Secular trends in mental health problems among young people in Norway: a review and meta-analysis.

There is a growing concern that the mental health of recent generations of youth is deteriorating, yet the etiology of these secular changes is not fully understood. We aimed to review the evidence on trends in mental health problems among young people in Norway. Seven large-scale repeated cross-sectional studies were included in this study, comprising 35 cross-sectional data collections between 1992 and 2019, with a total sample of 776,606 young people. Our study found a clear increase in mental health problems among young females in Norway over the past few decades, while the trends were less marked for males. The proportion of individuals scoring above the problematic symptom score threshold increased on average by 11.2% (range 2.2% to 21.9%) for females and 5.2% (range - 0.9% to 11.1%) for males, based on data from the individual studies. The results from a meta-regression analysis showed that across all surveys, mean symptom scores increased by 17% (95% CI 12 to 21%) among females and 5% (95% CI 1 to 9%) among males from 1992 to 2019. Overall, mental health problems have increased continually since the early 1990s among young people, especially among young females. The cause of these secular changes remains unknown but likely reflect the interplay of several factors at the individual and societal level.Protocol registration: Open science framework, November 8, 2021 ( https://osf.io/g7w3v ).

Loneliness in the Norwegian adolescent population: prevalence trends and relations to mental and self-rated health.

BACKGROUND: Loneliness has become a significant public health problem and should be addressed with more research over a broader period. This study investigates the variations in the prevalence of loneliness among a nationally representative study population of Norwegian adolescents over the last three decades and whether age, gender, self-rated health, and mental distress are associated with these changes. METHODS: Adolescents aged 13-19 years completed the structured and validated questionnaires from the three waves of the Young-HUNT Study: 1995-1997, 2006-2008, and 2017-2019. Loneliness was measured with one item asking, 'Are you lonely?'. Hopkins Symptom Checklist-5 was used to measure mental distress (cut-off ≥ 2). Self-rated health was assessed by a single question 'How is your health at the moment?' Measures were provided by self-report. Descriptive analyses were stratified by age, gender, self-rated health, and mental distress. Linear-by-Linear association test across survey years was performed to test time trends of loneliness. Logistic regression was used to analyze the cross-sectional associations of self-rated health and mental distress with loneliness, adjusting for sociodemographic factors in all three waves of Young-HUNT. RESULTS: Loneliness prevalence doubled from 5.9% in 1995/97 to 10.2% in 2017/19 in the total population sample. The highest loneliness prevalence and an increase from 8.9% in 1995/97 to 16.7% in 2017/19 was observed in girls of 16-19 years. Among mentally distressed adolescents, loneliness increased from 22.3% in 1995/97 to 32.8% in 2006/08 and lowered to 27% in 2017/19. Increasing loneliness prevalence was seen in those with poor self-rated health, i.e., 14.6% in 1995-97 and 26.6% in 2017-19. Mental distress and poor self-rated health were associated with higher odds of loneliness in each wave (p < 0.001). CONCLUSION: The results highlight the increasing burden of loneliness in the Norwegian adolescent population, especially girls. Those with mental distress and poor self-rated health have a higher risk of experiencing loneliness. Thus, health-promoting upbringing environments for children and adolescents that support mutual affinity, social support, integration, and belongingness in adolescents' daily arenas are essential.

Guideline evaluation and implementation mechanisms in school health services (GuideMe): protocol for a hybrid randomized factorial trial.

