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1.
J Clin Periodontol ; 48(1): 24-36, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33048362

RESUMO

AIM: To investigate the association of hyperglycaemia and changes in glycaemic control with periodontal status in non-diabetic individuals. MATERIALS AND METHODS: A sub-population (n = 647) of the Northern Finland Birth Cohort 1966 was studied. We categorized long-term glucose balance based on fasting plasma glucose (FPG) at ages 31 and 46: FPG <5.0 mmol/l (strict normoglycaemia), FPG 5.0-5.59 mmol/l (slightly elevated FPG) and FPG 5.6-6.9 mmol/l (prediabetes). Probing pocket depth (PPD) and alveolar bone level (BL) data were collected at age 46. Relative risks (RR, 95% CI) were estimated using Poisson regression models. RESULTS: Periodontal status was poorer in individuals whose glucose balance worsened from age 31 to 46 years than in those with a stable glucose balance. In the case of strict normoglycaemia at age 31 and slightly elevated FPG or prediabetes at age 46, the RRs for PPD ≥4 mm were 1.8 (95% CI 1.4-2.2) and 2.8 (95% CI 2.0-3.8) and for BL ≥5 mm 1.1 (95% CI 0.8-1.4) and 1.8 (95% CI 1.2-2.8), respectively. CONCLUSION: The results of this population-based cohort study suggest that impairment in glucose control in non-diabetic individuals is associated with periodontal pocketing and alveolar bone loss.

2.
PLoS One ; 15(10): e0240983, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33091029

RESUMO

Diabetic retinopathy is a microvascular complication of hyperglycaemia. Little is known about the association of glucose metabolism and retinopathy signs in the non-diabetic middle-aged population. We studied prevalence of retinopathy in a subsample of Northern Finland Birth Cohort study (NFBC1966) of 1809 subjects, at 47 years of age, without previously diagnosed type 2 diabetes and/or blood pressure-lowering medication. All participants underwent clinical evaluations including an oral glucose tolerance test (glucose and insulin values measured at 0, 30, 60 and 120 min) and HbA1c. The retinopathy signs were diagnosed by fundus photographs and classified according to the Eurodiab classification scheme. The overall prevalence of newly diagnosed retinopathy was 1.4%. The retinopathy signs were significantly associated with increased 30 min, 1-h and 2-h glucose levels and 2-h insulin level in an OGTT. After adjustment with systolic blood pressure, only 30 min glucose, 1-h glucose and 2-h insulin levels were associated with retinopathy signs. Our findings show the potential role of 30 min and 1-h post-load glucose and 2-h insulin levels as risk factors for retinopathy lesions among the participants without previously diagnosed diabetes or hypertensive medication.


Assuntos
Glucose/metabolismo , Doenças Retinianas/etiologia , Doenças Retinianas/metabolismo , Glicemia/metabolismo , Pressão Sanguínea/fisiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Finlândia , Intolerância à Glucose/metabolismo , Intolerância à Glucose/fisiopatologia , Teste de Tolerância a Glucose , Humanos , Insulina/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doenças Retinianas/fisiopatologia , Fatores de Risco
3.
Eur J Endocrinol ; 183(6): 619-626, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33105101

RESUMO

Objective: The use of combined hormonal contraceptives (CHCs) worsens glucose tolerance, but the risk for glucose metabolism disorders remains controversial. Design: The study is a prospective longitudinal population-based cohort study. Methods: The study was based on a cohort population that comprised 1879 women born in 1966. At age 46, the women answered a questionnaire on contraceptive use and underwent an oral glucose tolerance test. Glucose metabolism indices were evaluated in current CHC (n = 153), progestin-only contraceptive (POC, n = 842), and non-hormonal contraceptive users (n = 884). Results: In the entire study population, current CHC use was significantly associated with prediabetes (OR: 2.0, 95% CI: 1.3-3.2) and type 2 diabetes (OR: 3.3, 95% CI: 1.1-9.7) compared to non-hormonal contraceptive use. After 5 years of use, the prediabetes risk increased 2.2-fold (95% CI: 1.3-3.7) and type 2 diabetes risk increased 4.5-fold (95% CI: 1.5-13.5). Compared with the current POC use, current CHC use was significantly associated with prediabetes (OR: 1.9, 95% CI: 1.2-3.0). Current POC use was not associated with any glucose metabolism disorders. The results prevailed after adjusting for BMI and socioeconomic status. Conclusions: CHC use in perimenopausal women was associated with a significantly increased risk of glucose metabolism disorders. This association should be considered in women with increased metabolic risk.


