Proteomic analysis of serum in a population-based cohort did not reveal a biomarker for Modic changes.

Introduction: Modic changes (MC) are bone marrow lesions of vertebral bones, which can be detected with magnetic resonance imaging (MRI) adjacent to degenerated intervertebral discs. Defined by their appearance on T1 and T2 weighted images, there are three interconvertible types: MC1, MC2, and MC3. The inter-observer variability of the MRI diagnosis is high, therefore a diagnostic serum biomarker complementing the MRI to facilitate diagnosis and follow-up would be of great value. Methods: We used a highly sensitive and reproducible proteomics approach: DIA/SWATH-MS to find serum biomarkers in a subset of the Northern Finland Birth Cohort 1966. Separately, we measured a panel of factors involved in inflammation and angiogenesis to confirm some potential biomarkers published before with an ELISA-based method called V-Plex. Results: We found neither an association between the serum concentrations of the proteins detected with DIA/SWATH-MS with the presence of MC, nor a correlation with the size of the MC lesions. We did not find any association between the factors measured with the V-Plex and the presence of MC or their size. Conclusion: Altogether, our study suggests that a robust and generally usable biomarker to facilitate the diagnosis of MC cannot readily be found in serum.

Associations of socioeconomic and lifestyle characteristics, psychological symptoms, multimorbidity, and multisite pain with sciatica - a 15-year longitudinal study.

BACKGROUND CONTEXT: Sciatica is defined as pain radiating from the low back to the leg, usually below the knee. It is a disabling condition that causes a major burden to health care and society. Previous evidence of the multifactorial etiology of sciatica comes mostly from cross-sectional studies. Larger, longitudinal studies with a multidimensional set of variables are needed. PURPOSE: To examine how socioeconomic and lifestyle characteristics, psychological symptoms, multimorbidity, and multisite pain are associated with sciatica. STUDY DESIGN: A longitudinal study of the Northern Finland Birth Cohort 1966. PATIENT SAMPLE: In total 6,683 working-aged members of the Northern Finland Birth Cohort 1966. OUTCOME MEASURES: Self-reported sciatic pain status over a 15-year study period. METHODS: We conducted a 15-year longitudinal study from the age of 31 to 46. We used multivariable generalized estimation equations analysis to examine how socioeconomic characteristics (low education, unemployment, and living alone), lifestyle characteristics (overweight, obesity, current smoking, and physical inactivity), psychological symptoms (depression, anxiety), multimorbidity, and multisite pain were associated with sciatica. RESULTS: At the age of 31, 21.1% of the study population reported sciatic pain and at the age of 46, 36.7%. Multisite pain was clearly the strongest factor associated with sciatica (odds ratio [OR] 2.61, 95% confidence interval [CI] 2.34‒2.92). In descending order of effect size, older age, low education, psychological symptoms, multimorbidity, overweight, obesity, physical inactivity and current smoking were positively associated with sciatica. Their ORs varied between 1.17 and 2.18. Living alone was negatively associated with sciatica (OR 0.81, 95% CI 0.72‒0.90). CONCLUSIONS: Multisite pain had the strongest association with sciatica. The effect sizes of the other factors were clearly smaller. To our knowledge this is the first study to evaluate the association of multisite pain with sciatica. This finding may have considerable implications for clinical work treating patients with sciatica.

The role of co-occurring insomnia and mental distress in the association between lumbar disc degeneration and low back pain related disability.