BACKGROUND: Norwegian school health services received a national best-practice guideline in 2017. To promote healthy life skills and identify adolescents needing support, the guideline includes strong recommendations for individual consultations with all 8th graders and increased collaboration with schools. To help implement the recommendations, a blended implementation strategy (SchoolHealth) was co-created with school nurses, students, and stakeholders. SchoolHealth consists of three implementation elements: Digital dialog and administration tool (audit and feedback +), Dialog support (external consultation), and Collaboration materials (targeted dissemination). This hybrid study will test the main and combined effects of the elements on guideline fidelity and effectiveness. METHODS: The GuideMe study is a factorial cluster randomized controlled trial examining SchoolHealth's effectiveness on guideline fidelity and guideline effectiveness goals. Forty Norwegian secondary schools will be randomized to eight different combinations of the elements in SchoolHealth. Participants will include school nurses and school personnel from these schools, and 8th grade students (n = 1200). Primary outcomes are school nurses' fidelity to the guidelines and student's ability to cope with their life (i.e., health literacy, positive health behaviors and self-efficacy). Quantitative methods will be used to test effects and mechanisms, while mixed- and qualitative methods will be used to explore mechanisms, experiences, and other phenomena in depth. Participants will complete digital questionnaires at the start and end of the schoolyear, and after the consultation during the schoolyear. The study will run in two waves, each lasting for one school year. The multifactorial design allows testing of interactions and main effects due to equal distribution of all factors within each main effect. Sustainment and scale-up of optimized SchoolHealth elements using national infrastructure are simultaneously prepared. DISCUSSION: The study will investigate possible effects of the implementation elements in isolation and in combination, and hypothesized implementation mechanisms. In-depth study of user experiences will inform improvements to elements in SchoolHealth. The results will yield causal knowledge about implementation strategies and the mechanisms through which they assert effects. Mixed-methods will provide insights into how and when the elements work. Optimizing guideline implementation elements can support adolescents in a crucial life phase. TRAIL REGISTRATION: ISRCTN24173836. Registration date 8 August 2022.

HUNT for better public health.

AIMS: The Trøndelag Health Study (HUNT) has collected population data through comprehensive decennial surveys over the last four decades and has so far collected data from 240,000 participants. The participants are identified with the unique Norwegian birth number, which enables them to be followed throughout different life stages, from survey to survey, and to endpoint measures in Norwegian national health registers without attrition bias. METHODS: The study design of HUNT offers several advantages: it provides an overview of the public health development in the population over decades, the data can be used in health services research, clinical epidemiology, studies of causation, trajectories, and consequences of diseases, and to study gene × environment interactions. RESULTS: HUNT data have shown major shifts in public health trends, such as decreasing mean blood pressure and resting heart rate among adults, increasing prevalence of obesity, geographical and socioeconomic inequalities in health, increasing mental health distress among adolescents and young adults with an opposite development among the elderly. Data from HUNT have been used in several major international research projects, where data harmonization with several other population cohorts internationally has been done. HUNT has placed great emphasis on safeguarding research ethics, privacy, and data security. The Norwegian authorities established national regulations for the surveys from the time General Data Protection Regulation was introduced in 2018. CONCLUSIONS: Researchers can apply for HUNT data access from HUNT Research Centre provided they have obtained project approval from the Regional Committee for Medical and Health Research Ethics. Researchers not affiliated to a Norwegian research institution must collaborate with and apply through a Norwegian principal investigator. Information on the application and conditions for data access is available at www.ntnu.edu/hunt/data.

Depression, anxiety, and psychosocial stressors across BMI classes: A Norwegian population study - The HUNT Study.

Background: Obesity is a global issue with detrimental health impacts. Recent research has highlighted the complexity of obesity due to its psychological correlates. The purpose of the present study was to explore the relationship between body mass index (BMI) and depression, anxiety, and psychosocial stress. Methods: Data, including demographic, height, and weight information from 23 557 adult participants was obtained from the fourth survey of the Norwegian population based Trøndelag Health Study (HUNT4, 2017-2019). The Hospital Anxiety and Depression Scale (HADS) was used to measure self-reported depression and anxiety. We also collected data on 10 domains of psychosocial stress (violence, mental violence, unwanted sex, cyber bullying, school bullying, history of own life-threatening disease, life-threatening disease in family, relationship problems, divorce, and sudden family death), which were aggregated into a cumulative measure of psychosocial stress. Results: Multinomial logistic regression was utilized for statistical analysis. In the full model, the relationship between depression, anxiety, and psychosocial stress were explored controlling for age, sex, income, marital status, and educational attainment. After adjustments, a significant relationship was found between depression and obesity I (OR = 1.05, 95% CI 1.03-1.06, p <.001) and II and III (OR = 1.10, 95% CI 1.06-1.14, p <.001). After the same adjustments, significant relationship between anxiety and overweight and obesity class I was found among elderly participants (≥65 years old). Psychosocial stress significantly and positively related to all levels of BMI, with or without considering anxiety and depression, after controlling for sex, age, educational attainment, marital status, and income in all age groups. Conclusions: Obesity is a multifaceted health problem, significantly related to psychological factors including depression and psychosocial stress, which supports the need for a multifaceted, targeted approach to obesity treatment.

