Research Archive Show summary

  Background Observational studies examining the association between oral health and juvenile idiopathic arthritis (JIA) among children and adolescents have reported inconsistent findings. The aims of this systematic review and meta-analysis were to ascertain a potential difference in oral health and oral health-related quality of life (OHRQoL) among children and adolescents with JIA and healthy peers, and to assess the association of prevalence of oral diseases/conditions, temporomandibular disorders (TMD), including temporomandibular joint (TMJ) diseases, in relation to activity and severity of JIA. Method Medline Ovid, Embase, CINAHL, SweMed+ and Cochrane Library were searched up to 25 November 2018. All articles published in English, German and Scandinavian languages focusing on children and adolescents with JIA and without JIA in relation to oral health measures, were considered. Two authors independently evaluated observational studies for inclusion. The study quality was assessed using modified Newcastle Ottawa Scale. Meta-analysis was performed for studies focusing on dental caries as an outcome. Results Nineteen articles met the inclusion criteria, covering a range of oral diseases/conditions and OHRQoL. Eighteen studies had cross-sectional design. No mean difference of dmft/DMFT indices (decayed/missed/filled teeth) was observed between the JIA - and healthy group. None of the oral health measures including dental erosive wear, enamel defects, dental maturation and OHRQoL, indicated better oral health among children and adolescents with JIA compared to healthy group. However, periodontal conditions and TMD were more predominant among children and adolescents with JIA compared to healthy peers. Conclusions Based on the cross-sectional studies, periodontal diseases and TMD were found to be more frequent in children and adolescents with JIA compared to healthy peers. Furthermore, more high-quality studies with large sample size are needed before we infer any concrete conclusion regarding the association between the prevalence of oral and TMJ diseases or oral conditions in relation to activity and severity of JIA.

• Aune, Dagfinn; Sen, Abhijit; Norat, Teresa & Riboli, Elio (2019). Dietary fibre intake and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies. European Journal of Nutrition. ISSN 1436-6207. p. 1–12. doi: 10.1007/s00394-019-01967-w. Full text in Research Archive
• Sen, Abhijit; Papadimitriou, Nikos; Lagiou, Pagona; Perez-Cornago, Aurora; Travis, Ruth C. & Key, Timothy J. [Show all 47 contributors for this article] (2019). Coffee and tea consumption and risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition. International Journal of Cancer. ISSN 0020-7136. 144(2), p. 240–250. doi: 10.1002/ijc.31634. Full text in Research Archive
• Zhou, Bin; Bentham, James; Cesare, Mariachiara Di; Bixby, Honor; Danaei, Goodarz & Hajifathalian, Kaveh [Show all 847 contributors for this article] (2018). Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants. International Journal of Epidemiology. ISSN 0300-5771. 47(3), p. 872–883i. doi: 10.1093/ije/dyy016. Full text in Research Archive Show summary

  Background Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20–29 years to 70–79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results In 2005–16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.

• Zhou, Bin; Bentham, James; Cesare, Mariachiara Di; Bixby, Honor; Danaei, Goodarz & Cowan, Melanie J. [Show all 114 contributors for this article] (2017). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. The Lancet. ISSN 0140-6736. 389(10064), p. 37–55. doi: 10.1016/S0140-6736(16)31919-5. Full text in Research Archive Show summary

  Background Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.

• Maddock, Jane; Zhou, Ang; Cavadino, Alana; Kuźma, Elżbieta; Bao, Yanchun & Smart, Melissa C. [Show all 49 contributors for this article] (2017). Vitamin D and cognitive function: A Mendelian randomisation study. Scientific Reports. 7:13230, p. 1–8. doi: 10.1038/s41598-017-13189-3. Full text in Research Archive Show summary

  The causal nature of the association between hypovitaminosis D and poor cognitive function in mid- to later-life is uncertain. Using a Mendelian randomisation(MR) approach, we examined the causal relationship between 25(OH)D and cognitive function. Data came from 172,349 participants from 17 cohorts. DHCR7(rs12785878), CYP2R1 rs12794714) and their combined synthesis score were chosen to proxy 25(OH)D. Cognitive tests were standardised into global and memory scores. Analyses were stratified by 25(OH)D tertiles, sex and age. Random effects meta-analyses assessed associations between 25(OH)D and cognitive function. Associations of serum 25(OH)D with global and memory-related cognitive function were non-linear (lower cognitive scores for both low and high 25(OH)D, pcurvature ≤ 0.006), with much of the curvature attributed to a single study. DHCR7, CYP2R1, and the synthesis score were associated with small reductions in 25(OH)D per vitamin D-decreasing allele. However, coefficients for associations with global or memory-related cognitive function were non-significant and in opposing directions for DHCR7 and CYP2R1, with no overall association observed for the synthesis score. Coefficients for the synthesis score and global and memory cognition were similar when stratified by 25(OH)D tertiles, sex and age. We found no evidence for serum 25(OH)D concentration as a causal factor for cognitive performance in mid- to later life.

