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Al-Alawi, K., Johansson, H., Al Mandhari, A. & Norberg, M. (2019). Are the resources adoptive for conducting team-based diabetes management clinics? An explorative study at primary health care centers in Muscat, Oman. Primary Health Care Research and Development, 20, Article ID E3.
Open this publication in new window or tab >>Are the resources adoptive for conducting team-based diabetes management clinics? An explorative study at primary health care centers in Muscat, Oman
2019 (English)In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 20, article id E3Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this study is to explore the perceptions among primary health center staff concerning competencies, values, skills and resources related to team-based diabetes management and to describe the availability of needed resources for team-based approaches.

BACKGROUND: The diabetes epidemic challenges services available at primary health care centers in the Middle East. Therefore, there is a demand for evaluation of the available resources and team-based diabetes management in relation to the National Diabetes Management Guidelines.

METHOD: A cross-sectional study was conducted with 26 public primary health care centers in Muscat, the capital of Oman. Data were collected from manual and electronic resources as well as a questionnaire that was distributed to the physician-in-charge and diabetes management team members.

FINDINGS: The study revealed significant differences between professional groups regarding how they perceived their own competencies, values and skills as well as available resources related to team-based diabetes management. The perceived competencies were high among all professions. The perceived team-related values and skills were also generally high but with overall lower recordings among the nurses. This pattern, along with the fact that very few nurses have specialized qualifications, is a barrier to providing team-based diabetes management. Participants indicated that there were sufficient laboratory resources; however, reported that pharmacological, technical and human resources were lacking. Further work should be done at public primary diabetes management clinics in order to fully implement team-based diabetes management.

Place, publisher, year, edition, pages
Cambridge University Press, 2019
Keywords
Oman, diabetes care, perception, primary health care, team-based management
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-150612 (URN)10.1017/S1463423618000282 (DOI)000460940900001 ()29737963 (PubMedID)2-s2.0-85046698625 (Scopus ID)
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2019-04-04Bibliographically approved
Ljungberg, J., Johansson, B., Engström, K. G., Norberg, M., Bergdahl, I. A. & Söderberg, S. (2019). Arterial hypertension and diastolic blood pressure associate with aortic stenosis. Scandinavian Cardiovascular Journal, 53(2), 91-97
Open this publication in new window or tab >>Arterial hypertension and diastolic blood pressure associate with aortic stenosis
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2019 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 53, no 2, p. 91-97Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Due to age-related differences in aortic valve structure, it is likely that the pathophysiology of aortic stenosis (AS) and associated risk factors differ between age groups. Here we prospectively studied the influence of traditional cardiovascular risk factors on AS development requiring surgery among patients without concomitant coronary artery disease (CAD) and stratified for age.

DESIGN: This study included 322 patients, who had prior to surgery for AS participated in population-based surveys, and 131 of them had no visible CAD upon preoperative coronary angiogram. For each case, we selected four referents matched for age, gender, and geographic area. To identify predictors for surgery, we used multivariable conditional logistic regression with a model including arterial hypertension (or measured blood pressure and antihypertensive medication), cholesterol levels, diabetes, body mass index (BMI), and smoking.

RESULTS: In patients without CAD, future surgery for AS was associated with arterial hypertension and elevated levels of diastolic blood pressure in patients younger than 60 years at surgery (odds ratio [95% confidence interval]), (3.40 [1.45-7.93] and 1.60 [1.09-2.37], respectively), and with only impaired fasting glucose tolerance in patients 60 years or older at surgery (3.22 [1.19-8.76]).

CONCLUSION: Arterial hypertension and elevated diastolic blood pressure are associated with a risk for AS requiring surgery in subjects below 60 years of age. Strict blood pressure control in this group is strongly advocated to avoid other cardiovascular diseases correlated to hypertension. If hypertension and elevated diastolic blood pressure are risk factors for developing AS requiring surgery need further investigations. Notably, elevated fasting glucose levels were related to AS requiring surgery in older adults without concomitant CAD.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Aortic stenosis, bicuspid aortic valve, diabetes, hypertension, valve disease surgery
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-159471 (URN)10.1080/14017431.2019.1605094 (DOI)000469026200007 ()31109205 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20140799Swedish Heart Lung Foundation, 20120631Swedish Heart Lung Foundation, 20100635Västerbotten County Council, VLL-548791
Available from: 2019-05-28 Created: 2019-05-28 Last updated: 2019-06-17Bibliographically approved
Näslund, U., Lundgren, A., Vanoli, D. & Norberg, M. (2019). Is intima-media thickness a predictor for cardiovascular risk?: Authors' reply [Letter to the editor]. The Lancet, 394(10196), 381-381
Open this publication in new window or tab >>Is intima-media thickness a predictor for cardiovascular risk?: Authors' reply
2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 394, no 10196, p. 381-381Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-162305 (URN)10.1016/S0140-6736(19)30343-5 (DOI)000478698300018 ()31379329 (PubMedID)
Available from: 2019-08-27 Created: 2019-08-27 Last updated: 2019-08-27Bibliographically approved
Scribani, M., Norberg, M., Lindvall, K., Weinehall, L., Sorensen, J. & Jenkins, P. (2019). Sex-specific associations between body mass index and death before life expectancy: a comparative study from the USA and Sweden. Global Health Action, 12(1), Article ID 1580973.
Open this publication in new window or tab >>Sex-specific associations between body mass index and death before life expectancy: a comparative study from the USA and Sweden
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2019 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1580973Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Understanding the impact of obesity on premature mortality is critical, as obesity has become a global health issue.