Divergent decennial trends in mental health according to age reveal poorer mental health for young people: repeated cross-sectional population-based surveys from the HUNT Study, Norway.

OBJECTIVES: Public health trends are formed by political, economic, historical and cultural factors in society. The aim of this paper was to describe overall changes in mental health among adolescents and adults in a Norwegian population over the three last decades and discuss some potential explanations for these changes. DESIGN: Repeated population-based health surveys to monitor decennial changes. SETTING: Data from three cross-sectional surveys in 1995-1997, 2006-2008 and 2017-2019 in the population-based HUNT Study in Norway were used. PARTICIPANTS: The general population in a Norwegian county covering participants aged 13-79 years, ranging from 48 000 to 62 000 000 in each survey. MAIN OUTCOME MEASURES: Prevalence estimates of subjective anxiety and depression symptoms stratified by age and gender were assessed using the Hopkins Symptom Checklist-5 for adolescents and the Hospital Anxiety and Depression Scale for adults. RESULTS: Adolescents' and young adults' mental distress increased sharply, especially between 2006-2008 and 2017-2019. However, depressive symptoms instead declined among adults aged 60 and over and anxiety symptoms remained largely unchanged in these groups. CONCLUSIONS: Our trend data from the HUNT Study in Norway indicate poorer mental health among adolescents and young adults that we suggest are related to relevant changes in young people's living conditions and behaviour, including the increased influence of screen-based media.

Cross-sectional study of BMI, weight concern, body size perception, dieting and mental distress in adolescents: The HUNT Study.

OBJECTIVE: We examined the associations between body mass index (BMI), weight concern, body size perception, dieting and mental distress in a population-based study of 7350 adolescents. DESIGN: Cross-sectional. SETTINGS: Data from a Norwegian population-based cohort, The Young-HUNT3 (2006-2008) from the county of Nord-Trøndelag, Norway. PARTICIPANTS: A total of 7350 adolescents (13-19 years) who had both self-reported questionnaire data and anthropometric measures. PRIMARY OUTCOME MEASURES: Odds for mental distress given sex, BMI, weight concern, body size perception and dieting. Analyses were performed in binomial logistic regression models. RESULTS: Compared with being overweight/obese, having weight concern, irrespective of BMI, was associated with higher OR for mental distress (MD) among boys and girls. Body size overestimation was associated with an increase in the OR for MD, in participants who were overweight/obese, had weight concern or dieted. This effect was more pronounced in boys. CONCLUSIONS: Weight concern and body-size estimation are strongly associated with mental health in adolescent boys and girls. Routine assessment of adolescents' attitudes towards their weight and body size is advised.

Intergenerational polygenic obesity risk throughout adolescence in a cross-sectional study design: The HUNT study, Norway.

OBJECTIVE: This study examined the relationship between parental obesity polygenic risk and children's BMI throughout adolescence. Additionally, from a smaller subsample, the objective was to assess whether parental polygenic risk score (PRS) may act as a proxy for offspring PRS in studies lacking offspring genetic data. METHODS: A total of 8,561 parent-offspring (age 13-19 years) trios from the Trøndelag Health Study (the HUNT Study) were included, of which, 1,286 adolescents had available genetic data. Weighted parental PRSs from 900 single-nucleotide polymorphisms robustly associated with adult BMI were constructed and applied in linear mixed-effects models. RESULTS: A positive association between parental PRS and offspring sex- and age-adjusted BMI (iso-BMI) throughout adolescence was identified. The estimated marginal effects per standard deviation increase in parental PRS were 0.26 (95% CI: 0.18-0.33), 0.36 (95% CI: 0.29-0.43), and 0.62 kg/m2 (95% CI: 0.51-0.72) for maternal, paternal, and combined parental PRS, respectively. In subsample analyses, the magnitude of association of the parental PRS versus offspring PRS with iso-BMI in adolescents was similar. CONCLUSIONS: Parental PRS was consistently associated with offspring iso-BMI throughout adolescence. Results from subsample analyses support the use of parental PRS of obesity as a proxy for adolescent PRS in the absence of offspring genetic data.

Obesity measures, metabolic health and their association with 15-year all-cause and cardiovascular mortality in the SAMINOR 1 Survey: a population-based cohort study.

