Population-based screening for celiac disease reveals that the majority of patients are undiagnosed and improve on a gluten-free diet

The impact of a gluten-free diet (GFD) on screen-detected celiac disease (CD) is currently ambiguous. We aimed to identify the population-based prevalence of undiagnosed adult CD and examine the impact of a GFD on screen-detected CD. In total, 12,981 adults participated in a population-based health study in Tromsø, Norway. Participants with increased levels of anti-tissue transglutaminase-2 IgA or anti-deamidated gliadin peptide IgG were invited to undergo gastroduodenoscopy with both histological and immunohistochemical examination of small-bowel biopsies. The prevalence of previously diagnosed CD was 0.37%. Additionally, the prevalence of previously undiagnosed CD was 1.10%. Thus, 1.47% of the population had CD, of whom 75% were previously undiagnosed. A GFD resulted in signifcant improvements in overall gastrointestinal symptoms, diarrhea, and healthrelated quality of life, with reduced abdominal discomfort (76%) and improved levels of energy (58%). The large majority of patients with adult CD were undiagnosed and benefted from a GFD with reduced gastrointestinal symptoms and improved health-related quality of life. In clinical practice, there should be a low threshold for CD testing even in the absence of abdominal complaints because most adult patients appear to consider their symptoms a part of their normal state and therefore remain untested and undiagnosed

Body mass index and mortality in elderly men and women: the Tromsø and HUNT studies

The impact of body mass index (BMI; kg/m2) and waist circumference (WC) on mortality in elderly individuals is controversial and previous research has largely focused on obesity. With special attention to the lower BMI categories, associations between BMI and both total and cause-specific mortality were explored in 7604 men and 9107 women aged ≥65 years who participated in the Tromsø Study (1994–1995) or the North-Trøndelag Health Study (1995–1997). A Cox proportional hazards model adjusted for age, marital status, education and smoking was used to estimate HRs for mortality in different BMI categories using the BMI range of 25–27.5 as a reference. The impact of each 2.5 kg/m2 difference in BMI on mortality in individuals with BMI<25.0 and BMI≥25.0 was also explored. Furthermore, the relations between WC and mortality were assessed. We identified 7474 deaths during a mean follow-up of 9.3 years. The lowest mortality was found in the BMI range 25–29.9 and 25–32.4 in men and women, respectively. Mortality was increased in all BMI categories below 25 and was moderately increased in obese individuals. U-shaped relationships were also found between WC and total mortality. About 40% of the excess mortality in the lower BMI range in men was explained by mortality from respiratory diseases. BMI below 25 in elderly men and women was associated with increased mortality. A modest increase in mortality was found with increasing BMI among obese men and women. Overweight individuals (BMI 25–29.9) had the lowest mortality

Risk of malnutrition and health-related quality of life in community-living elderly men and women: The Tromsø study

Purpose To explore the association between risk of malnutrition as well as current body mass index (BMI) and health-related quality of life (HRQoL) in elderly men and women from the general population. Methods In a cross-sectional population survey including 1,632 men and 1,654 women aged 65 to 87 years from the municipality of Tromsø, Norway, we assessed HRQoL by using the EuroQol (EQ-5D) instrument in three risk groups of malnutrition and in different categories of BMI. The Malnutrition Universal Screening Tool (‘MUST’) was used to evaluate the risk of malnutrition. Results We found a significant reduction in HRQoL with an increasing risk of malnutrition, and this was more pronounced in men than in women. The relationship between BMI and HRQoL was dome shaped, with the highest score values in the BMI category being 25–27.5 kg/m2. Conclusions HRQoL was significantly reduced in elderly men and women at risk of malnutrition. The highest HRQoL was seen in moderately overweight individuals

Risk of malnutrition is associated with mental health symptoms in community living elderly men and women: The Tromsø Study

