|
|
Davies, S. J. C., Bjerkeset, O., Nutt, D. J., & Lewis, G. (2012). A U-shaped relationship between systolic blood pressure and panic symptoms: the HUNT study. Psychol Med, 42(9), 1969–1976.
Abstract: BACKGROUND: Previous studies on the relationship between blood pressure (BP) and psychological morbidity are conflicting. To resolve this confusing picture we examined the hypothesis that there is a non-linear relationship between panic and systolic BP (SBP) and explored the association of generalized anxiety symptoms with SBP. Method We used data from the population-based Nord-Trondelag health study (HUNT) in which all 92 936 individuals aged >/=20 years residing in one Norwegian county were invited to participate. Panic was assessed using one item from the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS) and generalized anxiety with the remaining six items of this subscale. SBP was the mean of two measurements by an automatic device. RESULTS: A total of 64 871 respondents had SBP recorded (70%). Both unadjusted (n=61 408) and adjusted analyses provided evidence for a non-linear relationship between panic and SBP, represented by a U-shaped curve with a minimum prevalence of panic at around 140 mmHg. The relationship was strengthened after adjustment for confounders, with the quadratic term significantly associated with panic (p=0.03). Generalized anxiety symptoms were associated only with low SBP. CONCLUSIONS: The U-shaped relationship between SBP and panic provides a unifying explanation for the separate strands of published literature in this area. The results support the hypothesis that high BP and panic disorder could share brainstem autonomic and serotonergic abnormalities. By contrast, generalized anxiety symptoms were more common only at lower BPs, suggesting that any biological link between panic and high BP does not extend to generalized anxiety.
|
|
|
|
Gabin, J. M., Tambs, K., Saltvedt, I., Sund, E., & Holmen, J. (2017). Association between blood pressure and Alzheimer disease measured up to 27 years prior to diagnosis: the HUNT Study. Alzheimers Res Ther, 9(1), 37.
Abstract: BACKGROUND: A lot of attention has been paid to the relationship of blood pressure and dementia because epidemiological research has reported conflicting evidence. Observational data has shown that midlife hypertension is a risk factor for cognitive decline and dementia later in life, whereas there is evidence that low blood pressure is predictive in later life. The aim of the present study was to examine the association between dementia and blood pressure measured up to 27 years (mean 17.6 years) prior to ascertainment. METHODS: In Nord-Trondelag County, Norway, incident dementia data were collected during 1995-2011, and the diagnoses were validated by a panel of experts in the field. By using the subjects' personal identification numbers, the dementia data were linked to data from the Nord-Trondelag Health Study (the HUNT Study), a large, population-based health study performed in 1984-1986 (HUNT 1) and 1995-1997 (HUNT 2). A total of 24,638 participants of the HUNT Study were included in the present study, 579 of whom were diagnosed with Alzheimer disease, mixed Alzheimer/vascular dementia, or vascular dementia. Multiple logistic regression analyses were conducted to analyze the association between dementia and blood pressure data from HUNT 1 and HUNT 2. RESULTS: Over the age of 60 years, consistent inverse associations were observed between systolic blood pressure and all-cause dementia, mixed Alzheimer/vascular dementia, and Alzheimer disease, but not with vascular dementia, when adjusting for age, sex, education, and other relevant covariates. This was observed for systolic blood pressure in both HUNT 1 and HUNT 2, regardless of antihypertensive medication use. There was an adverse association between systolic blood pressure, pulse pressure, and Alzheimer disease in individuals treated with antihypertensive medication under the age of 60 years. CONCLUSIONS: Our data are in line with those in previous studies demonstrating an inverse association between dementia and systolic blood pressure in individuals over the age of 60 years. We cannot exclude a survival effect, however. Among middle-aged subjects (<60 years), elevated systolic blood pressure and pulse pressure were associated with eventual Alzheimer disease in individuals who reported using antihypertensive medication.
|
|
|
|
Gronskag, A. B., Romundstad, P., Forsmo, S., Langhammer, A., & Schei, B. (2012). Excess mortality after hip fracture among elderly women in Norway. The HUNT study. Osteoporos Int, 23(6), 1807–1811.
