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Aim: We assessed the performance of non-invasive risk prediction models to predict 10-year incident type 2 diabetes in a large Swedish cohort.

Methods: Using the Västerbotten Intervention Programme (VIP) cohort, which includes serial oral glucose tolerance tests (OGTTs), we assessed discrimination (concordance (c)-statistic) and calibration (expected-to-observed probability ratio, integrated calibration index, calibration slope and plots) before and after recalibration in twelve non-invasive models. Incident diabetes cases were determined by an OGTT at a 10-year follow-up visit or through previously validated register-based cases.

Results: Among 91708 VIP participants, the 10-year diabetes incidence was 2.8 %. Most models had acceptable discrimination (c-statistic ≥0.70 and < 0.80). Discrimination was better in women and persons <50 years old. Eight models overestimated and four models underestimated mean absolute risk. Recalibration improved miscalibration in all models. Overall, the Framingham Personal and QDScore models’ predictions were most accurate but the Framingham model included more easily obtainable variables. Most models overestimated risk in older people while no consistent pattern was observed across sexes.

Conclusion: All models required recalibration to improve prediction accuracy. The Framingham personal model is recommended for risk predictions and will be the easiest to implement.

Introduction: Early-life determinants of middle-age cardiovascular health are poorly understood. This study examines associations of BMI and physical fitness in male adolescents with cardiovascular health measured by the Life's Essential 8 score in middle age.

Methods: A population-based cohort study linked BMI and physical fitness from the Swedish Military Conscription Register (men conscripted from 1972 to 1987) to cardiovascular health from the Swedish CArdioPulmonary bioImage Study (2013–2018). In 2025, a total of 8,930 men (mean age, 18.3 years) were analyzed after 38.2 years of follow-up.

Physical fitness included cardiorespiratory fitness (maximal cycle-ergometer test) and muscular strength (isometric dynamometry of knee extension, elbow flexion, and handgrip). Cardiovascular health was evaluated using the American Heart Association's Life's Essential 8 score (0–100 points; poor health: <60). Associations were assessed using linear and binomial logistic regressions and restricted cubic splines.

Results: BMI and cardiorespiratory fitness exhibited J-shaped and linear associations, respectively, with cardiovascular health. Compared with normal weight (BMI: 18.5–24.9 kg/m2), AORs of having poor cardiovascular health for overweight (BMI: 25.0–29.9 kg/m2) and obesity (BMI ≥30 kg/m2) were 2.42 (95% CI=2.00, 2.92) and 5.38 (95% CI=2.99, 9.70). No statistically significant associations were observed between muscular strength and cardiovascular health.

Conclusions: Obesity and low levels of cardiorespiratory fitness in male adolescents were associated with lower cardiovascular health in middle age, after nearly 4 decades of follow-up. Although further studies are needed, the promotion of a healthy body weight and cardiorespiratory fitness in youth may be of importance for later cardiovascular health.

Background: Leisure-time physical activity decreases the risk of type 2 diabetes. Whether occupational physical activity affects the risk of type 2 diabetes is still not fully understood. The primary aim of this study was to investigate the association between occupational physical activity and 10-year diabetes incidence in a general adult population in Northern Sweden. The secondary aim was to explore the moderating role of BMI on this association.

Methods: This population-based, longitudinal cohort study included 16,282 diabetes-free individuals aged 28–52 years who participated in a cardiovascular intervention programme in Northern Sweden, and who reported the same occupational physical activity level at baseline and at 10-year follow-up. Incident type 2 diabetes was diagnosed based on oral glucose tolerance testing or a register-based diagnosis. Occupational physical activity was self-reported and categorized as: a) Low: ‘Sedentary or standing’ or ‘Light but partly physically active’, b) Moderate: ‘Light and physically active’, or c) High: Sometimes physically strenuous or ‘Physically strenuous most of the time’. Odds ratios (OR) and 95% confidence intervals (CI) for incident diabetes were calculated using multivariable logistic regression analysis, adjusting for age, sex, smoking, education level, family history of diabetes, country of birth, intake of fruits and vegetables, leisure-time physical activity, prediabetes and BMI. Potential interactions between BMI category and T2D were tested using interaction terms in the multivariable model.

