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1.  Anxiety and depression lowers blood pressure: 22-year follow-up of the population based HUNT study, Norway 
BMC Public Health  2011;11:601.
Background
For decades, symptoms of anxiety and depression have been included among psychological factors associated with development of hypertension. Although this has been questioned in recent studies, most findings have been based on a single assessment of mental distress at baseline. We examined these associations using repeated assessments of anxiety, depression and blood pressure.
Methods
Data on 17,410 men and women aged 20 to 67 participating in the Nord-Trøndelag Health Study (HUNT) in Norway in 1984-86 were re-examined 11 and 22 years later. The main outcome was change in mean blood pressure (mm Hg) during follow-up.
Results
We found that a high symptom level score (≥80th percentile) of combined anxiety and depression at baseline, as compared to a lower symptom level, was associated with lower mean systolic (-0.67 mm Hg, p = 0.044) and diastolic (-0.25 mm Hg, p = 0.201) blood pressure at year 22. A high symptom level present at all three examinations was associated with a stronger decrease in mean systolic (-1.59 mm Hg, p = 0.004) and diastolic (-0.78 mm Hg, p = 0.019) blood pressure and with a 20% (p = 0.001) lower risk of developing hypertension (BP ≥140/90 mm Hg) at year 22. The associations were only slightly attenuated in multivariate analyses, with no evidence of a mediating effect of alteration in heart rate.
Conclusions
This study do not support previous hypothesis that emotional stress may be a cause of hypertension. Our findings indicate that symptoms of anxiety and depression are associated with decrease in blood pressure, particularly when a high symptom level can be detected over decades.
doi:10.1186/1471-2458-11-601
PMCID: PMC3162525  PMID: 21797992
2.  The welfare burden of adolescent anxiety and depression: a prospective study of 7500 young Norwegians and their families: the HUNT study 
BMJ Open  2012;2(6):e001942.
Objectives
To examine the association between anxiety and depression symptoms in adolescents and their families and later medical benefit receipt in young adulthood.
Design
Prospective cohort study. Norwegian population study linked to national registers.
Participants
Data from the Nord-Trøndelag Health Study 1995–1997 (HUNT) gave information on anxiety and depression symptoms as self-reported by 7497 school-attending adolescents (Hopkins Symptoms Checklist—SCL-5 score) and their parents (Hospital Anxiety and Depression Scale score). There were 2711 adolescents with one or more siblings in the cohort.
Outcome measures
Adolescents were followed for 10 years in national social security registers, identifying long-term receipt of medical benefits (main outcome) and unemployment benefits for comparison from ages 20–29.
Methods
We used logistic regression to estimate OR of benefit receipt for groups according to adolescent and parental anxiety and depression symptom load (high vs low symptom loads) and for a one point increase in the continuous SCL-5 score (range 1–4). We adjusted for family-level confounders by comparing siblings differentially exposed to anxiety and depression symptoms.
Results
Comparing siblings, a one point increase in the mean SCL-5 score was associated with a 65% increase in the odds of medical benefit receipt from age 20–29 (adjusted OR, 1.65, 95% CI 1.10 to 2.48). Parental anxiety and depression symptom load was an indicator of their adolescent's future risk of medical benefit receipt, and adolescents with both parents reporting high symptom loads seemed to be at a particularly high risk. The anxiety and depression symptom load was only weakly associated with unemployment benefits.
Conclusions
Adolescents in families hampered by anxiety and depression symptoms are at a substantially higher risk of medical welfare dependence in young adulthood. The prevention and treatment of anxiety and depression in adolescence should be family-oriented and aimed at ensuring work-life integration.
doi:10.1136/bmjopen-2012-001942
PMCID: PMC3533058  PMID: 23144262
Public Health; Epidemiology; Anxiety and depression; Adolescents; Social insurance; Family
3.  Depression and anxiety in relation to catechol-O-methyltransferase Val158Met genotype in the general population: The Nord-Trøndelag Health Study (HUNT) 
BMC Psychiatry  2008;8:48.
Background
The catechol-O-methyltransferase (COMT) gene contains a functional polymorphism, Val158Met, which has been linked to anxiety and depression, but previous results are not conclusive. The aim of the present study was to examine the relationship between the Val158Met COMT gene polymorphism and anxiety and depression measured by the Hospital Anxiety and Depression Scale (HADS) in the general adult population.
Methods
In the Nord-Trøndelag Health Study (HUNT) the association between the Val158Met polymorphism and anxiety and depression was evaluated in a random sample of 5531 individuals. Two different cut off scores (≥ 8 and ≥ 11) were used to identify cases with anxiety (HADS-A) and depression (HADS-D), whereas controls had HADS-A <8 and HADS-D <8.
Results
The COMT genotype distribution was similar between controls and individuals in the groups with anxiety and depression using cut-off scores of ≥ 8. When utilizing the alternative cut-off score HADS-D ≥ 11, Met/Met genotype and Met allele were less common among men with depression compared to the controls (genotype: p = 0.017, allele: p = 0.006). In the multivariate analysis, adjusting for age and heart disease, depression (HADS-D ≥ 11) was less likely among men with the Met/Met genotype than among men with the Val/Val genotype (OR = 0.37, 95% CI = 0.18–0.76).
