Ahmed Ali Madar

• Heen, Espen Kolstad; Kalvik, Skjalg Tønnessen; Clarke, Sara; Davis, Rachel C.; List, Saskia S. & Chappell, Kendal Gordon [Show all 10 contributors for this article] (2026). Design, methods and populations of the CURV-24 study: a global systematic review and meta-analysis of 24-h urine volume and creatinine excretion in community-dwelling adults. Frontiers in Public Health. 14, p. 1–17. doi: 10.3389/fpubh.2026.1892695. Full text in Research Archive Show summary

  Introduction Urinary biomarker concentrations are increasingly used to assess intake, exposure or excretion, often by applying pre-specified 24-h urine volume values or normalization to creatinine based on prediction-derived estimates. However, both urine volume and creatinine excretion rates can vary substantially by sex, BMI, protein and salt intake, ethnicity, food culture, and short- and long-term climate. Ignoring such population-level differences may bias temporal, spatial, and cross population comparisons and undermine the validity of fixed reference ranges. CURV-24 is a global systematic review and meta-analysis designed to investigate this variability and its determinants in community-dwelling populations. The aim of the current article is to present the design and methods of CURV-24. We further describe the included studies and populations. Taken together, readers should be positioned to assess the quality and representativeness of the study data in the forthcoming meta-analyses. Methods Using a broad, piloted syntax, we searched multiple bibliographic databases and registries (Medline, Embase, Web of Science, WHO Global Index Medicus, EBSCO Global Health, Cochrane, PROSPERO) without lan guage restrictions. Records published between 2015 and 2024 were investigated. We included primary studies with at least one timed 24-h urine collection from non-manipulated everyday conditions. Extensive efforts were made to identify companion reports and complementary datasets from authors and repositories. A tailored risk-of-bias and certainty-of-evidence framework, adapted from Grading of Recommendations Assessment, Development and Evaluation (GRADE), was developed to address population, collection, and analytical biases. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) have guided the development and reporting plans of the project. Results The final dataset comprises 212 studies from 71 countries and 234 national populations, including approximately 270,000 individuals, of whom three-quarters were studied after 2010. About half of the studies examined more than 200 participants and one third used census-based probability sampling. Complete subpopulation data by sex, age, location, and ethnicity are available from a substantial subset of studies. Discussion CURV-24 provides the most extensive synthesis to date of 24-h urine volume and creatinine excretion in populations worldwide. The project is positioned to improve hydration adjustment of urinary biomarkers, challenge fixed “one-size fits-all” assumptions and inform future best-practice guidelines in epidemiologi cal biomarker research. Looking ahead, CURV-24 has the potential to generate hypotheses on the relationship between climate and human hydration. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024495900 .

• Davis, Rachel; List, Saskia S.; Chappell, Kendal Gordon; Madar, Ahmed Ali; Henjum, Sigrun & Heen, Espen Kolstad (2026). Evaluating the performance of a custom GPT in full text screening of a systematic review. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948261423410. Full text in Research Archive Show summary

  Aim: Systematic reviewing is a time-consuming process that can be aided by artificial intelligence (AI). There are several AI options to assist with title/abstract screening, however options for full text screening are limited. The objective of this study was to evaluate the performance of a custom generative pretrained transformer (cGPT) for full text screening. Methods: A cGPT powered by OpenAI’s ChatGPT4o was tested with subsets of articles assessed in duplicate by human reviewers. Outputs from the testing subset were coded to simulate cGPT as an autonomous and an assistant reviewer. Cohen’s kappa was used to assess interrater agreement. Results: For the inclusion/exclusion decision, the human–human kappa scores ranged from 0.87 to 0.96, exceeding the ranges of kappa scores for autonomous cGPT–human pairings (0.59 to 0.67) and assistant cGPT–human pairings (0.62 to 0.72). For exclusion reason classification, the human–human kappa scores ranged from 0.71 to 0.78, exceeding the ranges of kappa scores for autonomous cGPT–human pairings (0.47 to 0.53) and assistant cGPT–human pairings (0.52 to 0.63). Conclusions: The assistant cGPT outperformed the autonomous cGPT. An assistant cGPT could speed up systematic reviewing in a sufficiently reliable manner, however, further research is needed to establish standardized thresholds for practical use. Improved speed of systematic reviewing has implications for directing timely public health policy decisions.

• Madar, Ahmed Ali; Labidi, Firass Al; Samia, Filali & Meyer, Haakon Eduard (2025). Vitamin D Status and SARS-CoV-2 Positivity in Lebanon Among Adults: A Cross-Sectional Study in South Lebanon. COVID. 5(7). doi: 10.3390/covid5070097. Full text in Research Archive Show summary

  Background: The COVID-19 pandemic has affected countries globally, causing significant respiratory tract symptoms, including shortness of breath, coughing, chest tightness, and wheezing. Vitamin D has been proposed to play a key role, especially in upper respiratory tract infections. Recently, numerous studies and reports associating low serum 25-hydroxyvitamin D levels (s-25-(OH)D) and adverse outcomes in COVID-19 have emerged. We aimed to assess the association between vitamin D status and SARS-CoV-2 positivity among adults in Lebanon. Method: A cross-sectional study was conducted, recruiting 384 participants aged 18–75 years from a university hospital in South Lebanon. Background variables were collected through structured questionnaires. Serum 25(OH)D levels were measured using electrochemiluminescence immunoassay, and SARS-CoV-2 positivity was assessed through PCR testing. Results: The mean s-25(OH)D level was 46.8 nmol/L (SD 28.1), and 30% of the participants had vitamin D deficiency (s-25-(OH)D level <30 nmol/L). SARS-CoV-2 positivity was reported in 28% of participants. However, no significant association was found between s-25(OH)D levels and SARS-CoV-2 positivity. This study had several limitations, including potential selection bias due to recruiting participants from a hospital for PCR testing, the collection of data across different seasons, and the refusal of several eligible individuals to participate. Additionally, the lack of data on participants’ immunization status and assay variability may impact the generalizability and interpretation of the findings. Conclusion: There was a high prevalence of vitamin D insufficiency among adults participating in COVID-19 tests in Lebanon, but it was not associated with SARS-CoV-2 positivity.

• Andersen, Eivind; Bøhler, Linn; Leirbakk, Maria J.; Cabral, Danielle; Wedegren, Mia C. & Wieland, Mark L. [Show all 8 contributors for this article] (2025). Effects of a lifestyle programme on accelerometer-measured physical activity level and sedentary time on overweight and obese women of Somali background living in Norway. BMC Public Health. 25(1), p. 1–11. doi: 10.1186/s12889-025-22475-z. Full text in Research Archive Show summary

  Background Given the elevated prevalence and impact of overweight and the potential risk of non-communicable diseases among women of Somali background in high-income countries and recognising the potential positive impact of physical activity (PA) on these health conditions, it becomes imperative to focus on understanding the PA behaviour of this specific population. The objectives of this paper were twofold: firstly, to provide a comprehensive description of both objectively and subjectively measured PA level and sedentary time in a group of overweight women of Somali background in Norway, and secondly, to assess the effectiveness of a tailored, culturally sensitive, community-based intervention in increasing PA and reducing sedentary time. Methods 169 overweight women of Somali background in Norway were randomised by borough to either a lifestyle programme or a comparison group. The programme consisted of two sessions per week for 12 weeks, combining classroom discussion with graded group-based PA led by coaches, followed by monthly sessions over nine months. PA was measured objectively using the ActivPAL monitor and subjectively using the international PA questionnaire short form (IPAQ-SF) at baseline and 12 months after baseline. Results The women took on average 6804 (SD = 3286) steps per day and were sedentary for 9.1 (SD = 3) hours per day at baseline. There were no differences between groups on any accelerometer measured PA variable at any timepoint. There were significant differences on vigorous intensity PA (25.9 min; 95% CI 7.7, 44.1) and total PA (77.6 min; 95% CI 13.2, 142.1) at the 12-month measurement session between the two groups using the IPAQ-SF. Conclusion Despite observing initially low PA levels and high sedentary time at baseline and thus a considerable potential for intervention, the intervention failed in attaining an increase in accelerometer measured PA or reduction in sedentary time compared to the control condition. However, self-reported measures indicated success in these aspects. The potential threats to the programme’s reliability and validity include high drop-out rates possible due to the COVID-19 pandemic, contamination and low attendance rates. These challenges underscore the complexity of interventions in this demographic, emphasising the need for further exploration and refinement of methodologies to effectively enhance PA levels and reduce sedentary time in immigrant women living in high-income countries.

