Influence of lifestyle risk factors on work ability and sick leave in a general working population in Norway: a 5-year longitudinal study.

OBJECTIVES: The aim of this study is to assess (1) whether lifestyle risk factors are related to work ability and sick leave in a general working population over time, and (2) these associations within specific disease groups (ie, respiratory diseases, cardiovascular disease and diabetes, and mental illness). SETTING: Telemark county, in the south-eastern part of Norway. DESIGN: Longitudinal study with 5 years follow-up. PARTICIPANTS: The Telemark study is a longitudinal study of the general working population in Telemark county, Norway, aged 16 to 50 years at baseline in 2013 (n=7952) and after 5-year follow-up. OUTCOME MEASURE: Self-reported information on work ability (moderate and poor) and sick leave (short-term and long-term) was assessed at baseline, and during a 5-year follow-up. RESULTS: Obesity (OR=1.64, 95% CI: 1.32 to 2.05) and smoking (OR=1.62, 95% CI: 1.35 to 1.96) were associated with long-term sick leave and, less strongly, with short-term sick leave. An unhealthy diet (OR=1.57, 95% CI: 1.01 to 2.43), and smoking (OR=1.67, 95% CI: 1.24 to 2.25) were associated with poor work ability and, to a smaller extent, with moderate work ability. A higher lifestyle risk score was associated with both sick leave and reduced work ability. Only few associations were found between unhealthy lifestyle factors and sick leave or reduced work ability within disease groups. CONCLUSION: Lifestyle risk factors were associated with sick leave and reduced work ability. To evaluate these associations further, studies assessing the effect of lifestyle interventions on sick leave and work ability are needed.

Lifestyle, sick leave and work ability among Norwegian employees with asthma-A population-based cross-sectional survey conducted in Telemark County, Norway.

OBJECTIVE: To investigate whether physician-diagnosed asthma modifies the associations between multiple lifestyle factors, sick leave and work ability in a general working population. METHODS: A cross-sectional study was conducted in Telemark County, Norway, in 2013. A sample of 16 099 respondents completed a self-administered questionnaire. We obtained complete data on lifestyle, work ability and sick leave for 10 355 employed persons aged 18-50 years. We modelled sick leave and work ability using multiple logistic regression, and introduced interaction terms to investigate whether associations with lifestyle factors were modified by asthma status. RESULTS: Several lifestyle risk factors and a multiple lifestyle risk index were associated with sick leave and reduced work ability score among persons both with and without physician-diagnosed asthma. A stronger association between lifestyle and sick leave among persons with asthma was confirmed by including interaction terms in the analysis: moderate lifestyle risk score * asthma OR = 1.4 (95% CI 1.02-2.1); high lifestyle risk score * asthma OR = 1.6 (95% CI 1.1-2.3); very high lifestyle risk score * asthma OR = 1.6 (95% CI 0.97-2.7); obesity * asthma OR = 1.5 (95% CI 1.02-2.1); past smoking * asthma OR = 1.4 (95% CI 1.01-1.9); and current smoking * asthma OR = 1.4 (95% CI 1.03-2.0). There was no significant difference in the association between lifestyle and work ability score among respondents with and without asthma. CONCLUSIONS: In the present study, we found that physician-diagnosed asthma modified the association between lifestyle risk factors and sick leave. Asthma status did not significantly modify these associations with reduced work ability score. The results indicate that lifestyle changes could be of particular importance for employees with asthma.

Lifestyle, appearance satisfaction and depressive symptoms in 13-16 years old Norwegian adolescents - A cross-sectional study.

Purpose: To examine gender-specific associations between multiple lifestyle-related risk factors, appearance satisfaction and depressive symptoms in a sample of Norwegian adolescents (13-16 years of age), and to study the role of appearance satisfaction as a possible confounder in the associations between lifestyle and depressive symptoms. Materials and methods: Data were obtained from Ungdata, a cross-sectional national survey of adolescents in Norway. In total 4379 subjects were included in the study. We constructed a lifestyle risk index and used multiple logistic regressions to examine the associations between lifestyle-related risk factors, appearance satisfaction, and depressive symptoms. Results: High screen time and use of alcohol were significantly associated with depressive symptoms among girls, while high screen time, tobacco and cannabis use were significantly associated with depressive symptoms among boys. An additive relationship was observed between the lifestyle risk index scores and the likelihood of depressive symptoms for both genders, the relationship being strongest among boys. Low appearance satisfaction was strongly associated with depressive symptoms, especially among boys, and identified as an important confounder in the associations between lifestyle and depressive symptoms, particularly among girls. Conclusions: High screen time was the most prevalent lifestyle risk behavior independently associated with depressive symptoms. Multiple lifestyle changes and improvement of appearance satisfaction should be included in measures targeting adolescents for the prevention and treatment of depressive symptoms. Future studies should elaborate on the gender differences in other adolescent age groups. Appearance satisfaction should be acknowledged as an important confounder in future studies of lifestyle and depressive symptoms.

