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  • 1.
    Kivimäki, Mika
    et al.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Luukkonen, Ritva
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Centre for Cognitive Ageing and Cognitive Epidemiology, Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom.
    Ferrie, Jane E.
    School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
    Pentti, Jaana
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Nyberg, Solja T.
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Fransson, Eleonor I.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden / School of Health Sciences and Welfare, Jönköping University, Jönköping, Sweden / Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm.
    Goldberg, Marcel
    Population-based Epidemiologic Cohort Unit, Villejuif, France.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Kuosma, Eeva
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Nordin, Maria
    Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm, Sweden / Department of Psychology, Umeå University, Umeå, Sweden.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Folkhälsan Research Center, Folkhälsan, Helsinki, Finland / Turku University Hospital, Turku, Finland.
    Theorell, Töres
    Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Vuoksimaa, Eero
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland.
    Westerholm, Peter
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Westerlund, Hugo
    Division of Epidemiology, Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Zins, Marie
    Population-based Epidemiologic Cohort Unit, France.
    Kivipelto, Miia
    Department of Neurobiology, Karolinska Institute, Stockholm, Sweden / National Institute for Health and Welfare, Helsinki, Finland.
    Vahtera, Jussi
    Turku University Hospital, Turku, Finland / University of Turku, Turku, Finland.
    Kaprio, Jaakko
    Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland / Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, United Kingdom / Population-based Epidemiologic Cohort Unit, France / Department of Psychology, Umeå University, Umeå, Sweden.
    Jokela, Markus
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland / Department of Psychology, Umeå University, Umeå, Sweden.
    Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals2018In: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 14, no 5, p. 601-609Article in journal (Refereed)
    Abstract [en]

    Introduction: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. Methods: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Results: Hazard ratios per 5-kg/m(2) increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis. Conclusions: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short. (C) 2017 The Authors. Published by Elsevier Inc. on behalf of the Alzheimer's Association.

  • 2.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London, United Kingdom / Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland / Finnish Inst Occupat Hlth, Helsinki, Finland.
    Nyberg, Solja T.
    Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London, United Kingdom / Univ Edinburgh, Ctr Cognit Ageing & Cognit Epidemiol, Edinburgh, Scotland, United Kingdom.
    Kawachi, Ichiro
    Harvard TH Chan Sch Publ Hlth, Dept Social & Behav Sci, Boston, USA.
    Jokela, Markus
    Univ Helsinki, Fac Med, Dept Psychol & Logoped, Helsinki, Finland.
    Alfredsson, Lars
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden / Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Bjorner, Jakob B.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Borritz, Marianne
    Bispebjerg Univ Hosp Copenhagen, Dept Occupat & Environm Med, Copenhagen, Denmark.
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth BAuA, Berlin, Germany.
    Dragano, Nico
    Univ Düsseldorf, Inst Med Sociol, Fac Med, Düsseldorf, Germany.
    Fransson, Eleonor I.
    Jönköping Univ, Sch Hlth & Welf, Jönköping, Sweden / Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Heikkilä, Katriina
    London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, London, United Kingdom / Royal Coll Surgeons England, Clin Effectiveness Unit, London, United Kingdom.
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Koskenvuo, Markku
    Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland.
    Kumari, Meena
    Univ Essex, Inst Social & Econ Res, Wivenhoe Pk, Colchester, Essex, England, United Kingdom.
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Copenhagen, Denmark.
    Nielsen, Martin L.
    AS3 Co, AS3 Employment, Viby, Denmark.
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden / Umeå Univ, Dept Psychol, Umeå, Sweden.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Copenhagen, Denmark.
    Pentti, Jaana
    Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland.
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen, Denmark / Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark / Univ Copenhagen, Dept Psychol, Copenhagen, Denmark.
    Salo, Paula
    Finnish Inst Occupat Hlth, Helsinki, Finland / Univ Turku, Dept Psychol, Turku, Finland.
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London, England, United Kingdom.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Univ Turku, Dept Publ Hlth, Turku, Finland.
    Theorell, Töres
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Turku, Finland / Turku Univ Hosp, Turku, Finland.
    Westerholm, Peter
    Uppsala Univ, Dept Med Sci, Akad Sjukhuset, Uppsala, Sweden.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London, England, United Kingdom.
    Singh-Manoux, Archana
    Hop Paul Brousse, INSERM, U1018, Ctr Res Epidemiol & Populat Hlth, Villejuif, France.
    Hamer, Mark
    Loughborough Univ Technol, Natl Ctr Sport & Exercise Med, Sch Sport Exercise & Hlth Sci, Loughborough, Leics, England, United Kingdom.
    Ferrie, Jane E.
    Univ Bristol, Sch Social & Community Med, Bristol, Avon, England, United Kingdom.
    Virtanen, Marianna
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Tabak, Adam G.
    UCL, Dept Epidemiol & Publ Hlth, London, England, United Kingdom / Semmelweis Univ, Fac Med, Dept Med 1, Budapest, Hungary.
    Long working hours as a risk factor for atrial fibrillation: a multi-cohort study2017In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, no 34, p. 2621-2628Article in journal (Refereed)
    Abstract [en]

    Aims Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working long hours (>= 55 per week) and those working standard 35-40 h/week. Methods and results In this prospective multi-cohort study from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium, the study population was 85 494 working men and women (mean age 43.4 years) with no recorded atrial fibrillation. Working hours were assessed at study baseline (1991-2004). Mean follow-up for incident atrial fibrillation was 10 years and cases were defined using data on electrocardiograms, hospital records, drug reimbursement registers, and death certificates. We identified 1061 new cases of atrial fibrillation (10-year cumulative incidence 12.4 per 1000). After adjustment for age, sex and socioeconomic status, individuals working long hours had a 1.4-fold increased risk of atrial fibrillation compared with those working standard hours (hazard ratio = 1.42, 95% CI= 1.13-1.80, P= 0.003). There was no significant heterogeneity between the cohort-specific effect estimates (I-2= 0%, P = 0.66) and the finding remained after excluding participants with coronary heart disease or stroke at baseline or during the follow-up (N= 2006, hazard ratio= 1.36, 95% CI= 1.05-1.76, P = 0.0180). Adjustment for potential confounding factors, such as obesity, risky alcohol use and high blood pressure, had little impact on this association. Conclusion Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours.

