No change in 24-h sodium intake estimated from spot urine in Norwegian adults from 2006 to 2019: the population-based Trøndelag Health Study (HUNT).

OBJECTIVE: Monitoring time trends in salt consumption is important for evaluating the impact of salt reduction initiatives on public health outcomes. There has so far not been available data to indicate if salt consumption in Norway has changed during the previous decade. We aimed to assess whether average 24-h salt intake estimated from spot urine samples in the adult population of mid-Norway changed from 2006-2008 to 2017-2019 and to describe variations by sex, age and educational level. DESIGN: Repeated cross-sectional studies. SETTING: The population-based Trøndelag Health Study (HUNT). PARTICIPANTS: In each of two consecutive waves (HUNT3: 2006-2008 and HUNT4: 2017-2019), spot urine samples were collected from 500 men and women aged 25-64 years, in addition to 250 men and women aged 70-79 years in HUNT4. Based on spot urine concentrations of Na, K and creatinine and age, sex and BMI, we estimated 24-h Na intake using the International Cooperative Study on Salt and Blood Pressure (INTERSALT) equation for the Northern European region. RESULTS: Mean (95 % CI) estimated 24-h salt intakes in men were 11·1 (95 % CI 10·8, 11·3) g in HUNT3 and 10·9 (95 % CI 10·6, 11·1) g in HUNT4, P = 0·25. Corresponding values in women were 7·7 (95 % CI 7·5, 7·9) g and 7·7 (95 % CI 7·5, 7·9) g, P = 0·88. Mean estimated salt intake in HUNT4 decreased with increasing age in women, but not in men, and it did not differ significantly across educational level in either sex. CONCLUSIONS: Estimated 24-h salt intake in adult men and women in mid-Norway did not change from 2006-2008 to 2017-2019.

Moderately increased albuminuria, chronic kidney disease and incident dementia: the HUNT study.

BACKGROUND: Epidemiologic studies has shown an association of albuminuria and low estimated glomerular filtration rate (eGFR) with dementia, but the findings are inconsistent. This study examines the association between eGFR, MA with dementia and its subtypes: AD, VaD, a mixture of AD/VaD, and other dementias. METHODS: Data from the second wave of the HUNT 2 Study (1995-1997) were linked with a dementia register known as the Health and Memory Study (HMS) collected during 1995-2011 in Nord-Trøndelag County, Norway. Dementia was ascertained using World Health Organization's ICD-10 criteria into subtypes: AD,VaD, mixed AD/VaD, and other dementia. eGFR and its association with dementia was examined in 48,508 participants of the HUNT Study, of which 668 were diagnosed with all-cause dementia. Association between MA and dementia were studied in a subset of 7024 participants, and 214 were diagnosed with all-cause dementia. Cox regression models were conducted analyzing the association between dementia and MA using albumin creatine ratio (ACR). Cox regression models and Fine-Gray models were used to examine the association between dementia and eGFR. RESULTS: A positive association was found between increasing ACR and dementia. ACR in the fourth quartile (> 1.78 mg/mmol) with increased hazard ratio of VaD, 3.97 (1.12 to 14.07), compared with ACR in the first quartile (<.53 mg/mmol). There was no association between eGFR and dementia or its subgroups. CONCLUSIONS: Our results strengthens the hypothesis that vascular mechanisms may affect both kidney and brain as an association between MA and dementia was found. However, eGFR was not significantly associated with dementia independent of diabetes mellitus or hypertension.

The association of high sensitivity C-reactive protein and incident Alzheimer disease in patients 60 years and older: The HUNT study, Norway.