Lifestyle and work ability in a general working population in Norway: a cross-sectional study.

OBJECTIVES: The aim of this study was to investigate the association between multiple lifestyle-related risk factors (unhealthy diet, low leisure-time physical activity, overweight/obesity and smoking) and self-rated work ability in a general working population. SETTING: Population-based cross-sectional study, in Telemark County, Norway, 2013. PARTICIPANTS: A random sample of 50 000 subjects was invited to answer a self-administered questionnaire and 16 099 responded. Complete data on lifestyle and work ability were obtained for 10 355 participants aged 18-50 years all engaged in paid work during the preceding 12 months. OUTCOME MEASURE: Work ability was assessed using the Work Ability Score (WAS)-the first question in the Work Ability Index. To study the association between multiple lifestyle risk factors and work ability, a lifestyle risk index was constructed and relationships examined using multiple logistic regression analysis. RESULTS: Low work ability was more likely among subjects with an unhealthy diet (ORadj 1.3, 95% CI 1.02 to 1.5), inactive persons (ORadj 1.4, 95% CI 1.2 to 1.6), obese respondents (ORadj 1.5, 95% CI 1.3 to 1.7) and former and current smokers (ORadj 1.2, 95% CI 1.1 to 1.4 and 1.3, 95% CI 1.2 to 1.5, respectively). An additive relationship was observed between the lifestyle risk index and the likelihood of decreased work ability (moderate-risk score: ORadj 1.3; 95% CI 1.1 to 1.6; high-risk score: ORadj 1.9; 95% CI 1.6 to 2.2; very high risk score: ORadj 2.4; 95% CI 1.9 to 3.0). The overall population attributable fraction (PAF) of low work ability based on the overall risk index was 38%, while the PAFs of physical activity, smoking, body mass index and diet were 16%, 11%, 11% and 6%, respectively. CONCLUSIONS: Lifestyle risk factors were associated with low work ability. An additive relationship was observed. The findings are considered relevant to occupational intervention programmes aimed at prevention and improvement of decreased work ability.

BMI-specific associations between health-related behaviours and overweight - a longitudinal study among Norwegian adolescents.

OBJECTIVE: To investigate BMI-specific associations between health-related behaviours in early adolescence and the likelihood of overweight in mid-adolescence in a sample of Norwegian adolescents. DESIGN: Longitudinal study of 393 adolescents recruited from schools in Telemark County, Norway. Parents reported baseline data on children's behavioural variables and background data (at age 12-13 years). Dietary data were reported by means of a retrospective FFQ. Eating patterns were identified using principal component analysis. Height and weight were measured at baseline and 3-year follow-up. BMI-specific differences in health-related behaviours (eating patterns, physical activity and screen time) at baseline were analysed using cross-tabulation and Pearson's χ 2 test (Fisher's test). Associations between early health-related behaviours and the likelihood of later overweight were examined using multiple logistic regression. SETTING: Primary and secondary schools, Telemark, Norway. SUBJECTS: Children (n 393) in 7th grade (mean age 12·7 (sd 0·3) years), followed up in 10th grade, and parents. RESULTS: A moderate to high intake of a varied Norwegian eating pattern combined with moderate-to-vigorous physical activity ≥1 h/d in the 7th grade were associated with a reduced likelihood of being overweight in the 10th grade, but only among already overweight adolescents (adjusted OR=0·2; 95 % CI 0·1, 1·0). Screen time of >3 h/d in the 7th grade was associated with an increased likelihood of subsequent overweight only among adolescents with an initial normal weight (adjusted OR=2·8; 95 % CI 1·1, 7·3). CONCLUSIONS: BMI-specific associations were observed between health-related behaviours in early adolescence and the likelihood of being overweight in mid-adolescence.