BACKGROUND: The mortality of metabolic-obesity phenotypes has been thoroughly studied, but it is not known if or how the association between mortality and body mass index (BMI), waist circumference or a body shape index (ABSI) differ in strata of cardiometabolic health status. METHODS: We linked data on 12,815 men and women aged 36-79 years from the SAMINOR 1 Survey with mortality data from the Norwegian Cause of Death Registry. We defined metabolically healthy and unhealthy as having zero and ≥ 1, respectively, of the following: MetS, pre-existing diabetes or cardiovascular disease (CVD), or prescribed drugs for high blood pressure, hyperglycaemia or dyslipidaemia. We defined general and abdominal obesity as BMI ≥ 30 kg/m2 and waist circumference ≥ 88 cm (women) or 102 cm (men), respectively, and cross-classified these categories with metabolic status to create metabolically healthy non-obese and obese (MHNO and MHO) and metabolically unhealthy non-obese and obese (MUNO and MUO) phenotypes. We used Cox regression to estimate the hazard ratio (HR) for all-cause and CVD mortality for 1) the four phenotypes and 2) BMI, waist circumference and ABSI fitted with restricted cubic splines. We adjusted for age and lifestyle, and tested for interactions with sex and metabolic status (only continuous measures). RESULTS: The MHO phenotype was present in 7.8% of women and 5.8% of men. During a median follow-up of 15.3/15.2 years, 596/938 women/men had died, respectively. The MUNO and MUO groups had higher mortality than the MHNO group. Sex and phenotypes interacted with respect to CVD mortality: relative to the MHNO group, the MHO group had an adjusted HR (95% confidence interval) for CVD mortality of 1.05 (0.38-2.88) in women and 2.92 (1.71-5.01) in men. We found curvilinear associations between BMI/waist circumference and all-cause mortality irrespective of metabolic status. Corresponding relationships with CVD mortality were linear and the slope differed by sex and metabolic status. ABSI was linearly and positively associated with all-cause and CVD mortality in men. CONCLUSION: The relationships between BMI, waist circumference or ABSI and mortality differed by sex, metabolic status and cause of death. Poor metabolic health substantially increases mortality regardless of obesity status.

Underestimation of Overweight and Health Beneficial Outcomes in Two Adolescent Cohorts in Norway - The HUNT Study.

PURPOSE: Underestimating overweight may prevent efforts toward reducing weight, but simultaneously benefit mental health and well-being. The magnitude of underestimation of overweight and obesity in adolescents is largely unknown, and so is to what extent this underestimation is associated with dieting behaviors, mental distress, and life satisfaction. As overweight has become more common during the past decades, associations between body size underestimation and mental health may have changed. METHODS: Overweight (iso-body mass index, iso-BMI ≥25) adolescents (aged 13-19 years) who participated in The Young-HUNT1 (1995-97, n = 1,338) or The Young-HUNT3 (2006-08, n = 1,833) surveys were included. Being overweight, but perceiving oneself as average-weighted or underweighted was defined as underestimation. Results were based on clinical examinations and self-report questionnaires. Multivariable logistic regression models were used to examine associations between body size underestimation, dieting behaviors, and symptoms of anxiety, depression, and life satisfaction. RESULTS: Among adolescents with overweight and obesity (iso-BMI ≥25), the prevalence of obesity (iso-BMI ≥30), body size underestimation, and having symptoms of anxiety and depression had increased from the first survey to the next. At both time points, body size underestimation was more common among boys than girls. In 2006-08, body size underestimation was negatively associated with symptoms of anxiety and depression in both sexes, and overall associated with higher life satisfaction equally over time. Dieting behavior was negatively associated with underestimation of body size. CONCLUSIONS: Body size underestimation in adolescents with overweight/obesity has become more prevalent and a phenomenon associated with less dieting, better life satisfaction and mental health in both boys and girls.

Genetic associations with temporal shifts in obesity and severe obesity during the obesity epidemic in Norway: A longitudinal population-based cohort (the HUNT Study).

