Background Whether all domains of daily‐life moderate‐to‐vigorous physical activity ( MVPA ) are associated with lower blood pressure ( BP ) and how this association depends on age and body mass index remains unclear. Methods and Results In the population‐based Lifelines cohort (N=125 402), MVPA was assessed by the Short Questionnaire to Assess Health‐Enhancing Physical Activity, a validated questionnaire in different domains such as commuting, leisure‐time, and occupational PA . BP was assessed using the last 3 of 10 measurements after 10 minutes’ rest in the supine position. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or use of antihypertensives. In regression analysis, higher commuting and leisure‐time but not occupational MVPA related to lower BP and lower hypertension risk. Commuting‐and‐leisure‐time MVPA was associated with BP in a dose‐dependent manner. β Coefficients (95% CI ) from linear regression analyses were −1.64 (−2.03 to −1.24), −2.29 (−2.68 to −1.90), and finally −2.90 (−3.29 to −2.50) mm Hg systolic BP for the low, middle, and highest tertile of MVPA compared with “No MVPA ” as the reference group after adjusting for age, sex, education, smoking and alcohol use. Further adjustment for body mass index attenuated the associations by 30% to 50%, but more MVPA remained significantly associated with lower BP and lower risk of hypertension. This association was age dependent. β Coefficients (95% CI ) for the highest tertiles of commuting‐and‐leisure‐time MVPA were −1.67 (−2.20 to −1.15), −3.39 (−3.94 to −2.82) and −4.64 (−6.15 to −3.14) mm Hg systolic BP in adults <40, 40 to 60, and >60 years, respectively. Conclusions Higher commuting and leisure‐time but not occupational MVPA were significantly associated with lower BP and lower hypertension risk at all ages, but these associations were stronger in older adults.

Aims: To investigate prospectively the association of body fat percentage (BF%) estimates using various equations from bioelectrical impedance analysis (BIA) with cardiovascular events, compared with body mass index (BMI) and waist circumference. Methods and results: We used data of 34 BIA-BF%-equations that were used for estimation of BF% in 6486 (men ¼ 3194, women ¼ 3294) subjects. During a median follow-up of 8.3 years, 510 (7.9%) cardiovascular events (363 in men; 147 in women) occurred. In men, the crude hazard ratio (95% confidence interval) for BF% from the best predicting BIA-BF%-equation was 3.97 (3.30-4.78) against 2.13 (1.85-2.45) for BF% from the BIA device's BIA-BF%equation, 1.34 (1.20-1.49) for BMI and 1.49 (1.40-1.73) for waist circumference per log-1-SD increase of all. In women, the hazard ratios for best predicting BIA-BF%-equation, BIA device estimation, BMI and waist circumference were 3.80 (2.85-4.99), 1.89 (1.57-2.28), 1.35 (1.21-1.51) and 1.52 (1.31-1.75), respectively. After adjustments for age, Framingham cardiovascular disease risk score and creatinine excretion -a marker of muscle mass -BF%s and BMI remained independently associated with cardiovascular events in both men and women, while waist circumference was independently associated with cardiovascular events in men, but not in women. According to discrimination ability (C-index) and additive predictive value (net reclassification index and integrated discrimination index) on obesity measures to the Framingham cardiovascular disease risk score, BF% was superior to BMI and waist circumference in both men and women. Conclusions: BF% was independently associated with future cardiovascular events. Body fat estimates from the bestpredicting BIA-BF%-equations can be a more predictive measurement in cardiovascular risk assessment than BMI or waist circumference.

Specific author contributions: Oyuntugs Byambasukh analyzed the data, designed the study's analytic strategy, and interpreted the results. Dorien Zelle contributed to the hypothesis and edited the manuscript. Eva Corpeleijn planned and designed the study, analyzed the data, directed its implementation, and reviewed the manuscript.

(1) Background: Little is currently known about the health impacts of daily-life moderate-to-vigorous physical activity (MVPA) in relation to the development of post-transplant diabetes mellitus (PTDM) and the long-term survival of renal transplant recipients (RTRs). (2) Methods: We analyzed self-reported data on MVPA within non-occupational and occupational domains, estimated with the SQUASH questionnaire, from a prospective cohort study of RTRs (n = 650) with a functioning graft exceeding 1 year. PTDM diagnoses were based on plasma glucose levels (≥126 mg/dL), HbA1c (≥6.5%), and the use of antidiabetic medication. Mortality data were retrieved from patient files up to the end of September 2015. (3) Results: During a median follow-up period of 5.3 years, 50 patients (10%) developed PTDM and 129 (19.8%) died. Of these deaths, 53 (8.9%) were caused by cardiovascular disease. Cox regression analyses showed that higher MVPA levels among patients were associated with a lower risk of PTDM (hazard ratio (HR); 95% confidence interval (95%CI) = 0.49; 0.25–0.96, p = 0.04), cardiovascular- (0.34; 0.15–0.77, p = 0.01), and all-cause mortality (0.37; 0.24–0.58, p < 0.001) compared with No-MVPA patients, independently of age, sex, and kidney function parameters. Associations of MVPA with cardiovascular and all-cause mortality remained significant and materially unchanged following further adjustments made for transplant characteristics, lifestyle factors, metabolic parameters, medication use, and creatinine excretion (muscle mass). However, the association between MVPA and PTDM was no longer significant after we adjusted for metabolic confounders and glucose levels. (4) Conclusion: Higher MVPA levels are associated with long-term health outcomes in RTRs.