• Aune, Dagfinn; Sen, Abhijit; o'Hartaigh, B; Janszky, Imre; Romundstad, Pål Richard & Tonstad, Serena [Show all 7 contributors for this article] (2017). Resting heart rate and the risk of cardiovascular disease, total cancer, and all-cause mortality. A systematic review and dose-response meta-analysis of prospective studies. NMCD. Nutrition Metabolism and Cardiovascular Diseases. ISSN 0939-4753. 27(6), p. 504–517. doi: 10.1016/j.numecd.2017.04.004. Full text in Research Archive
• Aune, Dagfinn; Sen, Abhijit & Vatten, Lars Johan (2017). Hypertension and the risk of endometrial cancer: A systematic review and meta-analysis of case-control and cohort studies. Scientific Reports. 7. doi: 10.1038/srep44808. Full text in Research Archive Show summary

  A history of hypertension has been associated with increased risk of endometrial cancer in several studies, but the results have not been consistent. We conducted a systematic review and meta-analysis of case-control and cohort studies to clarify the association between hypertension and endometrial cancer risk. PubMed and Embase databases were searched up to 27th of February 2016. Prospective and case-control studies which reported adjusted relative risk estimates and 95% confidence intervals of endometrial cancer associated with a hypertension diagnosis were included. Summary relative risks were estimated using a random effects model. Nineteen case-control studies and 6 cohort studies were included. The summary RR was 1.61 (95% CI: 1.41–1.85, I2 = 86%) for all studies, 1.73 (95% CI: 1.45–2.06, I2 = 89%) for case-control studies and 1.32 (95% CI: 1.12–1.56, I2 = 47%) for cohort studies. The association between hypertension and endometrial cancer was weaker, but still significant, among studies with adjustment for smoking, BMI, oral contraceptive use, and parity, compared to studies without such adjustment. This meta-analysis suggest an increased risk of endometrial cancer among patients with hypertension, however, further studies with more comprehensive adjustments for confounders are warranted to clarify the association.

• Sen, Abhijit; Opdahl, Signe; Strand, Linn B; Vatten, Lars Johan; Laugsand, Lars Erik & Janszky, Imre (2017). Insomnia and the risk of Breast Cancer: the HUNT study. Psychosomatic Medicine. ISSN 0033-3174. 79(4), p. 461–468. doi: 10.1097/PSY.0000000000000417. Full text in Research Archive
• Aune, Dagfinn; Sen, Abhijit; Leitzmann, Michael Fred; Tonstad, Serena; Norat, Teresa & Vatten, Lars Johan (2017). Tobacco smoking and the risk of diverticular disease - a systematic review and meta-analysis of prospective studies. Colorectal Disease. ISSN 1462-8910. 19(7), p. 621–633. doi: 10.1111/codi.13748. Full text in Research Archive
• Aune, Dagfinn; Sen, Abhijit; Leitzmann, Michael F.; Norat, Teresa; Tonstad, Serena & Vatten, Lars Johan (2017). Body mass index and physical activity and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies. European Journal of Nutrition. ISSN 1436-6207. p. 1–16. doi: 10.1007/s00394-017-1443-x. Full text in Research Archive
• Bentham, James; Cesare, Mariachiara Di; Bilano, Ver; Bixby, Honor; Zhou, Bin & Stevens, Gretchen A. [Show all 110 contributors for this article] (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. The Lancet. ISSN 0140-6736. 390(10113), p. 2627–2642. doi: 10.1016/S0140-6736(17)32129-3. Full text in Research Archive Show summary

  Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). Findings Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (−0·01 kg/m2 per decade; 95% credible interval −0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64–1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (−0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24–89) million girls and 74 (39–125) million boys worldwide were obese. Interpretation The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults.