BACKGROUND: Obesity has tripled worldwide since 1975 as environments are becoming more obesogenic. Our study investigates how changes in population weight and obesity over time are associated with genetic predisposition in the context of an obesogenic environment over 6 decades and examines the robustness of the findings using sibling design. METHODS AND FINDINGS: A total of 67,110 individuals aged 13-80 years in the Nord-Trøndelag region of Norway participated with repeated standardized body mass index (BMI) measurements from 1966 to 2019 and were genotyped in a longitudinal population-based health study, the Trøndelag Health Study (the HUNT Study). Genotyping required survival to and participation in the HUNT Study in the 1990s or 2000s. Linear mixed models with observations nested within individuals were used to model the association between a genome-wide polygenic score (GPS) for BMI and BMI, while generalized estimating equations were used for obesity (BMI ≥ 30 kg/m2) and severe obesity (BMI ≥ 35 kg/m2). The increase in the average BMI and prevalence of obesity was steeper among the genetically predisposed. Among 35-year-old men, the prevalence of obesity for the least predisposed tenth increased from 0.9% (95% confidence interval [CI] 0.6% to 1.2%) to 6.5% (95% CI 5.0% to 8.0%), while the most predisposed tenth increased from 14.2% (95% CI 12.6% to 15.7%) to 39.6% (95% CI 36.1% to 43.0%). Equivalently for women of the same age, the prevalence of obesity for the least predisposed tenth increased from 1.1% (95% CI 0.7% to1.5%) to 7.6% (95% CI 6.0% to 9.2%), while the most predisposed tenth increased from 15.4% (95% CI 13.7% to 17.2%) to 42.0% (95% CI 38.7% to 45.4%). Thus, for 35-year-old men and women, respectively, the absolute change in the prevalence of obesity from 1966 to 2019 was 19.8 percentage points (95% CI 16.2 to 23.5, p < 0.0001) and 20.0 percentage points (95% CI 16.4 to 23.7, p < 0.0001) greater for the most predisposed tenth compared with the least predisposed tenth, defined using the GPS for BMI. The corresponding absolute changes in the prevalence of severe obesity for men and women, respectively, were 8.5 percentage points (95% CI 6.3 to 10.7, p < 0.0001) and 12.6 percentage points (95% CI 9.6 to 15.6, p < 0.0001) greater for the most predisposed tenth. The greater increase in BMI in genetically predisposed individuals over time was apparent after adjustment for family-level confounding using a sibling design. Key limitations include a slightly lower survival to date of genetic testing for the older cohorts and that we apply a contemporary genetic score to past time periods. Future research should validate our findings using a polygenic risk score constructed from historical data. CONCLUSIONS: In the context of increasingly obesogenic changes in our environment over 6 decades, our findings reveal a growing inequality in the risk for obesity and severe obesity across GPS tenths. Our results suggest that while obesity is a partially heritable trait, it is still modifiable by environmental factors. While it may be possible to identify those most susceptible to environmental change, who thus have the most to gain from preventive measures, efforts to reverse the obesogenic environment will benefit the whole population and help resolve the obesity epidemic.

Impact of road traffic noise on obesity measures: Observational study of three European cohorts.

BACKGROUND: Environmental stressors such as transport noise may contribute to development of obesity through increased levels of stress hormones, sleep deprivation and endocrine disruption. Epidemiological evidence supporting an association of road traffic noise with obesity markers is still relatively scant and confined to certain geographical regions. We aimed to examine the cross-sectional associations between road traffic noise and obesity markers in three large European cohorts involving nearly 500,000 individuals. METHODS: Three population-based cohorts (UK Biobank, Lifelines, HUNT3) were established between 2006 and 2013 in the UK, the Netherlands and Norway respectively. For all three cohorts, residential 24-h road traffic noise (Lden) for 2009 was modelled from a standardised European noise assessment framework. Residential exposures to NO2 for 2007 and PM2.5 for 2010 were estimated from Europe-wide land use regression models. Obesity markers including body mass index and waist circumference were measured at recruitment. Obesity and central obesity status were subsequently derived. Regression models were fitted in each cohort, adjusting for a harmonised set of demographic and lifestyle covariates, with further adjustments for air pollution in the main model. RESULTS: The main analyses included 412,934 participants of UK Biobank, 61,032 of Lifelines and 30,305 of HUNT3, with a mean age of 43-56 years and Lden ranging 42-89 dB(A) across cohorts. In UK Biobank, per 10 dB(A) higher of Lden: BMI was higher by 0.14kg/m2 (95%CI: 0.11-0.18), waist circumference higher by 0.27 cm (95%CI: 0.19-0.35), odds of obesity was 1.06 (95%CI: 1.04-1.08) and of central obesity was 1.05 (95%CI: 1.04-1.07). These associations were robust to most other sensitivity analyses but attenuated by further adjustment of PM2.5 or area-level socioeconomic status. Associations were more pronounced among women, those with low physical activity, higher household income or hearing impairment. In HUNT3, associations were observed for obesity or central obesity status among those exposed to Lden greater than 55 dB(A). In contrast, no or negative associations were observed in the Lifelines cohort. CONCLUSIONS: This largest study to date providing mixed findings on impacts of long-term exposure to road traffic noise on obesity, which necessitates future analyses using longitudinal data to further investigate this potentially important epidemiological link.