Abstract: We wanted to study mortality after hip fractures among elderly women in Norway. We found that excess mortality was highest short time after hip fracture, but persisted for several years after the fracture. The excess mortality was not explained by pre-fracture medical conditions. INTRODUCTION: The purpose of the present study was to investigate short and long term mortality after hip fracture, and to evaluate how comorbidity, bone mineral density, and lifestyle factors affect the survival after hip fractures. METHODS: The study cohort emerges from a population-based health survey in the county of Nord-Trondelag, Norway. Women aged 65 or more at participation at the health survey who sustained a hip fracture after attending the health survey are cases in this study (n = 781). A comparison cohort was constructed based on participants at HUNT 2 with no history of hip fractures (n = 3, 142). Kaplan-Meier survival curves were used to evaluate crude survival, and Cox regression analyses were used to study age-adjusted hazard ratios for mortality and for multivariable analyses involving relevant covariates. RESULTS: Mean length of follow-up after fracture was 2.8 years. Within the first 3 months of follow-up, 78 (10.0%) of the hip fracture patients died, compared to only 39 (1.7%) in the control group. HR for mortality 3 months after hip fracture was 6.5 (95% CI 4.2-9.6). For the entire follow-up period women who sustained a hip fracture had an HR for mortality of 1.9 (95% CI 1.6-2.3), compared with women without a hip fracture. CONCLUSIONS: We found that elderly women who sustained a hip fracture had increased mortality risk. The excess mortality was highest short time after the fracture, but persisted for several years after the fracture, and was not explained by pre-fracture medical conditions.
|
|
|
|
Grov, E. K., Fossa, S. D., & Dahl, A. A. (2017). A controlled study of the influence of comorbidity on activities of daily living in elderly cancer survivors (the HUNT-3 survey). J Geriatr Oncol, 8(5), 328–335.
Abstract: OBJECTIVES: To examine the influence of somatic comorbidity on Activity of Daily Living (ADL) problems in cancer survivors >/=70years (ECSs) based on data from The Health Study of Nord-Trondelag County (HUNT-3) 2006-08. MATERIAL AND METHODS: Among participants of the HUNT-3 survey, 599 ECSs had a diagnosis of one invasive cancer according to both The Cancer Registry of Norway and self-report. Three controls without cancer aged >/=70years for each ECS were drawn from the HUNT-3 sample. We compared personal-ADL (P-ADL) and instrumental-ADL (I-ADL) problems for ECSs and differences between ADL problems for ECSs with and without comorbidity and controls with and without comorbidity. RESULTS: The prevalence of P-ADL problems was 3.5% among ECSs and 2.9% among controls (p=0.97) and for I-ADL 28.5% versus 21.4% (p=0.01), respectively. In bivariate analyses where ECSs versus controls was the dependent variable, presence of I-ADL problems, higher age, being female, paired relationship, poor self-rated health, hospitalization last year, and low level of neuroticism were associated being ECSs. In multivariate analyses, these variables, except I-ADL-problems and paired relationship, remained significantly associated being ECSs. No significant differences were shown for P-ADL problems when comparing ECSs and controls with comorbidity, and ECSs with and without comorbidity. ECSs with comorbidity reported significantly more I-ADL-problems than controls with comorbidity, and ECSs with comorbidity had significantly more I-ADL-problems than ECSs without comorbidity. CONCLUSION: Our results reflect common factors found in ADL studies in the elderly population. Health personnel have to be particularly observant on I-ADL problems among female ECSs, and those reporting poor self-rated health or comorbidity.
|
|
|
|
Heuch, I., Heuch, I., Hagen, K., & Zwart, J. - A. (2013). Body mass index as a risk factor for developing chronic low back pain: a follow-up in the Nord-Trondelag Health Study. Spine (Phila Pa 1976), 38(2), 133–139.
Abstract: STUDY DESIGN: A population-based, prospective cohort study. OBJECTIVE: To determine whether overweight, obesity, or more generally an elevated body mass index (BMI) increase the probability of experiencing chronic low back pain (LBP) after an 11-year period, both among participants with and without LBP at baseline. SUMMARY OF BACKGROUND DATA: Chronic LBP is a common disabling disorder in modern society. Cross-sectional studies suggest an association between an elevated BMI and LBP, but it is not clear whether this is a causal relationship. METHODS: Data were obtained from the community-based HUNT 2 (1995-1997) and HUNT 3 (2006-2008) studies of an entire Norwegian county. Participants were 8733 men and 10,149 women, aged 30 to 69 years, who did not have chronic LBP at baseline, and 2669 men and 3899 women with LBP at baseline. After 11 years, both groups indicated whether they currently had chronic LBP, defined as pain persisting for at least 3 months continuously during the last year. RESULTS: A significant positive association was found between BMI and risk of LBP among persons without LBP at baseline. The odds ratio for BMI 30 or more versus BMI less than 25 was 1.34 (95% confidence interval [CI], 1.08-1.67) for men and 1.22 (95% CI, 1.03-1.46) for women, in analyses adjusted for age, education, work status, physical activity at work and in leisure time, smoking, blood pressure, and serum lipid levels. A significant positive association was also established between BMI and recurrence of LBP among women. LBP status at baseline had negligible influence on subsequent change in BMI. CONCLUSION: High values of BMI may predispose to chronic LBP 11 years later, both in individuals with and without LBP. The association between BMI and LBP is not explained by an effect of LBP on later change in BMI.
|
|
|
|
Hjerkind, K. V., Stenehjem, J. S., & Nilsen, T. I. L. (2017). Adiposity, physical activity and risk of diabetes mellitus: prospective data from the population-based HUNT study, Norway. BMJ Open, 7(1), e013142.