Results: Six hundred twenty-four individuals developed type 2 diabetes in the 10 years between the first visit and the follow-up. A significant moderation effect of BMI on occupational physical activity was found (p = 0.01). Having a low level of occupational physical activity, compared with a moderate level of occupational physical activity, was associated with an increased risk of incident type 2 diabetes in overweight and obese individuals (OR 1.46, 95% CI 1.09–1.96), but not in those with normal weight (OR 0.80, 95% CI 0.52–1.23). High level of occupational physical activity was not associated with type 2 diabetes (OR 1.12, 95% CI 0.82–1.54).

Conclusions: Low occupational physical activity was associated with incident type 2 diabetes in overweight and obese individuals. Public-health efforts may benefit from encouraging less sitting and standing and more light physical activity during the workday.

INTRODUCTION: The prevalence of type 2 diabetes (T2D) within sub-Saharan Africa (SSA) is increasing. Despite the pathophysiology of T2D differing by ethnicity and sex, risk stratification and guidelines for the prevention of T2D are generic, relying on evidence from studies including predominantly Europeans. Accordingly, this study aims to develop ethnic-specific and sex-specific risk prediction models for the early detection of dysglycaemia (impaired glucose tolerance and T2D) to inform clinically feasible, culturally acceptable and cost-effective risk management and prevention strategies using dietary modification in SSA and European populations.

METHODS AND ANALYSIS: This multinational collaboration will include the prospective cohort data from two African cohorts, the Middle-Aged Soweto Cohort from South Africa and the Research on Obesity and Diabetes among African Migrants Prospective cohort from Ghana and migrants living in Europe, and a Swedish cohort, the Pre-Swedish CArdioPulmonary bioImage Study. Targeted proteomics, as well as targeted and untargeted metabolomics, will be performed at baseline to discover known and novel ethnic-specific and sex-specific biomarkers that predict incident dysglycaemia in the different longitudinal cohorts. Dietary patterns that explain maximum variation in the biomarker profiles and that associate with dysglycaemia will be identified in the SSA and European cohorts and used to build the prototypes for dietary interventions to prevent T2D. A comparative cost-effectiveness analysis of the dietary interventions will be estimated in the different populations. Finally, the perceptions of at-risk participants and healthcare providers regarding ethnic-specific and sex-specific dietary recommendations for the prevention of T2D will be assessed using focus group discussions and in-depth interviews in South Africa, Ghana, Germany (Ghanaian migrants) and Sweden.

ETHICS AND DISSEMINATION: Ethical clearance has been obtained from all participating sites. The study results will be disseminated at scientific conferences and in journal publications, and through community engagement events and diabetes organisations in the respective countries.

Background: Lifestyle modification plays a key role in prevention of cardiovascular disease (CVD), but often fails due to non-adherence to lifestyle recommendations. Previous research has highlighted the importance of psychosocial factors in non-adherence, though focused on secondary rather than primary prevention. The aim of this scoping review was to provide an overview of the moderating role of psychosocial factors on the effect of lifestyle interventions in primary CVD prevention.

Methods: A literature search of scientific databases was performed to identify studies published in peer-reviewed journals, that evaluated lifestyle interventions in primary prevention in adult populations (18 years and older), with a composite CVD risk score or a CVD risk factor (diet, physical activity, smoking or alcohol) as outcome, and assessed the moderating effect of a psychosocial factor.

Results: Thirty-five studies published between 2000 and 2025 were included in this review. Most were randomized controlled trials (RCT), included middle-aged participants, and investigated samples in which women were in majority. The outcomes differed, with fourteen studies reporting on physical activity, eleven on diet, six on body weight, two on smoking and one on alcohol. One study used a CVD risk score as the outcome. The studies included a broad array of psychological factors that were grouped into five categories: self-efficacy or motivation (n = 11), social support or relationship quality (n = 8), mental health (n = 6), personality or emotions (n = 6), and cognitive factors (n = 4). Sixteen (44%) of the studies did not use validated instruments in the assessment of the psychosocial factor.

Conclusions: This review highlights the potential role of psychosocial factors on the effectiveness of lifestyle interventions. However, our ability to draw detailed conclusions or identify any general trends were limited by the heterogeneity amongst the studies in terms of study design, assessment of outcomes and moderators, and populations. Still, we identified a lack of RCTs (1) with long follow-up time, (2) with sufficient sample size, (3) using validated instruments to assess the psychosocial moderator, and (4) using interaction analyses to assess moderating effect.

Objectives: To examine the associations between physical fitness in male adolescents and coronary and carotid atherosclerosis in middle age.