BACKGROUND: With ageing, long-standing inflammation can be destructive, contributing to development of several disorders, among these Alzheimer's disease (AD). C-reactive protein (CRP) is a relatively stable peripheral inflammatory marker, but in previous studies the association between highly sensitive CRP (hsCRP) and AD have shown inconsistent results. This study examines the association between AD and hsCRP in blood samples taken up to 15 years prior to the diagnoses of 52 persons with AD amongst a total of 2150 persons ≥60 years of age. RESULTS: Data from Norway's Nord-Trøndelag Health Study (HUNT 2) and the Health and Memory Study (HMS) were linked. The participants had an average age of 73 years, and diagnosed with AD up to 15 years [mean 8.0 (±3.9)] following hsCRP measurement. Logistic regression models showed an adverse association between hsCRP and AD in participants aged 60-70.5 (odds ratio: 2.37, 95% CI: 1.01-5.58). Conversely, in participants aged 70.6-94, there was an inverse association between hsCRP and AD (odds ratio: 0.39, 95% CI: 0.19-0.84). When applying multivariate models the findings were significant in individuals diagnosed 0.4-7 years after the hsCRP was measured; and attenuated when AD was diagnosed more than seven years following hsCRP measurement. CONCLUSIONS: Our study is in line with previous studies indicating a shift in the association between hsCRP and AD by age: in adults (60-70.5 years) there is an adverse association, while in seniors (>70.6 years) there is an inverse association. If our findings can be replicated, a focus on why a more active peripheral immune response may have a protective role in individuals ≥70 years should be further examined.

Are elderly HUNT participants healthier than before? / Er eldre HUNT-deltagere friskere enn før?

BACKGROUND: Since the number of elderly people will rise in the years to come, knowledge about their health trends is important for social planning. The objective of this study was to investigate trends in health development among elderly people over 70 years in Nord-Trøndelag county. MATERIAL AD METHOD: In the Nord-Trøndelag Health Study (HUNT) we have collected health data over three rounds: HUNT1 (1984 ­ 86), HUNT2 (1995 ­ 97) and HUNT3 (2006 ­ 08). Using cross-sectional analyses, we have studied changes in self-reported health, level of functioning and the use of health services. The material includes 12 391 persons (85 % participation) in HUNT1, 11 069 (69.3 % participation) in HUNT2 and 8 194 in HUNT3 (54.7 % participation). RESULTS: Subjective health and activities of daily living (ADL functions) were assessed as better in HUNT3 than in HUNT2. Self-reported physical activity increased from HUNT1 to HUNT3. The use of home-help services decreased from HUNT2 to HUNT3, while the use of nursing homes and home nursing services remained unchanged. The use of general practitioner services increased in all periods, while the use of outpatient services increased strongly from HUNT1 to HUNT2. INTERPRETATION: It appears that the elderly inhabitants of Nord-Trøndelag county feel that their health has improved and that they have become more self-reliant and more physically active in the period from 1984 to 2008, but the findings need to be interpreted with some caution due to the decline in the participation rate from HUNT1 to HUNT3.

A 15-Year Follow-Up Study of Sense of Humor and Causes of Mortality: The Nord-Trøndelag Health Study.

BACKGROUND: Associations between the sense of humor and survival in relation to specific diseases has so far never been studied. METHODS: We conducted a 15-year follow-up study of 53,556 participants in the population-based Nord-Trøndelag Health Study, Norway. Cognitive, social, and affective components of the sense of humor were obtained, and associations with all-cause mortality, mortality due to cardiovascular diseases (CVD), infections, cancer, and chronic obstructive pulmonary diseases were estimated by hazard ratios (HRs). RESULTS: After multivariate adjustments, high scores on the cognitive component of the sense of humor were significantly associated with lower all-cause mortality in women (HR = 0.52, 95% confidence interval [CI] = 0.33-0.81), but not in men (HR = 0.88, 95% CI = 0.59-1.32). Mortality due to CVD was significantly lower in women with high scores on the cognitive component (HR = 0.27, 95% CI = 0.15-0.47), and so was mortality due to infections both in men (HR = 0.26, 95% CI = 0.09-0.74) and women (HR = 0.17, 95% CI = 0.04-0.76). The social and affective components of the sense of humor were not associated with mortality. In the total population, the positive association between the cognitive component of sense of humor and survival was present until the age of 85 years. CONCLUSIONS: The cognitive component of the sense of humor is positively associated with survival from mortality related to CVD and infections in women and with infection-related mortality in men. The findings indicate that sense of humor is a health-protecting cognitive coping resource.

Blood pressure changes during 22-year of follow-up in large general population - the HUNT Study, Norway.