• Semsarian, Sepideh; Omsland, Tone Kristin; Heen, Espen Kolstad; Madar, Ahmed Ali; Frihagen, Frede & Gjertsen, Jan-Erik [Show all 14 contributors for this article] (2024). Subsequent fracture risk in Norwegians and immigrants with an index forearm fracture: a cohort study. Archives of Osteoporosis. ISSN 1862-3522. 19(1), p. 1–10. doi: 10.1007/s11657-024-01419-x. Full text in Research Archive Show summary

  Summary: The current study investigated subsequent fracture risk following a forearm fracture in three country of birth categories: Norway, Europe and North America, and other countries. Subsequent fracture risk was modestly higher in Norwegian-born individuals compared to the two other groups. Secondary fracture prevention should be recommended regardless of country background. Background: Fracture risk is higher in patients with a previous fracture, but whether subsequent fracture risk differs by origin of birth is unknown. This study explores subsequent fracture risk in patients with an index forearm fracture according to region of birth. Methods: Nationwide data on forearm fractures in patients ≥ 18 years in 2008–2019 were obtained from the Norwegian Patient Registry and Statistics Norway. Index fractures were identified by ICD-10 code S52, whereas subsequent fractures included any ICD-10 fracture code. Data on country of birth were from Statistics Norway and included three regional categories: (1) Norway, (2) other Europe and North America and (3) other countries. Direct age standardization and Cox proportional hazard regression were used to analyse the data. Results: Among 143,476 individuals with an index forearm fracture, 35,361 sustained a subsequent fracture. Norwegian-born forearm fracture patients had the highest subsequent fracture rates (516/10,000 person-years in women and 380 in men). People born outside Europe and North America had the lowest rates (278/10,000 person-years in women and 286 in men). Compared to Norwegian-born individuals, the hazard ratios (HRs) of subsequent fracture in individuals from Europe and North American were 0.93 (95% CI 0.88–0.98) in women and 0.85 (95% CI 0.79–0.92) in men. The corresponding HRs in individuals from other countries were 0.76 (95% CI 0.70–0.84) in women and 0.82 (95% CI 0.74–0.92) in men. Conclusion: Individuals born outside Norway had a lower subsequent fracture risk than Norwegian-born individuals; however, subsequent fracture risk increased with age in all groups. Our results indicate that secondary fracture prevention should be recommended regardless of region of origin.

• Bøhler, Linn; Meyer, Haakon Eduard; Stigum, Hein; Leirbakk, Maria Jensberg; Cabral, Danielle & Wedegren, Mia Charlott [Show all 9 contributors for this article] (2024). A controlled weight loss intervention study among women of Somali background in Norway. Journal of Migration and Health. 9. doi: 10.1016/j.jmh.2024.100231. Full text in Research Archive Show summary

  Background: Women of Somali background in Norway have a high prevalence of overweight and obesity, compared with women in the general Norwegian population. For lifestyle interventions to be applicable for immigrants to Norway, it is important to culturally tailor interventions in collaboration with relevant communities. The primary outcome was a difference in weight change between the intervention and control groups. Methods: In this interventional study, Somali women living in one borough of Oslo Municipality in Norway with body mass index (BMI) ≥27.0 kg.m-2 received a co-created, culturally tailored 12-month weight loss intervention consisting of 24 interactive sessions during the first three months, and monthly sessions for the next nine months, compared to a control group. Both groups were measured at baseline and 12 months. Results: A total of 169 participants were recruited, and 101 participants completed the follow-up. After multiple imputation, the mean difference in weight change adjusted for baseline weight, age, education, employment, marital status, number of children in the household and length of Norwegian residency was -1.6 kg (95 % CI -3.57, 0.43, p = 0.12) in the intervention compared to the control group. Conclusion: This culturally tailored intervention study demonstrated a modest non-significant effect on weight change after 12 months, possibly due to the short intervention duration and COVID-19. Further studies of a longer duration and considering the provision of childcare are needed to understand whether this approach can be transferred to other immigrant groups and genders.

• 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).

• Mohamed, Abdirahman Saeed; Bjertness, Espen; Htet, Aung Soe; Aye, Win Thuzar & Madar, Ahmed Ali (2024). Attitudes towards wife-beating justification and its association with female genital mutilation – analysis of ever-married Somali women in the 2020 Somali Health and Demographic Survey. International Health. ISSN 1876-3413. 17(3), p. 251–258. doi: 10.1093/inthealth/ihae047. Full text in Research Archive Show summary

  Background - In Somalia, despite its prohibition, female circumcision persists alongside significant intimate partner violence. This study examines the prevalence of wife-beating justification among Somali women and its link to the perception that female genital mutilation/cutting (FGM/C) is a religious obligation.<p> <p>Methods - We studied 7726 married Somali women 15–49 y of age from the 2020 Somali Health and Demographic Survey. Using χ2 tests and logistic regression, we examined wife-beating justification by covariates and its connection to the perception that FGM/C is a religious obligation.<p> <p>Results - The prevalence of women justifying wife-beating for any of six reasons was 56.5% (95% confidence interval [CI] 55.3 to 57.6). A higher prevalence of wife-beating justification was found among women 35–49 y of age (59.9% [95% CI 57.8 to 61.9]), without education (57.7% [95% CI 56.5 to 59.0]), rural residents (57.8% [95% CI 56.3 to 59.2]), with lower socio-economic status (60.4% [95% CI 58.7 to 62.1]) and married before age 18 y (58.4% [95% CI 56.7 to 60.1]). Adjusted for covariates, logistic regression analyses indicated a significant association between wife-beating justification and the belief that FGM/C is mandated by religion (adjusted odds ratio 1.40 [95% CI 1.17 to 1.68], p<0.001).<p> <p>Conclusions - Wife-beating justification is alarmingly common among Somali women and significantly associated with the belief that FGM/C is mandated by religion. Further research is necessary to investigate the drivers behind the acceptance of domestic violence, its impact on women's mental health and well-being and its association with FGM/C acceptance.

• 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.

• Dahroug, Abdelrahman Eid Mohamed Ismail; Heen, Espen Kolstad; Hussein, Mohamed A. & Madar, Ahmed Ali (2024). Dental caries status and related factors among 12-year-old Somali school children in Hargeisa. Community Dentistry and Oral Epidemiology. ISSN 0301-5661. 52(6). doi: 10.1111/cdoe.12990. Full text in Research Archive Show summary

  Objectives There is little data on the oral health conditions of Somali children. The aim was to assess the dental caries status and related risk factors of 12-aged children in primary schools in Hargeisa, Somaliland. Methods A school-based survey was conducted in Hargeisa in December 2022. Using 2-stage cluster sampling, 405 children (12-aged) were randomly selected from 16 primary schools. Data collection involved WHO structured interviewer-administered questionnaire and clinical examinations. The DMFT index was measured according to WHO criteria, and accordingly, the mean for the significant caries index (SiC) was calculated. The association between the DMFT and the relevant variables was analysed using negative binomial regression in STATA. Results The overall prevalence of dental caries was found to be 62.7%, with a mean DMFT of 1.7 and a SiC score of 3.7. Non-public school pupils showed significantly higher prevalence of dental caries and mean DMFT compared to public school counterparts (68.5% vs. 58.6%) and (1.91 vs. 1.48), respectively. Merely 14.7% of the participants utilized dental care services in the previous year. The multivariable analysis showed a significant positive association of the DMFT outcome with attending a non-public school (95% CI 1.16–2.12) and having many previous dental visits (95% CI 1.22–2.83). In the adjusted model, fathers of low education had children with better dental caries status (lower mean DMFT) than their well-educated counterparts. The mean DMFT was not significantly influenced by the factors sex, location, educational attainment (school class of the participants) and frequency of teeth cleaning. Conclusion Although the overall mean DMFT of school children in Hargeisa could be regarded low, the high levels of untreated caries especially in the one-third most affected are a cause for concern. Children enrolled in non-public schools formed the high-risk group. Preventive oral public health programs targeting Somali school children are recommended.

• 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.