Assuntos
Anticoncepcionais Orais Combinados/efeitos adversos , Anticoncepcionais Orais Hormonais/efeitos adversos , Diabetes Mellitus Tipo 2/induzido quimicamente , Transtornos do Metabolismo de Glucose/induzido quimicamente , Estado Pré-Diabético/induzido quimicamente , Adulto , Feminino , Teste de Tolerância a Glucose , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Perimenopausa , Estudos Prospectivos
4.
Menopause ; 28(1): 70-79, 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32960849

RESUMO

OBJECTIVE: To investigate whether the early-onset menopausal transition is associated with deteriorated glucose tolerance in women in their mid-forties. METHODS: A cross-sectional analysis of a cohort study including 2,632 women of the Northern Finland Birth Cohort 1966. The participants were divided into two groups by their menstrual history and follicle-stimulating hormone values at age 46: climacteric and preclimacteric women. Glucose and insulin parameters, as well as mathematical indices derived from them to evaluate insulin sensitivity, were compared between the groups. The results were adjusted for measured body mass index and smoking. The possible effect of hormone therapy was investigated in subanalyses excluding hormone therapy users. RESULTS: Climacteric women (n = 379) were more often current smokers at age 46 (P = 0.008), and their body mass indices increased more from 31 to 46 years (P = 0.013), compared to preclimacteric women (n = 2,253). In a multivariable generalized linear model, being climacteric at age 46 was associated with several findings suggesting decreased insulin sensitivity: increased glycated hemoglobin (P < 0.001), 2-hour oral glucose tolerance test 30- and 60-minute insulin (P = 0.040 and 0.006, respectively), and area under the insulin curve (P = 0.005). Being climacteric also was associated with a decreased the McAuley (P = 0.024) and Belfiore indices (P = 0.027) and glucose tolerance test 60-minute glucose (P = 0.015). In subanalyses excluding hormone therapy users (n = 94), the results did not change significantly. CONCLUSIONS: Earlier onset of climacteric transition is associated with impaired insulin sensitivity in middle-aged women.

5.
Scand J Prim Health Care ; 38(3): 281-290, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32777967

RESUMO

BACKGROUND: Worldwide, we are observing a rising prevalence of dementia and mild cognitive impairments that often co-occur with the heightened incidence of non-communicable diseases in the elderly. It is suggested that type 2 diabetes and defects in glucose metabolism might predispose to poorer cognitive performances and more rapid decline in old age. METHODS: to address existing knowledge gaps in this area, we systematically reviewed the literature to identify whether patients with type 2 diabetes (T2DM) and pre-diabetes are at a higher risk of poorer cognitive performance, and whether the risk (if any) might affect specific cognitive abilities. We concentrated the review on elderly individuals (65 years or older) at intake. In total, 3251 original articles were retrieved, of which 17 met our inclusion and quality control criteria, which comprised 12 structured questions used to define the articles. RESULTS: 11 of 17 studies found a statistically significant decline in cognition among individuals who had T2DM or pre-diabetes compared to their non-diabetic counterparts. The association between diabetes and cognitive decline was not always clear, and the extent of the cognitive tests used seemed to have the greatest effect on the results. CONCLUSION: Focusing on a population age 65 years and over, we found insufficient evidence to support an association between pre-diabetes stages and mild cognitive impairment. However, there is consistent evidence to support diabetes as an independent risk factor for low cognitive ability in the elderly. Finally, we found insufficient evidence to support effect of T2DM on distinct cognitive ability due to the scarcity of comparable findings.

6.
Diabetologia ; 63(10): 2123-2128, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32725280

RESUMO

AIMS/HYPOTHESIS: The aim of this work was to examine the progression to type 1 and type 2 diabetes after gestational diabetes mellitus (GDM) in a 23 year follow-up study. METHODS: We carried out a cohort study of 391 women with GDM diagnosed by an OGTT or the use of insulin treatment during pregnancy, and 391 age- and parity-matched control participants, who delivered in 1984-1994 at the Oulu University Hospital, Finland. Diagnostic cut-off levels for glucose were as follows: fasting, ≥4.8 mmol/l; 1 h, ≥10.0 mmol/l; and 2 h, ≥8.7 mmol/l. Two follow-up questionnaires were sent (in 1995-1996 and 2012-2013) to assess the progression to type 1 and type 2 diabetes. Mean follow-up time was 23.1 (range 18.7-28.8) years. RESULTS: Type 1 diabetes developed (5.7%) during the first 7 years after GDM pregnancy and was predictable at a 2 h OGTT value of 11.9 mmol/l during pregnancy (receiver operating characteristic analysis: AUC 0.91, sensitivity 76.5%, specificity 96.0%). Type 2 diabetes increased linearly to 50.4% by the end of the follow-up period and was moderately predictable with fasting glucose (AUC 0.69, sensitivity 63.5%, specificity 68.2%) at a level of 5.1 mmol/l (identical to the fasting glucose cut-off recommended by the International Association of Diabetes and Pregnancy Study Groups [IADPSG) and WHO]). CONCLUSIONS/INTERPRETATION: All women with GDM should be intensively monitored for a decade, after which the risk for type 1 diabetes is minimal. However, the incidence of type 2 diabetes remains linear, and therefore individualised lifelong follow-up is recommended.

