Cohort Profile: The HUNT Study, Norway KROKSTAD, S; LANGHAMMER, A; HVEEM, K ...
International journal of epidemiology,
08/2013, Volume:
42, Issue:
4
Journal Article
Peer reviewed
Open access
The HUNT Study includes large total population-based cohorts from the 1980ies, covering 125 000 Norwegian participants; HUNT1 (1984-86), HUNT2 (1995-97) and HUNT3 (2006-08). The study was primarily ...set up to address arterial hypertension, diabetes, screening of tuberculosis, and quality of life. However, the scope has expanded over time. In the latest survey a state of the art biobank was established, with availability of biomaterial for decades ahead. The three population based surveys now contribute to important knowledge regarding health related lifestyle, prevalence and incidence of somatic and mental illness and disease, health determinants, and associations between disease phenotypes and genotypes. Every citizen of Nord-Trøndelag County in Norway being 20 years or older, have been invited to all the surveys for adults. Participants may be linked in families and followed up longitudinally between the surveys and in several national health- and other registers covering the total population. The HUNT Study includes data from questionnaires, interviews, clinical measurements and biological samples (blood and urine). The questionnaires included questions on socioeconomic conditions, health related behaviours, symptoms, illnesses and diseases. Data from the HUNT Study are available for researchers who satisfy some basic requirements (www.ntnu.edu/hunt), whether affiliated in Norway or abroad.
Overweight and obesity increase the risk of elevated blood pressure, but the knowledge of the effect of weight change on blood pressure is sparse.
To investigate the association between change in ...body mass index (BMI) and change in diastolic blood pressure (DBP), systolic blood pressure (SBP), and hypertension status.
Two population-based cross-sectional studies, one in 1984-86 and the other in 1995-97.
The Nord-Trondelag Health Study (HUNT).
We included 15,971 women and 13,846 men who were 20 y or older at the first survey, without blood pressure medication at both surveys and without diabetes, cardiovascular disease or dysfunction in daily life at baseline.
Weight, height and blood pressure were measured standardised. Change in BMI was categorised as stable (initial BMI+/-0.1 kg/m2 each follow-up year), increased or decreased, and BMI was categorised by using World Health Organisation's categorisation (underweight BMI: <18.5 kg/m2, normal weight BMI: 18.5-24.9 kg/m2, overweight BMI: 25.0-29.9 kg/m2, obesity BMI> or =30 kg/m2).
An increase in BMI and a decrease in BMI were significantly associated with increased and decreased SBP and DBP, respectively, compared to a stable BMI in both genders and all age groups, although the strongest effect was found among those who were 50 y and older. The adjusted odds ratio for having hypertension at HUNT 2 was 1.8 (95% confidence interval (CI): 1.5, 2.2) among women and 1.6 (95% CI: 1.4,1.8) among men aged 20-49 y who increased their BMI compared to those who had stable BMI. A similar, but weaker association was found among women and men aged 50 y or more. The mean change in both SBP and DBP was higher for those who changed BMI category from first to the second survey than for those who were in the same BMI class at both surveys.
Our result supports an independent effect of change in BMI on change in SBP and DBP in both women and men, and that people who increase their BMI are at increased risk for hypertension.
Summary
Some reports indicate that the obesity epidemic may be slowing down or halting. We followed body mass index (BMI) and waist circumference (WC) in a large adult population in Norway (n = 90 ...000) from 1984–1986 (HUNT1) through 1995–1997 (HUNT2) to 2006–2008 (HUNT3) to study whether this is occurring in Norway. Height and weight were measured with standardized and identical methods in all three surveys; WC was also measured in HUNT2 and HUNT3. In the three surveys, mean BMI increased from 25.3 to 26.5 and 27.5 kg m−2 in men and from 25.1 to 26.2 and 26.9 kg m−2 in women. Increase in prevalence of obesity (BMI ≥ 30 kg m−2) was greater in men (from 7.7 to 14.4 and 22.1%) compared with women (from 13.3 to 18.3 and 23.1%). In contrast, women had a greater increase in abdominal obesity (WC ≥ 102 cm for men and WC ≥ 88 cm for women). There was a continuous shift in the distribution curve of BMI and WC to the right, demonstrating that the increase in body weight was occurring in all weight groups, but the increase of obesity was greatest in the youngest age groups. Our data showed no signs of a halt in the increase of obesity in this representative Norwegian population.
Aims
The aetiology of latent autoimmune diabetes in adults (LADA), assessed by autoimmune markers, is insufficiently clarified. We cross-sectionally investigated the prevalence and prospectively the ...prediabetic and postdiabetic presence of antibodies to glutamic acid decarboxylase (GADA), insulinoma-associated protein 2 and zinc transporter 8 in LADA and in type 1 diabetes.