• Aune, Dagfinn; Sen, Abhijit; Schlesinger, Sabrina; Norat, Teresa; Janszky, Imre & Romundstad, Pål Richard [Show all 9 contributors for this article] (2017). Body mass index, abdominal fatness, fat mass and the risk of atrial fibrillation: a systematic review and dose–response meta-analysis of prospective studies. European Journal of Epidemiology (EJE). ISSN 0393-2990. 32(3), p. 181–192. doi: 10.1007/s10654-017-0232-4. Full text in Research Archive
• Cesare, Mariachiara Di; Bentham, James; Stevens, Gretchen A; Zhou, Bin; Danaei, Goodarz & Lu, Yuan [Show all 740 contributors for this article] (2016). Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million participants. The Lancet. ISSN 0140-6736. 387(10026), p. 1377–1396. doi: 10.1016/S0140-6736(16)30054-X. Full text in Research Archive Show summary

  Background Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries. Methods We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m2 [underweight], 18·5 kg/m2 to <20 kg/m2, 20 kg/m2 to <25 kg/m2, 25 kg/m2 to <30 kg/m2, 30 kg/m2 to <35 kg/m2, 35 kg/m2 to <40 kg/m2, ≥40 kg/m2 [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue. Findings We used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m2 (95% credible interval 21·3–22·1) in 1975 to 24·2 kg/m2 (24·0–24·4) in 2014 in men, and from 22·1 kg/m2 (21·7–22·5) in 1975 to 24·4 kg/m2 (24·2–24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m2 in central Africa and south Asia to 29·2 kg/m2 (28·6–29·8) in Polynesia and Micronesia; for women the range was from 21·8 kg/m2 (21·4–22·3) in south Asia to 32·2 kg/m2 (31·5–32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13·8% (10·5–17·4) to 8·8% (7·4–10·3) in men and from 14·6% (11·6–17·9) to 9·7% (8·3–11·1) in women. South Asia had the highest prevalence of underweight in 2014, 23·4% (17·8–29·2) in men and 24·0% (18·9–29·3) in women. Age-standardised prevalence of obesity increased from 3·2% (2·4–4·1) in 1975 to 10·8% (9·7–12·0) in 2014 in men, and from 6·4% (5·1–7·8) to 14·9% (13·6–16·1) in women. 2·3% (2·0–2·7) of the world's men and 5·0% (4·4–5·6) of women were severely obese (ie, have BMI ≥35 kg/m2). Globally, prevalence of morbid obesity was 0·64% (0·46–0·86) in men and 1·6% (1·3–1·9) in women. Interpretation If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world's poorest regions, especially in south Asia.

• Bentham, James; Cesare, Mariachiara Di; Stevens, Gretchen A.; Zhou, Bin; Bixby, Honor & Cowan, Melanie [Show all 794 contributors for this article] (2016). A century of trends in adult human height. eLIFE. 5. doi: 10.7554/elife.13410. Full text in Research Archive
• Aune, Dagfinn; Sen, Abhijit; Prasad, Manya; Norat, Teresa; Janszky, Imre & Tonstad, Serena [Show all 8 contributors for this article] (2016). BMI and all cause mortality: Systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. The BMJ. 353. doi: 10.1136/bmj.i2156. Full text in Research Archive
• Aune, Dagfinn; Sen, Abhijit; Henriksen, Tore; Saugstad, Ola Didrik & Tonstad, Serena (2016). Physical activity and the risk of gestational diabetes mellitus: a systematic review and dose–response meta-analysis of epidemiological studies. European Journal of Epidemiology (EJE). ISSN 0393-2990. 31(10), p. 967–997. doi: 10.1007/s10654-016-0176-0. Full text in Research Archive
• Aune, Dagfinn; Sen, Abhijit; Norat, Teresa; Janszky, Imre; Romundstad, Pål Richard & Tonstad, Serena [Show all 7 contributors for this article] (2016). Body mass index, abdominal fatness, and heart failure incidence and mortality: a systematic review and dose-response meta-analysis of prospective studies. Circulation. ISSN 0009-7322. 133(7), p. 639–649. doi: 10.1161/CIRCULATIONAHA.115.016801. Full text in Research Archive
• Freudenberger, Paul; Petrovic, Katja; Sen, Abhijit; Töglhofer, Anna Maria; Fixa, Andre & Hofer, Edith [Show all 11 contributors for this article] (2016). Fitness and cognition in the elderly: The Austrian Stroke Prevention Study. Neurology. ISSN 0028-3878. 86(5), p. 418–424. doi: 10.1212/WNL.0000000000002329. Full text in Research Archive
• Sen, Abhijit; Tsilidis, Konstantinos K.; Allen, Naomi E.; Rinaldi, Sabina; Appleby, Paul N. & Almquist, Martin [Show all 47 contributors for this article] (2015). Baseline and lifetime alcohol consumption and risk of differentiated thyroid carcinoma in the EPIC study. British Journal of Cancer. ISSN 0007-0920. 113(5), p. 840–847. doi: 10.1038/bjc.2015.280. Full text in Research Archive Show summary