• Madar, Ahmed Ali; Brux, Christina Marie; Wedegren, Mia Charlott; Rangsvåg, Hege; Ek, Nina Lilly & Thompson, Anna Lorraine (2023). Barriers and facilitators to physical activity and healthy eating: A qualitative study among Somali women in Oslo, Norway. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 20, p. 7–11. doi: 10.18261/ntfe.21.1. Full text in Research Archive Show summary

  Background: In Norway, the proportion of overweight and obesity in the population is increasing with a significant social gradient and women from certain non-Western immigrant groups are particularly vulnerable. Few studies have investigated lifestyle changes related to physical activity and diet among immigrants. This study aimed to investigate the facilitators and barriers to a healthy diet and physical activity among Somali women in Norway. Method: This study used a qualitative design, where two focus group discussions (FGDs) were conducted among Somali women in Oslo to examine their perspectives and perceptions regarding barriers and facilitators to healthy eating and physical activity, as well as their suggestions to resolve these. Results: The study generated insight into several factors of potential importance for dietary habits and physical activity, including knowledge of nutrition, food culture and traditions, familial influence and challenges related to economy, religion, and language. Discussion: Somali women in Oslo experience several barriers to healthy eating and physical activity. The findings of this study emphasize the importance of culturally tailored and language-specific preventive health programs, designed to meet the unique needs of this group. These findings can contribute to the design and implementation of health interventions aimed at Somali and potentially other immigrant groups.

• 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.

• Madar, Ahmed Ali; Kurniasari, Astrid; Marjerrison, Niki & Mdala, Ibrahimu (2023). Breastfeeding and Sleeping Patterns Among 6–12-Month-Old Infants in Norway. Maternal and Child Health Journal. ISSN 1092-7875. doi: 10.1007/s10995-023-03805-2. Full text in Research Archive
• Bohler, Linn; Meyer, Haakon E.; Leirbakk, Maria J.; Wedegren, Mia Charlott; Rangsvåg, Hege G. & Kjøllesdal, Marte Karoline Råberg [Show all 8 contributors for this article] (2023). Risk factors for non-communicable diseases among overweight and obese women of Somali background in Oslo, Norway. Clinical Epidemiology and Global Health. ISSN 2452-0918. 23. doi: 10.1016/j.cegh.2023.101384. Full text in Research Archive Show summary

  Background Non-communicable diseases (NCDs) are the most common causes of morbidity and mortality globally. Somalis are a relatively new immigrant group in Norway and knowledge about their health status and risk factors for NCDs is limited. This study aimed to determine the prevalence of selected risk factors for NCDs among overweight and obese women of Somali background in Oslo, Norway. Methods Baseline data of an exercise intervention study among women of Somali background (n = 168, recruited between September 2020 and September 2022). Body mass index (BMI) (kg/m2), waist-hip-ratio (WHR), blood pressure, glycated hemoglobin (HbA1c), non-fasting glucose, and blood lipids were measured. Results Mean (SD) age was 46.8 years (10.4) and BMI was 33.9 kg/m2 (5.1). Mean total cholesterol (TC), low-density lipoprotein (LDL), HbA1c, non-fasting glucose, and blood pressure were within the normal range on average. Per one unit increase in BMI systolic blood pressure (SBP) increased by 0.89 mm/Hg (95%CI: 0.35−1.44, P = 0.002) and diastolic blood pressure (DBP) increased by 0.46 mm/Hg (95%CI: 0.17−0.75 P = 0.002). No relation between BMI and HbA1c, blood lipids, age, education level, number of children in the household, or length of residence in Norway was found. Conclusion Despite the high BMI, most of the selected risk factors for NCDs had mean values within the normal range. The participants had a low prevalence of diabetes type 2 and hyperlipidemia, although there was a moderate association between BMI and blood pressure. This indicates that it is possible to be obese and be of relatively good health in this population.

• Czapka, Elzbieta; Herrero-Arias, Raquel; Younes, Jasmin Haj; Hasha, Wegdan Hamed Nasser; Madar, Ahmed Ali & Møen, Kathy Ainul Mashrooka [Show all 8 contributors for this article] (2022). ‘Who is telling the truth?’ Migrants’ experiences with COVID-19 related information in Norway: a qualitative study. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948221135237. Full text in Research Archive Show summary

  Aims: The over-representation of migrants among those infected by COVID-19 in high-income countries has spurred questions about insufficient distribution of health information to society’s subgroups. Our study aimed to shed light on migrants’ experiences with information relating to COVID-19 in Norway. Methods: We conducted 55 semi-structured interviews with migrants from five different countries living in Norway: Somalia (10), Syria (15), Sri Lanka (10), Chile (10), and Poland (10). The interviews were performed by bilingual researchers with a migrant background, audio-recorded, transcribed and thematically analysed. Results: We identified the four key themes of multiple and contradictory information sources, language barriers, conspiracy theories/speculations, strategies for information provision and ways ahead. Participants accessed and combined several often transnational sources of information. Information was perceived as confusing and contradictory and there was a wish for more translated information. Conclusions: It is important to recognise the specific factors affecting migrants’ ability to receive, trust and use health-related information during pandemics and other health crises.

• Madar, Ahmed Ali; Benavente, Pierina; Czapka, Elżbieta; Herrero-Arias, Raquel; Younes, Jasmin Haj & Hasha, Wegdan Hamed Nasser [Show all 10 contributors for this article] (2022). COVID-19: information access, trust and adherence to health advice among migrants in Norway. Archives of Public Health. ISSN 0778-7367. 80(15). doi: 10.1186/s13690-021-00764-4. Full text in Research Archive Show summary

  Background Migrants in Norway bear a higher burden of COVID-19 infections and hospitalization as compared to non-migrants. The aim of our study was to understand how migrants perceive their own health risk, how they access information regarding the preventive measures, the degree of trust in this information, in the Norwegian authorities and the news media, and migrants’ adherence to authorities’ recommendations regarding the pandemic. Methods An online survey was performed between May and July 2020 among 529 Polish, Arabic, Somali, Tamil, and Spanish-speaking migrants in Norway. For each outcome presented in the aims, unweighted and weighted descriptive analyses were performed for all migrants together and for each language group. Results Sixty-one percent of migrants perceived their health as excellent or very good, with the lowest value (42%) in the Tamil group and the highest among Somalians (85%). The majority of respondents (82%) felt they had received sufficient information. Press conferences from the government, health authorities’ websites, and Norwegian news media were the preferred channels of information for all groups. Most migrants reported a high level of adherence to preventive measures (88%) and trust in Norwegian authorities (79%). However, there were variations among groups regarding the importance of sources of information and level of trust, which was lowest for the Polish group. Conclusion Migrants in Norway reported receiving sufficient information about COVID-19 and high adherence to preventive measures. However, the levels of trust in the information sources, the services and the authorities varied among the groups. Understanding how migrants are dealing with this pandemic is crucial to improve the dissemination of information and trust in the health authorities for the different groups.

• 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.

• 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.

• Heen, Espen Kolstad; Romøren, Maria; Yassin, Amal A & Madar, Ahmed Ali (2021). Household Water is the Main Source of Iodine Consumption Among Women in Hargeisa, Somaliland: A Cross-Sectional Study. Journal of Nutrition. ISSN 0022-3166. doi: 10.1093/jn/nxab377. Full text in Research Archive Show summary

  Background: Iodine status surveys of women in Somaliland present widely conflicting results. Previous research indicates elevated concentrations of iodine (IQR 18-72 µg/L) in groundwater used for drinking and cooking, but the relationship with iodine intake is not characterized well. Objective: We aimed to investigate the contribution of household water iodine concentration (WIC), breastfeeding, total fluid intake, hydration levels, and urine volume on urinary iodine concentration and excretion (UIC, UIE) during 24 hours, and to define iodine status from iodine intake estimates and median UIC, normalized to a mean urine volume of 1.38L/day (hydration-adjusted). Methods: The study sample comprised 118 nonpregnant, healthy women aged 15-69. All resided in Hargeisa; 27 breastfeeding. Data collection consisted of a 24-hour (24-h) urine collection, a 24-h fluid intake diary, a beverage frequency questionnaire, and a structured recall interview. We measured UIC and WIC in all urine and in 49 household-water samples using the Sandell-Kolthoff reaction. Results: WIC ranged between 3 and 188 μg/L, with significant median differences across the water sources and city districts (P