7.
Artigo em Inglês | MEDLINE | ID: mdl-32561923

RESUMO

BACKGROUND: Alcohol-related problems are common in intensive care unit (ICU) admitted patients. The aim of the present study is to assess the impact of alcohol consumption on the need of intensive care in 19 years follow-up period. METHODS: The study population consists of Northern Finland Birth Cohort 1966 participants, who responded alcohol-related questions at 31 years of age and Intensive Care Unit (ICU admissions from 1997 to 2016. RESULTS: There were a total of 8379 assessed people and 136 (1.6%) of them were later admitted to ICU. A total of 44 (32.4%) of the ICU-admitted persons had their alcohol consumption at the highest quartile of the cohort (P = 0.047). These patients had a lower number of malignancy-related admissions (3.6% versus 14.0%, P = 0.027), neurological admissions (14.3 versus 30.6%, P = 0.021), and were more often admitted due to poisonings (12.5% versus 5.0%, P = 0.07). There were no differences in 28-day post-ICU mortality but long-term mortality of ICU-admitted patients with lower alcohol consumption was higher than non-ICU-admitted population. CONCLUSION: Among ICU-admitted population, there was higher alcohol consumption at age of 31 years. People in the lower alcohol consumption quartiles were more often admitted to ICU due to malignancy-related causes and they had higher long-term mortality.

8.
Bone ; 137: 115462, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32485362

RESUMO

Fractures are common injuries in children, but their underlying biological and environmental risk factors are not well known. Maternal alcohol consumption during pregnancy is a known risk factor for bone malformations and impaired growth, in connection with Fetal Alcohol Spectrum Disorders (FASD). There is evidence that even lower doses of alcohol than what is needed for FASD can cause changes in the developing bone. Birth weight and length may also associate to childhood fractures. The aim of this study was to find out whether there exist associations between maternal alcohol use during pregnancy, birth weight or length and fractures of the long bones in childhood. A prospective birth cohort was performed, including all women in Northern Finland with an expected date of delivery between July 1985 and June 1986, and their offspring (N = 9432). The National Hospital Discharge Register (NHDR) provided the information on inpatient treated fractures. The subjects who declined participation or were treated as outpatient were excluded. The final study population consisted of 6718 children (71.2%). 98 (1.5%) of them suffered from inpatient treated fracture of a long bone (N = 105). Maternal alcohol consumption during pregnancy was inquired by questionnaires during late pregnancy or shortly after parturition. The birth length and weight were recorded immediately after birth. Binomial regression analysis was used to determine the association between the potential explanatory variables and bone fractures. Gender, socioeconomic status of the family, maternal age, premature birth, body mass index (BMI) of the children and maternal smoking during pregnancy were taken as possible confounders. In this study, the maternal alcohol consumption during pregnancy was associated to 2.22-fold (CI 1.09-4.12, p < 0.02) increased risk of a long bone fracture before the age of eight. Birth weight or length did not associate to childhood fractures. Bone fractures are an important cause of morbidity in childhood. Their prevention should start from the prenatal period by protecting the fetus from the alcohol exposure.

9.
BMC Public Health ; 20(1): 869, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503491

RESUMO

BACKGROUND: The relevance of health-related behaviors to exclusion from the labor market in early adulthood remains poorly studied in relation to the magnitude of the problem. We explored whether adolescents' accumulated unhealthy behaviors and psychosocial problems are associated with later labor market exclusion, and whether multisite musculoskeletal pain (MMSP) impacts these relations. METHODS: We gathered questionnaire data on unhealthy behaviors and psychosocial problems and MMSP among adolescents aged 15 to 16 belonging to the Northern Finland Birth Cohort 1986. The findings were combined with registry data on unemployment, employment and permanent work disability during a five-year follow-up between the ages of 25 and 29 (n = 6692). In the statistical modeling we used education, family leave and socioeconomic status of childhood family as potential confounders, as well as latent class and logistic regression analyses. RESULTS: The Externalizing behavior cluster associated with over one year of unemployment (RR 1.64, CI 1.25-2.14) and permanent work disability (OR 2.49, CI 1.07-5.78) in the follow-up among the men. The Sedentary cluster also associated with over one year (RR 1.41, CI 1.13-1.75) and under one year of unemployment (RR 1.25, CI 1.02-1.52) and no employment days (RR 1.93, CI 1.26-2.95) among the men. Obese male participants were at risk of over one year of unemployment (RR 1.50, CI 1.08-2.09) and no employment days (RR 1.93, CI 1.07-3.50). Among the women, the Multiple risk behavior cluster related significantly to over one year of unemployment (RR 1.77, CI 1.37-2.28). MMSP had no influence on the associations. CONCLUSIONS: Unhealthy behavior patterns and psychosocial problems in adolescence have long-term consequences for exclusion from the labor market in early adulthood, especially among men. Simultaneously supporting psychological well-being and healthy behaviors in adolescence may reduce labor market inclusion difficulties in the early phase of working life.