Abstract: BACKGROUND: Physical activity may counteract the adverse effects of adiposity on cardiovascular mortality; however, the evidence of a similar effect on diabetes is sparse. This study examines whether physical activity may compensate for the adverse effect of adiposity on diabetes risk. METHODS: The study population consisted of 38 231 individuals aged 20 years or more who participated in two consecutive waves of the prospective longitudinal Nord-Trondelag Health Study in Norway: in 1984-1986 and in 1995-1997. A Poisson regression model with SEs derived from robust variance was used to estimate adjusted risk ratios of diabetes between categories of body mass index and physical activity. RESULTS: Risk of diabetes increased both with increasing body mass (Ptrend <0.001) and with decreasing physical activity level (Ptrend <0.001 in men and 0.01 in women). Combined analyses showed that men who were both obese and had low activity levels had a risk ratio of 17 (95% CI 9.52 to 30) compared to men who were normal weight and highly active, whereas obese men who reported high activity had a risk ratio of 13 (95% CI 6.92 to 26). Corresponding analysis in obese women produced risk ratios of 15 (95% CI 9.18 to 25) and 13 (95% CI 7.42 to 21) among women reporting low and high activity levels, respectively. CONCLUSIONS: This study shows that overweight and obesity are associated with a substantially increased risk of diabetes, particularly among those who also reported being physically inactive. High levels of physical activity were associated with a lower risk of diabetes within all categories of body mass index, but there was no clear evidence that being physically active could entirely compensate for the adverse effect of adiposity on diabetes risk.
|
|
|
|
Kvalheim, S., Sandven, I., Hagen, K., & Zwart, J. - A. (2013). Smoking as a risk factor for chronic musculoskeletal complaints is influenced by age. The HUNT study. Pain, 154(7), 1073–1079.
Abstract: Chronic musculoskeletal complaints (MSCs) are among the major health problems, and cross-sectional studies suggest an association between smoking and MSCs. The causal relationship, however, is not known. The present study is designed to assess the association between smoking and chronic MSCs, and is based on data from a large longitudinal cohort study of all inhabitants 20years in Nord-Trondelag County (Helse Undersokelsen i Nord-Trondelag -HUNT), conducted in 1995-97 (HUNT 2) and 2006-08 (HUNT 3). The study population consisted of 15,134 subjects without chronic MSCs and valid exposure data on smoking at baseline (HUNT 2). The outcome was defined as presence of chronic MSCs at follow-up (HUNT 3). The results show that smoking at baseline represents a 20% increased risk (IRR=1.20, 95% CI 1.14-1.27, P=0.0001) for chronic MSCs at follow-up. The risk for chronic MSCs by daily smoking decreased with increasing age up to 50years; after this, there was no significant association. The results show that modifiable risk factors like smoking should be included in public health intervention programs for MSCs.
|
|
|
|
Langvik, E., & Hjemdal, O. (2015). Symptoms of depression and anxiety before and after myocardial infarction: The HUNT 2 and HUNT 3 study. Psychology, health & medicine, 20(5), 560–569.
Abstract: The long-term effect of having a myocardial infarction (MI) and to what extent post-MI anxiety and depression can be attributed to pre-MI anxiety and depression are not known. Anxiety as an independent risk factor for the onset of MI is not clear and studies treating anxiety and depression as continuous variables are lacking. Baseline data in this prospective study were obtained from the Health Study of Nord-Trondelag County (HUNT 2). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS) at HUNT 2. Age, gender, waist circumference, hypertension, total cholesterol, diabetes, and years of daily smoking were included as control variables. In the sample of 28,859 participants, 770 MI were reported in the follow-up study 5-8 years later (HUNT 3). The level of depressive symptoms at HUNT 2 was a significant and independent predictor of MI at HUNT 3, while symptoms of anxiety were not. Level of anxiety and depression at HUNT 3 was best predicted by baseline anxiety and depression. Having an MI had only a marginal effect on the levels of anxiety and depressive symptoms at HUNT 3. In the MI group, time since MI was not a significant predictor of anxiety and depression.
|
|
|
|
Mork, P. J., & Nilsen, T. I. L. (2012). Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway. Arthritis Rheum, 64(1), 281–284.
