Weight change and mortality: the Nord-Trøndelag Health Study

Objectives. The prevalence of obesity is increasing. Overweight and obese people have increased mortality compared with normal weight people. We investigated the effect of weight change on mortality. Design. Prospective population study. Setting. We utilized data from two large population-based health studies conducted in 1984–86 and 1995–97 respectively. Cox proportional hazards models were used to calculate mortality rate ratios (RRs) with 95% confidence intervals (CIs) between people with a stable weight and people who lost or gained weight. Subjects. Totally 20 542 men and 23 712 women aged 20 years or more, without cardiovascular disease or diabetes at the first survey and without a history of cancer at the second survey were followed up on all-cause mortality for 5 years after the second survey. Results. We found no association between weight gain and mortality. People who lost weight had a higher total mortality rate compared with those who were weight stable [RR was 1.6 (95% CI: 1.4–1.8) in men and 1.7 (95% CI: 1.5–2.0) in women]. Similar associations were found for cardiovascular and noncardiovascular mortality. Additional analysis showed a linear increase in mortality rates across categories of weight loss for both men and women (P < 0.001). There was a statistically significant interaction between weight change and initial BMI, but only amongst men (P = 0.001). Conclusions. Weight loss, but not weight gain, was associated with increased mortality amongst men and women. Although underlying undiagnosed disease is the most plausible explanation for this finding, the similar associations found for total mortality, cardiovascular mortality, and noncardiovascular mortality makes the causal pathway somewhat enigmatic.     

Alcohol consumption, problem drinking, abstention and disability pension award. The Nord-Trøndelag Health Study (HUNT)

Aims To examine associations of abstention, alcohol consumption and problem drinking with subsequent disability pensioning (DP), and whether previous excessive consumption (‘sick‐quitting’) could explain some of the increased risk for DP among abstainers. Design Prospective population‐based study. Setting and participants Data were from two waves of the Nord‐Trøndelag Health Study (HUNT) linked with the national insurance database. The two main analyses included 37 729 (alcohol consumption) and 34 666 (problem drinking) participants. Measurements Alcohol consumption was measured by self‐reported consumption, while problem drinking was assessed by the Cut down, Annoyed, Guilt, Eye‐opener (CAGE) questionnaire. Information on subsequent DP, including diagnosis for which the DP was awarded, was gathered from the national insurance database. Covariates included somatic illness and symptoms, mental health, health‐related behaviour, socio‐economic status and social activity. Findings Those reporting the highest level of alcohol consumption were not at increased risk for DP [hazard ratio (HR) 1.12, 95% confidence interval (CI): 0.92–1.38], whereas problem drinking was a strong predictor (HR 2.79, 95% CI: 2.08–3.75) compared to their corresponding reference groups. Alcohol abstainers were also at increased risk for DP, but among them, the previous consumers (HR 1.95, 95% CI: 1.48–2.57) and previous excessive consumers (HR 1.67, 95% CI: 1.01–2.74) were at higher risk for DP than constant abstainers. Conclusions Problem drinking is linked to subsequent requirement for a disability pension but mere alcohol consumption is not. This is partly explained by ‘sick‐quitting’.     

Subjective well-being before and after the onset of diabetes mellitus: results of the Nord-Trøndelag Health Study

Previous research has documented that people with diabetes mellitus report lower psychological well-being than do people with no reported disease. Very little empirical evidence is available to support the conclusion that the low well-being is a consequence of diabetes per se. In this article, we analysed changes in psychological well-being among people who developed diabetes between 1984-1986 and 1995-1997. On these two occasions, the entire adult population of one county in Norway was invited to health screenings (the Nord-Tr?ndelag Health Studies, HUNT 1 and HUNT 2). The participants were 77,224 (90.7%) in HUNT 1 and 65,599 (71.0%) in HUNT 2. A total of 46,320 people participated in both studies and were included in the analyses. The participation rate at HUNT 2 was lower among people with diabetes at HUNT 2 than among people without diabetes. The participants responded to questionnaires, including questions on several diseases, as well as self-assessed health and psychological well-being. In this article, the question is raised whether people who developed diabetes in the period between HUNT 1 and HUNT 2 reported lower well-being than people who did not. The analyses show that they did, but the differences were small, except for reported subjective health and vigor. Moreover, we found that people who reported diabetes in HUNT 2 but not in HUNT 1 reported lower well-being and more comorbidity, already in HUNT 1. They also reported a slight decline in well-being in the period, that is, poorer subjectively judged health and life satisfaction, less vigor and cheerfulness, and more use of tranquilizers than before they received the diabetes diagnosis.     