Relationships between metabolic markers and obesity measures in two populations that differ in stature-The SAMINOR Study.

BACKGROUND: The relationships between metabolic markers and obesity measures may differ by ethnicity, sex, and height. Questions have been posed whether these relationships differ by ethnicity in the population in Northern Norway, but this has not been explored yet. OBJECTIVES: Investigate the relationships between metabolic markers and obesity measures in Sami and non-Sami and explore the impact of stature. METHODS: In total, 13 921 men and women aged 30 and 36 to 79 years (22.0% Sami) from a population-based cross-sectional survey in Norway, the SAMINOR 1 Survey (2003-2004, 57.2% attendance), were included. Relationships between triglycerides, high-density lipoprotein cholesterol, glucose, systolic/diastolic blood pressure (BP), metabolic syndrome and diabetes mellitus as outcomes, and body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), respectively, were modelled using fractional polynomial regression. Appropriate interaction analyses and adjustments were made. RESULTS: The non-Sami were approximately 6 cm taller than the Sami. No interactions were found between ethnicity and obesity. At the same levels of WC, BMI, or WHtR, levels of lipids and BP differed marginally between Sami and non-Sami, but these were eliminated by height adjustment, with one exception: At any given WC, BMI, or WHtR, Sami had approximately 1.4 mmHg (95% CI, -2.1 to -0.7) lower systolic BP than non-Sami (P values < .001). CONCLUSIONS: Height explained the marginal ethnic differences in metabolic markers at the same level of obesity, except for systolic BP, which was lower in Sami than in non-Sami at any given BMI, WC, or WHtR.

A descriptive study of ten-year longitudinal changes in weight and waist circumference in the multi-ethnic rural Northern Norway. The SAMINOR Study, 2003-2014.

The obesity epidemic is dynamic with varying secular trends and differences between countries and ethnic groups. The objective of this study was to describe the age- and sex-specific longitudinal changes in weight and waist circumference in a rural Norwegian population with a high proportion of the indigenous Sami population. Based on two population-based surveys, SAMINOR 1 (2003-2004) and SAMINOR 2 (2012-2014), we present longitudinal changes in weight and waist circumference according to age at baseline in the SAMINOR 1 Survey and sex during the 10-year period. The analyses included 1538 men and 1958 women aged 36 to 69 at baseline (birth year 1934 to 1967). Forty-one percent of the population were Sami. Both weight and waist circumference were measured. The mean weight increased 0.8 kg (95% confidence interval: 0.5, 1.1) in men and 0.3 kg (95% confidence interval: 0, 0.5) in women. In both men and women, younger individuals gained significantly more weight during the 10-year follow-up than older participants (p < 0.001). The mean weight showed a statistically significant increase in men aged 36-54 and women aged 36-49 at baseline and was statistically significantly reduced in men and women aged 60-69. The mean waist circumference increased by 6.3 cm (95% confidence interval: 6.0, 6.6) in men and 8.4 cm (95% confidence interval 8.1, 8.8) in women. The mean waist circumference increased statistically significantly from SAMINOR 1 to SAMINOR 2 in all age groups, and there was an inverse relationship between age at baseline and change in waist circumference (p < 0.001). Waist circumference increased more than can be explained by changes in weight and age during the 10-year period. The inverse relationships between age at baseline in SAMINOR 1 and the 10-year change in weight and waist circumference were found in both Sami and non-Sami participants. The findings underline the need for prevention of obesity, particularly in younger people, as it is difficult to achieve permanent weight loss.

Adiposity and asthma in adults: a bidirectional Mendelian randomisation analysis of The HUNT Study.