BACKGROUND: Lumbar disc degeneration (LDD) is associated with low back pain (LBP). Although both insomnia and mental distress appear to influence the pain experience, their role in the association between LDD and LBP is uncertain. Our objective was to investigate the role of co-occurring insomnia and mental distress in the association between LDD and LBP-related disability. METHODS: A total of 1080 individuals who had experienced LBP during the previous year underwent 1.5-T lumbar magnetic resonance imaging, responded to questionnaires, and participated in a clinical examination at the age of 47. Full data was available for 843 individuals. The presence of LBP and LBP-related disability (numerical rating scale, range 0-10) were assessed using a questionnaire. LDD was assessed by a Pfirrmann-based sum score (range 0-15, higher values indicating higher LDD). The role of insomnia (according to the five-item Athens Insomnia Scale) and mental distress (according to the Hopkins Symptom Check List-25) in the association between the LDD sum score and LBP-related disability was analyzed using linear regression with adjustments for sex, smoking, body mass index, education, leisure-time physical activity, occupational physical exposure, Modic changes, and disc herniations. RESULTS: A positive association between LDD and LBP-related disability was observed among those with absence of both mental distress and insomnia (adjusted B = 0.132, 95% CI = 0.028-0.236, p = 0.013), and among those with either isolated mental distress (B = 0.345 CI = 0.039-0.650, p = 0.028) or isolated insomnia (B = 0.207, CI = 0.040-0.373, p = 0.015). However, among individuals with co-occurring insomnia and mental distress, the association was not significant (B = -0.093, CI = -0.346-0.161, p = 0.470). CONCLUSIONS: LDD does not associate with LBP-related disability when insomnia and mental distress co-occur. This finding may be useful when planning treatment and rehabilitation that aim to reduce disability among individuals with LDD and LBP. Future prospective research is warranted.

Unnatural-cause mortality patterns of Northern Finnish men and women diverge in adolescence - A 52-year follow-up.

The Finnish population has a long life expectancy but ranks high in unnatural deaths on the European scale. Mortality has historical regional discrepancy in Finland, as Northern Finns are overrepresented in both natural and unnatural deaths. This study aimed to characterize the age- and sex-related trends in unnatural mortality among Northern Finns. Altogether 12 143 individuals, constituting >95% of births in Northern Finland in 1966, were followed up for a median of 52 years. The mortality patterns of this population were studied using death record data. Crude annual mortality rates were calculated and graphed for 10-year age strata (all-cause, natural-cause, and unnatural-cause mortality, as well as accident, suicide, and homicide mortality). Cox regression was used to analyze the sex discrepancy in mortality. A total of 874 deaths (7.2%) occurred during the follow-up period. Women had 47% and 73% lower risks of any death and unnatural death than men, respectively. From the second decade of life onwards, the unnatural mortality of men was 3-5 times that of women. Accident and suicide mortality rates of men were 2-13 and 2-3 times those of women, respectively. Homicides were rare among either sex. We conclude that Northern Finnish women have a substantially lower risk of all-cause mortality and unnatural mortality than men. To aid the development of preventive strategies, future studies should aim to identify the underlying factors behind unnatural mortality. Primarily, emphasis should be placed on the increased mortality of men from the second decade of life onwards.

Association of Enamel Caries Lesions with Oral Hygiene and DMFT among Adults.

The aim of this study was to evaluate the prevalence of enamel caries lesions and their association with tooth brushing frequency, tooth brushing quality, and past caries experience among Finnish adults. The study population comprised 46-year-old members of the Northern Finland Birth Cohort 1966 (n = 1,961). Caries lesions were examined and recorded at surface level using the International Caries Detection and Assessment System (ICDAS). The cut-off point for enamel caries was set to ICDAS score 3. The cut-off point for brushing frequency was twice daily. Visible plaque on buccal tooth surfaces represented brushing quality. Using enamel caries lesions (ICDAS1-3) as a dependent variable, an adjusted logistic regression model was conducted to investigate the association with gender, brushing frequency, visible plaque, dentin caries lesions (ICDAS4-6), teeth with restorations, extractions and fractures. Almost all participants (99%) had enamel and 40% had dentin caries lesions; the mean number of teeth with enamel caries lesions was 13.8 (SD 4.6). According to the adjusted logistic regression model, the high prevalence of ICDAS1-3 lesions was associated with having visible plaque on more than 20% of teeth and having more than 13 restored teeth. In conclusion, the prevalence of enamel caries lesions is high among the Finnish adult population. The results of this study suggest that in addition to tooth brushing frequency, the presence of visible plaque seems to be critical when evaluating the association between tooth brushing and enamel caries.