BACKGROUND: While hypertension still is a major health problem worldwide, some studies have indicated that the blood pressure level has decreased in some populations. This population based cohort study aims at analysing blood pressure changes in a large Norwegian population over a 22 year period. METHODS: Data is acquired from three comprehensive health surveys of the HUNT Study conducted from 1984-86 to 2006-08. All citizens of Nord-Trøndelag County, Norway, >20 years were invited: 74,549 individuals participated in 1984-86; 64,523 in 1995-97; and 43,905 in 2006-08. RESULTS: Both systolic and diastolic blood pressure levels decreased substantially from mid 1980s to mid 2000s, with the most pronounced decrease from 1995-97 to 2006-08 (from 136.0/78.9 to 128.3/70.9 mmHg in women and from 140.1/82.1 to 133.7/76.5 mmHg in men). Although the use of blood pressure lowering medication increased, there was a considerable decrease even in those who reported never use of medication (mean decrease 6.8/7.2 mmHg in women and 6.3/5.3 mmHg in men), and the decrease was most pronounced in the elderly (mean decrease 16.1/12.4 mmHg in women and 14.7/10.4 mmHg in men aged 80+). Mean heart rate, total cholesterol and daily smoking decreased, self-reported hard physical activity increased, while body weight and the prevalence of diabetes increased during the same period. CONCLUSIONS: The BP decrease might seem paradoxically, as body weight and prevalence of diabetes increased during the same period. Salt consumption might have decreased, but no salt data is available. The parallel decrease in mean heart rate might indicate reduction in the white-coat phenomenon, or increased use of beta blockers or calcium channel blockers for other diagnosis than hypertension. Additionally, the data could support the "healthy obese" hypothesis, i.e., that subgroups in the population can sustain obesity without serious health consequences.

Alcohol consumption and risk of dementia up to 27 years later in a large, population-based sample: the HUNT study, Norway.

The relationship between alcohol consumption and dementia risk is unclear. This investigation estimates the association between alcohol consumption reported in a population-based study in the mid-1980s and the risk for dementia up to 27 years later. The entire adult population in one Norwegian county was invited to the Nord-Trøndelag Health Study during 1984-1986 (HUNT1): 88 % participated. The sample used in this study includes HUNT1 participants born between 1905 and 1946 who completed the questionnaire assessing alcohol consumption. A total of 40,435 individuals, of whom 1084 have developed dementia, are included in the analysis adjusted for age, sex, years of education, hypertension, obesity, smoking, and symptoms of depression. When adjusting for age and sex, and compared to reporting consumption of alcohol 1-4 times during the last 14 days (drinking infrequently), both abstaining from alcohol and reporting consumption of alcohol five or more times (drinking frequently) were statistically significantly associated with increased dementia risk with hazard ratios of 1.30 (95 % CI 1.05-1.61) and 1.45 (1.11-1.90), respectively. In the fully adjusted analysis, drinking alcohol frequently was still significantly associated with increased dementia risk with a hazard ratio of 1.40 (1.07-1.84). However, the association between dementia and abstaining from alcohol was no longer significant (1.15, 0.92-1.43). Equivalent results for Alzheimer's disease and vascular dementia indicated the same patterns of associations. When adjusting for other factors associated with dementia, frequent alcohol drinking, but not abstaining from alcohol, is associated with increased dementia risk compared to drinking alcohol infrequently.

Sedentary behaviour and risk of mortality from all-causes and cardiometabolic diseases in adults: evidence from the HUNT3 population cohort.