Conclusion
In this population-based study, no clear association between the Val158Met polymorphism and depression and anxiety was revealed. The Met/Met genotype was less likely among men with depression defined as HADS-D ≥ 11, but this may be an incidental finding.
doi:10.1186/1471-244X-8-48
PMCID: PMC2453123  PMID: 18578865
4.  Impact of hearing impairment on spousal mental health: the Nord-Trøndelag Health Study 
Background: Previous studies indicate that hearing loss have negative emotional implications also on spouses of the hearing impaired persons. We sought to assess the relationship between hearing impairment and spousal mental health in the general population. Methods: Pure tone audiometry and questionnaires were administered to the adult population of Nord–Trøndelag County, Norway (1996–97). In the age group between 20 and 44 years, the number of cases with hearing impairment was very low; thus, this age group was excluded from analyses. In total, 8607 couples with women over 44 years and 9530 couples with men over 44 years were identified. Associations between measured and self-reported hearing impairment and spousal self-reported symptoms of anxiety and depression, and subjective well-being were estimated. Stratified by sex and adjusting for several covariates, mental health in spouses of persons with hearing impairment was compared with that of spouses of persons with normal hearing using the general linear model. Results: Audiometrically measured hearing was not significantly associated with spousal mental health. Moderate relations between self-reported hearing and spousal mental health were observed. Conclusion: Contrary to previous results based on self-reported hearing loss, our results based on audiometry did not indicate severe loss of mental health among spouses of persons with impaired hearing.
doi:10.1093/eurpub/ckp176
PMCID: PMC2899895  PMID: 19887520
caregivers; hearing; mental health; well-being
5.  Life style related to blood pressure and body weight in adolescence: Cross sectional data from the Young-HUNT study, Norway 
BMC Public Health  2008;8:111.
Background
The associations between physical activity, unhealthy dietary habits and cigarette smoking and blood pressure, overweight and obesity are well established in adulthood. This is not the case for similar associations in adolescence. Thus, the purpose of this study is to examine how physical activity, smoking status and dietary habits were related to overweight, obesity and blood pressure in a population of Norwegian adolescents.
Methods
Weight, height, systolic (SBP) and diastolic blood pressure (DBP) were measured, and body mass index (BMI) was calculated among 8408 adolescents who participated in a population based study in 1995–97 in the county of Nord-Trøndelag. Internationally accepted cut-off values were used to determine if the adolescents were overweight or obese. The adolescents also completed a detailed questionnaire including dietary habits, physical activity and smoking habits. We calculated adjusted mean blood pressures and odds ratios for being overweight or obese for different exposure categories of life style variables.
Results
Low levels of physically activity were associated with increased odds of being overweight (odds ratio (OR), 1.4; 95% confidence interval (CI), 1.1–1.8 in girls and OR, 2.0; 95% CI, 1.6–2.5 in boys) or obese (girls: OR, 3.1; 95% CI, 1.6–6.0; boys: OR, 3.7; 95% CI, 2.1–6.4). In addition, the least physically active girls had a 1.5 mmHg higher mean DBP compared with the most active (p-trend <0.001), and among boys this difference was 1.0 mmHg (p-trend < 0.001). Smokers were more likely to be obese (OR, 1.6; 95% CI, 1.1–2.5 in girls and 1.4; 95% CI, 0.9–2.1 in boys) compared with non-smokers. Smokers also had lower mean SBP than non-smokers; however, this finding was restricted to smokers with the lowest smoking exposure. Associations between dietary habits and weight status largely disappeared after adjusting for weight losing behaviour.
Conclusion
In this population of adolescents low levels of physical activity were associated with higher mean DBP and higher odds of overweight or obesity. Smoking was also associated with higher odds of overweight and obesity. The paradoxical associations between healthy dietary habits and overweight and obesity are most likely an effect of reverse causality.
doi:10.1186/1471-2458-8-111
PMCID: PMC2375890  PMID: 18400086
6.  Diabetes related risk factors did not explain the increased risk for urinary incontinence among women with diabetes. The Norwegian HUNT/EPINCONT study 
BMC Urology  2009;9:11.
Background
Previous studies have shown an association between diabetes mellitus (DM) and urinary incontinence (UI) in women, especially severe UI. The purpose of this study was to investigate whether diabetes related variables could explain this association.
Methods
The study is part of the EPINCONT study, which is based on the large Nord-Trøndelag Health Study 2 (HUNT 2), performed in the county of Nord-Trøndelag, Norway, during the years 1995 - 1997. Questions on diabetes and UI were answered by a total of 21 057 women aged 20 years and older. Of these 685 were identified as having diabetes, and thus comprise the population of our study. A variety of clinical and biochemical variables were recorded from the participants.
Results
Blood-glucose, HbA1c, albumine:creatinine ratio (ACR), duration of diabetes, diabetes treatment, type of diabetes, cholesterol and triglycerides did not significantly differ in women with and without UI in crude analyses. However, the diabetic women with UI had more hospitalizations during the last 12 months, more homecare, and a higher prevalence of angina and use of oestrogene treatment (both local and oral/patch). After adjusting for age, BMI, parity and smoking, there were statistically significant associations between any UI and angina (OR 1.89; 95% CI: 1.22 - 2.93), homecare (OR 1.72; 95% CI: 1.02 - 2.89), and hospitalization during the last 12 months (OR 1.67; 95% CI: 1.18 - 2.38). In adjusted analyses severe UI was also significantly associated with the same variables, and also with diabetes drug treatment (OR 2.10; 95% CI: 1.07 - 4.10) and stroke (OR 2.47; 95% CI: 1.09 - 5.59).
Conclusion
No single diabetes related risk factor seems to explain the increased risk for UI among women with diabetes. However, we found associations between UI and some clinical correlates of diabetes.
doi:10.1186/1471-2490-9-11
PMCID: PMC2753577  PMID: 19740449
7.  Potentially traumatic interpersonal events, psychological distress and recurrent headache in a population-based cohort of adolescents: the HUNT study 
BMJ Open  2013;3(7):e002997.
Objectives
Recurrent headache co-occurs commonly with psychological distress, such as anxiety or depression. Potentially traumatic interpersonal events (PTIEs) could represent important precursors of psychological distress and recurrent headache in adolescents. Our objective was to assess the hypothesised association between exposure to PTIEs and recurrent migraine and tension-type headache (TTH) in adolescents, and to further examine the potential impact of psychological distress on this relationship.
