P.E. Wändell

The association between BMI value and long-term mortality

Objectives:To study total mortality in different categories of BMI values, with adjustments for important covariates in a population-based 26-year mortality follow-up. Special interest will be given to gender differences and low BMI values.Methods:From a stratified sample in 1969 of 32 185 individuals aged 18–64 years from Stockholm County, 2422 underwent a health examination, with complete data obtained for 1020 subjects. BMI was classified as underweight (<20), normal (20–24.9), overweight (25–29.9) or obesity (⩾30). Participants were followed up in the National Cause of Death Register until the end of 1996. Multivariate analysis was performed by Cox regression for men and women separately, with different models, with step-wise adjustment for age, care need category, heart rate, hypertension, blood glucose, alcohol intake and smoking, with hazard ratios (HR) and 95% confidence interval (CI) and with normal weight as reference.Results:Among men, the age-adjusted HR was 1.68 (95% CI 1.10–2.57) for underweight and 1.62 (95% CI 1.08–2.43) for obesity, and among women it was 0.93 (95% CI 0.58–1.51) for underweight and 1.88 (95% CI 1.26–2.82) for obesity. In men, the significantly increased mortality remained when also adjusting for care need category, but not when adjusting for other factors, whereas the opposite was found regarding obesity. For women, underweight was significantly associated with decreased mortality when adjusting for smoking and for all factors together, whereas obesity was associated with increased mortality when adjusting for the different factors except for all factors together.Conclusions:Underweight was associated with higher mortality among men, but not when adjusting for covariates, whereas underweight was associated with lower mortality among women when adjusting for smoking.

Estimation of diabetes prevalence among immigrants from the Middle East in Sweden by using three different data sources.

AIMS To estimate diabetes prevalence in immigrants from the Middle East in Sweden compared with Swedish-born subjects. This group accounts for around 15% of Swedens non-European immigrants. METHODS Three samples were used: self-reported diabetes in a random sample (SALLS sample) of subjects aged 35-64 years in Sweden (n=22,032); known diabetes among patients aged 35-64 years in primary care (PC) at four primary healthcare centers in Stockholm County (n=30,679); and known and newly diagnosed diabetes in a random population sample of subjects aged 60 years in Stockholm County (n=4106). RESULTS The odds ratio (OR) for subjects from the Middle East was: 1.69 (95% confidence interval [CI] 0.96-2.99) in the SALLS sample; 4.43 (95% CI 3.38-5.56) in the PC sample; and 3.96 (95% CI 1.98-7.92) in the age-60 sample, compared with native Swedes. Subjects from European and other Organization for Economic Cooperation and Development (OECD) countries showed an excess risk only in the SALLS sample (1.43, 95% CI 1.11-1.83). CONCLUSIONS Immigrants from the Middle East showed a four-fold higher risk of diabetes compared with Swedish-born subjects in two of the three data sources. More studies are needed to confirm these results, but the findings call for targeted preventative strategies in this population group.

Increased heart rate variability but no effect on blood pressure from 8 weeks of hatha yoga - a pilot study

BackgroundYoga exercises are known to decrease stress and restore autonomic balance. Yet knowledge about the physiological effects of inversion postures is limited. This study aimed to investigate the effects of inversion postures (head below the heart) on blood pressure (BP) and heart rate variability (HRV).MethodsTwelve healthy women and men took part in an 8-week yoga program (60 min once a week). BP was measured with an automatic Omron mx3 oscillometric monitoring device and HRV with a Holter 24-hour ECG at baseline and 8 weeks after the intervention.ResultsThere was no significant effect of inversion postures on BP. Nine out of 12 participants showed a significant increase in HRV (p < 0.05) at night (2 hours) on pNN50% (12.7 ± 12.5 to 18.2 ± 13.3). There were no significant changes in other HRV measures such as NN50, LF, HF, LF/HF ratio, LF normalized units (n.u.), HF n.u. and RMSSD.ConclusionEight weeks of hatha yoga improved HRV significantly which suggests an increased vagal tone and reduced sympathetic activity.