Purpose To compare the differences in lifestyle behaviours between cancer survivors (CSs) and cancer-free participants in a large and representative population-based cohort. Methods We included 115,257 adults from the Lifelines cohort. Cancer status was self-reported, and health behaviours were measured (e.g. body mass index [BMI]) or assessed by questionnaire (e.g. physical activity, smoking, alcohol consumption, sedentary behaviour and diet). The data were then categorised for logistic regression analysis, stratified and adjusted by sex and age (< 55 vs ≥ 55 years). Results CSs (5473; 4.7%) were diagnosed 9 ± 8.5 years before data collection, were older (mean age 55.4 vs 44.4 years) and more often female (66.6% vs 33.4%) than the cancer-free participants. They were also more likely to be physically active and to have a better diet, and also less likely to be alcohol drinkers; but, were more likely to have a higher BMI, be former smokers and to be sedentary. After adjustment for sex and age, however, BMI was more likely to be normal, physical activity was more likely to be higher and smoking to be prevalent in CSs. Current smoking was also significantly higher among females and those aged < 55 years who were CSs than for those with no history of cancer. Conclusions In this population-based cohort, CSs have health behaviour comparable to those without a cancer diagnosis. Implications for cancer survivors Smoking cessation strategies should target all CSs, but efforts could yield greatest benefit if they target females and those younger than 55 years.

Mongolia ranks third in the world in stroke-related deaths. Loss of skeletal muscle mass and function, known as sarcopenia, is associated with a higher risk of various metabolic disorders such as stroke. Thus, screening of sarcopenia is important. Hand-grip strength (HGS) can be used to predict sarcopenia in the short term. In this cross-sectional study, we used data (n=1180, mean age of 39.2 ± 15.2 and 33.2% males) from the Mon-Timeline cohort study, a multidisciplinary, prospective, population-based cohort study in Mongolia. A digital grip strength dynamometer (TKK 5401 GRIP D; Takei, Japan) was used to measure HGS. We performed binary logistic regression analysis between HGS and stroke risk. Suspected sarcopenia was defined when HGS is less than the 25th percentile of HGS. In this study, 3.3% of all participants had a stroke. The incidence of stroke was significantly higher (5.2% and 1.9%) in people with suspected sarcopenia. According to body composition, the incidence of stroke was more frequent in sarcopenic obese people: 1.3%, 2.4%, 2.8% and 6.2% in normal (non-obese and non-sarcopenic), sarcopenic (non-obese), obese (non-sarcopenic) and sarcopenic obese groups, respectively. In regression analysis, the OR (95% CI) was 2.84 (1.44; 5.59) for sarcopenic compared with non-sarcopenic. The adjustments for age, gender, education, body mass index, waist circumference and hypertensive status attenuated the associations, but lower HGS remained significantly associated with a higher risk of stroke. In conclusion, lower HGS was significantly associated with a higher risk of stroke independent of adiposity and hypertensive status in Mongolian adults.

(1) Background: The “Ger Recommendations” have been advised to promote a healthy diet in Mongolia. These recommendations emphasize the ratio of six macro-food components to ensure proper nutrition. In this study, the ratio of these six groups to the total daily caloric intake was determined. (2) Methods: This study was conducted as part of a study at the Clinical Cohort (“Mon-Timeline”) of the Mongolian National University of Medical Science. A macro-community ratio was calculated using a 24-h dietary recall diary of a total of 498 people. (3) Results: The mean age of the study participants was 43.9 ± 12.9 years. Among them, 21.8% (n = 110) were male. Of the total calories, 44.7% were grains, 29.2% were meat and protein products, 9.3% were fats, 7.1% were dairy products, 6.6% were vegetables, and 3.1% were fruits. According to the ratio of the six groups in the Ger Recommendations, meat and grains exceeded the recommended amount, while fruits, milk, and vegetables were consumed less. It has been observed that the older a person ages, the closer they are to following these recommendations. In terms of gender, women consumed more fruit and milk than men. (4) Conclusions: The ratio of macronutrients in the daily caloric intake of Mongolians is inadequate. Therefore, knowledge about the “Ger Recommendations” needs to be studied in relation to people’s healthy eating knowledge and attitudes. If necessary, the appropriate awareness needs to be increased to educate the public on proper eating habits.

People with diabetes have a higher risk of cognitive impairment than people without diabetes, and recently it is being considered a complication of diabetes mellitus (DM). Because of drastic lifestyle changes in the Mongolian population, diabetes prevalence is increasing rapidly. The rapid increase of diabetes prevalence and its poor control in Mongolia suggest that there might be significant cognitive impairment in the diabetes population. In this case-control study, we compared the Mini-Mental State Examination score to the risk of cognitive impairment, indicating vascular dementia in people with and without diabetes. Upon obtaining their informed consent, each subject was tested with Mini-Mental State Examination. We involved age and gender-matched diabetic (n = 131) and non-diabetic (n = 131) subjects. The mean age was 61.3 ± 8.5 and 61.0 ± 8.7 in people with and without diabetes, respectively, and 35.9% of the participants were male. According to study groups, the Mini-Mental State Examination scores were significantly different: 26.1 ± 3.7 and 27.5 ± 2.6 for people with and without diabetes, respectively. In logistic regression analysis, age was significantly associated with Mini-Mental State Examination score (Beta coefficient = 1.22; 1.11-1.35, P < 0.001) in people without diabetes after adjustments for potential confounders. However, age was not significantly associated with MMSE scores in people with diabetes mellitus. Thus, diabetes duration and poor control may contribute to developing cognitive impairment in people with diabetes. In conclusion, there might be a high prevalence of vascular dementia in people with type 2 diabetes mellitus. However, since Mini-Mental State Examination is sensitive to dementia and not specific to vascular dementia, further studies involving neuroimaging and neurological examination are needed to fully elucidate the link between type 2 diabetes and vascular dementia in dementia in a Mongolian population.