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Background/Objectives: Body mass index (BMI) is the most commonly used surrogate marker for evaluating the risk of cardiovascular disease (CVD) mortality in relation to general obesity, while abdominal obesity indicators have been proposed to be more informative in risk prediction. Subject/Methods: A prospective cohort study consisting of 46 651 Europeans aged 24–99 years was conducted to investigate the relationship between CVD mortality and different obesity indicators including BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR). Hazard ratio (HR) was estimated by the Cox proportional hazards model using age as timescale, and compared using paired homogeneity test. Results: During a median follow-up of 7.9 years, 3435 participants died, 1409 from CVD. All obesity indicators were positively associated with increased risk of CVD mortality, with HRs (95% confidence intervals) per standard deviation increase of 1.19 (1.12–1.27) for BMI, 1.29 (1.21–1.37) for WC, 1.28 (1.20–1.36) for WHR, 1.35 (1.27–1.44) for WSR, 1.34 (1.26–1.44) for ABSI and 1.34 (1.25–1.42) for WHHR in men and 1.37 (1.24–1.51), 1.49 (1.34–1.65), 1.45 (1.31–1.60), 1.52 (1.37–1.69), 1.32 (1.18–1.48) and 1.45 (1.31–1.61) in women, respectively. The prediction was stronger with abdominal obesity indicators than with BMI or ABSI ( P <0.05 for all paired homogeneity tests). WSR appeared to be the strongest predictor among all the indicators, with a linear relationship with CVD mortality in both men and women. Conclusions: Abdominal obesity indicators such as WC, WHR, WSR and WHHR, are stronger predictors for CVD mortality than general obesity indicator of BMI.

The New European Wind Atlas project will create a freely accessible wind atlas covering Europe and Turkey, develop the model chain to create the atlas and perform a series of experiments on flow in many different kinds of complex terrain to validate the models. This paper describes the experiments of which some are nearly completed while others are in the planning stage. All experiments focus on the flow properties that are relevant for wind turbines, so the main focus is the mean flow and the turbulence at heights between 40 and 300 m. Also extreme winds, wind shear and veer, and diurnal and seasonal variations of the wind are of interest. Common to all the experiments is the use of Doppler lidar systems to supplement and in some cases replace completely meteorological towers. Many of the lidars will be equipped with scan heads that will allow for arbitrary scan patterns by several synchronized systems. Two pilot experiments, one in Portugal and one in Germany, show the value of using multiple synchronized, scanning lidar, both in terms of the accuracy of the measurements and the atmospheric physical processes that can be studied. The experimental data will be used for validation of atmospheric flow models and will by the end of the project be freely available. This article is part of the themed issue 'Wind energy in complex terrains'.

We aimed to discover novel associations between leptin and circulating proteins which could link leptin to the development of cardiovascular disease in patients with type 2 diabetes (T2DM). In a discovery phase, we investigated associations between 88 plasma proteins, assessed with a proximity extension assay, and plasma leptin in a cohort of middle-aged patients with T2DM. Associations passing the significance threshold of a False discovery rate of 5% (corresponding to p  < 0.0017) were replicated in patients with T2DM in an independent cohort. We also investigated if proteins mediated the longitudinal association between plasma leptin and the incidence of major cardiovascular events (MACE). One protein, adipocyte fatty acid binding protein (A-FABP), was significantly associated with leptin in both the discovery phase [95% CI (0.06, 0.17) p = 0.00002] and the replication cohort [95% CI (0.12, 0.39) p = 0.0003]. Multiplicative interaction analyses in the two cohorts suggest a stronger association between A-FABP and leptin in men than in women. In longitudinal analyses, the association between leptin and MACE was slightly attenuated after adding A-FABP to the multivariate model. Our analysis identified a consistent association between leptin and A-FABP in two independent cohorts of patients with T2DM, particularly in men. Trial registration : ClinicalTrials.gov identifier NCT 01049737.