• Heen, Espen Kolstad; Madar, Ahmed Ali; Yassin, Amal A & Romøren, Maria (2021). Estimates of fluid intake, urine output and hydration-levels in women from Somaliland: a cross-sectional study. Journal of Nutritional Science (JNS). doi: 10.1017/jns.2021.54. Full text in Research Archive Show summary

  The study objective was to measure fluid intake and associations with background characteristics and hydration biomarkers in healthy, free-living, non-pregnant women aged 15–69 years from Hargeisa city. We also wanted to estimate the proportion of euhydrated participants and corresponding biomarker cut-off values. Data from 136 women, collected through diaries and questionnaires, 24h urine samples and anthropometric measurements, were obtained with a cross-sectional, purposeful sampling from fifty-two school and health clusters, representing approximately 2250 women. The mean (95 % CI) 24 h total fluid intake (TFI) for all women was 2⋅04 (1⋅88, 2⋅20) litres. In multivariate regression with weight, age, parity and a chronic health problem, only weight remained a predictor (P 0.034, B 0.0156 (l/kg)). Pure water, Somali tea and juice from powder and syrup represented 49⋅3, 24⋅6 and 11⋅7 % of TFI throughout the year, respectively. Mean (95 % CI) 24 h urine volume (Uvol) was 1⋅28 (1⋅17, 1⋅39) litres. TFI correlated strongly with 24 h urine units (r 0.67) and Uvol (r 0.59). Approximately 40 % of the women showed inadequate hydration, using a threshold of urine specific gravity (Usg) of 1⋅013 and urine colour (Ucol) of 4. Five percent had Usg > 1⋅020 and concomitant Ucol > 6, indicating dehydration. TFI lower cut-offs for euhydrated, non-breast-feeding women were 1⋅77 litres and for breast-feeding, 2⋅13 litres. Euhydration cut-off for Uvol was 0⋅95 litre, equalling 9⋅2 urine units. With the knowledge of adverse health effects of habitual hypohydration, Somaliland women should be encouraged to a higher fluid intake.

• Itkonen, Suvi T.; Andersen, Rikke; Björk, Anne K.; Konde, Åsa Brugård; Eneroth, Hanna & Erkkola, Maijaliisa [Show all 13 contributors for this article] (2020). Vitamin D status and current policies to achieve adequate vitamin D intake in the Nordic countries. Scandinavian Journal of Public Health. ISSN 1403-4948. p. 1–12. doi: 10.1177/1403494819896878. Full text in Research Archive Show summary

  Aims: Nordic countries share fairly similar food culture and geographical location as well as common nutrition recommendations. The aim of this paper was to review the latest data on vitamin D status and intake and to describe the national supplementation and food fortification policies to achieve adequate vitamin D intake in the Nordic countries. Methods: The data are based on results derived from a literature search presented in a workshop held in Helsinki in November 2018 and completed by recent studies. Results: Vitamin D policies and the implementation of the recommendations differ among the Nordic countries. Vitamin D fortification policies can be mandatory or voluntary and widespread, moderate or non-existent. Vitamin D supplementation recommendations differ, ranging from all age groups being advised to take supplements to only infants. In the general adult population of the Nordic countries, vitamin D status and intake are better than in the risk groups that are not consuming vitamin D supplements or foods containing vitamin D. Non-Western immigrant populations in all Nordic countries share the problem of vitamin D insufficiency and deficiency. Conclusions: Despite the common nutrition recommendations, there are differences between the Nordic countries in the implementation of the recommendations and policies to achieve adequate vitamin D intake and status. There is a need for wider Nordic collaboration studies as well as strategies to improve vitamin D status, especially in risk groups.

• Madar, Ahmed Ali; Heen, Espen Kolstad; Hopstock, Laila Arnesdatter; Carlsen, Monica Hauger & Meyer, Haakon E (2020). Iodine intake in Norwegian women and men: The population-based Tromsø Study 2015–2016. Nutrients. 12(11), p. 1–13. doi: 10.3390/nu12113246. Full text in Research Archive Show summary

  Ensuring sufficient iodine intake is a public health priority, but we lack knowledge about the status of iodine in a nationally representative population in Norway. We aimed to assess the current iodine status and intake in a Norwegian adult population. In the population-based Tromsø Study 2015–2016, 493 women and men aged 40–69 years collected 24-h urine samples and 450 participants also completed a food frequency questionnaire (FFQ). The 24-h urinary iodine concentration (UIC) was analyzed using the Sandell–Kolthoff reaction on microplates followed by colorimetric measurement. Iodine intake was estimated from the FFQ using a food and nutrient calculation system at the University of Oslo. The mean urine volume in 24 h was 1.74 L. The median daily iodine intake estimated (UIE) from 24-h UIC was 159 µg/day (133 and 174 µg/day in women and men). The median daily iodine intake estimated from FFQ was 281 µg/day (263 and 318 µg/day in women and men, respectively). Iodine intake estimated from 24-h UIC and FFQ were moderately correlated (Spearman rank correlation coefficient r = 0.39, <i>p</i> < 0.01). The consumption of milk and milk products, fish and fish products, and eggs were positively associated with estimated iodine intake from FFQ. In conclusion, this shows that iodine intake estimated from 24-h UIC describes a mildly iodine deficient female population, while the male population is iodine sufficient. Concurrent use of an extensive FFQ describes both sexes as iodine sufficient. Further studies, applying a dietary assessment method validated for estimating iodine intake and repeated individual urine collections, are required to determine the habitual iodine intake in this population.

• 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.

• Madar, Ahmed Ali; Strand, Bjørn Heine & Meyer, Haakon E (2020). Self-reported health and associated factors among the immigrant populations in Norway. Journal of Public Health (Berlin). ISSN 2198-1833. doi: 10.1007/s10389-020-01266-3. Full text in Research Archive Show summary

  Aim The immigrant population continues to increase in Norway, and Somali immigrants and their descendants are presently the largest non-Western group. We have limited knowledge about the health status in this population. The aim of this study was to assess self-perceived health status among Somalis in Norway. Method We used data from a study assessing risk factors for lifestyle diseases among Somali immigrants in Oslo, which was conducted between December 2015 and October 2016, among men and women aged 20–73 who were living in the Sagene borough in Oslo. Results The study population included 221 participants (112 females and 110 males). Overall, 78% of the participants (70% of females and 86% males) rated their health status as good or very good. Women had poorer self-reported health (p = 0.003) than men. Being unemployed and having diabetes, stress, and sleeping problems were associated with poor self-reported health, but time lived in Norway, education level, Norwegian language proficiency, and high BMI were not significantly associated. Around 2/3 of the participants reported being physically inactive, while around half reported walking or moving more than 30 min per day. Self-reported chronic diseases such as diabetes and hypertension were 5% and 9% respectively. Conclusion This study has shown the different patterns of self-reported health status among Somali immigrants in Norway, as associated with gender, age, psychosocial conditions, and employment status. Further research is needed to explain why Somali women in Norway have poorer self-reported health than men. The findings from this study should provide direction to healthcare providers for improving health among immigrants, for example through implementing a community-driven and culturally appropriate lifestyle intervention program.

• 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.

• Heen, Espen Kolstad & Madar, Ahmed Ali (2020). Bottled Water from National Manufacturers in Somaliland: Water Quality and Health Implications. ScienceOpen. ISSN 2199-1006. doi: 10.14293/S2199-1006.1.SOR-.PPRWQPU.v1. Full text in Research Archive
• Ahmed, Hassan Soheir; Marjerrison, Niki; Kjøllesdal, Marte Karoline Råberg; Stigum, Hein; Htet, Aung Soe & Bjertness, Espen [Show all 8 contributors for this article] (2019). Comparison of Cardiovascular Risk Factors among Somalis Living in Norway and Somaliland. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 16(13), p. 1–12. doi: 10.3390/ijerph16132353. Full text in Research Archive Show summary

  Objective: We aimed to assess and compare cardiovascular disease (CVD) risk factors and predict the future risk of CVD among Somalis living in Norway and Somaliland. Method: We included participants (20–69 years) from two cross-sectional studies among Somalis living in Oslo (n = 212) and Hargeisa (n = 1098). Demographic data, history of CVD, smoking, alcohol consumption, anthropometric measures, blood pressure, fasting serum glucose, and lipid profiles were collected. The predicted 10-year risk of CVD was calculated using Framingham risk score models. Results: In women, systolic and diastolic blood pressure were significantly higher in Hargeisa compared to Oslo (p &lt; 0.001), whereas no significant differences were seen in men. The ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol was significantly higher in Hargeisa compared to Oslo among both men (4.4 versus 3.9, p = 0.001) and women (4.1 versus 3.3, p &lt; 0.001). Compared to women, men had higher Framingham risk scores, but there were no significant differences in Framingham risk scores between Somalis in Oslo and Hargeisa. Conclusion: In spite of the high body mass index (BMI) in Oslo, most CVD risk factors were higher among Somali women living in Hargeisa compared to those in Oslo, with similar patterns suggested in men. However, the predicted CVD risks based on Framingham models were not different between the locations.

