Measurement of exposure
Physical examination Trained Swedish- and Arabic-speaking research nurses conducted standard physical examinations. Participants were instructed not to consume tobacco or eat or drink anything but water after 10 pm the day before testing and to bring a record of their current medications. Blood pressure was measured in the supine position after five minutes’ rest and with the arm at heart level. The mean of two measurements, taken one minute apart, was used in analyses. Body height was measured to the nearest centimetre using a wall-mounted stadiometer. Body weight was measured to the nearest kilogram with participants wearing light indoor clothes but no shoes using a calibrated electronic scale (Coline, 34-5062 RTC3010, China). BMI was calculated as weight (kg) divided by height squared (m2). Waist circumference was measured to the nearest cm in a standing position after a gentle expiration. A tape measure was placed around the bare midriff of each participant and the waist circumference measured midway between the lower border of the rib cage and the superior border of the iliac crest .
Blood samples were collected in the morning and analyzed continually during the study. Plasma cholesterol and triglyceride levels were determined using enzymatic methods (Bayer Diagnostics) , and plasma high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were measured enzymatically using a Cobas-® 6000 analyzer (Mannheim GmbH, Germany). Serum insulin levels were determined using a radioimmunoassay (Access© Ultrasensitive Insulin, Beckman Coulter, USA) . C-peptide levels were measured by a one-step immunometric sandwich method using an electrochemiluminescence immunoassay (ECLI) based on a ruthenium (Ru) derivative (Roche). Plasma glucose was measured immediately after sampling using a photometer (HemoCue AB, Ängelholm, Sweden) . HbA1c was estimated by high-pressure liquid chromatography (HPLC) with a VARIANT™ TURBO Hemoglobin A1c Kit 2.0 (Bio-Rad).
We used the risk factors for CVD reported in the INTERHEART study , including T2D, history of hypertension, elevated ApoB/ApoA ratio (replaced by elevated plasma (p)-LDL/p-HDL ratio in the present study), abdominal obesity, physical activity (PA) less than 4 hours per week, intake of fruit and vegetables less than once daily, regular alcohol consumption, tobacco smoking and psychosocial factors (i.e. stress, depression, life events and economic difficulties).
CVD was self-reported and included history of angina pectoris, myocardial infarction and/or stroke.
History of T2D was confirmed by either treatment with oral hypoglycemic agents and/or insulin or by a fasting plasma glucose level ≥7.0 mmol/L .
History of hypertension was self-reported .
Elevated p-LDL/p-HDL ratio was a proxy for elevated ApoB/ApoA ratio  and was defined as a value in the highest quintile (>3.67).
Abdominal obesity was defined as a waist-hip-ratio ≥0.95 in men and ≥0.90 in women .
Physical activity was estimated using questions developed by the Swedish National Board of Health and Welfare (NBHW) to estimate time spent physically active . Time spent physically active each week doing non-strenuous PA (e.g., walking, cycling or gardening), or undertaking strenuous PA (e.g., jogging, swimming, basketball or football) was estimated by the participants in terms of minutes. As recommended by NBHW, time spent doing strenuous PA was multiplied by two and then added to time spent doing non-strenuous PA . Total minutes per week were transformed to hours per week and participants were then dichotomized with a PA cut-off set at 4 hours per week.
Intake of fruit and vegetables was self-reported. Participants were dichotomized into those with intakes of once or more, or less than once per day .
Alcohol consumers were those who stated that they drink alcohol .
Tobacco smoking Participants stating that they had never smoked were considered non-smokers and the others were classified as smokers .
Psychosocial factors were depression, stress, life events and economic difficulties; Depression was defined as moderate to severe depression, as indicated by a score of >10 points on the Hospital Anxiety and Depression scale . Stress was defined by participants stating they often feel stressed in daily life. Life events were defined as participants who suffered more than one of the following life events during their lifetime: divorce, illness, experience of war, unemployment, death or illness in the family and experience of a natural disaster. Economic difficulties on several occasions: Difficulties in paying for food, rent or bills on more than one occasion during the last 12 months .
FINDRISC scores estimate the risk of developing diabetes within the next 10 years . The scores are based on anthropometrical measures, family history of diabetes, lifestyle factors such as physical activity and intake of fruit and vegetables, history of high blood sugar and medication for hypertension.