BACKGROUND: Sedentary behaviour is a potential risk factor for chronic-ill health and mortality, that is, independent of health-enhancing physical activity. Few studies have investigated the risk of mortality associated with multiple contexts of sedentary behaviour. OBJECTIVE: To examine the prospective associations of total sitting time, TV-viewing time and occupational sitting with mortality from all causes and cardiometabolic diseases. METHODS: Data from 50,817 adults aged ≥20 years from the Nord-Trøndelag Health Study 3 (HUNT3) in 2006-2008 were linked to the Norwegian Cause of Death Registry up to 31 December 2010. Cox proportional hazards models examined all-cause and cardiometabolic disease-related mortality associated with total sitting time, TV-viewing and occupational sitting, adjusting for multiple potential confounders including physical activity. RESULTS: After mean follow-up of 3.3 years (137,315.8 person-years), 1068 deaths were recorded of which 388 were related to cardiometabolic diseases. HRs for all-cause mortality associated with total sitting time were 1.12 (95% CI 0.89 to 1.42), 1.18 (95% CI 0.90 to 1.57) and 1.65 (95% CI 1.24 to 2.21) for total sitting time 4-<7, 7-<10 and ≥10 h/day, respectively, relative to <4 h/day after adjusting for confounders (p-trend=0.001). A similar pattern of associations was observed between total sitting time and mortality from cardiometabolic diseases, but TV-viewing time and occupational sitting showed no or borderline significant associations with all-cause or cardiometabolic disease-related mortality over the same follow-up period. CONCLUSIONS: Total sitting time is associated with all-cause and cardiometabolic disease-related mortality in the short term. However, prolonged sitting in specific contexts (ie, watching TV, at work) do not adversely impact health in the same timeframe. These findings suggest that adults should be encouraged to sit less throughout the day to reduce their daily total sitting time.

Somatic health of patients at an outpatient clinic for substance abuse.

BACKGROUND: Previous studies have detected a considerable degree of somatic illness among substance abusers. At our outpatient clinic for substance abuse we frequently find that referral documents provide scant information on somatic illnesses, and that patients complain of poor contact with their GP. We wished to investigate these issues. MATERIAL AND METHOD: From September 2009 to November 2012 a total of 155 of 365 patients (42%) at an outpatient clinic for substance abuse at Levanger Hospital were included in the study. Information was gathered on somatic illnesses according to ICPC using patient-reported medical history, clinical examination, laboratory tests, review of somatic hospital records and/or information from GPs. Somatic health information in referral documents, supplementary information from GPs and patient-GP relationships were examined. RESULTS: Altogether 119 men and 36 women with an average age of 41.7 years were included. Alcohol was the preferred intoxicant for 110 patients. We found an average of 4.2 disease diagnoses and 0.8 symptom diagnoses per patient. Dental disease was present in 69 patients, hypertension in 56, allergies in 45 and morbid obesity in 37. More serious diseases such as cancer and hepatic failure were detected. ECG showed pathology in 32 of 107 patients examined. A total of 101 referrals lacked information on somatic health. Sixty doctors replied to letters containing questions regarding somatic supplementary information. A total of 92 patients reported good or acceptable contact with their GP, 19 reported poor contact and 19 declined to answer the question, while 15 patients reported no contact and 10 reported that they had just changed their GP. INTERPRETATION: The substance abusers in this study had several somatic diagnoses, and many reported poor contact with their GPs. There are grounds for questioning whether the requirements set by the specialist health service for adequate health provisions for patients at the outpatient clinic for substance abuse are being met.

The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies.

BACKGROUND: Not all obese subjects have an adverse metabolic profile predisposing them to developing type 2 diabetes or cardiovascular disease. The BioSHaRE-EU Healthy Obese Project aims to gain insights into the consequences of (healthy) obesity using data on risk factors and phenotypes across several large-scale cohort studies. Aim of this study was to describe the prevalence of obesity, metabolic syndrome (MetS) and metabolically healthy obesity (MHO) in ten participating studies. METHODS: Ten different cohorts in seven countries were combined, using data transformed into a harmonized format. All participants were of European origin, with age 18-80 years. They had participated in a clinical examination for anthropometric and blood pressure measurements. Blood samples had been drawn for analysis of lipids and glucose. Presence of MetS was assessed in those with obesity (BMI ≥ 30 kg/m2) based on the 2001 NCEP ATP III criteria, as well as an adapted set of less strict criteria. MHO was defined as obesity, having none of the MetS components, and no previous diagnosis of cardiovascular disease. RESULTS: Data for 163,517 individuals were available; 17% were obese (11,465 men and 16,612 women). The prevalence of obesity varied from 11.6% in the Italian CHRIS cohort to 26.3% in the German KORA cohort. The age-standardized percentage of obese subjects with MetS ranged in women from 24% in CHRIS to 65% in the Finnish Health2000 cohort, and in men from 43% in CHRIS to 78% in the Finnish DILGOM cohort, with elevated blood pressure the most frequently occurring factor contributing to the prevalence of the metabolic syndrome. The age-standardized prevalence of MHO varied in women from 7% in Health2000 to 28% in NCDS, and in men from 2% in DILGOM to 19% in CHRIS. MHO was more prevalent in women than in men, and decreased with age in both sexes. CONCLUSIONS: Through a rigorous harmonization process, the BioSHaRE-EU consortium was able to compare key characteristics defining the metabolically healthy obese phenotype across ten cohort studies. There is considerable variability in the prevalence of healthy obesity across the different European populations studied, even when unified criteria were used to classify this phenotype.