OBJECTIVE: To contrast the relationship between body mass index (BMI) and premature death (all-cause; circulatory causes) in New York State (USA) and Northern Sweden.

METHODS: Baseline data were obtained between 1989 and 1999 via questionnaires (USA) and health exams (Sweden), with mortality data from health departments, public sources (USA) and the Swedish Death Register. Premature death was death before life expectancy based on sex and year of birth. Within country and sex, time to premature death was compared across BMI groups (18.5-24.9 kg/m2 (reference), 25-29.9 kg/m2, 30.0-34.9 kg/m2, ≥35.0 kg/m2) using Proportional Hazards regression. Absolute risk (deaths/100,000 person-years) was compared for the same stratifications among nonsmokers.

RESULTS: 60,600 Swedish (47.8% male) and 31,198 US subjects (47.7% male) were included. Swedish males with BMI≥30 had increased hazards (HR) of all-cause premature death relative to BMI 18.5-24.9 (BMI 30-34.9, HR = 1.71 (95% CI: 1.44, 2.02); BMI≥35, HR = 2.89 (2.16, 3.88)). BMI≥25 had increased hazards of premature circulatory death (BMI 25-29.9, HR = 1.66 (1.32, 2.08); BMI 30-34.9, HR = 3.02 (2.26, 4.03); BMI≥35, HR = 4.91 (3.05, 7.90)). Among US males, only BMI≥35 had increased hazards of all-cause death (HR = 1.63 (1.25, 2.14)), while BMI 30-34.9 (HR = 1.83 (1.20, 2.79)) and BMI≥35 (HR = 3.18 (1.96, 5.15)) had increased hazards for circulatory death. Swedish females showed elevated hazards with BMI≥30 for all-cause (BMI 30-34.9, HR = 1.42 (1.18, 1.71) and BMI≥35, HR = 1.61 (1.21, 2.15) and with BMI≥35 (HR = 3.11 (1.72, 5.63)) for circulatory death. For US women, increased hazards were observed among BMI≥35 (HR = 2.10 (1.60, 2.76) for all-cause and circulatory HR = 3.04 (1.75, 5.30)). Swedish males with BMI≥35 had the highest absolute risk of premature death (762/100,000 person-years).

CONCLUSIONS: This study demonstrates a markedly increased risk of premature death associated with increasing BMI among Swedish males, a pattern not duplicated among females.

Keywords
Obesity, all-cause mortality, circulatory disease mortality, longitudinal studies, premature mortality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-158199 (URN)10.1080/16549716.2019.1580973 (DOI)000463650600001 ()30947624 (PubMedID)
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-05-23Bibliographically approved
Näslund, U., Ng, N., Lundgren, A., Fhärm, E., Grönlund, C., Johansson, H., . . . Norberg, M. (2019). Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. The Lancet, 393(10167), 133-142
Open this publication in new window or tab >>Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial
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2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10167, p. 133-142Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.

METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575.

FINDINGS: 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]).

INTERPRETATION: This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-154318 (URN)10.1016/S0140-6736(18)32818-6 (DOI)000455437100026 ()30522919 (PubMedID)
Funder
Västerbotten County Council, Dnr ALFVLL-298001Swedish Research Council, Dnr 521-2013-2708Swedish Research Council, 2016-01891Swedish Heart Lung Foundation, Dnr 20150369Swedish Heart Lung Foundation, 20170481
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-02-22Bibliographically approved
Pujilestari, C. U., Nyström, L., Norberg, M. & Ng, N. (2019). Waist circumference and all-cause mortality among older adults in rural Indonesia. International Journal of Environmental Research and Public Health, 16, Article ID 116.
Open this publication in new window or tab >>Waist circumference and all-cause mortality among older adults in rural Indonesia
2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, article id 116Article in journal (Refereed) Published
Abstract [en]