Assuntos
Comportamentos Relacionados com a Saúde , Transtornos Mentais/epidemiologia , Dor Musculoesquelética/epidemiologia , Desemprego/estatística & dados numéricos , Adolescente , Adulto , Análise por Conglomerados , Estudos de Coortes , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Seguimentos , Estilo de Vida Saudável , Humanos , Análise de Classes Latentes , Modelos Logísticos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Dor Musculoesquelética/psicologia , Ocupações , Sistema de Registros , Comportamento Sedentário , Classe Social , Inquéritos e Questionários , Desemprego/psicologia , Trabalho/psicologia , Adulto Jovem
10.
BMC Pulm Med ; 20(1): 171, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32546146

RESUMO

BACKGROUND: Low lung function has been associated with increased body mass index (BMI). The aim of this study was to investigate whether the effect of BMI on lung function is mediated by DNA methylation. METHODS: We used individual data from 285,495 participants in four population-based cohorts: the European Community Respiratory Health Survey, the Northern Finland Birth Cohort 1966, the Swiss Study on Air Pollution and Lung Disease in Adults, and the UK Biobank. We carried out Mendelian randomisation (MR) analyses in two steps using a two-sample approach with SNPs as instrumental variables (IVs) in each step. In step 1 MR, we estimated the causal effect of BMI on peripheral blood DNA methylation (measured at genome-wide level) using 95 BMI-associated SNPs as IVs. In step 2 MR, we estimated the causal effect of DNA methylation on FEV1, FVC, and FEV1/FVC using two SNPs acting as methQTLs occurring close (in cis) to CpGs identified in the first step. These analyses were conducted after exclusion of weak IVs (F statistic < 10) and MR estimates were derived using the Wald ratio, with standard error from the delta method. Individuals whose data were used in step 1 were not included in step 2. RESULTS: In step 1, we found that BMI might have a small causal effect on DNA methylation levels (less than 1% change in methylation per 1 kg/m2 increase in BMI) at two CpGs (cg09046979 and cg12580248). In step 2, we found no evidence of a causal effect of DNA methylation at cg09046979 on lung function. We could not estimate the causal effect of DNA methylation at cg12580248 on lung function as we could not find publicly available data on the association of this CpG with SNPs. CONCLUSIONS: To our knowledge, this is the first paper to report the use of a two-step MR approach to assess the role of DNA methylation in mediating the effect of a non-genetic factor on lung function. Our findings do not support a mediating effect of DNA methylation in the association of lung function with BMI.