Mental health and wellbeing in spouses of persons with dementia: the Nord-Trøndelag Health Study.

BACKGROUND: Caring for a spouse diagnosed with dementia can be a stressful situation and can put the caregiving partner at risk of loss of mental health and wellbeing. The main aim of this study was to investigate the relationship between dementia and spousal mental health in a population-based sample of married couples older than 55 years of age. The association was investigated for individuals living together with their demented partner, as well as for individuals whose demented partner was living in an institution. METHODS: Data on dementia were collected from hospitals and nursing homes in the county of Nord-Trøndelag, Norway. These data were combined with data on spousal mental health, which were collected in a population-based health screening: the Nord-Trøndelag Health Study (HUNT). Of 6,951 participating couples (>55 years), 131 included one partner that had been diagnosed with dementia. RESULTS: Our results indicate that after adjustment for covariates, having a partner with dementia is associated with lower levels of life satisfaction and more symptoms of anxiety and depression than reported by spouses of elderly individuals without dementia. Spouses living together with a partner diagnosed with dementia experienced moderately lower levels of life satisfaction (0.35 standard deviation [SD]) and more symptoms of depression (0.38 SD) and anxiety (0.23 SD) than did their non-caregiving counterparts. Having a partner with dementia that resided in a nursing home was associated with clearly lower life satisfaction. Compared with non-caregivers, these spouses reported lower levels of life satisfaction (1.16 SD), and also more symptoms of depression (0.38 SD), and more symptoms of anxiety (0.42 SD). CONCLUSIONS: Having a partner with dementia is associated with loss of mental health and reduced life satisfaction. The risk of adverse mental health outcomes is greatest after the partner's nursing home admission.

Social and spatial patterns of obesity diffusion over three decades in a Norwegian county population: the HUNT Study.

BACKGROUND: In order to develop effective preventive strategies, knowledge of trends in socioeconomic and geographical differences in risk factor levels is important. The objective of this study was to examine social and spatial patterns of obesity diffusion in a Norwegian population during three decades. METHODS: Data on adults aged 30-69 years from three cross-sectional health surveys eleven years apart in the Nord-Trøndelag Health Study, Norway, HUNT1 (1984-1986), HUNT2 (1995-1997) and HUNT3 (2006-2008) were utilized. Body mass index (BMI) was used as a measure of obesity. Height and weight were measured clinically. Age standardized prevalences, absolute prevalence differences and ratios, prevalence odds ratios for BMI and the Relative Index of Inequality (RII) were calculated. Multilevel statistical models were fitted for analysing geographical patterns. RESULTS: The prevalence of obesity was systematically higher in groups with lower socio-economic status and increased successively in all groups in the population during the three decades. The relative socioeconomic inequalities in obesity measured by level of education did not change substantially in the period. In HUNT1 (1984-86) obesity was most prevalent among low educated women (14.1%) and in HUNT3 (2006-08) among low educated men (30.4%). The RII for men changed from 2.60 to 1.91 and 2.36 in HUNT1, HUNT2 and HUNT3. In women the RIIs were 1.71, 2.28 and 2.30 correspondingly. However, the absolute obesity prevalence inequalities increased, and a geographical diffusion from central to distal districts was observed from HUNT2 to HUNT3. CONCLUSIONS: The prevalence of obesity increased in all socioeconomic groups in this Norwegian adult county population from the 1980ies up to present time. The data did not suggest increasing relative inequalities, but increasing absolute socioeconomic differences and a geographical diffusion towards rural districts. Public health preventive strategies should be oriented to counteract the obesity epidemic in the population.