• Ahmed, Soheir H.; Meyer, Haakon E; Kjøllesdal, Marte Karoline Råberg; Marjerrison, Niki; Mdala, Ibrahimu & Htet, Aung Soe [Show all 8 contributors for this article] (2019). The prevalence of selected risk factors for non-communicable diseases in Hargeisa, Somaliland: a cross-sectional study. BMC Public Health. 19(1). doi: 10.1186/s12889-019-7101-x. Full text in Research Archive Show summary

  Background Non-communicable diseases (NCDs), particularly cardiovascular diseases, diabetes, respiratory conditions and cancers, are the most common causes of morbidity and mortality globally. Information on the prevalence estimates of NCD risk factors such as smoking, low fruit & vegetable intake, physical inactivity, raised blood pressure, overweight, obesity and abnormal blood lipid are scarce in Somaliland. The aim of this study was to determine the prevalence of these selected risk factors for NCDs among 20–69 year old women and men in Hargeisa, Somaliland. Methods A cross-sectional study was conducted in five districts of Hargeisa (Somaliland), using the STEPwise approach to noncommunicable disease risk factor surveillance (STEPS) to collect data on demographic and behavioral characteristics and physical measurements (n = 1100). The STEPS approach is a standardized method for collecting, analysing and disseminating data on NCD risk factor burden. Fasting blood sugar, serum lipids (total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides) were collected in half of the participants. Results The vast majority of participants had ≤1 serving of fruits daily (97.7%) and ≤ 1 serving of vegetables daily (98.2%). The proportion of participants with low physical activity levels was 78.4%. The overall prevalence of high salt intake was 18.5%. The prevalence of smoking and khat chewing among men was 27 and 37% respectively, and negligible among women. In women, the prevalence of hypertension increased from 15% in the age group 20–34 years to 67% in the age group 50–69 years, the prevalence of overweight and obesity (BMI ≥ 25 kg/m2) from 51 to 73%, and the prevalence of diabetes from 3 to 22%. Similar age-trends were seen in men. Conclusion Most of the selected risk factors for noncommunicable diseases were high and increased by age in both women and men. Overweight and obesity and low physical activity needs intervention in women, while hypertension and low fruit and vegetable consumption needs intervention in both men and women. Somaliland health authorities should develop and/or strengthen health services that can help in treating persons with hypertension and hyperlipidaemia, and prevent a future burden of NCDs resulting from a high prevalence of NCD risk factors.

• Chol, Ri Hak; Madar, Ahmed Ali; Slettedal, J.K; Bjertness, Kjersti B.; Sundby, Johanne & Bjertness, Espen (2019). Drivers of health transition in the DPRK. The Lancet Planetary Health. 3 (3), p. 118–119. doi: 10.1016/S2542-5196(19)30013-0. Full text in Research Archive
• Madar, Ahmed Ali; Meltzer, Helle Margrete; Heen, Espen K & Meyer, Haakon E (2018). Iodine Status among Somali Immigrants in Norway. Nutrients. 10(3). doi: 10.3390/nu10030305. Full text in Research Archive Show summary

  We lack knowledge about iodine status in the Norwegian population in general, and particularly among immigrants. We aimed to estimate the iodine status and potentially associated factors in a Somali population in Norway. Somali men and women aged 20–73, who were living in one district in Oslo, were recruited between December 2015 and October 2016. Twenty-four-hour urine was collected from 169 participants (91 females and 78 males). Iodine was analysed using the Sandell–Kolthoff reaction on microplates and colorimetric measurement. Information about diet was collected using a short food frequency questionnaire. Iodine intake was calculated from the 24-h iodine excretion. The mean urine volume over 24-h was 1.93 liters (min–max: 0.55–4.0) and the urinary iodine concentration (UIC) varied from 13 to 263 µg/L with a median value of 62.5 µg/L indicating a population with mild iodine deficiency. The median daily iodine intake for the study population was estimated to be 124 μg/day. Mean serum thyroid-stimulating hormone, thyroxine (T4) and triiodothyronine (T3) was 2.1 (SD 1.1) mU/L, 15.0 (SD 2.1) pmol/L, and 5.1 (SD 0.6) pmol/L, respectively. No food groups were associated with iodine intake and neither was gender, age, education level nor length of residence in Norway. In conclusion, this study showed that iodine intake was low, and a considerable proportion of the Somali population studied had sub-optimal iodine status. Monitoring of iodine status should be prioritised and measures to ensure adequate iodine intake, particularly among vulnerable groups initiated.

• Addawe, Mohammed-nur-Ahmed; Mburu, Christina Brux & Madar, Ahmed Ali (2018). Barriers to cervical cancer screening: A qualitative study among Somali women in Oslo Norway. Health and Primary Care (HPC). 2(1), p. 1–5. doi: 10.15761/HPC.1000128. Full text in Research Archive
• Chen, Sairah Lai Fa; Dahl, Cecilie; Meyer, Haakon E & Madar, Ahmed Ali (2018). Estimation of Salt Intake Assessed by 24-Hour Urinary Sodium Excretion among Somali Adults in Oslo, Norway. Nutrients. 10(7). doi: 10.3390/nu10070900. Full text in Research Archive Show summary

  High dietary salt intake is associated with increased blood pressure (BP) and cardiovascular disease (CVD) risk. The migration of Somalis from East Africa to Norway may have altered their dietary habits, making them vulnerable to adverse health outcomes. Since little is known about the lifestyle and health status of this population, the purpose of our study was to estimate salt intake in Somali adults in Oslo, Norway. In this cross-sectional study, we included 161 Somali adults (76 men, 86 women) from the Sagene borough in Oslo, Norway. Sodium and potassium excretion was assessed through the collection of 24-hour urine. Creatinine-based exclusions were made to ensure completeness of urine collections. Sodium excretion corresponding to an estimated dietary salt intake of 8.66 ± 3.33 g/24 h was found in men and 7.39 ± 3.64 g/24 h in women (p = 0.013). An estimated 72% of participants consumed >5 g salt/day. The Na:K ratio was 2.5 ± 1.2 in men and 2.4 ± 1.1 in women (p = 0.665). In conclusion, estimated salt intake was, while above the WHO recommendation, within the lower range of estimated salt intakes globally and in Western Europe. Further research is required to assess the health benefits of sodium reduction in this Somali immigrant population.

• Ahmed, Soheir Hassan; Meyer, Haakon E; Kjøllesdal, Marte Karoline Råberg & Madar, Ahmed Ali (2018). Prevalence and Predictors of Overweight and Obesity among Somalis in Norway and Somaliland: A Comparative Study. Journal of Obesity. ISSN 2090-0708. 2018. doi: 10.1155/2018/4539171. Full text in Research Archive Show summary

  Background and Aim: (e knowledge about the health status of Somalis in Norway and Somaliland is limited. (is paper reportsthe results of a comparative study on the prevalence and predictors of overweight/obesity among Somalis in Norway andSomaliland. Method: We conducted two cross-sectional studies using the same tools and procedures, between 2015 and 2016. (estudy population was adults aged 20–69 years (n�1110 (Somaliland) andn�220 (Norway)). Results: (e prevalence of obesity(body mass index (BMI)≥30 kg/m2) was 44% and 31% in women in Norway and Somaliland, respectively. In contrast, theprevalence of obesity was low in men (9% in Norway; 6% in Somaliland). Although the prevalence of high BMI was higher inSomali women in Norway than women in Somaliland, both groups had the same prevalence of central obesity (waist cir-cumference (WC)≥88 cm). In men, the prevalence of central obesity (WC≥102 cm) was lower in Somaliland than in Norway. Forwomen in Somaliland, high BMI was associated with lower educational level and being married. Conclusion: (e prevalence ofoverweight and obesity is high among Somali immigrants in Norway, but also among women in Somaliland. (e high prevalenceof overweight and obesity, particularly among women, calls for long-term prevention strategies.