Design
Population-based, cross-sectional cohort study. The study includes self-reported data from youth on exposure to potentially traumatic events, psychological distress and a validated interview on headache.
Setting
The adolescent part of the Nord-Trøndelag Health Study 2006–2008 (HUNT), conducted in Norway.
Participants
A cohort of 10 464 adolescents were invited to the study. Age ranged from 12 to 20 years. The response rate was 73% (7620), of whom 50% (3832) were girls.
Main outcome measures
Data from the headache interview served as the outcome. Recurrent headache was defined as headache recurring at least monthly during the past year, and was subclassified into monthly, weekly and daily complaints. Subtypes were classified as TTH, migraine, migraine with TTH and/or non-classifiable headache, in accordance with the International Classification of Headache Disorders criteria, second edition.
Results
Multiple logistic regression analysis, adjusted for sociodemographics, showed consistently significant associations between exposure to PTIEs and recurrent headache, regardless of the frequency or subtype of headache. Increasing exposure to PTIEs was associated with higher prevalence of recurrent headache, indicating a dose–response relationship. The strength of associations between exposure to PTIEs and all recurrent headache disorders was significantly attenuated when psychological distress was entered into the regression equation.
Conclusions
The empirical evidence of a strong and cumulative relationship between exposure to PTIEs, psychological distress and recurrent headache indicates a need for the integration of somatic and psychological healthcare services for adolescents in the prevention, assessment and treatment of recurrent headache. Prospective studies are needed.
doi:10.1136/bmjopen-2013-002997
PMCID: PMC3731723  PMID: 23901028
Public Health
8.  Prepregnancy cardiovascular risk factors as predictors of pre-eclampsia: population based cohort study 
BMJ : British Medical Journal  2007;335(7627):978.
Objective To examine the effect of cardiovascular risk factors before pregnancy on risk of pre-eclampsia.
Design Population based prospective study.
Setting Linkage between a Norwegian population based study (Nord-Trøndelag health study, HUNT-2) and Norway's medical birth registry.
Participants 3494 women who gave birth after participating in the Nord-Trøndelag health study at baseline; of whom 133 (3.8%) delivered after a pre-eclamptic pregnancy.
Main outcome measure Odds ratio of developing pre-eclampsia.
Results After adjustment for smoking; previous pre-eclampsia; parity; maternal age, education, and socioeconomic position; and duration between baseline measurements and delivery, positive associations were found between prepregnancy serum levels of triglycerides, cholesterol, low density lipoprotein cholesterol, non-high density lipoprotein cholesterol, and blood pressure and risk of pre-eclampsia. The odds ratio of developing pre-eclampsia for women with baseline systolic blood pressures greater than 130 mm Hg (highest fifth) was 7.3 (95% confidence interval 3.1 to 17.2) compared with women with systolic blood pressures less than 111 mm Hg (lowest fifth). Similar results were found for nulliparous and parous women. Women who used oral contraceptives at baseline had half the risk of pre-eclampsia compared with never or former users (0.5, 0.3 to 0.9).
Conclusion Women with cardiovascular risk factors may be predisposed to pre-eclampsia.
doi:10.1136/bmj.39366.416817.BE
PMCID: PMC2072028  PMID: 17975256
9.  Mental disorder and caregiver burden in spouses: the Nord-Trøndelag health study 
BMC Public Health  2010;10:516.
Background
Researchers generally agree that mental disorder represents a burden to the family. The present study concerns the subjective burden of living with a person with mental disorder, more specifically the association between mental disorder in the index person and subjective well-being and symptoms of anxiety and depression in the spouse.
Methods
Data were obtained from questionnaires administered to the adult population of Nord-Trøndelag County, Norway during the period 1995-1997. The present study is based on a subsample where 9,740 couples were identified. Subjective burden in spouses of persons with mental disorder was compared with subjective burden in spouses of persons without mental disorder, using analysis of variance (ANOVA). All analyses were stratified by sex.
Results
Adjusting for several covariates, spouses of persons with mental disorder scored significantly lower on subjective well-being and significantly higher on symptoms of anxiety and depression compared to spouses of index persons without mental disorder. Although highly significant, the effect sizes were moderate, corresponding to a difference in standard deviations ranging from .34 - .51.
Conclusions
Our study supports the notion that there is an association between mental disorder in one partner and subjective burden in the spouse, but not to the same extent that have been reported in earlier studies, as our results do not indicate that a large proportion of the spouses reach a symptom level of anxiety and depression that reflects clinical mental disorder.
doi:10.1186/1471-2458-10-516
PMCID: PMC2936431  PMID: 20796279
10.  Education-based health inequalities in 18,000 Norwegian couples: the Nord-Trøndelag Health Study (HUNT) 
BMC Public Health  2012;12:998.
Background
Education-based inequalities in health are well established, but they are usually studied from an individual perspective. However, many individuals are part of a couple. We studied education-based health inequalities from the perspective of couples where indicators of health were measured by subjective health, anxiety and depression.
Methods
A sample of 35,980 women and men (17,990 couples) was derived from the Norwegian Nord-Trøndelag Health Study 1995–97 (HUNT 2). Educational data and family identification numbers were obtained from Statistics Norway. The dependent variables were subjective health (four-integer scale), anxiety (21-integer scale) and depression (21-integer scale), which were captured using the Hospital Anxiety and Depression Scale. The dependent variables were rescaled from 0 to 100 where 100 was the worst score. Cross-sectional analyses were performed using two-level linear random effect regression models.