The HUNT study: participation is associated with survival and depends on socioeconomic status, diseases and symptoms.

BACKGROUND: Population based studies are important for prevalence, incidence and association studies, but their external validity might be threatened by decreasing participation rates. The 50 807 participants in the third survey of the HUNT Study (HUNT3, 2006-08), represented 54% of the invited, necessitating a nonparticipation study. METHODS: Questionnaire data from HUNT3 were compared with data collected from several sources: a short questionnaire to nonparticipants, anonymous data on specific diagnoses and prescribed medication extracted from randomly selected general practices, registry data from Statistics Norway on socioeconomic factors and mortality, and from the Norwegian Prescription Database on drug consumption. RESULTS: Participation rates for HUNT3 depended on age, sex and type of symptoms and diseases, but only small changes were found in the overall prevalence estimates when including data from 6922 nonparticipants. Among nonparticipants, the prevalences of cardiovascular diseases, diabetes mellitus and psychiatric disorders were higher both in nonparticipant data and data extracted from general practice, compared to that reported by participants, whilst the opposite pattern was found, at least among persons younger than 80 years, for urine incontinence, musculoskeletal pain and headache. Registry data showed that the nonparticipants had lower socioeconomic status and a higher mortality than participants. CONCLUSION: Nonparticipants had lower socioeconomic status, higher mortality and showed higher prevalences of several chronic diseases, whilst opposite patterns were found for common problems like musculoskeletal pain, urine incontinence and headache. The impact on associations should be analyzed for each diagnosis, and data making such analyses possible are provided in the present paper.

Anxiety and depression symptoms in arterial hypertension: the influence of antihypertensive treatment. the HUNT study, Norway.

Antihypertensive drugs have been suggested to modulate symptoms of depression and anxiety. It is disputed whether this is due to the hypertension per se, its treatment, or both. The aim of this study was to investigate these associations in a large population sample. 55,472 participants in the Nord-Trøndelag Health Study (HUNT 2, 1995-1997), Norway, who completed the Hospital Anxiety and Depression rating Scale, were divided into 3 groups according to their diastolic blood pressure and antihypertensive treatment status. A cut-off of ≥90 mmHg diastolic blood pressure was used to identify hypertensive status. Differences in anxiety and depression symptom levels in untreated and treated hypertensives (all treatments) versus the normotensive reference group were explained by differences in age and gender distribution in the three groups in this study. However, the receipt of two or more antihypertensive drugs was associated with depressive symptoms alone (OR = 1.40, 95% CI = 1.03-1.90), but not with symptoms of anxiety (OR = 1.14, 95% CI = 0.83-1.57) or mixed anxiety and depression (OR = 1.19, 95% CI = 0.82-1.72) in the fully adjusted model, compared to untreated hypertension. Antihypertensive monotherapy (all agents) nor any single antihypertensive drug class were associated with symptoms of depression, anxiety, or mixed anxiety and depression. There may be a positive association between multi antihypertensive drug use and symptoms of depression, whereas this was not found in persons with symptoms of anxiety or mixed anxiety and depression. This might reflect poor antihypertensive treatment adherence leading to polypharmacy, or other unfavorable health behaviors in people with symptoms of pure depression.

Leisure time activities in adolescence in the presence of susceptibility genes for obesity: risk or resilience against overweight in adulthood? The HUNT study.