Arsenic, cadmium, lead and mercury levels in blood of Finnish adults and their relation to diet, lifestyle habits and sociodemographic variables.

The Northern Finland Birth Cohort program (NFBC) is the epidemiological and longitudinal prospective general population research program, which was established to promote health and wellbeing of the population in northern Finland. The aim of present study, as a part of the NFBC program, was to analyze the blood levels of arsenic (B-As), cadmium (B-Cd), lead (B-Pb), total mercury (B-Hg) and selenium (B-Se); to compare these levels with threshold limits; to study sociodemographic factors; and to correlate these levels with calcium and haemoglobin. The study was comprised of 249 NFBC subjects, of which 123 were female and 126 were male (ages 31.1 ± 0.3 and 31.1 ± 0.4, respectively). All participants were asked to complete a questionnaire regarding diet and living habits. The geometric means (± SD) of B-As were 0.49 ± 2.80 µg/l and 0.44 ± 2.72 µg/l; B-Cd were 0.18 ± 4.02 µg/l and 0.12 ± 3.21 µg/l; B-Pb were 17.0 ± 1.8 µg/l and 9.06 ± 2.20 µg/l; B-Hg were 2.18 ± 2.02 µg/l and 1.85 ± 1.78 µg/l; and B-Se were 106.0 ± 1.3 and 94.3 ± 1.3 µg/l in males and females, respectively. Among the subjects in the present analysis, 23 % of males and 17.1 % of females had B-As levels above the ATSDR normal human levels of B-As in unexposed individuals (1.0 µg/l). The B-Pb geometric mean (12.44 µg/l) was approximately one eighth the CDC toxicological cut-off point of 100 µg/l. Twenty-one individuals (8.4 %) exceeded a B-Hg level of 5.8 µg/l. Fifty-eight females (47 %) had a B-Hg higher than 2.0 µg/l, the German Federal Environmental Agency cut-off point for women (18-69 years) who consume fish at least three times/month; therefore, their babies could be at risk of adverse effects during development.

Associations of meal frequency and breakfast with obesity and metabolic syndrome traits in adolescents of Northern Finland Birth Cohort 1986.

BACKGROUND AND AIMS: Breakfast consumption and meal frequencies have been linked to the risk of obesity in youth but their associations with metabolic syndrome (MetS) in young populations are yet to be studied. We examined associations of three meal patterns on weekdays--five meals including breakfast, ≤four meals including breakfast and ≤four meals without breakfast--with overweight/obesity and MetS components in Finnish adolescents. METHODS AND RESULTS: A population-based sample of 16-year-old boys and girls (n = 6247) from the Northern Finland Birth Cohort 1986 was used. Adolescents were clinically examined and dietary data were collected using self-administered questionnaires. Overweight/obesity and MetS features were defined according to the International Obesity Task Force cut-offs and the International Diabetes Federation MetS paediatric criteria and their associations with meal patterns assessed using logistic regression, adjusted separately for early life factors (birth size, maternal health) and later childhood factors (health behaviours, weight status, parental education). After adjustment for early life factors, the adolescents who ate five meals/day were at lower risk for overweight/obesity (OR [95% CI] for boys: 0.47 [0.34, 0.65]; girls: 0.57 [0.41, 0.79]), abdominal obesity (OR [95% CI] for boys: 0.32 [0.22, 0.48]; girls: 0.54 [0.39, 0.75]) and hypertriglyceridaemia (boys only). Adjusting for later childhood factors, the five-meal-a-day pattern was associated with decreased odds of overweight/obesity (OR [95% CI] for boys: 0.41 [0.29, 0.58]; girls: 0.63 [0.45, 0.89]) and abdominal obesity in boys (OR 0.32, 95% CI 0.16, 0.63). CONCLUSION: Among 16-year-olds, the five-meal-a-day pattern was robustly associated with reduced risks of overweight/obesity in both genders and abdominal obesity in boys.