Results
The variance attributable to the couple level was 42% for education, 16% for subjective health, 19% for anxiety and 25% for depression. A one-year increase in education relative to that of one’s partner was associated with an improvement of 0.6 scale points (95% confidence interval = 0.5–0.8) in the subjective health score (within-couple coefficient). A one-year increase in a couple’s average education was associated with an improvement of 1.7 scale points (95% confidence interval = 1.6–1.8) in the subjective health score (between-couple coefficient). There were no education-based differences in the anxiety or depression scores when partners were compared, whereas there were substantial education-based differences between couples in all three outcome measures.
Conclusions
We found considerable clustering of education and health within couples, which highlighted the importance of the family environment. Our results support previous studies that report the mutual effects of spouses on education-based inequalities in health, suggesting that couples develop their socioeconomic position together.
doi:10.1186/1471-2458-12-998
PMCID: PMC3533525  PMID: 23157803
Anxiety; Couples; Depression; Education; Family health; Multilevel analysis; Subjective health
11.  Inflammatory Cytokines as Risk Factors for a First Venous Thrombosis: A Prospective Population-Based Study 
PLoS Medicine  2006;3(8):e334.
Background
In case-control studies, elevated levels of interleukins 6 and 8 have been found to be associated with an increased risk of venous thrombosis (VT). Because of the design of these studies, it remained uncertain whether these alterations were a cause or a result of the VT. In order to distinguish between the two, we set out to measure the levels of six inflammatory markers prior to thrombosis in a population-based cohort using a nested case-cohort design.
Methods and Findings
Between August 1995 and June 1997, blood was collected from 66,140 people in the second Norwegian Health Study of Nord-Trøndelag (HUNT2). We identified venous thrombotic events occurring between entry and 1 January 2002. By this date we had registered 506 cases with a first VT; an age- and sex-stratified random sample of 1,464 controls without previous VT was drawn from the original cohort. Levels of interleukins 1β, 6, 8, 10, 12p70, and tumour necrosis factor-α were measured in the baseline sample that was taken 2 d to 75 mo before the event (median 33 mo). Cut-off points for levels were the 80th, 90th, and 95th percentile in the control group. With odds ratios ranging from 0.9 (95% CI: 0.6–1.5) to 1.1 (95% CI: 0.7–1.8), we did not find evidence for a relationship between VT and an altered inflammatory profile.
Conclusions
The results from this population sample show that an altered inflammatory profile is more likely to be a result rather than a cause of VT, although short-term effects of transiently elevated levels cannot be ruled out.
An altered inflammatory profile appears more likely to be a result than a cause of venous thrombosis.
Editors' Summary
Background.
Blood clots (thromboses) are a common medical problem, especially in people who have been immobilized for a variety of reasons, who have other medical or surgical conditions, or who take certain types of drugs such as oral contraceptives. As well as these factors, various genetic changes make it more likely that certain people will develop a thrombosis. The most well known of these genetic changes is in a clotting factor, Factor V. Instead of the normal clotting factor V, some people have a variant known as Factor V Leiden, which makes them more likely to develop a thrombosis. (It is so named as it was discovered by researchers in Leiden, Netherlands.) Researchers are trying to find out if other abnormalities, particularly in levels of substances involved in inflammation, might make the chance of thrombosis more common. Identifying such changes might make it easier to predict who might be at risk of getting a thrombosis—for example, when a patient has to have an operation—and thus give them appropriate preventative measures.
Why Was This Study Done?
Previous studies have shown that the levels of inflammatory substances, known as cytokines, are raised around the time of a thrombosis. However, because of the design of these studies it was not clear whether these alterations were a cause or a result of the thrombosis. These researchers wanted to measure the levels of six cytokines before thrombosis in a large group of people and follow them to see if any particular level of cytokine made it more likely that they would go on to develop a thrombosis.
What Did the Researchers Do and Find?
During a three-year period between August 1995 and June 1997, blood was collected from 66,140 people in the second Norwegian Health Study of Nord-Trøndelag (HUNT2). Anyone who had a thrombosis between the start of the study and the beginning of 2002 was identified—506 people in all. Blood samples, taken from these people (cases) between two days and 75 months before the thrombosis happened, were used to measure levels of a number of different cytokines (abbreviated to IL-1β, IL-6, IL-8, IL-10, IL12p70, and tumour necrosis factor alpha [TNF-α]). These levels were then compared with those in samples also taken earlier from 1,464 people who were similar to the cases but had no thrombosis (controls). The authors found no evidence for a relationship between the chance of getting a thrombosis and a change in any of these markers of inflammation.
What Do These Findings Mean?
It seems unlikely that any long-term changes in levels of cytokines make any difference as to whether or not people develop a thrombosis. Hence, any changes seen in previous studies are most likely to have been the result of the thrombosis. However, the researchers could not rule out that changes occurred in the hours or days immediately before the thrombosis, although that seems unlikely. In any case, the levels of these cytokines do not seem to be useful as a clinical tool to predict who is at risk of thrombosis.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/101371/journal.pmed.0030334.
MedlinePlus encyclopedia entries on deep venous thrombosis and pulmonary embolus
Omni, a health information service in the UK run by the Resource Discovery Network, has links to pages of information on venous thrombosis
The HUNT studies are described in this Web site
doi:10.1371/journal.pmed.0030334
PMCID: PMC1551920  PMID: 16933968
12.  Physical inactivity is associated with chronic musculoskeletal complaints 11 years later: results from the Nord-Trøndelag Health Study 
Background
Physical inactivity is associated with several diseases, but studies evaluating the association between chronic musculoskeletal complaints (MSCs) and physical exercise have shown conflicting results. The aim of this large-scale prospective population-based study was to investigate the association between self-reported physical exercise at baseline and the prevalence of chronic musculoskeletal complaints (MSCs) 11 years later.