BACKGROUND: Environment, health behavior, and genetic background are important in the development of obesity. Adolescents spend substantial part of daily leisure time on cultural and social activities, but knowledge about the effects of participation in such activities on weight is limited. METHODS: A number of 1450 adolescents from the Norwegian HUNT study (1995-97) were followed-up in 2006-08 as young adults. Phenotypic data on lifestyle and anthropometric measures were assessed using questionnaires and standardized clinical examinations. Genotypic information on 12 established obesity-susceptibility loci were available for analyses. Generalized estimating equations were used to examine the associations between cultural and social activities in adolescence and adiposity measures in young adulthood. In addition, interaction effects of a genetic predisposition score by leisure time activities were tested. RESULTS: In girls, participation in cultural activities was negatively associated with waist circumference (WC) (B = -0.04, 95%CI: -0.08 to -0.00) and with waist-hip ratio (WHR) (B = -0.058, 95%CI: -0.11 to -0.01). However, participation in social activities was positively associated with WC (B = 0.040, CI: 0.00 to 0.08) in girls and with BMI (B = 0.027, CI: 0.00 to 0.05) in boys. The effect of the obesity-susceptibility genetic variants on anthropometric measures was lower in adolescents with high participation in cultural activities compared to adolescents with low participation. CONCLUSION: This study suggests that the effects of cultural activities on body fat are different from the effects of participation in social activities. The protective influence of cultural activities in female adolescents against overweight in adulthood and their moderating effect on obesity-susceptibility genes suggest that even cultural activities may be useful in public health strategies against obesity.

Dementia and neuropsychiatric symptoms in nursing-home patients in Nord-Trøndelag County.

BACKGROUND: Earlier studies have revealed a high prevalence of dementia among nursing home patients. We conducted a descriptive study of dementia and neuropsychiatric symptoms among patients in nursing homes in Nord-Trøndelag County, Norway. MATERIAL AND METHODS: 704 nursing home patients were included and studied with the Norwegian versions of the clinical demential rating scale (CDR) and the neuropsychiatric inventory (NPI). RESULTS: The study indicated that 575 patients (82%) had dementia. Of these, 430 patients (75%) had at least one clinically significant neuropsychiatric syndrome in addition, most commonly delusions, apathy or irritability. The neuropsychiatric symptoms could be grouped in four categories: psychosis, apathy, affective symptoms and agitation. INTERPRETATION: The findings are comparable with earlier studies of Norwegian nursing home patients. The high prevalence of dementia and neuropsychiatric symptoms is of significance for the clinical practice, running and planning of nursing homes.

Anxiety and depression lowers blood pressure: 22-year follow-up of the population based HUNT study, Norway.

BACKGROUND: For decades, symptoms of anxiety and depression have been included among psychological factors associated with development of hypertension. Although this has been questioned in recent studies, most findings have been based on a single assessment of mental distress at baseline. We examined these associations using repeated assessments of anxiety, depression and blood pressure. METHODS: Data on 17,410 men and women aged 20 to 67 participating in the Nord-Trøndelag Health Study (HUNT) in Norway in 1984-86 were re-examined 11 and 22 years later. The main outcome was change in mean blood pressure (mm Hg) during follow-up. RESULTS: We found that a high symptom level score (≥80th percentile) of combined anxiety and depression at baseline, as compared to a lower symptom level, was associated with lower mean systolic (-0.67 mm Hg, p = 0.044) and diastolic (-0.25 mm Hg, p = 0.201) blood pressure at year 22. A high symptom level present at all three examinations was associated with a stronger decrease in mean systolic (-1.59 mm Hg, p = 0.004) and diastolic (-0.78 mm Hg, p = 0.019) blood pressure and with a 20% (p = 0.001) lower risk of developing hypertension (BP ≥140/90 mm Hg) at year 22. The associations were only slightly attenuated in multivariate analyses, with no evidence of a mediating effect of alteration in heart rate. CONCLUSIONS: This study do not support previous hypothesis that emotional stress may be a cause of hypertension. Our findings indicate that symptoms of anxiety and depression are associated with decrease in blood pressure, particularly when a high symptom level can be detected over decades.

Program for data extraction in primary health records: a valid tool for knowledge production in general practice?

OBJECTIVES: Research in general practice demands it-tools which give the practitioner trusty results. Medrave 4 is a program designed for extraction of data from all areas of the health record. We wanted to do research on the database in a health center, but found no proof of the quality of the data extracted by Medrave 4. Today the database contains about 40,000 records. In this study we wanted to examine if the program could extract correct data. RESULTS: From the database 20 records were randomly selected from five different time periods, making a total of 100 records. 14 records did not meet the inclusion criteria, resulting in 86 records included in the study. In phase one these variables were registered manually from the records: Age, gender, systolic and diastolic blood pressure (from free text) and six different laboratory tests. In phase two, Medrave 4 extracted the same variables from the same records. Medrave 4 found correct systolic and diastolic blood pressure values in 79 records (92%). The laboratory results were extracted correct in all 86 records (100%). We conclude that Medrave 4 can be a useful tool in quantifying the work of general practitioners.