Background As the understanding of how different aspects of the physical activity (PA) pattern relate to health and disease, proper assessment is increasingly important. In clinical care, self-reports are the most commonly used assessment technique. However, systematic comparisons between questions regarding concurrent or criterion validity are rare, as are measures of predictive validity. The aim of the study was to examine the concurrent (using accelerometry as reference) and predictive validity (for metabolic syndrome) of five PA questions. Methods A sample of 948 middle-aged Swedish men and women reported their PA patterns via five different questions and wore an accelerometer (Actigraph GT3X) for a minimum of 4 days. Concurrent validity was assessed as correlations and ROC-analyses. Predictive validity was assessed using logistic regression, controlling for potential confounders. Results Concurrent validity was low-to-moderate ( r <0.35 and ROC AUC <0.7) with large misclassifications regarding time spent sitting/sedentary and in moderate-to vigorous PA. The predictive validity of the questions was good, and one question (PHAS) showed an 80 % decreased odds-ratio of having metabolic syndrome, after taking potential confounders into consideration. Discussion In this mixed sample of adults, both concurrent and predictive validity vaired between items and between measures of the physical activity pattern. The PHAS and WALK items are proposed for assessment of adherence to PA recommendations. Conclusion Assessing PA patterns using self-report measures results in methodological problems when trying to predict individual risk for the metabolic syndrome, as the concurrent validity generally was low. However, several of the investigated questions may be useful for assessing risk at a group level, showing better predictive validity.

Objective: The aim of the study was to investigate the crude prevalence and estimated probability of undiagnosed diabetes in different ethnic groups, given the same level of obesity. Design and Subjects: Cross-sectional data from 24 515 men and 29 952 women, aged ⩾30 years, and free of previously diagnosed diabetes were included. Baseline body mass index (BMI) and waist circumference were measured. Diabetes was defined according to both fasting and 2-h 75-g glucose criteria. Results: Prevalence of undiagnosed diabetes was the highest in Asian Indians, the lowest in Europeans and intermediate in others, given the same BMI or waist circumference category across the BMI or waist circumference ranges ( P <0.001 for all BMI or waist categories). β-Coefficients corresponding to a 1 s.d. increase in BMI were 0.34/0.28, 0.41/0.43, 0.42/0.61, 0.36/0.59 and 0.33/0.49 for the Asian Indians, Chinese, Japanese, Mauritian Indians and European men/women (homogeneity test: P >0.05 in men and P <0.001 in women), and in waist: 0.31/0.31, 0.30/0.46, 0.22/0.57 and 0.38/0.58 for the Asian Indians, Chinese, Mauritian Indians and Europeans, respectively (homogeneity test: P >0.05 in men and P <0.001 in women). Conclusion: Prevalence of undiagnosed diabetes increased with an increasing BMI or waist circumference to a similar degree in men in all ethnic groups but to a lesser degree in Asian Indian women than in others, regardless of the higher prevalence in Asian Indians than in others at the same BMI (or) waist circumference levels.

Objective: To determine if levels of the adipocyte-derived hormone, leptin, predict the development of type 2 diabetes. Methods: Population-based surveys were undertaken in the multiethnic nation of Mauritius in 1987, 1992 and 1998. Questionnaires, anthropometric measurements, and a 2-h 75-g oral glucose tolerance test were included. A cohort of 2330 participants who were free of diabetes, aged 25-79 years in 1987, and who were followed-up in 1992 and 1998 was studied. Serum leptin was measured in baseline samples. Glucose tolerance was classified according to WHO (World Health Organization) 1999 criteria. Results: In total, 456 subjects developed diabetes over 11 years with similar incidences in all ethnic groups (P=0.2). Baseline leptin correlated positively with anthropometric measurements, fasting and postload insulin and homeostasis model assessment indices (all P<0.001), and inversely with subsequent weight increase. Participants with incident diabetes had higher serum levels of leptin at baseline than those remaining nondiabetic (P<0.001). After adjustment for confounders, high leptin levels and high leptin/body mass index ratio were independently associated with incident diabetes over 11 years in men (odds ratio for top versus bottom quartile of leptin 2.18; 95% CI: 1.09-4.35), but not in women. Conclusion: We conclude that high leptin levels are associated with the future development of diabetes, and the association is independent of other factors in men, but not in women.