Does mild hypothermia protect against reperfusion injury? The debate continues

Mild hypothermia (32–35°C) salvages ischemic myocardium and reduces infarct size in hearts undergoing ischemia/reperfusion. It is clear that a cardioprotective effect is evident when the heart is cooled during ischemia, and the protection is greater as the duration of normothermic ischemia is increasingly limited. The effect of cooling just before and at reperfusion is more controversial. Multiple experimental studies have revealed no effect of mild hypothermia on myocardial infarction when cooling was initiated in the waning minutes of ischemia. But Götberg et al. have demonstrated a small effect in pigs cooled with cold intravenous saline and a venous thermode, although the effect of cooling during ischemia continued to be more prominent. Clinical studies have been disappointing, and possible explanations are offered. Götberg’s new data are encouraging, but it is questioned whether this is the correct time to conduct a new large-scale clinical trial.     

High systolic blood pressure is associated with Val/Val genotype in the catechol-o-methyltransferase gene. The Nord-Trøndelag Health Study (HUNT)

BACKGROUND: The catechol-O-methyltransferase (COMT) gene contains a functional polymorphism, Val158Met. A few studies on animals have shown a relationship between the COMT gene and BP, but whether this exists in human beings is unclear. The aim of this study was to evaluate the relationship between codon 158 COMT gene polymorphism and BP in a population-based cohort. METHODS: In the 1995-97 Nord-Tr?ndelag Health Study (HUNT), the association between Val/Met polymorphism at the COMT gene and BP was evaluated in a group of 2966 nondiabetic individuals. RESULTS: Among the 2591 individuals without current use of antihypertensive drugs, systolic BP > or =140 mm Hg was more likely among persons with Val/Val genotype compared with the other genotypes (44.8% v 39.1%, P = .02). In the multivariate analysis the prevalence odds ratio for having the Val/Val genotype was 1.63 (95% CI = 1.18 to 2.24) among individuals with systolic BP > or =160 mm Hg compared with those with systolic BP <140 mm Hg. Val/Val genotype was also more likely (OR = 1.30, 95% CI = 1.04 to 1.63) among individuals with hypertension (as defined by use of antihypertensive medication, systolic BP > or =140 mm Hg, or diastolic BP > or =90 mm Hg) than among those with normal BP. CONCLUSIONS: Based on the study findings, the Val/Val genotype appears to be associated with a higher prevalence of increased systolic BP compared with the Met/Met or Met/Val genotypes at the COMTgene.     

Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trøndelag Health Survey

Abstract Aims/hypothesis. To study if people with Type I (insulin-dependent) or Type II (non-insulin-dependent) diabetes mellitus have increased risk of hip fracture. Methods. The study population consisted of 35 444 people 50 years of age and older, attending a health screening in a Norwegian county. They were followed up with respect to hip fracture for 9 years, and 1643 new hip fractures were recorded. Results. The relative risk of hip fracture for women with Type I diabetes compared with women without diabetes was 6.9 (95 % confidence interval 2.2–21.6) adjusted for age, body mass index and daily smoking. The relative risk for men was nearly the same, but not statistically significant. Among women 50–74 years of age with Type II diabetes for more than 5 years, the relative risk was 1.8 (95 % confidence interval 1.1–2.9). This increased risk persisted when insulin-treated women were excluded from the analysis. After additional adjustment for possible medical consequences of diabetes (impaired vision, impaired motor abilities and history of stroke) the relative risk among women 50–75 years of age with Type II diabetes was reduced to 1.5 (95 % confidence interval 0.9–2.5). Conclusion/interpretation. We found an increased risk of hip fracture in women younger than 75 years with Type I diabetes or with Type II diabetes of long duration. In older men, there was an increased risk associated with Type II diabetes of shorter duration. Whether the increased risk is attributed to reduced bone mass or to factors associated with falling has not been determined. [Diabetologia (1999) 42: 920–925] Received: 4 January 1999 and in revised form: 29 March 1999     

Diabetes mellitus and comorbidity. Change between 1984-1986 and 1995-1997: results of the Nord-Trøndelag Health Study

The prevention of diabetic complications is a challenge to the health services. A health survey was carried out in the Nord-Tr?ndelag county of Norway during the period 1984-1986 (77,224 respondents) and repeated in 1995-1997 (65,599 respondents). In this study, self-reports of diabetes and other diseases and impairments in the two screenings are compared. Did respondents report more or less morbidity in 1995-1997 than in 1984-1986? Comparisons between self-reports in the two surveys show higher morbidity among young people (below 40 years of age) in 1995-1997 than in 1984-1986, both among people with and without diabetes, but the change was not statistically significant. For the middle-aged (40-59 years of age), there were smaller changes. For older people (above 60 years of age) with diabetes, there was a decrease in some of the reported morbidity, namely for cerebral stroke, mobility impairment, and impairment due to other physical diseases, compared to older people without diabetes. There was a slight increase in reported vision impairment, but smaller than for people without diabetes. The changes in relative risk for people with stroke, mobility and vision impairment, and other physical disease are statistically significant. Splitting the sample according to gender, this trend was only significant among women.     