Sex differences in time trends for overweight and obesity in adolescents: the Young-HUNT study.

AIMS: To investigate sex differences in the prevalence and extent of overweight and obesity in adolescents aged 14-18 years. METHODS: Standardized measurements of height and weight were collected from surveys of adolescents in the same geographical area in 1966-69 (n = 8378) and in 1995-97 (n = 6673). The prevalence rates of overweight and obesity were calculated using criteria approved by the International Obesity Task Force. The extents of overweight and obesity were assessed by computing age- and sex-specific body mass index (BMI) percentiles. RESULTS: In 1995-97, 17.2% met the criteria for either overweight or obesity, as compared with 10.7% in 1966-69. The prevalence of overweight and obesity combined was higher in girls (13.0%) than in boys (8.5%) in 1966-69 (difference 4.5%, 95% confidence interval (CI) 3.1-5.9), while no sex difference was found in 1995-97 (girls 16.9%, boys 17.5%, difference -0.6, 95% CI -2.3-1.1). The increase in overweight was greater in boys (6.2PP, 95% CI 4.7-7.6) than in girls (1.9PP, 95% CI 0.4-3.5), while the sex difference in increased obesity was smaller (boys 2.8PP, 95% CI 2.1-3.4, girls 2.0PP, 95% CI 1.3-2.6). The increase in extent of overweight and obesity was highest in boys. The values of the 85th percentile and the 95th percentile in boys increased by 1.3 and 3.0 BMI units, respectively. The corresponding increases in girls were 0.7 and 1.7 BMI units. CONCLUSIONS: A marked sex difference in time trends for both the prevalence and extent of overweight and obesity, with a more pronounced increase in boys than in girls, was demonstrated. This might have implications for preventive strategies.

Validity of the FINDRISC as a prediction tool for diabetes in a contemporary Norwegian population: a 10-year follow-up of the HUNT study.

Objective: The Finnish Diabetes Risk Score (FINDRISC) is a recommended tool for type 2 diabetes prediction. There is a lack of studies examining the performance of the current 0-26 point FINDRISC scale. We examined the validity of FINDRISC in a contemporary Norwegian risk environment. Research design and methods: We followed 47 804 participants without known diabetes and aged ≥20 years in the HUNT3 survey (2006-2008) by linkage to information on glucose-lowering drug dispensing in the Norwegian Prescription Database (2004-2016). We estimated the C-statistic, sensitivity and specificity of FINDRISC as predictor of incident diabetes, as indicated by incident use of glucose-lowering drugs. We estimated the 10-year cumulative diabetes incidence by categories of FINDRISC. Results: The C-statistic (95% CI) of FINDRISC in predicting future diabetes was 0.77 (0.76 to 0.78). FINDRISC ≥15 (the conventional cut-off value) had a sensitivity of 38% and a specificity of 90%. The 10-year cumulative diabetes incidence (95% CI) was 4.0% (3.8% to 4.2%) in the entire study population, 13.5% (12.5% to 14.5%) for people with FINDRISC ≥15 and 2.8% (2.6% to 3.0%) for people with FINDRISC <15. Thus, FINDRISC ≥15 had a positive predictive value of 13.5% and a negative predictive value of 97.2% for diabetes within the next 10 years. To approach a similar sensitivity as in the study in which FINDRISC was developed, we would have to lower the cut-off value for elevated FINDRISC to ≥11. This would yield a sensitivity of 73%, specificity of 67%, positive predictive value of 7.7% and negative predictive value of 98.5%. Conclusions: The validity of FINDRISC and the risk of diabetes among people with FINDRISC ≥15 is substantially lower in the contemporary Norwegian population than assumed in official guidelines. To identify ~3/4 of those developing diabetes within the next 10 years, we would have to lower the threshold for elevated FINDRISC to ≥11, which would label ~1/3 of the entire adult population as having an elevated FINDRISC necessitating a glycemia assessment.