Grete Helen Bratberg

Cohort Profile: The HUNT Study, Norway

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.

Gender differences in subjective well-being, self-esteem and psychosocial functioning in adolescents with symptoms of anxiety and depression: findings from the Nord-Trøndelag Health Study

Gender differences in the prevalence of symptoms of anxiety and depression during adolescence are well documented. However, little attention has been given to differences in subjective well-being, self-esteem and psychosocial functioning between boys and girls with symptoms of anxiety and depression. The aim of this study was to investigate gender differences in the associations between such symptoms and subjective well-being, self-esteem, school functioning and social relations in adolescents. Data were taken from a major population-based Norwegian study, the Nord-Trøndelag Health study (HUNT), in which 8984 (91% of all invited) adolescents, aged 13-19 years, completed an extensive self-report questionnaire. Although prevalence rates of symptoms of anxiety and depression were higher in girls than in boys, a significant interaction between gender and symptoms of anxiety and depression was found in respect of each of the following outcome variables: subjective well-being, self-esteem, academic problems, frequency of meeting friends and the feeling of not having enough friends. These interactions indicate that the associations between symptoms of anxiety and depression and lower subjective well-being and self-esteem, more academic problems in school and lower social functioning were stronger for boys than for girls. Our findings may contribute to an earlier assessment and more efficient treatment of male adolescent anxiety and depression.

Early sexual maturation, central adiposity and subsequent overweight in late adolescence. A four-year follow-up of 1605 adolescent Norwegian boys and girls: the Young HUNT study

BackgroundEarly sexual maturation has been associated with overweight that may persist after the completion of biological growth and development. We have prospectively examined the influence of early sexual maturation on subsequent overweight in late adolescence and assessed if this association was modified by central adiposity in early adolescence.Methods1605 Norwegian adolescents were followed from early (baseline, mean age 14.2 years) to late adolescence (follow-up, mean age 18.2 years). Maturational timing was assessed by self-reports of pubertal status (PDS) in boys and age at menarche (AAM) in girls. Central adiposity was classified according to waist circumference (waist) measured at baseline, using age and gender specific medians as cut off. Overweight was classified according to International Obesity Task Force (IOTF) standards.ResultsAt follow-up, early sexual maturation in girls, but not in boys, was associated with overweight. This association, however, was restricted to girls with high waist circumference (> median) at baseline (OR, 2.7, 95% CI 1.5–4.9). Thus, age at menarche was not associated with overweight in girls with low waist (≤ median) at baseline. Central adiposity was, independent of maturational timing, associated with higher BMI at follow-up in both genders, but differences were more pronounced among early matured girls (3.5 kg/m2), than among intermediate (2.7 kg/m2) and late matured girls (1.2 kg/m2).ConclusionIn girls, the combination of central adiposity and early age at menarche appears to increase the risk of being overweight in late adolescence.

Cohort profile of the Young-HUNT Study, Norway: A population-based study of adolescents

The Young-HUNT Study is the adolescent part (13-19 years) of HUNT, the Nord-Trøndelag Health Study, Norway. Three cross-sectional surveys have been conducted: Young-HUNT1 (1995-97), Young-HUNT2 (2000-01) and Young-HUNT3 (2006-08). Major public health issues, including somatic and mental health, quality of life and health behaviours are covered. Young-HUNT was performed in schools visited by trained nurses. Data collection included self-reported questionnaires, structured interviews, clinical measurements and, in Young-HUNT3, buccal smears. The total response rates varied from 90% to 83% and the Young-HUNT database includes 17 820 teenagers. Some Young-HUNT1 participants constitute the baseline for two follow-up studies: a 4-year follow-up through adolescence to Young-HUNT2 and an 11-year follow-up into young adulthood to the adult HUNT3. Longitudinal data are also obtained by linkage of data from Young-HUNT to different national health registers. Linkage to family registers allows the possibility of studying genetic and environmental interactions through generations. Presently 20 PhD students are working with the data, 11 Young-HUNT based PhD theses have been completed and more than 50 scientific papers published.

Being Normal Weight but Feeling Overweight in Adolescence May Affect Weight Development into Young Adulthood—An 11-Year Followup: The HUNT Study, Norway

Objectives. To explore if self-perceived overweight in normal weight adolescents influence their weight development into young adulthood and if so, whether physical activity moderates this association. Methods. A longitudinal study of 1196 normal weight adolescents (13–19 yrs) who were followed up as young adults (24–30 yrs) in the HUNT study. Lifestyle and health issues were assessed employing questionnaires, and standardized anthropometric measurements were taken. Chi square calculations and regression analyses were performed to investigate the associations between self-perceived overweight and change in BMI or waist circumference (WC) adjusted for age, age squared, sex, and other relevant cofactors. Results. Adolescents, defined as being normal weight, but who perceived themselves as overweight had a larger weight gain into young adulthood than adolescents who perceived themselves as normal weight (difference in BMI: 0.66 units [CI95%: 0.1, 1.2] and in WC: 3.46 cm [CI95%: 1.8, 5.1]). Level of physical activity was not found to moderate this association. Conclusions. This study reveals that self-perceived overweight during adolescence may affect development of weight from adolescence into young adulthood. This highlights the importance of also focusing on body image in public health interventions against obesity, favouring a “healthy” body weight taking into account natural differences in body shapes.

Perceived pubertal timing, pubertal status and the prevalence of alcohol drinking and cigarette smoking in early and late adolescence: a population based study of 8950 Norwegian boys and girls

Aim: To study whether perceived pubertal timing is related to the prevalence of alcohol drinking and cigarette smoking among adolescent boys and girls.