Methods
The results are based upon two consecutive public health studies conducted within the county of Nord-Trøndelag, Norway (The HUNT studies). A total of 39,520 (83%) out of 47,556 adults who participated in HUNT 1 and HUNT 2 responded to questions about physical exercise at baseline in 1984–86, and to questions about musculoskeletal complaints 11 years later (1995–97). Chronic MSCs was defined as MSCs ≥ 3 months during the past year, and chronic widespread MSCs such as pain ≥ 15 days during the last month from the axial region, above the waist, and below the waist. Associations were assessed using multiple logistic regression, estimating prevalence odds ratio (OR) with 95% confidence intervals (CIs). All the final analyses were adjusted for age, gender, body mass index, smoking and education level.
Results
At follow-up 20,223 (51%) reported chronic MSCs, and among these 2,318 (5.9%) reported chronic widespread MSCs. Individuals who exercised at baseline were less likely to report chronic MSCs 11 years later (OR 0.91, 95% CI 0.85–0.97) than inactive persons. Among individuals who exercised more than three times per week, chronic widespread MSCs were 28% less common (OR 0.72, 95% CI 0.59–0.88) compared to inactive individuals.
Conclusion
In this large-scale population-based study, physical exercise was associated with lower prevalence of chronic MSCs, in particular chronic widespread MSCs. Future studies should try to clarify whether chronic MSCs are a cause or a consequence of inactivity.
doi:10.1186/1471-2474-9-159
PMCID: PMC2606680  PMID: 19046448
13.  Age-specific prevalence of the metabolic syndrome defined by the International Diabetes Federation and the National Cholesterol Education Program: the Norwegian HUNT 2 study 
BMC Public Health  2007;7:220.
Background
The 2005 International Diabetes Federation (IDF) definition of the metabolic syndrome was designed to be useful worldwide, but to date few prevalence studies have used that definition in European populations. We estimated the age- and sex-stratified prevalence of IDF-defined metabolic syndrome in a county of Norway and compared it with the prevalence estimated using the revised National Cholesterol Education Program-Adult Treatment Panel-III definition (2005 ATP III).
Methods
Cross-sectional analysis of 10,206 participants aged 20–89 years in the Nord-Trøndelag Health Study 1995–97 (HUNT 2).
Results
Prevalence of IDF-defined metabolic syndrome was 29.6% (95% CI: 28.8 to 30.5), compared to 25.9% (95% CI: 25.0 to 26.7) using the 2005 ATP III criteria. The prevalence of IDF-defined metabolic syndrome increased from 11.0% in the 20–29 years age group to 47.2% in the 80–89 years group in men, and from 9.2% to 64.4% for women in the corresponding age groups. Among men and women aged ≥60 years, the IDF criteria classified 56.7% and 75.0%, respectively, as having central obesity, and 89.3% and 90.9%, respectively, as being hypertensive.
Conclusion
According to both definitions, the prevalence of the metabolic syndrome increased strongly with age. The IDF and the American Heart Association/National Heart, Lung, and Blood Institute guidelines for clinical management of metabolic syndrome would classify a high proportion of elderly Norwegians as in need of overall risk assessment for cardiovascular disease.
doi:10.1186/1471-2458-7-220
PMCID: PMC2048947  PMID: 17727697
14.  Physical activity in adolescents with psychiatric disorders and in the general population 
Background
Adults who suffer from psychiatric disorders report low levels of physical activity and the activity levels differ between disorders. Less is known regarding physical activity across psychiatric disorders in adolescence. We investigate the frequency and type of physical activity in adolescent psychiatric patients, compared with adolescents in the general population.
Methods
A total of 566 adolescent psychiatric patients aged 13–18 years who participated in the CAP survey, Norway, were compared to 8173 adolescents aged 13–19 years who participated in the Nord-Trøndelag Health Study, Young-HUNT 3, Norway. All adolescents completed a questionnaire, including questions about physical activity and participation in team and individual sports.
Results
Approximately 50% of adolescents with psychiatric disorders and 25% of the population sample reported low levels of physical activity. Within the clinical sample, those with mood disorders (62%) and autism spectrum disorders (56%) were the most inactive and those with eating disorders (36%) the most active. This pattern was the same in individual and team sports. After multivariable adjustment, adolescents with a psychiatric disorder had a three-fold increased risk of lower levels of physical activity, and a corresponding risk of not participating in team and individual sports compared with adolescents in the general population.
Conclusions
Levels of physical activity were low in adolescent psychiatric patients compared with the general population, yet activity levels differed considerably between various disorders. The findings underscore the importance of assessing physical activity in adolescents with psychiatric disorders and providing early intervention to promote mental as well as physical health in this early stage of life.
doi:10.1186/1753-2000-8-2
PMCID: PMC3914726  PMID: 24450542
Physical activity; Prevalence; Sports; Psychiatric disorders; Adolescents
15.  Hearing loss and risk of early retirement. The HUNT study 
Background: We explore the possible consequences of measured hearing impairment (HI) and perceived hearing difficulties for early retirement in a large population-based study. Furthermore, we study whether having a part-time position was associated with measured HI and perceived hearing difficulties in the same population. Methods: This study included 25 740 persons from the Nord-Trøndelag Health Study (HUNT) aged 20–54 years at baseline in HUNT1 (1984–1986) who also participated in the follow up, HUNT2, including a hearing examination 11 years later. Logistic regression analysis was conducted for men and women separately and in two age strata. Effects of low-, middle- and high-frequency hearing levels were explored, adjusting for each other. Further adjustment was made for socio-economic class and general health in HUNT1. Results: The risk of early retirement increased with degree of loss of low-frequency hearing in young and middle-aged men and middle-aged women. The middle-aged men and women experiencing hearing disability had an increased risk of early retirement. Degree of hearing level was not associated with part-time work, but in middle-aged men, awareness of having a hearing loss was associated with part-time employment. Conclusions: Degree of low-frequency hearing loss was associated with early retirement but not with part-time work. Perceived hearing disability increased the risk of early retirement in middle-aged men and women and also the risk of part-time work in middle-aged men.
doi:10.1093/eurpub/cks118
PMCID: PMC3719475  PMID: 22930741
16.  Reading and writing difficulties in adolescence and later risk of welfare dependence. A ten year follow-up, the HUNT Study, Norway 
BMC Public Health  2011;11:718.