Gender-specific association of weight perception and appearance satisfaction with slimming attempts and eating patterns in a sample of young Norwegian adolescents.

OBJECTIVE: To examine gender-specific associations of weight perception and appearance satisfaction with slimming attempts and eating patterns among young Norwegian adolescents. DESIGN: Cross-sectional study. Adolescent dietary data were reported by parents using a retrospective FFQ. Eating patterns were identified using principal component analysis. Adolescents' reported weight perception, appearance satisfaction and slimming attempts were analysed using cross-tabulation and Pearson's χ 2 test. Associations between perceived weight, appearance satisfaction and slimming attempts/eating patterns were examined using multiple logistic regression analysis. SETTING: Primary schools, Telemark, Norway. SUBJECTS: Children (n 469), mean age 12·7 (sd 0·3) years, and parents. RESULTS: Gender differences were observed in self-perceived weight and appearance satisfaction. Girls were most satisfied with appearance when feeling thin, boys when feeling just the right weight. Perceived overweight was the main predictor of slimming attempts across genders (adjusted OR=15·3; 95 % CI 6·0, 39·1 for girls; adjusted OR=18·2; 95 % CI 5·8, 57·3 for boys). Low appearance satisfaction was associated with slimming attempts (adjusted OR=3·3; 95 % CI 1·0, 10·5) and a dieting eating pattern (adjusted OR=2·8; 95 % CI 1·5, 5·2) in girls. Perceived underweight was associated with a junk/convenience eating pattern in boys (adjusted OR=2·8; 95 % CI 1·2, 6·4). CONCLUSIONS: Gender differences were observed in subjective body concerns. Perceived overweight was the main predictor of slimming attempts by both genders. Different aspects of body dissatisfaction were related to different food behaviours in boys and girls. Health professionals should be aware of these gender differences when planning health promotion programmes targeting young adolescents.

Meal pattern among Norwegian primary-school children and longitudinal associations between meal skipping and weight status.

OBJECTIVE: To investigate meal pattern longitudinally and explore whether meal skipping was associated with overweight among Norwegian children and adolescents. DESIGN: Longitudinal study. Children's meal frequencies were reported by their parents using a retrospective FFQ. Weight and height were measured by public health nurses. Descriptive data comparing 4th and 7th grade were analysed by paired-sample t tests for continuous variables and χ 2 tests for categorical variables. Odds ratio estimates, including confidence intervals, with BMI category (normal/overweight) as the dependent variable, were determined through logistic regression analyses. SETTING: Primary schools, Telemark County, Norway. SUBJECTS: A cohort of 428 Norwegian boys and girls; 4th graders in 2007, 7th graders in 2010. RESULTS: The number of children eating four main meals per day (regular meal frequency) decreased from 4th grade (47 %) to 7th grade (38 %; P = 0·001). Those who ate regular meals in 4th grade but not in 7th grade had higher odds (OR = 3·1; 95 % CI 1·1, 9·0) of being overweight in 7th grade after adjusting for gender, maternal education and physical activity, but the odds ratio was not statistically significant after adjusting for overweight in 4th grade (OR = 2·8; 95 % CI 0·7, 11·6). CONCLUSIONS: The present study showed significant increases in overall meal skipping among children between 4th and 7th grade. The results indicate an association between overweight and meal skipping, but additional prospective and longitudinal analyses and intervention trials are warranted to confirm this relationship.

Eating patterns and mental health problems in early adolescence--a cross-sectional study of 12-13-year-old Norwegian schoolchildren.