Sexual maturation in early adolescence and alcohol drinking and cigarette smoking in late adolescence: a prospective study of 2,129 Norwegian girls and boys

Early sexual maturation has been associated with higher involvement in risk behaviour during early and mid-adolescence. In a prospective study of 2,129 girls and boys, we investigated whether the timing of sexual maturation was associated with cigarette smoking and alcohol drinking in late adolescence and whether this relation differed between boys and girls. Nine hundred and eighty boys and 1,149 girls, who participated in a cross-sectional study in middle school, were included in a follow-up study in high school 4 years later. Self-rating of pubertal status, as registered at baseline in middle school, was used to indicate the timing of sexual maturation. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CIs), estimated by logistic regression, were used to assess the association between sexual maturation and alcohol drinking and daily smoking at follow-up. We found that girls who had matured early (OR 1.7, CI 1.2–2.4) or late (OR, 1.5, CI, 1.1–2.2) were both more likely to report more advanced drinking in late adolescence than were girls who were on time. Boys who had matured late were less likely (OR 0.5, CI 0.3–0.8) than boys who were on time to engage in advanced drinking. In general, daily smoking was more common among girls than boys, and more common among girls who had matured early (OR 1.5, CI 1.1–2.2) than among girls who were on time. Adjustment for social factors, e.g. parental education and marital status and parental drinking and smoking habits, did not substantially influence these results. We concluded that, for girls, but not for boys, early sexual maturation was associated with more advanced drinking and higher frequency of smoking in late adolescence. In boys, late sexual maturation was associated with reduced risk of advanced drinking.

Factors Predicting Changes in Physical Activity Through Adolescence: The Young-HUNT Study, Norway

PURPOSE The purpose of this prospective population-based study was to analyze predictors of changes in physical activity (PA) levels from early to late adolescence. METHODS Data presented are from 2,348 adolescents and their parents who participated in the Nord-Trøndelag Health study (HUNT 2, 1995-1997) and at follow-up in Young-HUNT 2, 2000-2001 Participants completed a self-reported questionnaire and participated in a clinical examination that included measurements of height and weight. RESULTS Four patterns of PA emerged in the study: active or inactive at both time points (active maintainers, 13%; inactive maintainers, 59%), inactive and became active (adopters, 12%), active and became inactive (relapsers, 16%). Being overweight, dissatisfied with life, and not actively participating in sports at baseline were significant predictors of change regarding PA among boys at follow-up. For girls, smoking, drinking, low maternal education, and physical inactivity predicted relapsers and inactive maintainers. Higher levels of education and more physically active parents at baseline seemed to protect against decreased PA during follow-up for both genders. CONCLUSION Predictors of change in, or maintaining PA status during adolescence differed by gender. These results suggest that PA-promoting interventions should be tailored by gender and focus on encouraging activity for inactive adolescents and maintenance of PA in those already active.

Parental alcohol misuse and hazardous drinking among offspring in a general teenage population: gender-specific findings from the Young-HUNT 3 study

BackgroundParental alcohol misuse may negatively affect drinking behaviours among offspring, but it is unclear to what extent influences are gender-specific and dependent upon the actual drinking behaviour measured. The aim of this study was to investigate whether hazardous drinking among Norwegian teenage boys (N = 2538) and girls (N = 2494) was associated with paternal and maternal alcohol misuse (CAGE).MethodsDefinitions of hazardous drinking among offspring were based on self-reported alcohol consumption (in litres a year), frequency of drinking, and frequency of drunkenness. Based on this information, two composite measures of hazardous drinking were also constructed. Cross-sectional data from the Norwegian Young-HUNT 3 survey (2006–2008) were linked to information from biological parents who participated in the adult part of the HUNT study.ResultsLogistic regression analyses showed that both boys and girls with alcohol misusing fathers were more likely to report high levels of alcohol intake compared to others of the same age and gender. This was contrary to boys with misusing mothers, who reported less alcohol consumption than other boys. Among girls, but not boys, high frequency of drunkenness was associated with maternal as well as paternal misuse.ConclusionsThis study suggests that adolescent hazardous drinking is more prevalent among boys and girls with alcohol misusing parents versus those whose parents do not misuse alcohol. However, findings were gender specific and varied depending on the drinking outcomes under investigation. More evidence-based knowledge in this field is of great importance for better understanding the possible role paternal and maternal alcohol misuse may play in the development of hazardous alcohol drinking patterns among adolescent boys and girls.

Age for onset of walking and prewalking strategies

BACKGROUND Age for onset of independent walking (AOW) is frequently used as an indicator of the progress of motor development in early life. Yet there is considerable uncertainty in the research literature about the age we should expect children to walk independently, and also whether prewalking strategies are of importance for this milestone. In clinical practice we commonly experience that children start walking at later ages than the standards presented in the Alberta Infant Motor Scale (AIMS), the most frequently used standardized instrument of gross motor development in Norway. AIMS To investigate the normal distribution of AOW among Norwegian children, which prewalking locomotor strategies (PLS) children used before AOW, and if children who crawled on hands and knees started to walk earlier than children with other strategies. DESIGN AND METHODS This cross-sectional study was based on parental self reports from two data sources, i.e. the Norwegian Mother and Child Cohort Study (MoBa, n = 47,515), and project specific regionally collected data (n = 636). RESULTS Half of the Norwegian children had started to walk at 13 months (median). Twenty-five percent walked at 12 months and 75% of the children walked at 14 months. Mean AOW, claiming at least 5 independent steps, was 13.1 (1.91)months. Children who used crawling on hands and knees (84.5%) as PLS started to walk unaided 0.9 months earlier (95% CI = 0.32-1.49, p < 0.05) than bottom shufflers (7.1%). CONCLUSION Norwegian children start to walk considerably later than standards reported in AIMS. Crawling on hands and knees is associated with an earlier onset of walking.