BACKGROUND: We aimed to investigate the potential causal associations of adiposity with asthma overall, asthma by atopic status or by levels of symptom control in a large adult population and stratified by sex. We also investigated the potential for reverse causation between asthma and risk of adiposity. METHODS: We performed a bidirectional one-sample Mendelian randomisation (MR) study using the Norwegian Nord-Trøndelag Health Study population including 56 105 adults. 73 and 47 genetic variants were included as instrumental variables for body mass index (BMI) and waist-to-hip ratio (WHR), respectively. Asthma was defined as ever asthma, doctor-diagnosed asthma and doctor-diagnosed active asthma, and was further classified by atopic status or levels of symptom control. Causal OR was calculated with the Wald method. RESULTS: The ORs per 1 SD (4.1 kg/m2) increase in genetically determined BMI were ranged from 1.36 to 1.49 for the three asthma definitions and similar for women and men. The corresponding ORs for non-atopic asthma (range 1.42-1.72) appeared stronger than those for the atopic asthma (range 1.18-1.26), but they were similar for controlled versus partly controlled doctor-diagnosed active asthma (1.43 vs 1.44). There was no clear association between genetically predicted WHR and asthma risk or between genetically predicted asthma and the adiposity markers. CONCLUSIONS: Our MR study provided evidence of a causal association of BMI with asthma in adults, particularly with non-atopic asthma. There was no clear evidence of a causal link between WHR and asthma or of reverse causation.

Weight underestimation linked to anxiety and depression in a cross-sectional study of overweight individuals in a Sami and non-Sami Norwegian population: the SAMINOR Study.

OBJECTIVES: Underestimation of overweight/obesity may prevent weight loss attempts, resulting in further weight gain and maintenance of overweight. Mental health benefits may nevertheless surpass negative consequences. Our main objective was to study the association between underestimation of overweight/obesity and symptoms of anxiety and depression in Sami and non-Sami populations. DESIGN: Population-based cross-sectional study. SETTING: The SAMINOR 2 Clinical Study with participants from 10 municipalities in Northern Norway enrolled between 2012 and 2014. PARTICIPANTS: The study included 3266 adults of multiethnic rural origin with overweight/obesity (body mass index (BMI) ≥25 kg/m2) whereof 1384 underestimated their weight (42%). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measure was symptoms of anxiety and depression and secondary outcome measures were BMI and the demographic variables: sex, age, education and marital status. RESULTS: A higher proportion of Sami men compared with non-Sami men were obese, and reported more symptoms of anxiety and depression. More men than women, and a higher proportion of Sami women compared with non-Sami women, underestimated their weight. Multivariable-adjusted analyses showed that women were less likely to underestimate their weight compared with men (OR 0.43, 95% CI 0.33 to 0.55 in Sami and OR 0.33, 95% CI 0.26 to 0.42 in non-Sami), higher BMI was protective against weight underestimation (OR 0.72, 95% CI 0.69 to 0.75 in Sami and OR 0.63, 95% CI 0.60 to 0.67 in non-Sami), slightly higher odds of weight underestimation were observed with increasing age in both ethnic groups (OR 1.03, 95% CI 1.01 to 1.05 in Sami and OR 1.02, 95% CI 1.00 to 1.03 in non-Sami), while higher education lowered the odds in non-Sami (OR 0.69, 95% CI 0.55 to 0.87). Weight underestimation was protectively associated with anxiety and depression in Sami men (OR 0.48, 95% CI 0.27 to 0.84) and in non-Sami women (OR 0.44, 95% CI 0.25 to 0.78) adjusted for age, BMI, education and marital status. CONCLUSIONS: Independent of ethnicity, more men than women underestimated their weight. Underestimation of weight was protectively associated with anxiety and depression in Sami men and non-Sami women.

Suicidal ideation in relation to disordered eating, body size and weight perception: a cross-sectional study of a Norwegian adolescent population: the HUNT Study.