Background
Welfare dependence and low work participation among young people have raised concern in many European countries. Reading and writing difficulties (RWD) might make young people vulnerable to work integration problems and welfare dependence through negative influences on education and health. Our main objective of this study was to examine if RWD in adolescence affected the risk of welfare dependence in young adulthood.
Methods
Baseline information on self-reported RWD, health and family was obtained for 8950 school-attending adolescents in Nord-Trøndelag County, Norway, participating in the Young-HUNT1 survey, 1995-97. All individuals were linked to biological parents to identify siblings and parental education from national registers. Welfare dependence was assessed by the reception of social benefits (medical and economic) from the national social insurance database (1998-2007). Only long-term benefits (> 180 days) were included.
Results
The adolescents who reported RWD at baseline were more likely to receive medical or social benefits during follow-up compared with those who did not report RWD. In girls with RWD, the adjusted 5-year risk (at age 24 to 28) for receiving medical benefits was 0.20 (95% confidence interval 0.14-0.26), compared with 0.11 (0.09-0.12) in girls without RWD. In boys the corresponding risks were 0.13 (0.09-0.17) and 0.08 (0.07-0.09).
Conclusions
The associations between RWD in adolescence and welfare dependence later in life suggest that increased attention should be paid to these problems when discussing the public health aspects of work integration, since there might be a potential for prevention.
doi:10.1186/1471-2458-11-718
PMCID: PMC3188496  PMID: 21943369
17.  Lactation and cardiovascular risk factors in mothers in a population-based study: the HUNT-study 
Background
Lactation has beneficial short term effects on maternal metabolic health, but the long term effects are less well known.
Methods
We studied the association between lifetime duration of lactation and cardiovascular risk factors in mothers later in life among 21,368 parous women aged 20 to 85 years attending the second Nord-Trøndelag Health Study (HUNT2) in 1995–1997, Norway, a cross-sectional population-based study. General linear modelling was used to calculate mean values of known cardiovascular risk factor levels in five categories of lifetime duration of lactation. Logistic regression was conducted to estimate odds ratios of hypertension, obesity and diabetes.
Results
Among women aged 50 years or younger, lifetime duration of lactation was significantly and inversely associated with body mass index (P-trend, < 0.001), waist circumference (P-trend, < 0.001), systolic and diastolic blood pressure (both P-trends, < 0.001), and serum levels of triglycerides, total cholesterol and low density lipoprotein cholesterol (all P-trends, < 0.001) after adjustment for covariates. Parous women aged 50 years or younger who had never lactated had higher prevalence of hypertension, obesity and diabetes. In this age group, compared to women who had lactated for 24 months or more, parous women who had never lactated had an OR for hypertension of 1.88 (95% CI 1.41, 2.51), an OR for obesity of 3.37 (95% CI 2.51, 4.51) and an OR for diabetes of 5.87 (95% CI 2.25, 15.3). Among women older than 50 years there were no clear associations.
Conclusion
Lifetime duration of lactation was associated with long term reduced cardiovascular risk levels in mothers aged 50 years or younger.
doi:10.1186/1746-4358-7-8
PMCID: PMC3489591  PMID: 22713515
18.  The Combined Effect of Leisure-Time Physical Activity and Diabetes on Cardiovascular Mortality 
Diabetes Care  2013;36(3):690-695.
OBJECTIVE
To examine if leisure-time physical activity could cancel out the adverse effect of diabetes on cardiovascular mortality.
RESEARCH DESIGN AND METHODS
This study prospectively examined the combined effect of clinical diabetes and reported leisure-time physical activity on cardiovascular mortality. Data on 53,587 Norwegian men and women participating in the population-based Nord-Trøndelag Health (HUNT) Study (1995–1997) were linked with the Cause of Death Registry at Statistics Norway.
RESULTS
Overall, 1,716 people died of cardiovascular disease during follow-up through 2008. Compared with the reference group of 3,077 physically inactive people without diabetes, 121 inactive people with diabetes had an adjusted hazard ratio (HR) of 2.81 (95% CI 1.93–4.07). The HR (95% CI) among people who reported ≥3 h of light activity per week was 0.89 (0.48–1.63) if they had diabetes (n = 403) and 0.78 (0.63–0.96) if they did not (n = 17,714). Analyses stratified by total activity level showed a gradually weaker association of diabetes with mortality with increasing activity level (Pinteraction = 0.003).
CONCLUSIONS
The data suggest that even modest physical activity may cancel out the adverse impact of diabetes on cardiovascular mortality.
doi:10.2337/dc11-2472
PMCID: PMC3579362  PMID: 23160724
19.  Individual, family, and area predictors of BMI and BMI change in an adult Norwegian population: Findings from the HUNT study 
Social science & medicine (1982)  2010;70(8):10.1016/j.socscimed.2010.01.007.