Psychosocial problems in patients with newly diagnosed diabetes: Number and characteristics

Early in the course of diabetes, it is important to identify and support patients whose psychosocial situations and reactions to the diagnosis may affect their ability to adjust or take adequate responsibility for self-care. We aimed to identify (a) the number and characteristics of patients, 18-65 years, newly diagnosed with diabetes, who needed psychosocial interventions and (b) the type of psychosocial problems they had. A total of 106 patients (72 men) were included in the study. Interviews showed that 41.5% had psychosocial problems. Fifteen dropped out early in the study; 38% of those remaining had psychosocial problems (PSP). More than half had problems with their life situation; most commonly in relationships. About a third had problems related to diabetes, most commonly, work-related. Compared to other participants, PSP patients lived in more strained social situations, especially regarding personal finances and social support. More of the PSP patients were anxious and depressed. They used negative coping strategies more often and more frequently expected that diabetes would negatively affect their future. In conclusion, early in the course of diabetes, screening instruments should be used to identify PSP patients. Treatment by medical social workers skilled in diabetes care should be offered.

Diabetes and impaired glucose tolerance among Turkish immigrants in Sweden

AIM To investigate whether the prevalence of diabetes and impaired glucose tolerance (IGT) was higher among Turkish immigrants in Sweden, than in their area of origin in Turkey. METHODS 238 Turkish immigrants aged 20 years and older living in Flemingsberg, Sweden, were compared with 1549 participants of the same age living in the Konya area of Turkey. Data collection included anthropometric measurements, blood pressure (BP) measurements, and an oral glucose tolerance test (OGTT). RESULTS Prevalence of laboratory-verified diabetes was 11.8% among participants in Sweden compared to 7.1% among participants in Turkey (p 0.018). Turkish women in Sweden had a higher prevalence of diabetes than Turkish women in Turkey, 12.8% vs. 7.6% (p=0.037). Similarly, IGT was 17.8% among Turkish men in Sweden compared to 4.9% among men in Turkey (p<0.001) and 2-h blood glucose was higher among the immigrants (p<0.001). Systolic BP was also higher among the immigrants, especially in men (p<0.001) who also had a higher BMI (p=0.003). CONCLUSIONS The higher prevalence of diabetes and IGT among Turkish immigrants in Flemingsberg, Sweden, suggests that migration is associated with diabetes and that there are important implications for public health in Sweden.

Poor self-rated health is not associated with a high total allostatic load in type 2 diabetic patients--but high blood pressure is

OBJECTIVE Allostatic load has been linked to self-rated health (SRH), cardiovascular disease and mortality in non-diabetic individuals. The aim of this study was to construct an allostatic load score and to find any correlations with SRH. METHODS The subjects included in the study came from a randomized, controlled trial of type 2 diabetes. Blood samples were drawn, urine was collected for 24h, and questionnaires, including SRH, were filled out on three occasions: at baseline; after the 10-week intervention; and at a follow-up 3 months after the intervention. Allostatic load was estimated using a wide range of variables, including systolic and diastolic blood pressure, pulse pressure, cortisol, catecholamines, HbA(1c), insulin, plasma glucose and waist circumference. RESULTS There was no association between SRH and allostatic load. However, three other components were significantly correlated with allostatic load at the baseline investigation and the two follow-up investigations - namely, systolic blood pressure, diastolic blood pressure and HbA(1c). CONCLUSION The absence of an association between allostatic load and SRH in diabetic individuals contrasts with previous findings in non-diabetic women, and shows that it is hazardous to apply findings in one population to another, especially diabetic and non-diabetic populations.

Mental disorder and long-term risk of mortality: 41 years of follow-up of a population sample in Stockholm, Sweden