  Background: Results from several cohort and case–control studies suggest a protective association between current alcohol intake and risk of thyroid carcinoma, but the epidemiological evidence is not completely consistent and several questions remain unanswered. Methods: The association between alcohol consumption at recruitment and over the lifetime and risk of differentiated thyroid carcinoma was examined in the European Prospective Investigation into Cancer and Nutrition. Among 477 263 eligible participants (70% women), 556 (90% women) were diagnosed with differentiated thyroid carcinoma over a mean follow-up of 11 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards models. Results: Compared with participants consuming 0.1–4.9 g of alcohol per day at recruitment, participants consuming 15 or more grams (approximately 1–1.5 drinks) had a 23% lower risk of differentiated thyroid carcinoma (HR=0.77; 95% CI=0.60–0.98). These findings did not differ greatly when analyses were conducted for lifetime alcohol consumption, although the risk estimates were attenuated and not statistically significant anymore. Similar results were observed by type of alcoholic beverage, by differentiated thyroid carcinoma histology or according to age, sex, smoking status, body mass index and diabetes. Conclusions: Our study provides some support to the hypothesis that moderate alcohol consumption may be associated with a lower risk of papillary and follicular thyroid carcinomas.

• Sen, Abhijit (2012). Driving cessation and dementia: results of the prospective registry on dementia in Austria (PRODEM). PLOS ONE. doi: 10.1371/journal.pone.0052710. Full text in Research Archive

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• Myhr, Arnhild; Bhattarai, Sanju & Sen, Abhijit (2025). Association Between Metabolic Syndrome and Dental Caries in Adults: The HUNT4 Oral Health Study. European Journal of Public Health. ISSN 1101-1262. 35(Supplement_4). doi: 10.1093/eurpub/ckaf161.673. Full text in Research Archive Show summary

  Background Metabolic syndrome (MetS)-a cluster of conditions including dysglycemia, abdominal obesity, dyslipidemia, and hypertension-raises the risk of cardiovascular disease and other systemic complications. Emerging evidence suggests it may also be associated with dental caries, possibly due to shared risk factors like diet and inflammation. This study aimed to examine the association between MetS and dental caries in adults. Methods This cross-sectional study utilized data from participants of the HUNT4 Oral Health Study (2017-2019), who answered questionnaires and underwent clinical and radiographic examinations. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria (2001). Negative binomial regression models were used to assess the associations between dental caries - measured as total caries experience (i.e., number of decayed, missing, and filled teeth; D3-5MFT) and number of decayed teeth (i.e., teeth with dentin caries; D3-5T) - and MetS, as well as its individual components. Results are presented as ratios of means (RMs) with 95% confidence intervals (CIs), adjusted for confounders. Results The study included 4,728 individuals (55.9% women) with a mean age 51.4 years (SD 16.3). MetS was prevalent in 34.9% of participants. Mean D3-5MFT was 14.9 (range: 0-28). MetS was associated with an increased mean number of D3-5MFT (RM: 1.04; 95% CI: 1.02-1.06), though no significant association was found with D3-5T alone. Total caries experience increased with the number of MetS components present in adults. Among individual components of MetS, abdominal obesity (RM:1.07; 95% CI: 1.04-1.09) and elevated triglyceride levels (RM:1.02; 95% CI: 1.00-1.06) demonstrated the strongest associations with caries experience. Conclusions We observed that both the presence of MetS and a higher number of its components were associated with increased dental caries experience. Key messages • Metabolic syndrome was associated with greater dental caries experience (D3-5MFT), but not with the number of untreated decayed teeth (D3-5T) in adults. • Total dental caries experience (D3-5MFT) increased with the number of metabolic syndrome components present in adults.