Interaction of Physical Activity and Body Mass Index on Mortality in Coronary Heart Disease: Data from the Nord-Trøndelag Health Study

Objective

The role of physical activity in the relationship between body mass index (BMI) and survival in coronary heart disease is unclear. Our aim was to examine the isolated and combined associations among BMI, physical activity, and mortality in subjects with coronary heart disease.

Microalbuminuria,cardiovascular disease and risk factors in a nondiabetic/nonhypertensive population. The Nord-Trøndelag Health Study (HUNT, 1995-97), Norway

Abstract. Romundstad S, Holmen J, Hallan H, Kvenild K, Krüger Ø, Midthjell K (HUNT Research Centre, Verdal, Norway; Levanger Hospital, Levanger, Norway; and Nærøy Health Centre, Nærøy, Norway). Microalbuminuria, cardiovascular disease and risk factors in a nondiabetic/nonhypertensive population. The Nord‐Trøndelag Health Study (HUNT, &1995–97), Norway. J Intern Med 2002; 252 : 164–172. Objective. Microalbuminuria (MA) as an independent marker of cardiovascular morbidity and mortality in nondiabetic/nonhypertensive individuals is under international debate. The aim of this study was to investigate the associations between MA and known cardiovascular risk factors/markers and disease in a randomly selected nondiabetic/nonhypertensive sample. Design. Cross‐sectional study. Setting. Participants in the population‐based Nord‐Trøndelag Health Study (HUNT), Norway (n = 65 258). Subjects. A total of 2113 individuals (≥20 years), randomly selected without diabetes and treated hypertension, delivered three morning urine samples for MA analysis. Main outcome measures. MA expressed as albumin‐to‐creatinine ratio (ACR), cardiovascular risk factors and disease. Results. Increasing age, pulse pressure, systolic (SBP) and diastolic blood pressure (DBP) and coronary heart disease (CHD) significantly predicted MA in men and increasing pulse pressure, SBP and DBP were associated with MA in women, adjusted for other cardiovascular risk factors/markers. After excluding individuals with known CHD and untreated hypertension (SBP ≥ 140 mmHg, DBP ≥ 90 mmHg) and hence a high total risk of cardiovascular disease (CVD), only increasing age was associated with ACR in men and increasing SBP and pulse pressure in women. Smoking, elevated lipid and glucose levels were strongly associated with MA in individuals with a high total risk of CVD than in individuals with a low total risk. Conclusion. MA was associated with increasing blood pressure in both genders, age and CHD in men. Other cardiovascular risk factors/markers might be more influential in predicting ACR variation in nondiabetic/nonhypertensive individuals with a high total risk of CVD than in individuals with a low total risk.     

Diabetes mellitus and psychological well-being. Change between 1984-1986 and 1995-1997. Results of the Nord-Trøndelag Health Study

Previous research has documented that people with diabetes report lower psychological well-being than do people with no reported disease. In recent years, new treatment regimens for diabetes have been introduced, including improved insulin and tablet treatment, easier blood sugar tests, and transfer of responsibility from doctor to patient. Have these improved methods for controlling diabetes resulted in enhanced psychological well-being for this group of patients? In this paper, we analyze changes in psychological well-being between 1984-1986 and 1995-1997 among diabetic patients. On these two occasions, the entire adult population of one county in Norway was invited to a health screening (the Nord-Tr?ndelag Health Studies, HUNT 1 and HUNT 2). Participants reached 77,224 and 65,599 persons, respectively (90.7% in HUNT 1 and 71.0% in HUNT 2). The participants responded to questionnaires, including questions on several diseases and impairments, as well as self-assessed health and psychological well-being. People with diabetes reported significantly lower well-being than people with no reported diabetes in HUNT 1 as well as in HUNT 2. However, the relationship between diabetes and well-being was significantly weaker in HUNT 2 than in HUNT 1. Self-reported Subjective health, the feeling of being strong and fit, the use of Tranquilizers, and Psychological distress had improved between the two surveys, for people with diabetes compared to people with no reported diabetes. Other outcome variables - Calmness, Cheerfulness, and Life satisfaction - were only weakly related to diabetes, and the relationship did not change significantly from HUNT 1 to HUNT 2.     