The global obesity epidemic is a major public health concern and there is strong evidence that the drivers are varied and operate via diverse pathways. Taking a systems approach allows the contextual influences operating upon the individual to be identified and quantified. We adopt such a perspective in this study, where longitudinal data from a cohort of 24,966 settled individuals participating in two major health surveys, the Nord-Trøndelag Health Study (HUNT 1 and 2) in the county of Nord-Trøndelag, Norway, were used to investigate associations between individual, family and area characteristics and two outcomes: body mass index (BMI) at follow-up and BMI change over an 11 year period. Linear multilevel models were fitted, with individuals nested in 17,500 families, 447 wards and 24 municipalities. A range of putative individual, family, and area predictors were tested. We found both outcomes were strongly associated with individual characteristics, with higher BMIs generally being amongst males, unmarried participants, non-smokers, those of lower education and those undertaking physically demanding work but participating in less physical activity outside work. The characteristics of those in the sample exhibiting higher BMI gain were rather similar except that women gained more and those with no employment income gained less. Contextual influences were also found to be important; although just 1 % of the unexplained variance was located on the neighbourhood and municipality levels respectively, and hence suggesting small environmental influences, between 10-13 % could be attributed to families, highlighting the importance of the familial contextual environment. Rather little is known about the manner by which family influences may operate on bodyweight hence further work is needed to understand likely mechanisms and guide future interventions.
doi:10.1016/j.socscimed.2010.01.007
PMCID: PMC3821002  PMID: 20163904
20.  Familial risk of urinary incontinence in women: population based cross sectional study 
BMJ : British Medical Journal  2004;329(7471):889-891.
Objective To determine whether there is an increased risk of urinary incontinence in daughters and sisters of incontinent women.
Design Population based cross sectional study.
Setting EPINCONT (the epidemiology of incontinence in the county of Nord-Trøndelag study), a substudy of HUNT 2 (the Norwegian Nord-Trøndelag health survey 2), 1995-7.
Participants 6021 mothers, 7629 daughters, 332 granddaughters, and 2104 older sisters of 2426 sisters.
Main outcome measures Adjusted relative risks for urinary incontinence.
Results The daughters of mothers with urinary incontinence had an increased risk for urinary incontinence (1.3, 95% confidence interval 1.2 to 1.4; absolute risk 23.3%), stress incontinence (1.5, 1.3 to 1.8; 14.6%), mixed incontinence (1.6, 1.2 to 2.0; 8.3%), and urge incontinence (1.8, 0.8 to 3.9; 2.6%). If mothers had severe symptoms then their daughters were likely to have such symptoms (1.9, 1.3 to 3.0; 4.0%). The younger sisters of female siblings with urinary incontinence, stress incontinence, or mixed incontinence had increased relative risks of, respectively, 1.6 (1.3 to 1.9; absolute risk 29.6%), 1.8 (1.3 to 2.3; 18.3%), and 1.7 (1.1 to 2.8; 10.8%).
Conclusion Women are more likely to develop urinary incontinence if their mother or older sisters are incontinent.
PMCID: PMC523112  PMID: 15485965
21.  The impact of the Catechol-O-methyltransferase Val158Met polymorphism on survival in the general population – the HUNT study 
BMC Medical Genetics  2007;8:34.
Background
The catechol-O-methyltransferase (COMT) gene contains a functional polymorphism, Val158Met which has been related to common diseases like cancer, psychiatric illness and myocardial infarction. Whether the Val158Met polymorphism is associated with survival has not been evaluated in the general population. The aim of this prospective study was to evaluate the impact of codon 158 COMT gene polymorphism on survival in a population-based cohort.
Methods
The sample comprised 2979 non-diabetic individuals who participated in the Nord-Trøndelag Health Study (HUNT) in the period 1995–97. The subjects were followed up with respect to mortality throughout year 2004.
Results
212 men and 183 women died during the follow up. No association between codon 158 COMT gene polymorphism and survival was found. The unadjusted relative risk of death by non-ischemic heart diseases with Met/Met or Met/Val genotypes was 3.27 (95% confidence interval, 1.19–9.00) compared to Val/Val genotype. When we adjusted for age, gender, smoking, coffee intake and body mass index the relative risk decreased to 2.89 (95% confidence interval, 1.04–8.00).
Conclusion
During 10 year of follow-up, the Val158Met polymorphism had no impact on survival in a general population. Difference in mortality rates from non-ischemic heart diseases may be incidental and should be evaluated in other studies.
doi:10.1186/1471-2350-8-34
PMCID: PMC1906749  PMID: 17577421
22.  Cigarette smoking gives more respiratory symptoms among women than among men The Nord-Trøndelag Health Study (HUNT) 
STUDY OBJECTIVE—Studies have indicated that women are more vulnerable to the effect of tobacco smoking compared with men. The aim of this study was to explore the prevalence of reported respiratory symptoms and diseases according to smoking burden, age and sex.
DESIGN—Questionnaire in a cross sectional population based study.
SETTING—The BONT (Bronchial obstruction in Nord-Trøndelag) study is part of a comprehensive health survey of all inhabitants aged above 19 years in the county of Nord-Trøndelag, Norway, which was carried out from 1995 to 1997.
PARTICIPANTS—A total of 65 717 subjects, 71.3% of the total population aged 20-100, answered the main questionnaire.
MAIN RESULTS—In all, 12.7% men and 12.1% women reported episodes of wheezing or breathlessness during the past 12 months, 8.8% men and 8.4% women reported that they had or had had asthma, 7.5% men and 8.2% women had ever used asthma medication, and 4.0% men and 3.0% women reported chronic bronchitis. Thirty per cent of men and 31% of women were smokers, and average pack years of smoking were 15.9 and 10.3, respectively. Among previous and current smokers, significant more women reported episodes of wheezing or breathlessness, current asthma and persistent coughing compared with men with the same smoke burden (pack years) and daily number of cigarettes.
CONCLUSION—The prevalence of reported asthma and use of asthma medication was higher than reported in previous Scandinavian studies. Respiratory symptoms increased by smoking burden. Comparing the prevalence of symptoms and current asthma among women and men with the same smoke burden or daily cigarette consumption, women seemed to be more susceptible to the effect of tobacco smoking than men.