• Høvik, Hedda; Jensen, Knut Helge Midtbø; Børsting, Torunn; Eftedal, Randi Krog; Dahllöf, Göran & Hafell, Bjørnar [Show all 11 contributors for this article] (2025). Kariestilvekst fra 12 til 18 år: Betydningen av karieserfaring ved 12 års alder. Den norske tannlegeforenings Tidende. ISSN 0029-2303. 135(12), p. 952–953. doi: 10.56373/692442c631afb. Full text in Research Archive
• Hasha, Wegdan Hamed Nasser; Lie, Stein Atle; Sen, Abhijit & Sharafeldin, Manal Ibrahim Mustafa (2024). Use of dental service among immigrant seniors living in Norway. Full text in Research Archive
• Myhr, Arnhild; Jiang, Lin; Stangvaltaite-Mouhat, Lina; Skudutyte-Rysstad, Rasa & Sen, Abhijit (2024). Body mass index change and risk of poor oral health in Norwegian adults: the HUNT longitudinal study. European Journal of Public Health. ISSN 1101-1262. doi: 10.1093/eurpub/ckae144.2301. Full text in Research Archive
• Reda, Mariam; Sen, Abhijit; Åstrøm, Anne-Kristine N & Mustafa, Manal (2023). Correction: Prevention of caries and obesity in children with immigrant background in Norway- a study protocol for a cluster randomized controlled trial (BMC Oral Health, (2023), 23, 1, (620), 10.1186/s12903-023-03329-9). BMC Oral Health. 23(1). doi: 10.1186/s12903-023-03616-5. Full text in Research Archive
• Skeie, Marit Slåttelid; Sen, Abhijit; Dahllöf, Göran; Fagerhaug, Tone Natland; Høvik, Hedda & Klock, Kristin S. (2023). Correction: Dental caries at enamel and dentine level among European adolescents – a systematic review and meta-analysis (BMC Oral Health, (2022), 22, 1, (620), 10.1186/s12903-022-02631-2). BMC Oral Health. 23(1). doi: 10.1186/s12903-023-02819-0. Full text in Research Archive
• Morooka, Hikaru; Haug, Eirin Beate; Malmo, Vegard; Loennechen, Jan Pål; Mukamal, Kenneth & Rich-Edwards, Janet Wilson [Show all 8 contributors for this article] (2023). Association between parity, age at first birth and atrial fibrillation: the HUNT Study. Full text in Research Archive
• Morooka, Hikaru; Haug, Eirin Beate; Malmo, Vegard; Loennechen, Jan Pål; Mukamal, Kenneth & Rich-Edwards, Janet Wilson [Show all 9 contributors for this article] (2023). Association between parity, age at first birth, infertility and atrial fibrillation: the HUNT Study. Full text in Research Archive
• Shakya, Pushpanjali; Bajracharya, Monish; Skovlund, Eva; Shrestha, Abha; Karmacharya, Biraj Man & Kulseng, Bård Eirik [Show all 9 contributors for this article] (2022). Experiences of making lifestyle changes among people with prediabetes attending Diabetes Prevention Education Program (DiPEP): A qualitative study in Nepal. Full text in Research Archive Show summary

  Background Development of diabetes can be prevented through lifestyle modification in the prediabetic phase. A group-based lifestyle intervention called ‘Diabetes Prevention Education Program’ (DiPEP) was tested recently in Nepal. The present qualitative study aimed to explore the experiences of making lifestyle changes among people with prediabetes who participated in the DiPEP. Method A qualitative study with semi-structured interviews of 20 participants was conducted four to seven months following DiPEP intervention. DiPEP was developed considering the local and cultural context of Nepali users and was delivered in Nepali language. It was a 6-month lifestyle intervention with a group-based physical or digital educational sessions for the four weeks of the first month and next five months with either group-based weekly physical follow-up or individual biweekly telephone follow-up calls, and a group-based monthly physical or digital meetings. Four topics in the educational sessions were introduction to diabetes and prediabetes, healthy eating & physical activity, stress management and management of social cues. The monthly meetings included revision of the four topics, practical exercise sessions followed by a question-answer session. The data was analysed thematically. Results The findings were categorized into four themes, i) understanding that diabetes could be prevented, ii) lifestyle changes made, iii) hurdles to overcome, and iv) experiencing benefits leading to sustained change. Some participants said that it was a relief to have learned that they had a chance to prevent diabetes. The participants talked mostly about making changes in diet like reducing carbohydrate intake and in physical activity like starting exercises. Some obstacles faced by participants were lack of motivation and time, lack of family support and lack of space to do exercises. Having experienced benefits from lifestyle changes such as weight loss and reduced level of blood sugar were reported to lead them to maintain the changes they had made. Conclusion Understanding that diabetes could be prevented was a key motivator for implementing changes after the DiPEP intervention. The benefits and hurdles experienced by the participants of the present study can be taken into consideration while designing lifestyle intervention programs in similar settings. Key words Benefits, Hurdles, Lifestyle changes, Prediabetes, Understanding