Waist circumference, a measure of abdominal obesity, is associated with all-cause mortality in general adult population. However, the link between abdominal obesity with all-cause mortality in the studies of older adults is unclear. This study aims to determine the association between waist circumference and all-cause mortality in older adults in Indonesia. The association between waist circumference and all-cause mortality was examined in 10,997 men and women aged 50 years and older, in the World Health Organization (WHO) and International Network of field sites for continuous Demographic Evaluation of Populations and their Health in developing countries (INDEPTH) collaboration Study on global AGEing and adult health (SAGE) in Purworejo District Central Java, Indonesia during 2007–2010. Multivariate Cox regression analysis with restricted cubic splines was used to assess the non-linear association between waist circumference and all-cause mortality. During the 3-year follow-up, a total of 511 men and 470 women died. The hazard ratio plot shows a pattern of U-shape relationship between waist circumference and all-cause mortality among rich women, though the result was significant only for women in the lower end of waist circumference distribution (p < 0.05). Poor men with a low waist circumference (5th percentile) have a two times higher mortality risk (HR = 2.1; 95% CI = 1.3, 3.3) relative to those with a waist circumference of 90 cm. Poor women with a low waist circumference (25th percentile) have a 1.4 times higher mortality risk (HR = 1.4; 95% CI = 1.1, 1.8) relative to those with a waist circumference of 80 cm. This study shows a significant association between low waist circumference measure and mortality, particularly among poor men and women. Though the association between large waist circumference and mortality was not significant, we observed a trend of higher mortality risk particularly among rich women with large waist circumference measure. Public health intervention should include efforts to improve nutritional status among older people and promoting healthy lifestyle behaviours including healthy food and active lifestyle.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
abdominal obesity, deaths, Indonesia, older people, waist circumference
National Category
Gerontology, specialising in Medical and Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-152117 (URN)10.3390/ijerph16010116 (DOI)000459111400116 ()30609857 (PubMedID)
Note

Originally included in thesis in manuscript form

Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2019-03-20Bibliographically approved
Lindholm, L., Stenling, A., Norberg, M., Stenlund, H. & Weinehall, L. (2018). A cost-effectiveness analysis of a community based CVD program in Sweden based on a retrospective register cohort. BMC Public Health, 18, Article ID 452.
Open this publication in new window or tab >>A cost-effectiveness analysis of a community based CVD program in Sweden based on a retrospective register cohort
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2018 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 452Article in journal (Refereed) Published
Abstract [en]

Background: Several large scale community-based cardiovascular disease prevention programs were initiated in the 80s, and one was the Västerbotten Intervention Programme, Sweden. As an initial step in 1985, a pilot study was introduced in the Norsjö municipality that combined individual disease prevention efforts among the middle-aged population with community-oriented health promotion activities. All citizens at 30, 40, 50, and 60 years of age were invited to a physical examination combined with a healthy dialogue at the local primary health care centre. Västerbotten Intervention Program is still running following the same lines and is now a part of the ordinary public health in the county. The purpose of this study is to estimate the costs of running Västerbotten Intervention Programme from 1990 to 2006, versus the health gains and savings reasonably attributable to the program during the same time period. Methods: A previous study estimated the number of prevented deaths during the period 1990-2006 which can be attributed to the programme. We used this estimate and calculated the number of QALYs gained, as well as savings in resources due to prevented non-fatal cases during the time period 1990 to 2006. Costs for the programmes were based on previously published scientific articles as well as current cost data from the county council, who is responsible for the programme. Result: The cost per QALY gained from a societal perspective is SEK 650 (Euro 68). From a health care sector perspective, the savings attributable to the VIP exceeded its costs. Conclusion: Our analysis shows that Västerbotten Intervention Programme is extremely cost-effective in relation to the Swedish threshold value (SEK 500000 per QALY gained or Euro 53,000 per QALY gained). Other research has also shown a favorable effect of Västerbotten Intervention Programme on population health and the health gap. We therefore argue that all health care organizations, acting in settings reasonably similar to Sweden, have good incentive to implement programs like Västerbotten Intervention Programme.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Prevention, Community-based, Cost-effectiveness
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-147306 (URN)10.1186/s12889-018-5339-3 (DOI)000429848700006 ()29618323 (PubMedID)
Available from: 2018-05-28 Created: 2018-05-28 Last updated: 2018-08-21Bibliographically approved
Ghandour, R., Mikki, N., Abu Rmeileh, N. M. E., Jerdén, L., Norberg, M., Eriksson, J. W. & Husseini, A. (2018). Complications of type 2 diabetes mellitus in Ramallah and al-Bireh: The Palestinian Diabetes Complications and Control Study (PDCCS). Primary Care Diabetes, 12(6), 547-557
Open this publication in new window or tab >>Complications of type 2 diabetes mellitus in Ramallah and al-Bireh: The Palestinian Diabetes Complications and Control Study (PDCCS)
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2018 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 12, no 6, p. 547-557Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a growing pandemic that will lead, if not managed and controlled, to frequent complications, poor quality of life, and high rates of disability and death. Little is known about T2DM complications in Palestine. The aim of this study is to estimate the prevalence of T2DM complications in Ramallah and al-Bireh governorate of Palestine.