11.
Lancet Diabetes Endocrinol ; 8(6): 501-510, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32445737

RESUMO

BACKGROUND: Adequate transplacental passage of maternal thyroid hormone is important for normal fetal growth and development. Maternal overt hypothyroidism and hyperthyroidism are associated with low birthweight, but important knowledge gaps remain regarding the effect of subclinical thyroid function test abnormalities on birthweight-both in general and during the late second and third trimester of pregnancy. The aim of this study was to examine associations of maternal thyroid function with birthweight. METHODS: In this systematic review and individual-participant data meta-analysis, we searched MEDLINE (Ovid), Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and Google Scholar from inception to Oct 15, 2019, for prospective cohort studies with data on maternal thyroid function during pregnancy and birthweight, and we issued open invitations to identify study authors to join the Consortium on Thyroid and Pregnancy. We excluded participants with multiple pregnancies, in-vitro fertilisation, pre-existing thyroid disease or thyroid medication usage, miscarriages, and stillbirths. The main outcomes assessed were small for gestational age (SGA) neonates, large for gestational age neonates, and newborn birthweight. We analysed individual-participant data using mixed-effects regression models adjusting for maternal age, BMI, ethnicity, smoking, parity, gestational age at blood sampling, fetal sex, and gestational age at birth. The study protocol was pre-registered at the International Prospective Register of Systematic Reviews, CRD42016043496. FINDINGS: We identified 2526 published reports, from which 36 cohorts met the inclusion criteria. The study authors for 15 of these cohorts agreed to participate, and five more unpublished datasets were added, giving a study population of 48 145 mother-child pairs after exclusions, of whom 1275 (3·1%) had subclinical hypothyroidism (increased thyroid stimulating hormone [TSH] with normal free thyroxine [FT4]) and 929 (2·2%) had isolated hypothyroxinaemia (decreased FT4 with normal TSH). Maternal subclinical hypothyroidism was associated with a higher risk of SGA than was euthyroidism (11·8% vs 10·0%; adjusted risk difference 2·43%, 95% CI 0·43 to 4·81; odds ratio [OR] 1·24, 1·04 to 1·48; p=0·015) and lower mean birthweight (mean difference -38 g, -61 to -15; p=0·0015), with a higher effect estimate for measurement in the third trimester than in the first or second. Isolated hypothyroxinaemia was associated with a lower risk of SGA than was euthyroidism (7·3% vs 10·0%, adjusted risk difference -2·91, -4·49 to -0·88; OR 0·70, 0·55 to 0·91; p=0·0073) and higher mean birthweight (mean difference 45 g, 18 to 73; p=0·0012). Each 1 SD increase in maternal TSH concentration was associated with a 6 g lower birthweight (-10 to -2; p=0·0030), with higher effect estimates in women who were thyroid peroxidase antibody positive than for women who were negative (pinteraction=0·10). Each 1 SD increase in FT4 concentration was associated with a 21 g lower birthweight (-25 to -17; p<0·0001), with a higher effect estimate for measurement in the third trimester than the first or second. INTERPRETATION: Maternal subclinical hypothyroidism in pregnancy is associated with a higher risk of SGA and lower birthweight, whereas isolated hypothyroxinaemia is associated with lower risk of SGA and higher birthweight. There was an inverse, dose-response association of maternal TSH and FT4 (even within the normal range) with birthweight. These results advance our understanding of the complex relationships between maternal thyroid function and fetal outcomes, and they should prompt careful consideration of potential risks and benefits of levothyroxine therapy during pregnancy. FUNDING: Netherlands Organization for Scientific Research (grant 401.16.020).


Assuntos
Peso ao Nascer/fisiologia , Hipotireoidismo/fisiopatologia , Complicações na Gravidez/fisiopatologia , Glândula Tireoide/fisiologia , Glândula Tireoide/fisiopatologia , Feminino , Idade Gestacional , Humanos , Hipotireoidismo/complicações , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Gravidez , Testes de Função Tireóidea/tendências
12.
J Pediatr ; 221: 151-158.e1, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32446475

RESUMO

OBJECTIVES: To evaluate the influence of early growth patterns that have previously been associated with later cardiometabolic risk on cardiac left ventricular (LV) structure and function in midlife. STUDY DESIGN: A subpopulation of the Northern Finland Birth Cohort 1966 took part in follow-up, including echocardiography (n = 1155) at the age of 46 years. Body mass index (BMI) growth curves were modeled based on frequent anthropometric measurements in childhood. Age and BMI at adiposity peak (n = 482, mean age 9.0 months) and at adiposity rebound (n = 586, mean age 5.8 years) were determined. Results are reported as unstandardized beta (ß) or OR with 95% CIs for 1 SD increase in early growth variable. RESULTS: Earlier adiposity rebound was associated with increased LV mass index (ß = -4.10 g/m2 (-6.9, -1.3); P = .004) and LV end-diastolic volume index (ß = -2.36 mL/m2 (-3.9, -0.84); P = .002) as well as with eccentric LV hypertrophy (OR 0.54 [0.38, 0.77]; P = .001) in adulthood in males. BMI at adiposity rebound was directly associated with LV mass index (ß = 2.33 g/m2 [0.80, 3.9]; P = .003). Higher BMI at both adiposity peak and at adiposity rebound were associated with greater LV end-diastolic volume index (ß = 1.47 mL/m2; [0.51, 2.4], ß = 1.28 mL/m2 [0.41, 2.2], respectively) and also with eccentric LV hypertrophy (OR 1.41 [1.10, 1.82], OR 1.53 [1.23, 1.91], respectively) and LV concentric remodeling (OR 1.38 [1.02, 1.87], OR 1.40 [1.06, 1.83], respectively) in adulthood (P < .05 for all). These relationships were only partly mediated by adult BMI. CONCLUSIONS: Early growth patterns in infancy and childhood contribute to cardiac structure at midlife.