Blood pressure reference values in adolescents: methodological aspects and suggestions for Northern Europe tables based on the Nord-Trøndelag Health Study II

The secular weight increase in European and US adolescents and the increasing use of oscillometric devices pose a problem to decide on normative blood pressure levels. We studied how biological and statistical aspects influence standards, and suggest new Northern Europe reference tables. All adolescents of Nord-Tr?ndelag county, Norway, aged 13-18 years were invited to the Nord-Tr?ndelag Health Study II (1995-1997), and the participation rate was 90% (n = 7682 after excluding 278 chronically ill patients). Blood pressure was measured with an oscillometric device (Criticare 507N, Criticare Systems Inc., Waukesha, Wisconsin, USA). We found that overweight introduced a systematic bias in blood pressure results (+3-5 mmHg). In addition to the well known differences with age and sex, we found evident 95th percentile differences in systolic blood pressure between the tallest and shortest individuals, ranging from 3-17 mmHg, and postpubertal status increased systolic blood pressure by 2-4 mmHg. We also found that a polynomial regression model with ln(blood pressure) as the dependent variable better accounted for the higher variation in blood pressure in subgroups with higher mean blood pressure. The suggested reference tables have a similar 50th percentile to British oscillometric data (1-4 mmHg above), whereas our 95th percentiles were 4-7 mmHg above. Compared with US sphygmomanometric data, our values range 5-12 and 10-16 mmHg above, respectively. We conclude that all blood pressure reference tables for adolescents should be region specific and based on normal-weight individuals. In addition to age and sex, height, puberty, type of measurement device and different variances in different age groups should also be accounted for.     

Metabolic syndrome and risk of mortality in middle-aged versus elderly individuals: the Nord-Tr?ndelag Health Study (HUNT)

Aims/hypothesis

Recent reviews indicate that the metabolic syndrome is a risk factor for cardiovascular disease and mortality, but evidence is scarce in elderly individuals. We therefore examined the relationship between the metabolic syndrome and mortality rates among individuals aged 40–59, 60–74 and 75–89 years. We also examined whether the syndrome was associated with mortality rates over and above the Framingham risk score.

Methods

We studied prospectively 6,748 men and women who participated in the Nord-Trøndelag Health Study, Norway, from 1995 to 1997 (HUNT 2) and defined the metabolic syndrome by the International Diabetes Federation criteria.

Results

During 53,617 person-years of follow-up (mean per person, 7.9 years), 955 individuals died, of whom 585 died from cardiovascular disease. Among individuals who were 40–59 years of age at baseline, the presence of the metabolic syndrome was associated with increased relative risk of cardiovascular and total mortality (age- and sex-adjusted hazard ratios 3.97 [95% CI: 2.00–7.88] and 2.06 [1.35–3.13], respectively, equivalent to population-attributable risks of 20.7 and 14.2%, respectively). The Framingham risk score accounted for less than one-third of the effect of metabolic syndrome on mortality rates. After the age of 60 years, the metabolic syndrome was not associated with increased mortality rates. We found a significant interaction between the metabolic syndrome and age on the relative risk of mortality. Results were confirmed in a sub-sample without cardiovascular disease at baseline.

Conclusions/interpretation

The metabolic syndrome is a risk factor for mortality, over and above the Framingham risk score, in middle-aged, but not in elderly individuals.

     

Patterns of Cardiac Troponin I Concentrations as Risk Predictors of Cardiovascular Disease and Death: The Trøndelag Health Study

BackgroundConcentrations of cardiac troponin predict risk of cardiovascular disease and death in the general population. There is limited evidence on changing patterns of cardiac troponin in the years preceding cardiovascular events.MethodsWe analyzed cardiac troponin I (cTnI) with a high-sensitivity assay in 3272 participants in the Trøndelag Health (HUNT) Study at study visit 4 (2017-2019). Of these, 3198 had measurement of cTnI at study visit 2 (1995-1997), 2661 at study visit 3, and 2587 at all 3 study visits. We assessed the trajectories of cTnI concentrations in the years prior to cardiovascular events using a generalized linear mixed model, with adjustment for age, sex, cardiovascular risk factors, and comorbidities.ResultsAt HUNT4 baseline, median age was 64.8 (range 39.4-101.3) years, and 55% were women. Study participants who were admitted because of heart failure or died from cardiovascular cause on follow-up had a steeper increase in cTnI compared with study participants with no events (P < .001). The average yearly change in cTnI was 0.235 (95% confidence interval, 0.192-0.289) ng/L for study participants with heart failure or cardiovascular death, and −0.022 (95% confidence interval, −0.022 to −0.023) ng/L for study participants with no events. Study participants who experienced myocardial infarction, ischemic stroke, or noncardiovascular mortality exhibited similar cTnI patterns.ConclusionsFatal and nonfatal cardiovascular events are preceded by slowly increasing concentrations of cardiac troponin, independently of established cardiovascular risk factors. Our results support the use of cTnI measurements to identify at-risk subjects who progress to subclinical and later overt cardiovascular disease.