Methods: This population-based cohort study linked physical fitness data from the Swedish Military Conscription Register during adolescence to atherosclerosis data from the Swedish CArdioPulmonary bioImage Study in middle age. Cardiorespiratory fitness was assessed using a maximal cycle-ergometer test, and knee extension muscular strength was evaluated through an isometric dynamometer. Coronary atherosclerosis was evaluated via Coronary Computed Tomography Angiography (CCTA) stenosis and Coronary Artery Calcium (CAC) scores, while carotid plaques were evaluated by ultrasound. The associations were analysed using multinomial logistic regression, adjusted (marginal) prevalences and restricted cubic splines.

Results: The analysis included 8986 male adolescents (mean age 18.3 years) with a mean follow-up of 38.2 years. Physical fitness showed a reversed J-shaped association with CCTA stenosis and CAC, but no consistent association was observed for carotid plaques. After adjustments, compared with adolescents in the lowest tertile of cardiorespiratory fitness and muscular strength, those in the highest tertile had 22% (OR 0.78; 95% CI 0.61 to 0.99) and 26% (OR 0.74; 95% CI 0.58 to 0.93) lower ORs for severe (≥50%) coronary stenosis, respectively. The highest physical fitness group (high cardiorespiratory fitness and muscular strength) had 33% (OR 0.67; 95% CI 0.52 to 0.87) lower OR for severe coronary stenosis compared with those with the lowest physical fitness.

Conclusion: This study supports that a combination of high cardiorespiratory fitness and high muscular strength in adolescence is associated with lower coronary atherosclerosis, particularly severe coronary stenosis, almost 40 years later.

AIMS: Poor exercise capacity and muscle strength in early adulthood are risk factors for cardiovascular disease (CVD). However, it is unclear how these factors relate to subclinical atherosclerosis due to a lack of longitudinal studies. This study investigated whether early adulthood exercise capacity and muscle strength associated with later adulthood subclinical atherosclerosis.

METHODS AND RESULTS: This study included Swedish men (n = 797) who were eligible for military conscription (at ∼18-years of age) and who participated in the baseline assessment of the visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention trial between 2013 and 2016 (at 60 years of age). At conscription, isometric muscle strength (dynamometer) and maximum exercise capacity (maximal load cycle ergometer test) were measured. During later adulthood (at 60 years old), the presence of carotid plaques and intima media thickness were measured by using high-resolution ultrasound. At follow-up, plaques were present in 62% (n = 493) of men. Exercise capacity in early adulthood associated with 19% lower odds of plaques [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.68-0.96], independent of muscle strength. This association was not mediated by any single CVD risk factor. However, the total indirect effect of later, but not early, adulthood CVD risk factors was significant, while the direct effect was non-significant (OR 0.85, 95% CI 0.71-1.02). Associations between muscle strength and subclinical atherosclerosis were non-significant.

CONCLUSION: Higher exercise capacity during early adulthood, but not muscle strength, may protect against carotid plaque development during adulthood mediated by the combination rather than a single later adulthood CVD risk factors.

AIMS: This study aimed to evaluate the association between physical activity and the incidence of coronary heart disease (CHD) in individuals with and without CHD risk factors.

METHODS AND RESULTS: EPIC-CVD is a case-cohort study of 29 333 participants that included 13 582 incident CHD cases and a randomly selected sub-cohort nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Self-reported physical activity was summarized using the Cambridge physical activity index (inactive, moderately inactive, moderately active, and active). Participants were categorized into sub-groups based on the presence or the absence of the following risk factors: obesity (body mass index ≥30 kg/m2), hypercholesterolaemia (total cholesterol ≥6.2 mmol/L), history of diabetes, hypertension (self-reported or ≥140/90 mmHg), and current smoking. Prentice-weighted Cox regression was used to assess the association between physical activity and incident CHD events (non-fatal and fatal).Compared to inactive participants without the respective CHD risk factor (referent), excess CHD risk was highest in physically inactive and lowest in moderately active participants with CHD risk factors. Corresponding excess CHD risk estimates amongst those with obesity were 47% [95% confidence interval (CI) 32-64%] and 21% (95%CI 2-44%), with hypercholesterolaemia were 80% (95%CI 55-108%) and 48% (95%CI 22-81%), with hypertension were 80% (95%CI 65-96%) and 49% (95%CI 28-74%), with diabetes were 142% (95%CI 63-260%), and 100% (95%CI 32-204%), and amongst smokers were 152% (95%CI 122-186%) and 109% (95%CI 74-150%).

CONCLUSIONS: In people with CHD risk factors, moderate physical activity, equivalent to 40 mins of walking per day, attenuates but does not completely offset CHD risk.