OBJECTIVE: We conducted a population-based study on a sample of more than 7000 adolescents where we examined the associations between suicidal ideation (SI) and disordered eating (DE) and its related traits. DESIGN: Cross-sectional. SETTINGS: Data were derived from two Norwegian population-based cohorts, the Young-HUNT1 (1995-1997) and Young-HUNT3 (2006-2008) from the county of Nord-Trøndelag, Norway. PARTICIPANTS: A total of 7268 adolescents (15-19 years) who had completed self-reported questionnaires including items on SI, DE, body size and weight perception were included. PRIMARY OUTCOME MEASURES: ORs for SI given DE, body size or weight perception. Analyses were performed in multivariate logistic regression models. RESULTS: The prevalence of SI was 23.1% in total population. Both girls and boys who reported DE, evaluated their body size as not 'about the same as others' or were 'unhappy about their weight' had between twofold to fivefold increase in odds for SI; these incremental risks were observed independent of sex, age, body mass index and socioeconomic status. We observed higher odds for SI among boys. CONCLUSIONS: Our findings suggest a clear association between SI and DE and its associated traits, in both genders but especially in males. Special attention should be paid on early detection of DE traits among adolescents.

Change in prevalence and severity of metabolic syndrome in the Sami and non-Sami population in rural Northern Norway using a repeated cross-sectional population-based study design: the SAMINOR Study.

OBJECTIVE: To examine the change in both the prevalence and severity of metabolic syndrome (MetS) in the Sami and non-Sami in Northern Norway due to a lack of knowledge regarding the development of MetS in this population. DESIGN: Repeated cross-sectional study. SETTING: The study is based on data from the SAMINOR 1 Survey (2003-2004, n=6550) and the SAMINOR 2 Clinical Survey (2012-2014, n=6004), conducted in 10 municipalities in Northern Norway. PARTICIPANTS: Men and women aged 40-79 years were invited. We excluded participants not handing in the questionnaire and with missing information concerning ethnicity questions or MetS risk factors resulting in a final sample of 6308 (36.0% Sami) subjects in SAMINOR 1 and 5866 (40.9% Sami) subjects in SAMINOR 2. OUTCOME MEASURES: MetS prevalence was determined using the harmonised Adult Treatment Panel III (ATP-III) criteria, and severity was assessed with the MetS severity Z-score. Generalised estimating equations with an interaction term (survey × ethnicity) were used to compare prevalence and severity between the two surveys while accounting for partly repeated measurements. RESULTS: The overall, age-standardised ATP-III-MetS prevalence was 31.2% (95% CI: 29.8 to 32.6) in SAMINOR 1 and 35.6% (95% CI: 34.0 to 37.3) in SAMINOR 2. Both the ATP-III-MetS prevalence and the mean MetS severity Z-score increased between the surveys in all subgroups, except the ATP-III-MetS prevalence in non-Sami women, which remained stable. Over time, Sami men showed a slightly larger increase in MetS severity than non-Sami men (p<0.001): the score increased by 0.20 (95% CI: 0.14 to 0.25) and 0.06 (95% CI: 0.01 to 0.10) in Sami and non-Sami men, respectively. Abdominal obesity increased markedly between the surveys in all subgroups. CONCLUSION: The prevalence and severity of MetS increased over time in rural Northern Norway. Abdominal obesity appeared to drive the increase in ATP-III-MetS prevalence. Sami men had a slightly larger increase in severity than non-Sami.

Epigenome-wide methylation differences in a group of lean and obese women - A HUNT Study.

Knowledge of epigenetically regulated biomarkers linked to obesity development is still scarce. Improving molecular understanding of the involved factors and pathways would improve obesity phenotype characterization and reveal potentially relevant targets for obesity intervention. The Illumina Infinium HumanMethylation450 BeadChip was used in a leucocyte epigenome-wide association study (EWAS) to quantify differential DNA methylation in 60 lean compared with 60 obese young women. Replication was done in monozygotic twins discordant for obesity. At adolescence and adulthood, the two weight groups differed significantly in obesity-related traits and metabolic risk factors. Differential hypomethylation was overrepresented in obese compared to lean women. In the adjusted model, the EWAS revealed 10 differentially methylated CpG sites linked to 8 gene loci - COX6A1P2/FGD2, SBNO2, TEX41, RPS6KA2, IGHE/IGHG1/IGHD, DMAP1, SOCS3, and SETBP1- and an enhancer locus at chromosome 2 (2p25.1). The sites linked to TEX41, IGHE/IGHG1/IGHD, DMAP1, and SETBP1 were novel findings, while COX6A1P/FGD2, SBNO2, RPS6KA2, and SOCS3 had been identified previously with concordant direction of effects. RPS6KA2, DMAP1, and SETBP1 were replicated in the BMI-discordant monozygotic twin cohort using the FDR of 5%.