<p>Abstract</p> <p>Background</p> <p>Little research has been done on the relationship between malnutrition and mental health in community living elderly individuals. In the present study, we aimed to assess the associations between mental health (particularly anxiety and depression) and both the risk of malnutrition and body mass index (BMI, kg/m²) in a large sample of elderly men and women from Tromsø, Norway.</p> <p>Methods</p> <p>In a cross-sectional survey, with 1558 men and 1553 women aged 65 to 87 years, the risk of malnutrition was assessed by the Malnutrition Universal Screening Tool ('MUST'), and mental health was measured by the Symptoms Check List 10 (SCL-10). BMI was categorised into six groups (< 20.0, 20.0-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.9, ≥ 30.0 kg/m²).</p> <p>Results</p> <p>The risk of malnutrition (combining medium and high risk) was found in 5.6% of the men and 8.6% of the women. Significant mental health symptoms were reported by 3.9% of the men and 9.1% of the women. In a model adjusted for age, marital status, smoking and education, significant mental health symptoms (SCL-10 score ≥ 1.85) were positively associated with the risk of malnutrition (odds ratio 3.9 [95% CI 1.7-8.6] in men and 2.5 [95%CI 1.3-4.9] in women), the association was positive also for subthreshold mental health symptoms. For individuals with BMI < 20.0 the adjusted odds ratio for significant mental health symptoms was 2.0 [95% CI 1.0-4.0].</p> <p>Conclusions</p> <p>Impaired mental health was strongly associated with the risk of malnutrition in community living elderly men and women and this association was also significant for subthreshold mental health symptoms.</p

Digital Communication an Actor in Leadership. Limitations and opportunities related to the use of digital communication by e.mail in hospital leadership

Masteroppgave i helseledelse (EMBA) - Nord universitet 2018Sperret til 2023-01-0

Body mass index and risk of malnutrition in community-living elderly men and women: relationships with morbidity, mortality and health- related quality of life. The Tromsø and HUNT studies

The elderly population is rapidly growing, and elderly individuals are more vulnerable to nutritional problems than other adults. A number of studies have found evidence for adverse health outcomes in elderly patients at risk of malnutrition. However, much of the previous research has been performed in hospital populations or in groups of elderly patients with specific diagnoses. More population-based studies in this area are therefore needed. Increased understanding of nutrition in elderly individuals can contribute to the identification of individuals at risk of malnutrition at an earlier stage. Based on data from three large health surveys, we aimed to study the relationship between nutritional status and important health outcomes in community-living elderly individuals. We first explored the associations between disease burden, social and life style variables in a crosssectional design based on data from the Tromsø 4 survey (1994-1995) (paper I). We found that fractures (hip), mental distress, reduced muscle strength and current smoking were more prevalent in underweight individuals. Chronic lung disease and reduced physical activity had a U-shaped relation with body mass index (BMI). Diabetes and ischemic heart disease were more prevalent in obese individuals. In the Tromsø 6 survey (2007-08), we included the Malnutrition Universal Screening Tool (MUST). We found that approximately 8% of this community-living population was at medium or high risk of malnutrition and that 20% was obese (BMI >30 kg/m2). We used a cross-sectional design to explore the association between mental health symptoms and both risk of malnutrition and BMI (paper II). Mental health symptoms were significantly associated with the risk of malnutrition, and an association was also found for subthreshold mental health symptoms. Quality of Life is an important health aspect for the increasing number of elderly individuals with longer life expectancy. We found a significant reduction in Health-related Quality of Life with an increasing risk of malnutrition, and this was more pronounced in men than in women (paper III). In paper IV, we combined the HUNT 2 (The Nord-Trøndelag Health Study, 1995-97) and Tromsø 4 surveys with the intention of exploring the relationship between BMI categories and both total and cause-specific mortality in a prospective design. We found mortality to be increased in all BMI categories below 25 kg/m2 and that overweight individuals had the lowest mortality (BMI 25-29.9 kg/m2 in men and 25-32.4 kg/m2 in women). A modest increase in mortality was found with increasing BMI among obese men and women. About 40% of the excess mortality in the lower BMI range in men was explained by mortality from respiratory diseases. This thesis describes increased morbidity, mortality and reduced HRQoL in community-living elderly individuals at risk of malnutrition or with lower BMI. These findings emphasise the importance of nutritional screening, especially in primary care. Previous research has demonstrated that nutritional intervention can reduce adverse health outcomes in elderly at risk of malnutrition