OBJECTIVE: To investigate the association between eating patterns and mental health problems in young Norwegian adolescents (12-13 years of age). DESIGN: Cross-sectional study. Dietary information was reported by parents using a retrospective FFQ. Eating patterns were identified using principal component analysis. The Strengths and Difficulties Questionnaire was used to measure mental health problems. The association between eating patterns and mental health problems was examined using multiple logistic regression analysis. SETTING: Primary schools, Telemark County, Norway. SUBJECTS: Children (n 1095) aged 12-13 years and their parents. RESULTS: Children with high scores on a 'varied Norwegian' eating pattern were less likely to have indications of any psychiatric disorders (adjusted OR = 0·5; 95 % CI 0·3, 1·0) and hyperactivity-inattention disorders (adjusted OR = 0·4; 95 % CI 0·2, 0·8) than children with low scores on this pattern. Children with high scores on a 'junk/convenient' eating pattern were more likely to have indications of hyperactivity-inattention disorders (adjusted OR = 3·4; 95 % CI 1·3, 8·6) than children with low scores on this pattern. Children with high scores on a 'snacking' eating pattern were more likely to have indications of conduct/oppositional disorders (adjusted OR = 3·8; 95 % CI 1·2, 11·5) than those with low scores on this eating pattern. CONCLUSIONS: We identified a significant association between eating patterns and mental health problems in young adolescents, independently of physical activity, sedentary activity and background variables. A diverse diet rich in unrefined plant foods, fish and regular meals was associated with better mental health, while energy-dense, nutrient-poor diets and irregular meals were associated with poorer mental health.

Association between parental motives for food choice and eating patterns of 12- to 13-year-old Norwegian children.

OBJECTIVE: To determine (i) the importance of parents' motives for everyday family food choices; and (ii) the relationship between parental food choice motives and eating patterns of 12- to 13-year-old children. DESIGN: Cross-sectional study. A modified version of the Food Choice Questionnaire was used to determine parental motives for food choices. The children's food and drink intake was reported by their parents using a retrospective FFQ. Eating patterns were derived using principal component analysis. The association between food choice motives and eating patterns was examined using multiple linear regression analysis. SETTING: Primary schools, Telemark County, Norway. SUBJECTS: In total, 1095 children aged 12­13 years and their parents. RESULTS: The parental motive 'sensory appeal' was the most important for food choice, followed by 'health', 'convenience', 'natural content' and 'weight control'. The food choice motives were associated with the eating patterns of the children, independent of background variables. The motive 'health' was most strongly associated with a 'varied Norwegian' eating pattern, representing a diverse diet and regular meals, while the motive 'convenience' appeared to be the most important barrier to this eating pattern. 'Weight control' was not associated with the 'varied Norwegian' eating pattern. CONCLUSIONS: To encourage parents to make healthy food choices for their children, health promotion activities should focus on the health benefits of a diverse diet and regular meals, rather than weight control. Recommended food products should be made more convenient and easily available for families with children.

Tracking of eating patterns and overweight - a follow-up study of Norwegian schoolchildren from middle childhood to early adolescence.

BACKGROUND: The aim of this study was to describe eating patterns in early adolescence and to determine associations between eating patterns and overweight from middle childhood (4th grade, 9 to 10 years old) to early adolescence (7th grade, 12 to 13 years old). METHODS: Children were recruited from primary schools in Telemark County, Norway. Dietary data were obtained by parental report using a food frequency questionnaire. Height and weight were objectively measured, and overweight was defined using international standard cut-off points. Complete data were obtained for 924 4th grade and 691 7th children, and 427 children provided complete data at both time points. Principal component analysis was applied to identify eating patterns. We used multiple logistic regression to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for being overweight. RESULTS: The same four distinct eating patterns were identified at both time points. Correlation coefficients for the factor scores of corresponding eating patterns at baseline and follow up ranged from 0.44 to 0.60. In the follow-up sample, 345 children (80%) were still of normal weight, while 41 (10%) remained overweight. Children with high "dieting" pattern scores and low "varied Norwegian" pattern scores in the 7th grade had an increased risk of being overweight. Children with stable or increased "varied Norwegian" pattern scores had a lower risk of remaining overweight over time than children with decreased scores for this pattern; adjusted OR: 0.4 (95% CI: 0.2, 0.8). This pattern included foods and meals close to current dietary guidelines, including vegetables, fruit and unrefined cereal products. We did not observe an increased risk of overweight in children with high "unhealthy" eating pattern scores, termed "snacking" or "junk/convenient" in either cross-sectional or longitudinal analyses. CONCLUSIONS: Slight to moderate stability of eating patterns was observed. Children adhering to a "varied Norwegian" eating pattern were less likely to remain overweight than children with declining adherence to this pattern. Overweight children should be encouraged to eat regular main meals and retain a diverse diet that includes unrefined plant foods, water and fish, rather than fat- and sugar-reduced foods and drinks.