• Shakya, Pushpanjali; Shrestha, Archana; Skovlund, Eva; Kulseng, Bård Eirik; Shrestha, Abha & Karmacharya, BirajMan [Show all 7 contributors for this article] (2021). Diabetes Prevention Education Program in a population with pre-diabetes in Nepal: a study protocol of a cluster randomised controlled trial (DiPEP). BMJ Open. doi: 10.1136/bmjopen-2020-047067. Full text in Research Archive
• Lundestad, Anette; Cetrelli, Lena Elisabet; Frid, Paula; Hoff, Mari; Hoftun, Gry Børmark & Bletsa, Athanasia [Show all 11 contributors for this article] (2021). P198 Biomarkers in juvenile idiopathic arthritis associated with inflammation and bone health. Proceedings of the 27th European Paediatric Rheumatology Congress (PReS 2021): Virtual. 19-21 September 2021. Pediatric Rheumatology. 19, p. 155–155. doi: 10.1186/s12969-021-00632-z. Full text in Research Archive
• Lyshol, Heidi; Sen, Abhijit; Jullumstrø, Astrid; Jakhelln, Gry; Grøtvedt, Liv & Fagerhaug, Tone Natland (2020). Socioeconomic inequalities in self-reported dental and general health in a Norwegian county study. European Journal of Public Health. ISSN 1101-1262. 30, p. 635–635. doi: 10.1093/eurpub/ckaa166.286. Full text in Research Archive
• Cetrelli, Lena Elisabet; Gil, Elisabeth Grut; Lundestad, Anette; Frid, Paula; Halbig, Josefine Mareile & Fischer, Johannes Maria [Show all 17 contributors for this article] (2020). Serum Vitamin D and Caries in Juvenile Idiopathic Arthritis. Journal of Dental Research. ISSN 0022-0345. 99(Spec Iss A). Full text in Research Archive
• Sen, Abhijit; Vardaxis, Ioannis; Lindqvist, Bo Henry; Brumpton, Ben Michael; Strand, Linn B & Bakken, Inger Johanne Landsjøåsen [Show all 11 contributors for this article] (2020). Author Correction: Systematic assessment of prescribed medications and short-term risk of myocardial infarction – a pharmacopeia-wide association study from Norway and Sweden (Scientific Reports, (2019), 9, 1, (8257), 10.1038/s41598-019-44641-1). Scientific Reports. 10(1). doi: 10.1038/s41598-020-57847-5. Full text in Research Archive
• Nymoen, Line Cathrine; Sen, Abhijit & frutos, Javier Pérez de (2024). Inter-rater agreement among multiple examiners for the caries assessment on intra-oral X-ray images. Norges teknisk-naturvitenskapelige universitet. Full text in Research Archive Show summary

  Dagens samfunn er i utvikling, og vi møter utfordringer til stadig. I tannhelsetjeneste er karies en av de største utfordringene. Dette krever god kunnskap om forebygging, og behandling. For å kunne utvikle tjenesten videre, er det essensielt at den følger med i utviklingen. For å kunne bidra til dette jobber AI-Dentify prosjektet med å utvikle et beslutningsstøtte-system, i forbindelse med dette har fem tannleger og en tannpleier annotert karies på intraorale røntgenbilder. Ved å analysere annoteringene, og bruke Cohens kappa, har denne masteroppgaven sett på hvordan annotørene har merket opp karies på røntgen. I tillegg har vi sett på presisjon og om erfarne tannleger er mer presise enn en tannpleier med mindre klinisk erfaring. Erfaring er helt klart en faktor som gjør at annotørene kan være mer trygge og sikre på annoteringen de gjøre. Videre har dette vist at det trengs mer forskning på området og at det er avhengig av hvilke faktorer en ønsker å ta med.

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