• Larsen, Tine Mejdell; Mburu, Christina Brux; Kongelf, Anine; Tingberg, Tonje; Sannoh, Fatmata & Madar, Ahmed Ali (2017). Red Cross volunteers’ experience with a mobile community event- based surveillance (CEBS) system in Sierra Leone during-and after the Ebola outbreak- A qualitative study. Health and Primary Care (HPC). doi: 10.15761/hpc.1000114. Full text in Research Archive Show summary

  Purpose: The objective of this study was to explore the volunteers’ experiences with and perspectives on the community event-based surveillance system in Sierra Leone. Methods and materials: 62 volunteers from 14 different chiefdoms participated in in-depth interviews and focus group discussions, which were audio recorded and transcribed. A comprehensive and systematic thematic analysis was conducted, which identified key benefits and challenges. Results: The volunteers believe CEBS positively impacts their communities. CEBS increases knowledge and behavior change, contributing to the prevention of Ebola and other diseases and decreasing overall mortality. Volunteers are motivated to participate by an aspiration of helping their community, although many volunteers also participated in the hope of receiving monetary incentives. Communities were initially reluctant to participate in surveillance due to fear of Ebola, but acceptance increased with improved community engagement. Reporting by phone call and SMS was perceived as a quick and simple way of reporting, although challenges with access to mobile network, sim registration and cost for charging were identified. Many of the volunteers could not repeat or explain the different case definitions and explained reporting on symptoms solely or other health events, suggesting that the volunteers did not have a clear understanding of case definitions or purpose of CEBS. Conclusion: SMS reporting directly from the community is perceived as a timely, easy and reliable way of sharing important information, but the usefulness of the system relies not only on the structure of the system itself, but also on external factors, such as the relationship between the community members and the volunteers, and the logistical structure.

• Knutsen, Kirsten Irene Valebjørg; Madar, Ahmed Ali; Brekke, Mette; Meyer, Haakon E; Eggemoen, Åse Ruth & Mdala, Ibrahimu [Show all 7 contributors for this article] (2017). Effect of Vitamin D on Thyroid Autoimmunity: A Randomized, Double-Blind, Controlled Trial Among Ethnic Minorities. Journal of the Endocrine Society (JES). 1 (5), p. 470–479. doi: 10.1210/js.2017-00037. Full text in Research Archive
• Madar, Ahmed Ali; Gundersen, Thomas E; Haug, Anne M & Meyer, Haakon E (2017). Vitamin D supplementation and vitamin D status in children of immigrant background in Norway. Public Health Nutrition (PHN). ISSN 1368-9800. 20(16), p. 2887–2892. doi: 10.1017/S136898001700180X. Full text in Research Archive Show summary

  Objective Sufficient vitamin D status during infancy is important for child health and development. Several initiatives for improving vitamin D status among immigrant children have been implemented in Norway. The present study aimed to evaluate the vitamin D status and its determinants in children of immigrant background in Oslo. Design Cross-sectional study. Setting Child health clinics in Oslo. Subjects Healthy children with immigrant background (n 102) aged 9–16 months were recruited at the routine one-year check-up from two child health clinics with high proportions of immigrant clients. Blood samples were collected using the dried blood spot technique and analysed for serum 25-hydroxyvitamin D (s-25(OH)D) concentration using LC–MS/MS. Results Mean s-25(OH)D was 52·3 (sd 16·7) nmol/l, with only three children below 25 nmol/l and none below 12·5 nmol/l. There was no significant gender, ethnic or seasonal variation in s-25(OH)D. However, compared with breast-fed children, s-25(OH)D concentration was significantly higher among children who were about 1 year of age and not breast-fed. About 38 % of the children were anaemic, but there was no significant correlation between s-25(OH)D and Hb (Pearson correlation, r=0·1, P=0·33). Conclusions Few children in the study had vitamin D deficiency, but about 47 % of the children in the study population were under the recommended s-25(OH)D sufficiency level of ≥50 nmol/l.

• Meyer, Haakon E; Skram, Kristina; Berge, Ingvill Almås; Madar, Ahmed Ali & Bjørndalen, Hilde (2017). Nutritional rickets in Norway: a nationwide register-based cohort study. BMJ Open. 7(5). doi: 10.1136/bmjopen-2016-015289. Full text in Research Archive Show summary

  Objectives: Poor vitamin D status has been reported to be highly prevalent in many non-western immigrant groups living in Norway and other western countries. However, data on rickets are scarce, and the aim of the current study was to identify new cases of nutritional rickets in Norway in the period 2008–2012 among children under the age of 5 years. Results: Nutritional rickets was confirmed in 39 children aged 0–4 years with the diagnosis of E55.0. In addition, three patients with the diagnosis of unspecified vitamin D deficiency (E55.9) were classified as having nutritional rickets, giving a total of 42 patients. Mean age at diagnosis was 1.40 years (range 0.1–3.5 years), and 93% had a non-western immigrant background. The incidence rate of rickets was estimated to be 0.3 per 10 000 person-years in the total Norwegian child population under the age of 5 years and 3.1 per 10 000 person-years in those with an immigrant background from Asia or Africa. Conclusion: The number of children with nutritional rickets in Norway remained low in the period 2008–2012. Nearly all children had a non-western immigrant background.

• Madar, Ahmed Ali; Stene, Lars Christian; Meyer, Haakon E; Brekke, Mette; Lagerløv, Per & Knutsen, Kirsten Irene Valebjørg (2016). Effect of vitamin D3 supplementation on iron status: a randomized, double-blind, placebo-controlled trial among ethnic minorities living in Norway. Nutrition Journal. 15. doi: 10.1186/s12937-016-0192-7. Full text in Research Archive Show summary

  Background Both vitamin D and iron deficiencies are widespread globally, and a relationship between these deficiencies has been suggested. However, there is a paucity of randomised controlled trials assessing the effect of vitamin D supplementation on iron status. Purpose We aimed to investigate whether 16 weeks of daily vitamin D3 supplementation had an effect on serum ferritin, haemoglobin, serum iron and transferrin saturation. Methods Overall, 251 participants from South Asia, Middle East and Africa aged 18–50 years who were living in Norway were randomised to receive daily oral supplementation of 10 μg vitamin D3, 25 μg vitamin D3, or placebo for 16 weeks during the late winter. Blood samples from baseline and after 16 weeks were analysed for serum 25-hydroxyvitamin D (s-25(OH) D), serum ferritin, haemoglobin and serum iron. In total, 214 eligible participants completed the intervention (86 % of those randomised). Linear regression analysis were used to test the effect of vitamin D3 supplementation combined (10 or 25 μg) and separate doses 10 or 25 μg compared to placebo on change (T2-T1) in each outcome variable adjusted for baseline s-25(OH)D values. Results There was no difference in change in the levels of s-ferritin (1.9 μg/L, 95 % CI: -3.2, 7.0), haemoglobin (-0.02 g/dL, 95 % CI: -0.12, 0.09), s-iron (0.4 μg/L, 95 % CI: -0.5, 1.3) or transferrin saturation (0.7 %, 95 % CI: -0.6.1, 2.0) between those receiving vitamin D3 or those receiving placebo. Serum 25-hydroxyvitamin D increased from 29 nmol/L at baseline to 49 nmol/L after the intervention, with little change in the placebo group. Conclusions In this population of healthy ethnic minorities from South Asia, the Middle East and Africa who had low vitamin D status, 16 weeks of daily supplementation with 10 or 25 μg of vitamin D3 did not significantly affect the haemoglobin levels or other markers of iron status.