Methods
We included 208 ‘classic’ type 1, 161 LADA and 302 type 2 diabetic cases from the second (HUNT2: 1995–1997) and third (HUNT3: 2006–2008) Nord-Trøndelag health surveys. Prospective data were available for 59 type 1, 44 LADA and 302 type 2 diabetic cases followed from HUNT2 to HUNT3. From HUNT3, 24 type 1 diabetic and 31 LADA incident cases were available.
Results
Cross-sectionally, 90% of LADA cases were positive for only one antibody (10% multiple-antibody-positive). Prospectively, 59% of GADA-positive LADA patients in HUNT2 were no longer positive in HUNT3. LADA patients who became negative possessed less frequently risk HLA haplotypes and were phenotypically more akin to those with type 2 diabetes than to those who stayed positive. Still, those losing positivity differed from those with type 2 diabetes by lower C-peptide levels (
p
= 0.009). Of incident LADA cases in HUNT3, 64% were already antibody-positive in HUNT2, i.e. before diabetes diagnosis. These incident LADA cases were phenotypically more akin to type 1 diabetes than were those who did not display positivity in HUNT2.
Conclusion/interpretation
The pattern of antibodies, the postdiabetic loss or persistence as well as the prediabetic absence or presence of antibodies influence LADA phenotypes. Time-dependent presence or absence of antibodies adds new modalities to the heterogeneity of LADA.
The aim of this study was to analyse changes in body weight and height, and the changes in the prevalence of overweight and obesity.
Prospective population based study with 11-year follow-up.
...Norwegian men (n=21565) and women (n=24337) aged 20 years or more who participated in two health surveys, the first in 1984-1986 and the other in 1995-1997.
Height and weight were measured by using standardised procedures at both surveys, and we computed body mass index (BMI) as weight in kilo divided by the squared value of height in meters.
Participants who were younger than 50 years at the first survey showed a large increase in body weight, and men and women aged 20-29 years increased their weight with an average of 7.9 kg and 7.3 kg, respectively. Contradictory, participants who were 70 years or older had on average a weight loss. The prevalence of overweight (BMI=25.0-29.9 kg/m(2)) and obesity (BMI>/=30 kg/m(2)) increased between the surveys, especially in the youngest age groups. Overall, the proportion classified as obese increased from 6.7 to 15.5% among men and from 11.0 to 21.0% among women. Some of this increase was due to a reduction in height, which was most pronounced in the oldest age groups.
During approximately 10 years, body weight increased in all age groups below 70 years, and the prevalence of overweight and obese persons was approximately 20% higher at the second survey compared with the first survey.
Objective: To examine the associations of depression and anxiety with the metabolic syndrome.
Method: Cross‐sectional study of 9571 participants aged 20–89 years in the Nord‐Trøndelag Health Study ...(HUNT 2). We assessed anxiety and depression with the Hospital Anxiety and Depression Scale and the metabolic syndrome with the International Diabetes Federation criteria.
Results: Despite generous statistical power and use of both continuous and categorical approaches, we found no association between anxiety or depression and the metabolic syndrome in models adjusted for age, gender, educational level, smoking, physical activity and pulse rate. When adjusted for age and gender only, we found a weak positive association for depression when a continuous measure was used, but not at the case level. The findings were similar across sexes, and robust for exclusion of cardiovascular disease and antidepressants.
Conclusion: In this largest study to date we found no association of anxiety and depression with the metabolic syndrome.
We investigated the influence of different aspects of alcohol consumption on the risk of Type 2 diabetes and autoimmune diabetes in adults.
We used data from the Nord-Trøndelag Health Survey (HUNT) ...study, in which all adults aged ≥ 20 years from Nord-Trondelag County were invited to participate in three surveys in 1984-1986, 1995-1997 and 2006-2008. Patients with diabetes were identified using self-reports, and participants with onset age ≥ 35 years were classified as having Type 2 diabetes if they were negative for anti-glutamic acid decarboxylase (n = 1841) and as having autoimmune diabetes if they were positive for anti-glutamic acid decarboxylase (n = 140). Hazard ratios of amount and frequency of alcohol use, alcoholic beverage choice, and binge drinking and alcohol use disorders were estimated.
Moderate alcohol consumption (adjusted for confounders) was associated with a reduced risk of Type 2 diabetes in men, but not in women (hazard ratio for men 10-15 g/day 0.48, 95% CI 0.28-0.77; hazard ratio for women ≥ 10 g/day 0.81, 95% CI 0.33-1.96). The reduced risk was primarily linked to consumption of wine hazard ratio 0.93, 95% CI 0.87-0.99 (per g/day). No increased risk was seen in participants reporting binge drinking or in problem drinkers. The results were also compatible with a reduced risk of autoimmune diabetes associated with alcohol consumption hazard ratio 0.70, 95% CI 0.45-1.08 (frequent consumption) and hazard ratio 0.36, 95% CI 0.13-0.97 (2-7 g/day).
