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It is not known whether a change in cardiorespiratory fitness can modify the association between a change in alcohol intake and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data of the healthy adults from the second (HUNT2; 1995\u20137) and third (HUNT3; 2006\u20138) surveys of the population-based Tr\u00f8ndelag Health Study, Norway. Alcohol intake at HUNT2 and HUNT3 was divided into three groups: abstainers, within recommendations (\u2264\u2009140\u00a0g\/week for men,\u2009\u2264\u200970\u00a0g\/week for women) or above recommendations (&gt;\u2009140\u00a0g\/week for men,\u2009&gt;\u200970\u00a0g\/week for women). Using a validated non-exercise prediction equation, we classified participants into two sex- and age-specific fitness groups (unfit: 20% least fit; fit: 80% most fit) at both HUNT2 and HUNT3. Using multi-variable-adjusted Cox analyses, adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated for an association between all-cause mortality and a change in alcohol and fitness status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 24,853 healthy adults (mean [standard deviation] age, 54.7 [12]\u00a0years; 54.1% women) were included. Over a median follow-up of 16.6 (interquartile range, 16.2\u201317.1) years, 3921 participants died. Increased alcohol intake from HUNT2 to HUNT3 was associated with an increased risk of mortality. Alcohol abstainers who reported to drink within the recommendations 10\u00a0years later (aHR, 1.20; 95% CI 1.00\u20131.44), and drinkers who increased their intake from within the recommendations at HUNT2 to above at HUNT3 (aHR, 1.25; 95% CI 0.99\u20131.57) had an increased risk of mortality, compared with the persistent abstainers. Participants drinking within the recommendations at HUNT2 but abstained from drinking at HUNT3 were not at a higher risk of mortality (aHR, 1.14; 95% CI 0.80\u20131.62). A change in fitness modified the relationship between alcohol intake and all-cause mortality (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.03), and participants who remained unfit had higher mortality risks. Compared with the reference group who abstained from alcohol and remained fit from HUNT2 to HUNT3, those who\n                      <jats:italic>remained unfit<\/jats:italic>\n                      and persistently abstained, started drinking or consistently drank alcohol within the recommended limits had aHRs of 1.65 (95% CI 1.19\u20132.30), 1.46 (95% CI 1.04\u20132.06) and 1.68 (95% CI 1.36\u20132.08), respectively. For participants who\n                      <jats:italic>remained fit<\/jats:italic>\n                      , the mortality risk associated with changes in alcohol intake was not higher than for the reference group, except for those who started drinking [aHR, 1.32 (195% CI 04\u20131.68)]. Compared with peers remaining fit, decreasing fitness increased the mortality risk among persistent abstainers and consistent drinkers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Increased alcohol intake over the years was associated with an increased risk of mortality. A change in cardiorespiratory fitness was a better predictor of mortality, and maintaining fitness above the lowest 20% for one\u2019s age and sex attenuated the association between a change in alcohol intake and all-cause mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40279-025-02360-w","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T19:58:15Z","timestamp":1765310295000},"page":"1023-1033","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Running from Death: Can Fitness Outpace Alcohol\u2019s Harm? Changes in Alcohol Intake, Fitness and All-Cause Mortality in the HUNT Study, Norway"],"prefix":"10.1007","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1347-2448","authenticated-orcid":false,"given":"Javaid","family":"Nauman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma M. 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Ingestr\u00f6m, Atefe R. Tari and Ulrik Wisl\u00f8ff have no conflicts of interest that are directly relevant to the content of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of Interest"}},{"value":"The study was approved by the Regional Committee on Medical and Health Research Ethics of Norway (REK 745308), and was performed in strict accordance with the ethical principles for medical research involving human subjects outlined in the Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"All participants were informed orally and in writing, and gave a signed consent to partake in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}},{"value":"Because of privacy policies, data cannot be shared publicly. Researchers associated with Norwegian research institutes can apply for the use of HUNT material: data and samples, given approval by a Regional Committee for Medical and Health Research Ethics. Researchers from other countries are welcome to apply in cooperation with a Norwegian Principal Investigator. Access to the requested HUNT material is given after the application is approved by the HUNT Data Access Committee, and an agreement is signed. The agreement gives the researcher(s) the right to research a specific topic for a limited time period and to publish a decided upon number of articles. More information is available at\n                      \n                      .","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Availability of Data and Material"}},{"value":"Not applicable.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Code Availability"}},{"value":"JN and EMLI had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: JN, UW. Acquisition, analysis or interpretation of data: JN, EMLI, ART, UW. Drafting of the manuscript: JN, EMLI. Critical review of the manuscript for important intellectual content: all authors. Statistical analysis: JN, EMLI. Obtained funding: UW. Administrative, technical or material support: EMLI, ART. Supervision: JN, UW.","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 Contributions"}},{"value":"We are dependent on the experiences and input of HUNT participants to identify needs, solutions and challenges. Therefore, participants have been involved in all the surveys, from the planning stage to the final evaluation. Many of them have contributed to several HUNT surveys, giving them a unique perspective. We have taken their input seriously, and all feedback has been recorded and further followed up.","order":9,"name":"Ethics","group":{"name":"EthicsHeading","label":"Patient and Public Involvement"}}]}}