METHODS: The study was conducted in eleven primary healthcare clinics offering services for persons with T2DM. Macrovascular complications were assessed using the Diabetes complication index. Microvascular complications were measured by physical examinations and laboratory tests. Questionnaires, laboratory tests, and physical examinations were used to assess socio-demographic characteristics, co-morbidities and other risk factors.

RESULTS: 517 adult men and nonpregnant women participated in the study (166 men, 351 women). The response rate was 84%. Mean age and mean duration of diabetes were 58.1 and 9.4 years respectively. Prevalence of diagnosed microvascular and macrovascular complications was 67.2% and 28.6% respectively. 78.2% of the participants had poor glycemic control (HbA1c≥7.0%).

CONCLUSION: Significant proportions of persons with T2DM had macro- and microvascular complications and poor metabolic control. These findings are important for policy development and the planning of health services.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Glycemic control, Macrovascular complications, Microvascular complications, Primary health care clinics, Risk factors, Type 2 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-150611 (URN)10.1016/j.pcd.2018.07.002 (DOI)000452344100009 ()30072279 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2019-01-08Bibliographically approved
Lassale, C., Tzoulaki, I., Moons, K. G. M., Sweeting, M., Boer, J., Johnson, L., . . . Butterworth, A. S. (2018). Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis. European Heart Journal, 39(5), 397-406
Open this publication in new window or tab >>Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis
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2018 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no 5, p. 397-406Article in journal (Refereed) Published
Abstract [en]

Aims: The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study.

Methods and results: We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction ('unhealthy') as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses.

Conclusion: Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of 'metabolically healthy obesity', encouraging population-wide strategies to tackle obesity.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
Adiposity, Coronary heart disease, Epidemiology, Metabolic syndrome, Obesity
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-143325 (URN)10.1093/eurheartj/ehx448 (DOI)000424198900016 ()29020414 (PubMedID)
Available from: 2017-12-20 Created: 2017-12-20 Last updated: 2018-06-09Bibliographically approved
Granlund, L., Norberg, M., Ramnemark, A., Andersson, C., Lindkvist, M. & Fhärm, E. (2018). Vitamin D is associated with lower limb muscle strength and grip strength in Middle Eastern- and African-born immigrants in Sweden. Nutrition Research, 59, 29-35
Open this publication in new window or tab >>Vitamin D is associated with lower limb muscle strength and grip strength in Middle Eastern- and African-born immigrants in Sweden
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2018 (English)In: Nutrition Research, ISSN 0271-5317, E-ISSN 1879-0739, Vol. 59, p. 29-35Article in journal (Refereed) Published
Abstract [en]

There is increasing evidence that vitamin D status is associated with muscle function. Vitamin D deficiency is common in immigrants. We hypothesized that there was a positive association between vitamin D status and muscle strength in immigrants. The aim of this study was to examine associations between vitamin D status and muscle strength in an immigrant population in Sweden. All immigrants aged 25-65 years, born in 9 African or Middle East countries, and living in a district in Umeå (n = 1306) were invited. A total of 111 men and 105 women (16.5%) completed the study. Lower limb muscle strength was examined using a standardized muscle function indices of muscle strength. Grip strength was examined using a JAMAR hand dynamometer. Serum 25-hydroxyvitamin D [25(OH)D] was measured using liquid chromatography–tandem mass spectrometry. The analyses were adjusted for sex, age, height, body mass index, years since immigration, 25(OH)D, vitamin D deficiency, physical activity, and medical and socioeconomic factors. Twelve percent of the immigrants had vitamin D deficiency [25(OH)D levels <25 nmol/L]. In multivariable analyses, reduced lower limb muscle strength remained linearly associated with lower 25(OH)D concentrations (P = .008) and weaker grip strength remained associated with vitamin D deficiency (P = .022) after adjustments. The association between vitamin D deficiency and reduced lower limb muscle strength did not reach statistical significance (P = .052). The results demonstrate that vitamin D deficiency and low 25(OH)D concentrations were associated with muscle weakness in immigrants.

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
General Practice
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-147571 (URN)10.1016/j.nutres.2018.07.009 (DOI)000451792500003 ()30442230 (PubMedID)
Note

First published in thesis in manuscript form.

Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-12-19Bibliographically approved
Projects
Direct visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention. A population based pragmatic randomised controlled trial within ordinary care [2013-02708_VR]; Umeå UniversityVIsualiZation of Asymptomatic atherosclerotic disease for optimun cardiovascular prevention ? VIPVIZA ? a RCT nested in routine care in Västerbotten Intervention Programme, Sweden [2016-01891_VR]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2475-7131

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