Moderate alcohol consumption associates with reduced risk of both Type 2 diabetes and autoimmune diabetes. A protective effect of alcohol intake may be limited to men. High alcohol consumption does not seem to carry an increased risk of diabetes.
To examine the prevalence of thyroid disease and dysfunction including thyroid autoimmunity in Norway.
All inhabitants 20 years and older (94009) in Nord-Trondelag were invited to participate in a ...health survey with a questionnaire and blood samples.
The prevalence of former diagnosed hyperthyroidism was 2.5% in females and 0.6% in males, hypothyroidism 4.8% and 0.9%, and goitre 2.9% and 0.4% respectively. In both sexes the prevalence increased with age. In individuals without a history of thyroid disease the median, 2.5 and 97.5 percentiles for TSH (mU/l) were 1.80 and 0.49-5.70 for females and 1. 50 and 0.56-4.60 for males. The TSH values increased with age. When excluding individuals with positive thyroid peroxidase antibodies (TPOAb) (>200U/ml), the 97.5 percentiles dropped to 3.60 mU/l and 3. 40 mU/l respectively. The prevalence of pathological TSH values in females and males were TSH >/=10mU/l 0.90% and 0.37%; TSH 4.1-9. 9mU/l 5.1% and 3.7%; and TSH</=0.05mU/l 0.45% and 0.20% respectively. The prevalence of positive TPOAb (>200U/ml) was 13.9% in females and 2.8% in males. In females the lowest percentage (7.9%) of positive TPOAb was seen with TSH 0.2-1.9mU/l and increased both with lower and higher levels of TSH. The percentage of males with positive TPOAb was lower than in females in all TSH groups except for those with TSH>10mU/l (85% TPOAb positive).
In spite of a high prevalence of recognised thyroid disease in the population a considerable number of inhabitants have undiagnosed thyroid dysfunction and also positive TPOAb.
Latent autoimmune diabetes (LADA) is a common form of diabetes, yet the risk factors are poorly characterised. The aim of this study was to investigate the influence of age, overweight and physical ...activity on the risk of LADA.
We analysed age, overweight and physical inactivity and the incidence of LADA in 38,800 men and women, observed between 1984 and 1986 and 1995 and 1997 as part of the Nord-Trøndelag Health Survey. We also compared such factors with incident cases of type 2 (n = 738) and 'classic' type 1 diabetes (n = 18). Patients classified as LADA (n = 81) had antibodies against GAD and were insulin independent at diagnosis.
The proportion of those who were older, overweight and inactive before diagnosis was almost identical in LADA and type 2 diabetes patients. BMI >or=30 kg/m(2) was strongly associated with LADA incidence (relative risk RR = 15.0, 95% CI 7.51-29.97). The association was similar for type 2 diabetes (RR = 15.37, 95% CI 12.07-19.57) but not for type 1 diabetes. Similarly, age (>or=60 years) was an important risk factor for LADA (RR = 5.62, 95% CI 2.36-13.4) as well as for type 2 diabetes (RR = 6.78, 95% CI 5.07-9.06) in contrast to type 1 diabetes. Physical inactivity was associated with an increased risk of both LADA and type 2 diabetes.
This study suggests that increased age, overweight and physical inactivity are as strong risk factors for LADA as for type 2 diabetes. These findings suggest a role for insulin resistance in the pathogenesis of LADA.
It has been suggested that moist snuff (snus), a smokeless tobacco product that is high in nicotine and widespread in Scandinavia, increases the risk of Type 2 diabetes. Previous studies are however ...few, contradictory and, with regard to autoimmune diabetes, lacking. Our aim was to study the association between snus use and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood (LADA).
Analyses were based on incident cases (Type 2 diabetes, n = 724; LADA, n = 200) and population-based controls (n = 699) from a Swedish case-control study. Additional analyses were performed on cross-sectional data from the Norwegian HUNT study (n = 21 473) with 829 prevalent cases of Type 2 diabetes. Odds ratios (OR) were estimated adjusted for age, BMI family history of diabetes and smoking. Only men were included.
No association between snus use and Type 2 diabetes or LADA was seen in the Swedish data. For Type 2 diabetes, the OR for > 10 box-years was 1.00 95% confidence interval (CI), 0.47 to 2.11 and for LADA 1.01 (95% CI, 0.45 to 2.29). Similarly, in HUNT, the OR for Type 2 diabetes in ever-users was estimated at 0.91 (95% CI, 0.75 to 1.10) and in heavy users at 0.92 (95% CI, 0.46 to 1.83).
The risk of Type 2 diabetes and LADA is unrelated to the use of snus, despite its high nicotine content. This opens the possibility of the increased risk of Type 2 diabetes seen in smokers may not be attributed to nicotine, but to other substances in tobacco smoke.
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