Keywords: asthma; chronic bronchitis; coughing; tobacco smoking
doi:10.1136/jech.54.12.917
PMCID: PMC1731608  PMID: 11076988
23.  Predictors for Adolescent Visits to Practitioners of Complementary and Alternative Medicine in a Total Population (the Young-HUNT Studies) 
PLoS ONE  2011;6(10):e25719.
Aim
To investigate the factors predicting adolescent visits to practitioners of complementary and alternative medicine (CAM).
Methods
A longitudinal cohort study conducted in an adolescent total population in Central Norway (The Nord-Trøndelag Health Studies (HUNT)). In Young-HUNT 1, all inhabitants aged 13 to 19 years (N = 8944, 89% response rate) were invited to participate, and the youngest group (13 to 15 year olds) was surveyed again 4 years later (Young-HUNT 2, N = 2429, 82% response rate). The participants completed a comprehensive questionnaire on health and life style which included a question regarding visits to a CAM practitioner in the last 12 months.
Results
One in eleven (8.7%, 95%CI 7.6-9.8%) had visited a CAM practitioner, an increase of 26% in 4 years (1.8% points). The final multivariable analysis predicted increased odds of an adolescent becoming a CAM visitor four years later (p<0.05) if she or he had previously visited a CAM practitioner (adjOR 3.4), had musculoskeletal pain (adjOR 1.5), had migraine (adjOR 2.3), used asthma medicines (adjOR 1.8) or suffered from another disease lasting more than three months (adjOR 2.1). Being male predicted reduced odds of visiting a CAM practitioner in the future (adjOR 0.6).
Conclusion
We can conclude from this study that future visits to a CAM practitioner are predicted by both predisposing factors (being female, having visited a CAM practitioner previously) and medical need factors (having had musculoskeletal pain, migraine, used asthma medicines or experienced another disease lasting more than three months). None of the specific variables associated with CAM visits were predictive for CAM visits four years later.
doi:10.1371/journal.pone.0025719
PMCID: PMC3189196  PMID: 22003404
24.  Do parental heights influence pregnancy length?: a population-based prospective study, HUNT 2 
Background
The objective of this study was to examine the association of maternal and paternal height with pregnancy length, and with the risk of pre- and post-term birth. In addition we aimed to study whether cardiovascular risk factors could explain possible associations.
Methods
Parents who participated in the Nord-Trøndelag Health Study (HUNT 2; 1995–1997) were linked to offspring data from the Medical Birth Registry of Norway (1997–2005).
The main analyses included 3497 women who had delivered 5010 children, and 2005 men who had fathered 2798 pregnancies. All births took place after parental participation in HUNT 2. Linear regression was used to estimate crude and adjusted differences in pregnancy length according to parental heights. Logistic regression was used to estimate crude and adjusted associations of parental heights with the risk of pre- and post-term births.
Results
We found a gradual increase in pregnancy length by increasing maternal height, and the association was essentially unchanged after adjustment for maternal cardiovascular risk factors, parental age, offspring sex, parity, and socioeconomic measures. When estimated date of delivery was based on ultrasound, the difference between mothers in the lower height quintile (<163 cm cm) and mothers in the upper height quintile (≥ 173 cm) was 4.3 days, and when estimated date of delivery was based on last menstrual period (LMP), the difference was 2.8 days. Shorter women (< 163 cm) had lower risk of post-term births, and when estimated date of delivery was based on ultrasound they also had higher risk of pre-term births. Paternal height was not associated with pregnancy length, or with the risks of pre- and post-term births.
Conclusions
Women with shorter stature had shorter pregnancy length and lower risk of post-term births than taller women, and when EDD was based on ultrasound, they also had higher risk of preterm births. The effect of maternal height was generally stronger when pregnancy length was based on second trimester ultrasound compared to last menstrual period. The association of maternal height with pregnancy length could not be explained by cardiovascular risk factors. Paternal height was neither associated with pregnancy length nor with the risk of pre- and post-term birth.
doi:10.1186/1471-2393-13-33
PMCID: PMC3608172  PMID: 23383756
Cardiovascular risk factors; Maternal height; Paternal height; Pregnancy length; Pre-term birth
25.  The relationship between health promoting resources and work participation in a sample reporting musculoskeletal pain from the Nord-Trøndelag Health Study, HUNT 3, Norway 
Background
Musculoskeletal pain (MSP) is one of the most frequent causes of sick leave from work, and is a common and potentially disabling condition. This study is based on the salutogenic perspective and investigates the relationship between personal, social, and functional health resources and work participation in a population reporting MSP.
Method
Analysis was performed on cross sectional data from the Nord-Trøndelag Health Study, HUNT 3, in Norway. The sample of n= 6702 was extracted from HUNT 3, including a total of N= 50807 participants. Self-reported health (SRH) and, personal, social, and functional resources were assessed by a questionnaire. Reported sick leave was collected by interview at the point of time when the data were collected, from October 2006 until June 2008.
Results
Logistic regression analysis demonstrated statistically significant differences between the work group and sick leave group in self-rated health, work support, work control, work load, and feeling strong, and the model predicted 68% of the cases correctly. Females had a lower statistically significant probability (B= −.53) to be in the work group then men when suffering from MSP, with odds of 41%.
Conclusion
There was a statistically significant relationship between health promoting resources such as SRH, feeling strong, absence of neuroticism, work load, work control, and work participation in MSP population.
doi:10.1186/1471-2474-14-100
PMCID: PMC3606465  PMID: 23509959
Musculoskeletal pain (MSP); Health promotion; Resources; Salutogenic; Work- participation

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