BACKGROUND An increased mortality risk associated with mental disorder has been reported for patients, but there are few studies are based on random samples with interview-based psychiatric diagnoses. Part of the increased mortality for those with mental disorder may be attributable to worse somatic health or hazardous health behaviour - consequences of the disorder - but somatic health information is commonly lacking in psychiatric samples. This study aims to examine long-term mortality risk for psychiatric diagnoses in a general population sample and to assess mediation by somatic ill health and hazardous health behaviour. METHOD We used a double-phase stratified random sample of individuals aged 18-65 in Stockholm County 1970-1971 linked to vital records. First phase sample was 32 186 individuals screened with postal questionnaire and second phase was 1896 individuals (920 men and 976 women) that participated in a full-day examination (participation rate 88%). Baseline examination included both a semi-structured interview with a psychiatrist, with mental disorders set according to the 8th version of the International Classification of Disease (ICD-8), and clinical somatic examination, including measures of body composition (BMI), hypertension, fasting blood glucose, pulmonary function and self-reported tobacco smoking. Information on vital status was obtained from the Total Population Register for the years 1970-2011. Associations with mortality were studied with Cox proportional hazard analyses. RESULTS A total of 883 deaths occurred among the participants during the 41-year follow-up. Increased mortality rates were found for ICD-8 functional psychoses (hazard ratio, HR = 2.22, 95% confidence interval (95% CI): 1.15-4.30); psycho-organic symptoms (HR = 1.94, 95% CI: 1.31-2.87); depressive neuroses (HR = 1.71, 95% CI: 1.23-2.39); alcohol use disorder (HR = 1.91, 95% CI: 1.40-2.61); drug dependence (HR = 3.71, 95% CI: 1.80-7.65) and psychopathy (HR = 2.88, 95% CI: 1.02-8.16). Non-participants (n = 349) had mortality rates similar to participants (HR = 0.98, 95% CI: 0.81-1.18). In subgroup analyses of those with psychoses, depression or alcohol use disorder, adjusting for the potential mediators smoking and pulmonary function, showed only slight changes in the HRs. CONCLUSIONS This study confirms the increased risk of mortality for several psychiatric diagnoses in follow-up studies on American, Finnish and Swedish population-based samples. Only a small part of the increased mortality hazard was attributable to differences in somatic health or hazardous health behaviour measured at baseline.

Effects of tactile massage on metabolic biomarkers in patients with type 2 diabetes

AIM Tactile massage (TM) is a gentle and superficial form of massage. A pilot study of patients with type 2 diabetes in primary care reported a reduction of 0.8% in glycosylated haemoglobin (HbA1c), whereas a randomized study comparing the effects of 10 weeks of TM once per week with relaxation exercises performed once per week as per instructions on a CD found no effects of TM on HbA(1c) in an intention-to-treat analysis. However, a significant reduction in waist circumference (WC) was found between the groups. METHODS This was a secondary per-protocol analysis of the effect of TM (n=21) compared with relaxation (n=25) on other metabolic biomarkers. Anthropometrics (BMI and WC) and metabolic factors (B HbA(1c), S IGF, fS insulin, S adiponectin, S leptin and fP ghrelin) were assessed, insulin resistance (IR) was determined by modified homoeostasis model assessment (HOMA2-IR) using fP glucose and fS insulin, and ratios of adiponectin-to-leptin, adiponectin-to-HOMA-IR, adiponectin-to-WC and adiponectin-to-HbA1c were calculated at baseline, and at 10 weeks and 6 months after the intervention. RESULTS Significant results adjusted for age, gender and changes in lifestyle and medical factors were shown for WC in women (-6.2 cm [95% CI: -10.4, -1.9]), but not in men. In addition, improvements in the TM group were found for adiponectin and ratios of adiponectin-to-leptin and adiponectin-to-HbA1c levels. CONCLUSION Our data indicate that TM therapy may affect metabolic markers in type 2 diabetes despite the lack of significant effects on HbA(1c). The clinical implications of our findings need to be evaluated in further studies.

Selective prevention of cardiometabolic diseases: activities and attitudes of general practitioners across Europe.

Abstract Background Cardiometabolic diseases (CMDs) are the number one cause of death. Selective prevention of CMDs by general practitioners (GPs) could help reduce the burden of CMDs. This measure would entail the identification of individuals at high risk of CMDs—but currently asymptomatic—followed by interventions to reduce their risk. No data were available on the attitude and the extent to which European GPs have incorporated selective CMD prevention into daily practice. Methods A survey among 575 GPs from the Czech Republic, Denmark, Greece, the Netherlands and Sweden was conducted between September 2016 and January 2017, within the framework of the SPIMEU-project. Results On average, 71% of GPs invited their patients to attend for CMD risk assessment. Some used an active approach (47%) while others used an opportunistic approach (53%), but these values differed between countries. Most GPs considered selective CMD prevention as useful (82%) and saw it as part of their normal duties (84%). GPs who did find selective prevention useful were more likely to actively invite individuals compared with their counterparts who did not find prevention useful. Most GPs had a disease management programme for individuals with risk factor(s) for cardiovascular disease (71%) or diabetes (86%). Conclusions Although most GPs considered selective CMD prevention as useful, it was not universally implemented. The biggest challenge was the process of inviting individuals for risk assessment. It is important to tailor the implementation of selective CMD prevention in primary care to the national context, involving stakeholders at different levels.

High levels of leptin are associated with poor self-rated health in men and women with type 2 diabetes treated with metformin

High levels of leptin are associated with poor self-rated health in men and women with type 2 diabetes treated with metformin.