• Løvlie, Astrid Louise & Madar, Ahmed Ali (2016). Postpartum Depression Among Somali Women in Norway. Journal of Immigrant and Minority Health. ISSN 1557-1912. p. 1–7. doi: 10.1007/s10903-016-0487-y. Full text in Research Archive
• Avagyan, Diana; Neupane, Sudan Prasad; Gundersen, Thomas & Madar, Ahmed Ali (2015). Vitamin D status in pre-school children in rural Nepal. Public Health Nutrition (PHN). ISSN 1368-9800. p. 1–7. doi: 10.1017/S136898001500083X. Full text in Research Archive
• Madar, Ahmed Ali; Knutsen, Kirsten Irene Valebjørg; Stene, Lars Christian; Brekke, Mette; Lagerløv, Per & Meyer, Haakon E [Show all 7 contributors for this article] (2015). Effect of vitamin D3-supplementation on bone markers (serumP1NP and CTX): A randomized, double blinded, placebo controlled trial among healthy immigrants living in Norway. Bone Reports. 2, p. 82–88. doi: 10.1016/j.bonr.2015.05.004. Full text in Research Archive
• Knutsen, Kirsten Irene Valebjørg; Madar, Ahmed Ali; Brekke, Mette; Meyer, Haakon E; Natvig, Bård & Mdala, Ibrahimu [Show all 7 contributors for this article] (2014). Effect of vitamin D on musculoskeletal pain and headache: A randomized, double-blind, placebo-controlled trial among adult ethnic minorities in Norway. Pain. ISSN 0304-3959. 155(12), p. 2591–2598. doi: 10.1016/j.pain.2014.09.024. Full text in Research Archive
• Madar, Ahmed Ali; Knutsen, Kirsten Irene Valebjørg; Stene, Lars Christian; Brekke, Mette; Meyer, Haakon E & Lagerløv, Per (2014). Effect of vitamin D3 supplementation on glycated hemoglobin (HbA1c), fructosamine, serum lipids, and body mass index: a randomized, doubleblinded, placebo-controlled trial among healthy immigrants living in Norway. BMJ Open Diabetes Research & Care. 2. doi: 10.1136/bmjdrc-2014-000026. Full text in Research Archive Show summary

  Objective Despite the suggested role of vitamin D in the prevention of diabetes and cardiovascular disease or its risk factors, the evidence is not consistent and there is a paucity of randomized controlled trials in this field. We aimed to investigate the effect of 16-week daily vitamin D3 supplementation on glycated hemoglobin (HbA1c), fructosamine, body mass index (BMI), and serum lipids. Design Double-blind, randomized, placebo-controlled trial. Setting Immigrant community centers in Oslo, Norway. Participants 251 healthy adults aged 18–50 years with a non-Western immigrant background. All participants performed the baseline test and 215 (86%) returned to the follow-up test. Intervention 16 weeks of daily oral supplementation with either 10 µg vitamin D3, 25 µg vitamin D3, or placebo. Main outcome measures Difference in absolute change during the 16-week intervention between the intervention groups combined (10 or 25 µg of vitamin D3/day) and placebo, in HbA1c, fructosamine, serum lipids (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides), and BMI. Results A total of 215 (86%) participants completed the study. Serum 25-hydroxyvitamin D increased from 29 nmol/L at baseline to 49 nmol/L after intervention, with little change in the placebo group. However, there was no difference in change of HbA1c between those receiving vitamin D3 compared with placebo (mean difference: 0.01% (95% CI -0.04 to 0.06, p=0.7)). Neither did the vitamin D3 supplementation have any effect on the other end points: fructosamine, serum lipids, and BMI. Conclusions 16-week vitamin D3 supplementation to healthy immigrants from South Asia, the Middle East, or Africa and now living in Norway with low vitamin D status did not improve HbA1c, fructosamine, lipid profiles, or BMI. An updated meta-analysis of similar published trials showed that our results were generally consistent with those of other studies.

• Avagyan, Diana; Neupane, Sudan Prasad; Gundersen, Thomas Erik & Madar, Ahmed Ali (2014). Vitamin D status in pre-school children in rural Nepal. Public Health Nutrition (PHN). ISSN 1368-9800. 19(3), p. 470–476. doi: 10.1017/S136898001500083X. Full text in Research Archive
• Knutsen, Kirsten Irene Valebjørg; Madar, Ahmed Ali; Lagerløv, Per; Brekke, Mette; Raastad, Truls & Stene, Lars Christian [Show all 7 contributors for this article] (2014). Does Vitamin D Improve Muscle Strength in Adults? A Randomized, Double-blind, Placebo-controlled Trial Among Ethnic Minorities in Norway. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 99(1), p. 194–202. doi: 10.1210/jc.2013-2647. Full text in Research Archive
• Holvik, Kristin; Madar, Ahmed Ali; Meyer, Haakon E; Lofthus, Cathrine Marie & Stene, Lars Christian (2012). Changes in the vitamin D endocrine system and bone turnover after oral vitamin D3 supplementation in healthy adults: results of a randomised trial. BMC Endocrine Disorders. 12. doi: 10.1186/1472-6823-12-7. Full text in Research Archive Show summary

  Background: There is uncertainty as to which intake of vitamin D is needed to suppress PTH and maintain normal bone metabolism throughout winter at northern latitudes. We aimed to investigate whether four weeks’ daily supplementation with 10 μg vitamin D3 from fish oil produced a greater change in serum vitamin D metabolites, parathyroid hormone, and bone turnover in healthy adults compared with solid multivitamin tablets. Furthermore, it was studied whether age, gender, ethnic background, body mass index, or serum concentrations at baseline predicted the magnitude of change in these parameters. Methods: Healthy adults aged 19–48 years living in Oslo, Norway (59°N) were randomised to receive a daily dose of 10 μg vitamin D3 given as fish oil capsules or multivitamin tablets during four weeks in late winter. Serum samples from baseline and after 28 days were analysed for 25-hydroxyvitamin D (s-25(OH)D), 1,25-dihydroxyvitamin D (s-1,25(OH)2D), intact parathyroid hormone (s-iPTH), and osteoclast-specific tartrate-resistant acid phosphatase 5b (s-TRACP). Fifty-five eligible participants completed the intervention (74% of those randomised). Results: S-25(OH)D increased by mean 34.1 (SD 13.1) nmol/l, p < 0.001; s-iPTH decreased by mean 1.2 (SD 2.5) pmol/l, p = 0.001; s-1,25(OH)2D increased by mean 13 (SD 48) pmol/l, p = 0.057; and s-TRACP increased by mean 0.38 (SD 0.33) U/l, p < 0.001. For all these parameters, there was no difference between fish oil and multivitamin formulation. Baseline concentrations were the only independent predictors of changes in biochemical parameters. Conclusions: Four weeks of daily supplementation with 10 μg vitamin D3 decreased mean s-iPTH and increased s-TRACP concentration, and this did not differ by mode of administration. Our results suggest an increased bone resorption following vitamin D supplementation in young individuals, despite a decrease in parathyroid hormone levels. Trial Registration: ClinicalTrials.gov: NCT01482689

• Madar, Ahmed Ali; Klepp, Knut Inge & Meyer, Haakon E (2011). The effect of tailor-made information on vitamin D status of immigrant mothers in Norway: a cluster randomized controlled trial. Maternal & Child Nutrition. ISSN 1740-8695. 7(1), p. 92–99. doi: 10.1111/j.1740-8709.2009.00238.x. Full text in Research Archive
• Madar, Ahmed A; Stene, Lars Christian & Meyer, Haakon E (2009). Vitamin D status among immigrant mothers from Pakistan, Turkey and Somalia and their infants attending child health clinics in Norway. British Journal of Nutrition. ISSN 0007-1145. 101(7), p. 1052–1058. doi: 10.1017/S0007114508055712. Full text in Research Archive
• Madar, AA; Klepp, KI & Meyer, Haakon E (2009). Effect of free vitamin D-2 drops on serum 25-hydroxyvitamin D in infants with immigrant origin: a cluster randomized controlled trial. European Journal of Clinical Nutrition. ISSN 0954-3007. 63(4), p. 478–484. doi: 10.1038/sj.ejcn.1602982. Full text in Research Archive
• Holvik, Kristin; Madar, Ahmed A; Meyer, Haakon E; Lofthus, Cathrine M & Stene, Lars Christian (2007). A randomised comparison of increase in serum 25-hydroxyvitamin D concentration after 4 weeks of daily oral intake of 10 mu g cholecalciferol from multivitamin tablets or fish oil capsules in healthy young adults. British Journal of Nutrition. ISSN 0007-1145. 98(3), p. 620–625. doi: 10.1017/S000711450773074X. Full text in Research Archive

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• Madar, Ahmed Ali; Sahragard, Sahragard; Bøhler, Linn; Wedegren, Mia Charlott; Rangsvåg, Hege Gambo & Leirbakk, Maria [Show all 8 contributors for this article] (2023). Food and nutrient intake among overweight/obese women of Somali background in Oslo, Norway. Scandinavian Journal of Public Health. ISSN 1403-4948. 50. doi: 10.1177/14034948231190. Full text in Research Archive Show summary