Assuntos
Adiposidade , Índice de Massa Corporal , Hipertrofia Ventricular Esquerda/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Diástole , Ecocardiografia , Feminino , Finlândia/epidemiologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Remodelação Ventricular , Adulto Jovem
13.
Spine (Phila Pa 1976) ; 45(19): 1360-1367, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32341297

RESUMO

STUDY DESIGN: A cross-sectional study of the Northern Finland Birth Cohort 1966 (NFBC1966). OBJECTIVE: The aim of this study was to evaluate the association between the type, size, and location of lumbar Modic changes (MC), and prolonged disabling low back pain (LBP). SUMMARY OF BACKGROUND DATA: LBP is the leading cause of disability worldwide and it affects all age- and socioeconomical groups. Only a small proportion of LBP patients are diagnosed with a specific cause: In most cases no single nociceptive cause for the pain can be identified. MC are visualized in magnetic resonance imaging (MRI) as a signal intensity change in vertebral bone marrow and have been proposed to represent a specific degenerative imaging phenotype associated with LBP. MC can be classified into several subtypes, of which inflammatory Type 1 (MC1) is suggested as being more likely to be associated with LBP. METHODS: We assessed lumbar MRI (n = 1512) for the presence, type, and size of MC. The associations of MC characteristics with prolonged (≥30 days during the past year) and disabling (bothersomeness of LBP at least 6 on a 0-10 Numeric Rating Scale) LBP, evaluated at the time of imaging at 47 years, were analyzed using binary logistic regression, adjusted for sex, BMI, smoking, educational status, lumbar disc degeneration, and disc herniations. RESULTS: Any MC and MC1 were associated with prolonged disabling LBP (odds ratio [OR] after full adjustments 1.50 [95% confidence interval, CI 1.05-2.15] and 1.50 [95% CI 1.10-2.05], respectively). Furthermore, MC covering the whole anterior-posterior direction or the whole endplate, as well as the height of MC, were significantly associated with prolonged disabling LBP (OR after full adjustments 1.59 [95% CI 1.14-2.20], 1.67 [95% CI 1.13-2.46] and 1.26 [95% CI 1.13-1.42], respectively). CONCLUSION: Our study showed a significant and independent association between MC and clinically relevant LBP. LEVEL OF EVIDENCE: 3.


Assuntos
Pessoas com Deficiência , Dor Lombar/diagnóstico por imagem , Dor Lombar/epidemiologia , Vértebras Lombares/diagnóstico por imagem , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Finlândia/epidemiologia , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/epidemiologia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/epidemiologia , Imagem por Ressonância Magnética/efeitos adversos , Masculino , Pessoa de Meia-Idade
14.
Eur Respir J ; 55(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32341110

RESUMO

RATIONALE: Environmental tobacco smoke (ETS) exposure increases asthma risk in children. There is limited knowledge of prenatal ETS for adult-onset asthma. OBJECTIVES: To determine the association between prenatal ETS and adult onset asthma. MEASUREMENTS AND MAIN RESULTS: The questionnaire and clinical data of 5200 people, free of physician-diagnosed asthma by 31 years of age, who were included in the Northern Finland Birth Cohort 1966 Study was used. The association of maternal smoking during the last 3 months of pregnancy with onset of physician-diagnosed asthma and with lung function in adult offspring was studied using adjusted multivariate regression analyses. The cumulative incidence of physician-diagnosed asthma between the ages of 31 and 46 years was 5.1% among men and 8.8% among women. Gestational smoke exposure was associated with adult-onset asthma among offspring (adjusted OR 1.54, 95% CI 1.04-2.29), namely among offspring who reported either past non-diagnosed asthma (OR 9.63, 95% CI 2.28-40.67) or past cough with wheeze (3.21, 95% CI 1.71-6.05). A significant association was detected between gestational smoke exposure and the offspring's forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio at 31 years of age. In offspring with the haplotype rs11702779-AA of RUNX1, gestational smoke exposure was associated with adult-onset asthma (5.53, 95% CI 2.11-14.52, adjusted p-value for interaction 0.10). CONCLUSION: Maternal smoking during pregnancy is associated with the cumulative incidence of asthma in offspring between the ages of 31 and 46 years. The association was accentuated in offspring who at age 31, reported having past respiratory problems and/or who had haplotype rs11702779-AA. A reduction in FEV1/FVC ratio was also observed at age 31 years in offspring with gestational smoke exposure. These results could reflect the early vulnerability of offspring's airways to ETS and its putative long-term effects.