Abstract: OBJECTIVE: Sleep problems are common among patients with fibromyalgia (FM). However, it is not known whether poor sleep is a contributing factor in FM or a consequence of the illness. The aim of the current study was to prospectively investigate the association between self-reported sleep problems and risk of FM among adult women. METHODS: We longitudinally studied 12,350 women who did not have FM, musculoskeletal pain, or physical impairments at baseline (1984-1986). A generalized linear model was used to calculate the adjusted relative risk (RR) of FM at followup in 1995-1997. RESULTS: Incident FM was reported by 327 women at followup. A dose-dependent association was found between sleep problems and risk of FM (P for trend<0.001), with an adjusted RR of 3.43 (95% confidence interval [95% CI] 2.26-5.19) among women who reported having sleep problems often or always, compared to women who never experienced sleep problems. Age-stratified analysis showed that women age>/=45 years who reported having sleep problems often or always had an adjusted RR of 5.41 (95% CI 2.65-11.05), whereas the corresponding RR for women ages 20-44 years who reported having sleep problems often or always was 2.98 (95% CI 1.76-5.05). CONCLUSION: These prospective data indicate a strong dose-dependent association between sleep problems and risk of FM. The association is somewhat, although not significantly, stronger in middle-aged and older women than in younger women.
|
|
|
|
Naicker, K., Johnson, J. A., Skogen, J. C., Manuel, D., Overland, S., Sivertsen, B., et al. (2017). Type 2 Diabetes and Comorbid Symptoms of Depression and Anxiety: Longitudinal Associations With Mortality Risk. Diabetes Care, 40(3), 352–358.
Abstract: OBJECTIVE: Depression is strongly linked to increased mortality in individuals with type 2 diabetes. Despite high rates of co-occurring anxiety and depression, the risk of death associated with comorbid anxiety in individuals with type 2 diabetes is poorly understood. This study documented the excess mortality risk associated with symptoms of depression and/or anxiety comorbid with type 2 diabetes. RESEARCH DESIGN AND METHODS: Using data for 64,177 Norwegian adults from the second wave of the Nord-Trondelag Health Study (HUNT2), with linkage to the Norwegian Causes of Death Registry, we assessed all-cause mortality from survey participation in 1995 through to 2013. We used Cox proportional hazards models to examine mortality risk over 18 years associated with type 2 diabetes status and the presence of comorbid affective symptoms at baseline. RESULTS: Three clear patterns emerged from our findings. First, mortality risk in individuals with diabetes increased in the presence of depression or anxiety, or both. Second, mortality risk was lowest for symptoms of anxiety, higher for comorbid depression-anxiety, and highest for depression. Lastly, excess mortality risk associated with depression and anxiety was observed in men with diabetes but not in women. The highest risk of death was observed in men with diabetes and symptoms of depression only (hazard ratio 3.47, 95% CI 1.96, 6.14). CONCLUSIONS: This study provides evidence that symptoms of anxiety affect mortality risk in individuals with type 2 diabetes independently of symptoms of depression, in addition to attenuating the relationship between depressive symptoms and mortality in these individuals.
|
|
|
|
Sivertsen, B., Salo, P., Mykletun, A., Hysing, M., Pallesen, S., Krokstad, S., et al. (2012). The bidirectional association between depression and insomnia: the HUNT study. Psychosom Med, 74(7), 758–765.
Abstract: OBJECTIVE: Depression and insomnia are closely linked, yet our understanding of their prospective relationships remains limited. The aim of the current study was to investigate the directionality of association between depression and insomnia. METHODS: Data were collected from a prospective population-based study comprising the most recent waves of the Nord-Trondelag Health Study (HUNT) (the HUNT2 in 1995-1997 and the HUNT3 in 2006-2008). A total of 24,715 persons provided valid responses on the relevant questionnaires from both surveys. Study outcomes were onset of depression or insomnia at HUNT3 in persons not reporting the other disorder in HUNT2. RESULTS: Both insomnia and depression significantly predicted the onset of the other disorder. Participants who did not have depression in HUNT2 but who had insomnia in both HUNT2 and HUNT3 had an odds ratio (OR) of 6.2 of developing depression at HUNT3. Participants who did not have insomnia in HUNT2 but who had depression in both HUNT2 and HUNT3 had an OR of 6.7 of developing insomnia at HUNT3. ORs were only slightly attenuated when adjusting for potential confounding factors. CONCLUSIONS: The results support a bidirectional relationship between insomnia and depression. This finding stands in contrast to the previous studies, which have mainly focused on insomnia as a risk factor for the onset of depression.
|
|