Vitamin D deficiency is common in psychogeriatric patients, independent of diagnosis

This article is part of Ole Kristian Grønli's doctoral thesis which is available in Munin at http://hdl.handle.net/10037/6930Background:Previous studies have found an association between psychiatric disorders and vitamin D deficiency, but most studies have focused on depression. This study aimed to establish the prevalence of vitamin D deficiency in elderly patients with a wider range of psychiatric diagnoses. Method: The study included elderly patients (>64 years) referred to a psychiatric hospital in Northern Norway and a control group from a population survey in the same area. An assessment of psychiatric and cognitive symptoms and diagnoses was conducted using the Montgomery and Aasberg Depression Rating Scale, the Cornell Scale for Depression in Dementia, the Mini Mental State Examination, the Clockdrawing Test, and the Mini International Neuropsychiatric Interview (MINI+), as well as clinical interviews and a review of medical records. The patients’ mean level of 25-hydroxyvitamin D (25(OH)D) and the prevalence of vitamin D deficiency were compared with those of a control group, and a comparison of vitamin D deficiency across different diagnostic groups was also made. Vitamin D deficiency was defined as 25(OH)D <50 nmol/L (<20 ng/ml). Results: The mean levels of 25(OH)D in the patient group (n = 95) and the control group (n = 104) were 40.5 nmol/L and 65.9 nmol/L (p < 0.001), respectively. A high prevalence of vitamin D deficiency was found in the patient group compared with the control group (71.6% and 20.0%, respectively; p < 0.001). After adjusting for age, gender, season, body mass index, and smoking, vitamin D deficiency was still associated with patient status (OR: 12.95, CI (95%): 6.03-27.83, p < 0.001). No significant differences in the prevalence of vitamin D deficiency were found between patients with different categories of psychiatric diagnoses, such as depression, bipolar disorders, psychosis, and dementia. Conclusion: Vitamin D deficiency is very common among psychogeriatric patients, independent of diagnostic category. Even though the role of vitamin D in psychiatric disorders is still not clear, we suggest screening for vitamin D deficiency in this patient group due to the importance of vitamin D for overall health

Zinc deficiency is common in several psychiatric disorders

Background: Mounting evidence suggests a link between low zinc levels and depression. There is, however, little knowledge about zinc levels in older persons with other psychiatric diagnoses. Therefore, we explore the zinc status of elderly patients suffering from a wide range of psychiatric disorders. Methods: Clinical data and blood samples for zinc analyzes were collected from 100 psychogeriatric patients over 64 of age. Psychiatric and cognitive symptoms were assessed using the Montgomery and Aasberg Depression Rating Scale, the Cornell Scale for Depression in Dementia, the Mini-Mental State Examination, the Clockdrawing Test, clinical interviews and a review of medical records. In addition, a diagnostic interview was conducted using the Mini International Neuropsychiatric Interview instrument. The prevalence of zinc deficiency in patients with depression was compared with the prevalence in patients without depression, and the prevalence in a control group of 882 older persons sampled from a population study. Results: There was a significant difference in zinc deficiency prevalence between the control group (14.4%) and the patient group (41.0%) (x2 = 44.81, df = 1, p,0.001). In a logistic model with relevant predictors, zinc deficiency was positively associated with gender and with serum albumin level. The prevalence of zinc deficiency in the patient group was significantly higher in patients without depression (i.e. with other diagnoses) than in patients with depression as a main diagnosis or comorbid depression (x2 = 4.36, df = 1, p = 0.037). Conclusions: Zinc deficiency is quite common among psychogeriatric patients and appears to be even more prominent in patients suffering from other psychiatric disorders than depression. Limitations: This study does not provide a clear answer as to whether the observed differences represent a causal relationship between zinc deficiency and psychiatric symptoms. The blood sample collection time points varied in both the control group and the patient group. No data regarding zinc supplementation were collected