15.
Acta Obstet Gynecol Scand ; 99(10): 1311-1319, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32333801

RESUMO

INTRODUCTION: The aim of the study was to determine the association of body mass index (BMI), self-reported symptoms or diagnosis of polycystic ovary syndrome (PCOS), and hyperandrogenemia with the occurrence of gestational diabetes mellitus (GDM) through reproductive life. MATERIAL AND METHODS: A cohort of women born in 1966 were investigated at ages 14, 31 and 46. Women with self-reported PCOS symptoms (presence of both oligo-amenorrhea and hirsutism) at age 31 or with formally diagnosed polycystic ovaries (PCO)/PCOS by age 46 formed the group of self-reported PCOS (srPCOS, n = 222) and were compared with women without self-reported PCOS symptoms or diagnosis (n = 1357). We investigated also the association of hyperandrogenism (hirsutism or biochemical hyperandrogenism) at age 31 with the occurrence of GDM throughout reproductive life. RESULTS: Self-reported PCOS alone was not a risk factor for GDM, but combined with overweight at age 31 (odds ratio [OR] 2.43, 95% confidence interval [CI] 1.22-4.86) or 46 (OR 3.04, 95% CI 1.58-5.83) srPCOS was associated with GDM when compared with normal weight controls. The association disappeared when comparing overweight srPCOS women with overweight controls. However, hyperandrogenemia at age 31, but not hirsutism, was associated with GDM even after adjustment for BMI. CONCLUSIONS: The increased risk of GDM in women with srPCOS was mostly attributed to overweight or obesity. Importantly, normal weight women with srPCOS did not seem to be at increased risk for developing GDM. However, hyperandrogenemia was associated with GDM even after adjustment for BMI. These findings strengthen the importance of weight management in reproductive-age women and suggest a noteworthy role of hyperandrogenemia in the pathophysiology of GDM.


Assuntos
Diabetes Gestacional/epidemiologia , Hiperandrogenismo/epidemiologia , Obesidade Materna/epidemiologia , Sobrepeso/epidemiologia , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Pessoa de Meia-Idade , Síndrome do Ovário Policístico/epidemiologia , Gravidez , Fatores de Risco
16.
Eur Psychiatry ; 63(1): e24, 2020 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-32146919

RESUMO

BACKGROUND: We studied the cumulative incidence of physical illnesses, and the effect of early environmental factors (EEFs) on somatic comorbidity in schizophrenia, in nonschizophrenic psychosis and among nonpsychotic controls from birth up to the age of 50 years. METHODS: The sample included 10,933 members of the Northern Finland Birth Cohort 1966, of whom, 227 had schizophrenia and 205 had nonschizophrenic psychosis. Diagnoses concerning physical illnesses were based on nationwide registers followed up to the end of 2016 and classified into 13 illness categories. Maternal education and age, family type at birth and paternal socioeconomic status were studied as EEFs of somatic illnesses. RESULTS: When adjusted by gender and education, individuals and especially women with nonschizophrenic psychosis had higher risk of morbidity in almost all somatic illness categories compared to controls, and in some categories, compared to individuals with schizophrenia. The statistically significant adjusted hazard ratios varied from 1.27 to 2.42 in nonschizophrenic psychosis. Regarding EEFs, single-parent family as the family type at birth was a risk factor for a higher somatic score among men with schizophrenia and women with nonschizophrenic psychosis. Maternal age over 35 years was associated with lower somatic score among women with nonschizophrenic psychosis. CONCLUSIONS: Persons with nonschizophrenic psychoses have higher incidence of somatic diseases compared to people with schizophrenia and nonpsychotic controls, and this should be noted in clinical work. EEFs have mostly weak association with somatic comorbidity in our study.


Assuntos
Transtornos Psicóticos/epidemiologia , Esquizofrenia/epidemiologia , Adulto , Transtornos Psicóticos Afetivos/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Incidência , Masculino , Transtornos Psicóticos/diagnóstico , Fatores de Risco , Esquizofrenia/diagnóstico , Fatores Sexuais
17.
Diabetes Res Clin Pract ; 160: 108009, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31926844

RESUMO

AIMS: To evaluate the predictive ability of 2-h post-load glucose level in addition to fasting and 1-h glucose levels in predicting the risk of type 2 diabetes. METHODS: We examined a prospective population-based cohort study of 654 subjects without type 2 diabetes at baseline. All subjects underwent an oral glucose tolerance test (OGTT), with measurement of glucose at 0, 60, and 120 min at baseline, and after 12 years in a follow-up survey. We evaluated the predictive properties of fasting, 1- and 2-h post-load glucose levels by comparing the areas under the receiver-operating characteristic (ROC) curve. RESULTS: We found that 2-h glucose concentration in the prediction model with fasting and 1-h glucose levels did not significantly increase the predictability of type 2 diabetes compared to a model only including fasting and 1-h glucose levels (AUC 0.83 vs. AUC 0.82, respectively; p = 0.23). The area under the ROC curve was the largest for 1-h glucose level (AUC 0.81), compared to fasting (AUC 0.71; p < 0.01) and 2-h glucose levels (AUC 0.72; p = 0.01). CONCLUSIONS: Adding 2-h glucose to the model with fasting and 1-h glucose levels did not improve the predictability of new onset type 2 diabetes.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/diagnóstico , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
18.
Homo ; 71(1): 37-42, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-31939993