Background/Objectives: To investigate the relationship between body mass index (BMI) and mortality from various causes. Subjects/Methods: Data of 72 947 European men and 62 798 women aged 24–99 years at baseline were collaboratively analyzed. Both absolute and relative mortality risks were estimated within each BMI categories. The hazard ratio was estimated using Cox regression analysis adjusting for age, cohort and smoking status. Results: Over a median follow-up of 16.8 years, 29 071 participants died, 13 502 from cardiovascular disease (CVD) and 8748 from cancers of all types. All-cause and cancer mortality showed a U-shaped relationship: decreased first, leveled off, and then increased with increasing BMI with the lowest mortality risk approximately between 23.0 and 28.0 kg/m 2 of BMI in men and 21.0 and 28.0 kg/m 2 in women. The U-shaped relationship held for all-cause mortality but disappeared for cancer mortality among non-smokers. The CVD mortality was constant until a BMI of approximately 28.0 kg/m 2 and then increased gradually in both men and women, which was independent of age, cohort and smoking status. Conclusions: A U-shaped relationship of BMI with all-cause mortality but a graded relationship with CVD mortality at BMI >28.0 kg/m 2 was detected. The relationship between cancer mortality and BMI largely depended on smoking status, and need to be further investigated with site-specific cancers.

The aim of the present paper is to obtain a better understanding of long distance wakes generated by wind farms as a first step towards a better understanding of farm to farm interaction. The Horns Rev I (HR) wind farm is considered for this purpose, where comparisons are performed between microscale Large Eddy Simulations (LES) using an Actuator Disc model (ACD), mesoscale simulations in the Weather Research and Forecasting Model (WRF) using a wind turbine parameterization, production data as well as wind measurements in the wind farm wake. The LES is manually set up according to the wind conditions obtained from the mesoscale simulation as a first step towards a meso/microscale coupling. The LES using an ACD are performed in the EllipSys3D code. A forced boundary layer (FBL) approach is used to introduce the desired wind shear and the atmospheric turbulence field from the Mann model. The WRF uses a wind turbine parameterization based on momentum sink. To make comparisons with the LESs and the site data possible an idealized setup of WRF is used in this study. The case studied here considers a westerly wind direction sector (at hub height) of 270 ± 2.5 degrees and a wind speed of 8 ± 0.5 m/s. For both the simulations and the site data a neutral atmosphere is considered. The simulation results for the relative production as well as the wind speed 2 km and 6 km downstream from the wind farm are compared to site data. Further comparisons between LES and WRF are also performed regarding the wake recovery and expansion. The results are also compared to an earlier study of HR using LES as well as an earlier comparison of LES and WRF. Overall the results in this study show a better agreement between LES and WRF as well as better agreement between simulations and site data. The procedure of using the profile from WRF as inlet to LES can be seen as a simplified coupling of the models that could be developed further to combine the methods for cases of farm to farm interaction.

Background and purpose: Leptin predicts cardiovascular diseases and type 2 diabetes, diseases to which Asian Indians are highly susceptible. As a risk marker, leptin's intra-individual and seasonal stability is unstudied and only small studies have compared leptin levels in Asian Indians with other populations. The aim of this study was to explore ethnicity related differences in leptin levels and its intra-individual and seasonal stability. Methods: Leptin and anthropometric data from the northern Sweden MONICA (3513 Europids) and the Mauritius Non-communicable Disease (2480 Asian Indians and Creoles) studies were used. In both studies men and women, 25- to 74-year old, participated in both an initial population survey and a follow-up after 5–13 years. For the analysis of seasonal leptin variation, a subset of 1780 participants, 30- to 60-year old, in the Västerbotten Intervention Project was used. Results: Asian Indian men and women had higher levels of leptin, leptin per body mass index (BMI) unit (leptin/BMI) or per cm in waist circumference (WC; leptin/waist) than Creoles and Europids when adjusted for BMI (all P<0.0005) or WC (all P<0.005). In men, Creoles had higher leptin, leptin/BMI and leptin/waist than Europids when adjusted for BMI or WC (all P<0.0005). In women, Creoles had higher leptin/BMI and leptin/waist than Europids only when adjusted for WC (P<0.0005). Asian Indian ethnicity in both sexes, and Creole ethnicity in men, was independently associated with high leptin levels. The intra-class correlation for leptin was similar (0.6–0.7), independently of sex, ethnicity or follow-up time. No seasonal variation in leptin levels was seen. Conclusion: Asian Indians have higher levels of leptin, leptin/BMI and leptin/waist than Creoles and Europids. Leptin has a high intra-individual stability and seasonal leptin variation does not appear to explain the ethnic differences observed here.