  • 3.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England / Univ Helsinki, Clinicum, Finland /Univ Helsinki, Helsinki Inst Life Sci, Finland.
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, England / INSERM, U1153, Epidemiol Ageing & Neurodegenerat Dis, Paris, France.
    Pentti, Jaana
    Univ Helsinki, Clinicum, Finland / Univ Turku, Dept Publ Hlth, Finland.
    Sabia, Séverine
    UCL, Dept Epidemiol & Publ Hlth, England / INSERM, U1153, Epidemiol Ageing & Neurodegenerat Dis, Paris, France.
    Nyberg, Solja T.
    Univ Helsinki, Clinicum, Finland.
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Goldberg, Marcel
    INSERM, UMS 011, Populat Based Epidemiol Cohorts Unit, Villejuif, France.
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Koskenvuo, Markku
    Univ Helsinki, Clinicum, Finland.
    Koskinen, Aki
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kouvonen, Anne
    Univ Helsinki, Fac Social Sci, Finland / SWPS Univ Social Sci & Humanities Wroclaw, Poland / Queens Univ Belfast, Ctr Publ Hlth, Adm Data Res Ctr Northern Ireland, Belfast, Antrim, North Ireland.
    Nordin, Maria
    Stockholm Univ, Stress Res Inst, Sweden / Umea Univ, Dept Psychol, Sweden.
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Strandberg, Timo
    Univ Helsinki, Clinicum, Finland / Helsinki Univ Hosp, Finland / Univ Oulu, Ctr Life Course Hlth Res, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Univ Turku, Dept Publ Hlth, Finland.
    Theorell, Töres
    Stockholm Univ, Stress Res Inst, Sweden.
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Finland / Turku Univ Hosp, Finland.
    Väänanen, Ari
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Virtanen, Marianna
    Univ Eastern Finland, Sch Educ Sci & Psychol, Joensuu, Finland.
    Westerholm, Peter
    Uppsala Univ, Dept Med Sci, Sweden.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Sweden.
    Zins, Marie
    INSERM, UMS 011, Populat Based Epidemiol Cohorts Unit, Villejuif, France.
    Seshadri, Sudha
    Univ Texas Hlth Sci Ctr San Antonio, Glenn Biggs Inst Alzheimers & Neurodegenerat Dis, San Antonio, TX 78229 USA / Framingham Heart Dis Epidemiol Study, Framingham, MA USA.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Sipilä, Pyry N.
    Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England.
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Lindbohm, Joni V.
    Univ Helsinki, Clinicum, Finland.
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England / Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, Avon, England.
    Jokela, Markus
    Univ Helsinki, Biomedicum, Fac Med, Finland.
    Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis2019In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 365, article id l1495Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To examine whether physical inactivity is a risk factor for dementia, with attention to the role of cardiometabolic disease in this association and reverse causation bias that arises from changes in physical activity in the preclinical (prodromal) phase of dementia. DESIGN Meta-analysis of 19 prospective observational cohort studies. DATA SOURCES The Individual-Participant-Data Meta-analysis in Working Populations Consortium, the Inter-University Consortium for Political and Social Research, and the UK Data Service, including a total of 19 of a potential 9741 studies. REVIEW METHOD The search strategy was designed to retrieve individual-participant data from prospective cohort studies. Exposure was physical inactivity; primary outcomes were incident all-cause dementia and Alzheimer's disease; and the secondary outcome was incident cardiometabolic disease (that is, diabetes, coronary heart disease, and stroke). Summary estimates were obtained using random effects meta-analysis. RESULTS Study population included 404 840 people (mean age 45.5 years, 57.7% women) who were initially free of dementia, had a measurement of physical inactivity at study entry, and were linked to electronic health records. In 6.0 million person-years at risk, we recorded 2044 incident cases of all-cause dementia. In studies with data on dementia subtype, the number of incident cases of Alzheimer's disease was 1602 in 5.2 million person-years. When measured < 10 years before dementia diagnosis (that is, the preclinical stage of dementia), physical inactivity was associated with increased incidence of all-cause dementia (hazard ratio 1.40, 95% confidence interval 1.23 to 1.71) and Alzheimer's disease (1.36, 1.12 to 1.65). When reverse causation was minimised by assessing physical activity >= 10 years before dementia onset, no difference in dementia risk between physically active and inactive participants was observed (hazard ratios 1.01 (0.89 to 1.14) and 0.96 (0.85 to 1.08) for the two outcomes). Physical inactivity was consistently associated with increased risk of incident diabetes (hazard ratio 1.42, 1.25 to 1.61), coronary heart disease (1.24, 1.13 to 1.36), and stroke (1.16, 1.05 to 1.27). Among people in whom cardiometabolic disease preceded dementia, physical inactivity was non-significantly associated with dementia (hazard ratio for physical activity assessed > 10 before dementia onset 1.30, 0.79 to 2.14). CONCLUSIONS In analyses that addressed bias due to reverse causation, physical inactivity was not associated with all-cause dementia or Alzheimer's disease, although an indication of excess dementia risk was observed in a subgroup of physically inactive individuals who developed cardiometabolic disease.

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