  Background: In Norway, women with a Somali background are more overweight and obese than their Norwegian counterparts, with an increased susceptibility to diabetes and other lifestyle-related diseases. However, there is limited information on their dietary intake. This study aimed to describe food and nutrient intake among overweight and obese women with a Somali background in Oslo. Methods: Design: Baseline data for the lifestyle intervention study. Setting: Oslo municipality. Participants: Overweight and obese women (n = 168) aged 22-82 years, were included in the intervention study between September 2020 and September 2022. A trained interviewer performed 24-hour dietary recalls on two consecutive days to assess food and beverage intake. The dietary assessment system KBS (version 7.3, University of Oslo, Oslo, Norway, database AE-18) was used for energy, food, and nutrient estimation. Results: The mean (SD) age was 46.8 (10.4) years, and the mean BMI (SD) was 33.9 kg/m2 (5.1). The main dietary intake was traditional Somali foods, such as rice, pasta, and meat. The mean energy intake was 4.3 MJ/day. The median energy percentages from carbohydrates, fat, protein, and added sugar were in accordance with the Norwegian nutrition recommendations. The total median intake of almost all micronutrients was below the recommended daily intake, except for vitamin A, niacin, vitamin B12, zinc, and selenium. Conclusions: We found that overweight and obese women with a Somali background most commonly eat cereal products such as rice, pasta, and meat. The average energy intake was low, suggesting assessment bias. Most of the macronutrient intake was in compliance with the daily recommendations. However, the intake of micronutrients was below the recommended daily intake, which may be a result of the generally low energy intake. Weekend days were not systematically included in the repeated 24-hour recall and may have resulted in underreporting of dietary intake; thus, the results need to be interpreted with caution. Further research is required to investigate the dietary intake in this population using different dietary assessment methods for developing preventive public health programs for immigrant groups. Main message: Diet is an important factor for the burden of disease in Norway and therefore it is important to improve the diet of immigrant population particularly the intake of vitamins and minerals.

• Madar, Ahmed Ali; Sahragard, Sahragard; Bøhler, Linn; Wedegren, Mia Charlott; Rangsvåg, Hege Gambo & Leirbakk, Maria [Show all 8 contributors for this article] (2023). Food and nutrient intake among overweight/obese women of Somali background in Oslo, Norway. Full text in Research Archive
• Diaz, Esperanza; Nørredam, Marie; Aradhya, Siddartha; Benfield, T.L.; Krasnik, Allan & Madar, Ahmed Ali [Show all 9 contributors for this article] (2020). Situational Brief: Migration and Covid-19 in Scandinavian Countries. Lancet ERA - International Health. Full text in Research Archive
• Holvik, Kristin; Meyer, Haakon E; Madar, Ahmed Ali & Brustad, Magritt (2019). Ikke nødvendig med høydosetilskudd av vitamin D. 139(7), p. 602–604. doi: 10.4045/tidsskr.18.0749. Full text in Research Archive
• Holst, Christine; Sukums, Felix; Ngowi, Helena; Radovanović, Danica; Mwakapeje, Elibariki & Mdala, Ibrahimu [Show all 11 contributors for this article] (2019). Free access to digital health information in Iringa, Tanzania: Development, provision and testing the effect of digital health messages to rural communities. Full text in Research Archive
• Abel, Marianne Hope; Brantsæter, Anne Lise; Dahl, Lisbeth; Torheim, Liv Elin; Madar, Ahmed Ali & Meltzer, Helle Margrete (2017). Jodsituasjonen i Norge -Et akutt behov for tiltak. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. p. 24–29. Full text in Research Archive
• Torheim, Liv Elin; Meltzer, Helle Margrete; Dahl, Lisbeth; Brantsæter, Anne Lise; Madar, Ahmed Ali & Abel, Marianne Hope (2017). - Gode grunner til å ha melk og sjømat i kostholdet. Full text in Research Archive
• Knutsen, Kirsten Irene Valebjørg; Madar, Ahmed Ali; Brekke, Mette; Meyer, Haakon E; Natvig, Bård & Mdala, Ibrahimu [Show all 7 contributors for this article] (2015). Effect of vitamin D on musculoskeletal pain and headache: a randomized, double-blind, placebo-controlled trial among adult ethnic minorities in Norway. Full text in Research Archive
• Bjertness, Espen & Madar, Ahmed Ali (2014). North Korea: A challenge for global solidarity. The Lancet. ISSN 0140-6736. 383(9926), p. 1381–1382. doi: 10.1016/S0140-6736(14)60677-2. Full text in Research Archive
• Holvik, Kristin; Madar, Ahmed Ali; Stene, Lars Christian; Lofthus, Cathrine Marie & Meyer, Haakon E (2010). Changes in the vitamin D endocrine system and bone turnover (serum tracp) after four weeks of daily vitamin D3 supplementation in healthy adults: Are there ethnic differences? Osteoporosis International. ISSN 0937-941X. 21, p. 99–99. doi: 10.1007/s00198-010-1247-9. Full text in Research Archive
• Knutsen, Kirsten Irene Valebjørg; Madar, Ahmed Ali; Meyer, Haakon E; Brekke, Mette; Raastad, Truls & Stene, Lars Christian [Show all 7 contributors for this article] (2010). Effekt av vitamin D-tilskudd på muskelstyrke, muskelskjelettsmerter og hodepine hos immigranter i Norge. En randomisert, dobbelt blindet, kontrollert studie. Frie foredrag, forskningsdagen. Tildelt AFUs forskningpris. Full text in Research Archive
• Holvik, Kristin; Madar, AA; Meyer, HE; Lofthus, CM & Stene, Lars Christian (2007). Effect of four weeks of vitamin D3 supplementation during late winter on markers of the vitamin D endocrine system and bone turnover. Journal of Bone and Mineral Research. ISSN 0884-0431. 22. Full text in Research Archive
• Holvik, Kristin; Madar, Ahmed Ali; Meyer, Haakon E; Lofthus, Cathrine Marie & Stene, Lars Christian (2007). Effect of Four Weeks of Vitamin D3 Supplementation During Late Winter on Markers of the Vitamin D Endocrine System and Bone Turnover. Journal of Bone and Mineral Research. ISSN 0884-0431. 22, p. S430–S430. Full text in Research Archive
• Holvik, Kristin; Madar, Ahmed Ali; Meyer, Haakon E; Lofthus, Cathrine Marie & Stene, Lars Christian (2006). A Randomized Comparison of Increase in Serum 25-Hydroxyvitamin D after Oral Intake of 10 µg Vitamin D3 from Multivitamin Tablets or Fish Oil Capsules in Healthy Young Adults. Full text in Research Archive Show summary

  Many types of vitamin supplements are available on the market, but little is known about whether vitamin D3 obtained from fat-containing capsules differs in bioavailability from that of solid tablets. We performed a randomized trial in order to compare two common vitamin D supplements. Our objective was to test whether four weeks of daily supplementation with 10 µg vitamin D3 given as a fish oil capsule produces a larger increase in serum 25-hydroxyvitamin D levels compared with the same dose of vitamin D3 given as a multivitamin tablet. A total of 55 healthy subjects aged 19-48 yr (mean 28.5 yr) completed the study during late winter 2005. After completing a self-administered questionnaire about diet and sun exposure and having a non-fasting venous blood sample drawn, participants were randomized to receive either multivitamin tablets of type Vitaplex ABCD, or fish oil capsules. A second blood sample was drawn after 28 days of supplementation. The vitamin D3 content of both supplements was assessed by an independent laboratory; mean (SD) 9.79 (1.51) µg and 9.99 (0.23) µg, respectively. Statistical analysis was performed using linear regression analysis with change in serum 25-hydroxyvitamin D as the dependent variable and intervention supplement as the independent variable, adjusted for serum 25-hydroxyvitamin D at baseline. In the total sample, mean (95% CI) serum 25-hydroxyvitamin D was 44.3 (38.0, 50.7) nmol/l at baseline, and it increased by 34.1 (30.5, 37.6) nmol/l during the intervention. The increase in serum 25-hydroxyvitamin D was not significantly different between the two groups (p=0.33). We conclude that fish oil capsules and multivitamin tablets containing 10 µg vitamin D3 produced a similar increase in serum 25-hydroxyvitamin D levels over a 4-week period.

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