RESUMO

Anatomical stature estimation methods reconstruct stature for skeletal specimens by adding up the heights of skeletal elements contributing to stature. In addition, these estimations factor in a certain amount of soft tissue known as "soft tissue correction". Our study focuses on the relationship between living stature and one of the major soft tissue contributors to stature: the intervertebral disc thickness/height. The purpose of this study was to clarify whether intervertebral disc thickness is greater in tall individuals and whether there is a linear correlation between stature and intervertebral disc height. To conduct this study, we utilized a subsample of the Northern Finland Birth Cohort of 1966 (n = 12,058) with known stature. We measured vertebral heights and intervertebral disc heights from low back MRI examination performed at the age of 46 years (n = 200). All subjects were considered healthy with no spinal injuries or pathologies. Our results clearly indicate that stature and intervertebral disc height have positive, statistically significant association. According to our results it is advisable to take into account the individual's skeletal height when soft tissue corrections for anatomical stature estimations are performed. Further studies utilizing full body MRI are needed to produce more accurate soft tissue corrections.


Assuntos
Antropologia Física/métodos , Estatura/fisiologia , Disco Intervertebral/anatomia & histologia , Coluna Vertebral/anatomia & histologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Sci Rep ; 10(1): 290, 2020 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-31937867

RESUMO

The Short form of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-short) and the STarT Back Tool (SBT) have been developed to screen for risk factors for future low back pain (LBP) -related disability and work loss respectively. The aim of this study was to investigate the accordance of the two questionnaires and to evaluate the accumulation of risk factors in the risk groups of both screening tools in a large population-based sample. The study population consisted of 3079 participants of the Northern Finland Birth Cohort 1966 who had reported LBP over the previous 12 months and had SBT and ÖMPSQ-short data. We evaluated the association of depressive and anxiety symptoms (Hopkins symptom check list-25, Generalized anxiety disorder 7 questionnaire, and Beck's Depression Inventory 21), psychological features (Fear-Avoidance Beliefs Questionnaire), lifestyle characteristics (BMI, smoking, alcohol abuse, physical inactivity) and social factors (education level) with the SBT and ÖMPSQ-short risk groups. The high-risk groups of both questionnaires were associated (p < 0.001) with depressive and anxiety symptoms and fear-avoidance beliefs. In addition, adverse lifestyle factors accumulated in the higher risk groups, especially from the ÖMPSQ-short. Agreement between the two questionnaires was moderate for men and fair for women.


Assuntos
Dor Lombar/diagnóstico , Medição da Dor/métodos , Adulto , Ansiedade/complicações , Índice de Massa Corporal , Depressão/complicações , Avaliação da Deficiência , Escolaridade , Feminino , Humanos , Estilo de Vida , Dor Lombar/patologia , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores de Risco , Fumar , Inquéritos e Questionários
20.
J Clin Endocrinol Metab ; 105(6)2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31970392

RESUMO

CONTEXT: Polycystic ovary syndrome (PCOS) is associated with decreased health-related quality of life (HRQoL), but longitudinal data beyond the reproductive years are lacking, and the impact of isolated PCOS symptoms is unclear. OBJECTIVE: To study generic HRQoL using the 15D questionnaire, life satisfaction, and self-reported health status in women with PCOS symptoms at ages 31 and 46 years. DESIGN: A longitudinal assessment using the Northern Finland Birth Cohort 1966. SETTING: General community. PARTICIPANTS: The 15D data were available for women reporting isolated oligo-amenorrhea (OA; at age 31 years, 214; and 46 years, 211), isolated hirsutism (H; 31 years, 211; and 46 years, 216), OA + H (PCOS; 31 years, 74; and 46 years, 75), or no PCOS symptoms (controls; 31 years, 1382; and 46 years, 1412). Data for life satisfaction and current health status were available for OA (31 years, 329; and 46 years, 247), H (31 years, 323; and 46 years, 238), PCOS (31 years, 125; and 46 years, 86), control (31 years, 2182; and 46 years, 1613) groups. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): 15D HRQoL, questionnaires on life satisfaction, and self-reported health status. RESULTS: HRQoL was lower at ages 31 and 46 in women with PCOS or H than in the controls. PCOS was an independent risk factor for low HRQoL, and the decrease in HRQoL in PCOS was similar to that of women with other chronic conditions, such as asthma, migraine, rheumatoid arthritis, and depression. The risk for low HRQoL in PCOS remained significant after adjusting for body mass index, hyperandrogenism, and socioeconomic status. Mental distress was the strongest contributing factor to HRQoL. PCOS was also associated with a risk for low life satisfaction and a 4-fold risk for reporting a poor health status. CONCLUSIONS: Women with PCOS present with low HRQoL, decreased life satisfaction, and a poorer self-reported health status up to their late reproductive years. Assessments and interventions aiming to improve HRQoL in PCOS should be targeted beyond the fertile age.

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