The HUNT for better health

By Nancy Bazilchuk
January 29, 2007

More than 100 000 residents of one county in central Norway have joined forces to help make you healthier. Beginning in 1984, they’ve volunteered to be pricked by needles, measured by nurses, probed by X-rays and submitted to questionnaires. They are the subjects of one of the world’s largest-ever health studies, known as HUNT, the Nord-Trøndelag Health Study.

Illustrasjonsbilde/FOTO

In October 2006, researchers launched HUNT 3, the third and most ambitious HUNT study to date. The NOK 120 million programme features 130 projects that explore everything from factors that predispose people to develop dementia to whether or not owning a pet affects your health.

“We have the whole age range from 13 upwards and no upper age limit, as well as a broad scientific programme,” said Jostein Holmen, a medical doctor, principal investigator for the HUNT projects, and professor at NTNU’s Faculty of Medicine. “We study most organic diseases, but we also study mental health, quality of life, people’s social lives and social capital, even religion. That is very unusual.”

400 scientific articles, better health
HUNT’s goal is to use the power of numbers to solve one of the central puzzles of the 21st century: how can modern medicine improve our daily lives? Doctors and scientists know a lot about how the human body works. But the effects of lifestyle and the environment on the body’s functioning makes designing preventative treatments without bankrupting the medical system a much more complex problem.

HUNT can help answer these questions in part because of its long time span. Roughly 20 000 people who participated in the original HUNT 1 study have now died, Professor Holmen said. The project has roughly 65 000 blood samples from participants in HUNT 2. That gives researchers powerful information from the past to see if they can determine what might have led to illnesses or mortality among the HUNT participants. “We’ve measured how they lived, if they drank, if they smoked, how much physical activity they engaged in,” adds Jostein Holmen. “We can now go back and see what was so different about people who have received various diagnoses or have died. This is a very strong design for studying the causes of different diseases.”The HUNT programme is voluntary, and is open to all residents of Nord-Trøndelag aged 20 and older.

A separate programme, Young HUNT, is carried out through the county’s secondary schools. Participants provide basic information about themselves, along with blood and urine samples, which are stored in a biobank. Researchers can then use the information to explore everything from heart and cardiovascular disease to diabetes, and mental illnesses. In all, more than 400 scientific studies and 32 PhDs have already been based on information from HUNT’s database.

Evaluating lifestyle risks – and finding surprises
Sometimes the information from HUNT helps researchers challenge conventional wisdom.Linn Getz, an MD at the Landspitali University Hospital in Iceland who received her PhD from NTNU’s Faculty of Medicine in June, 2006, knows this well. When Getz and fellow researchers used data from HUNT 2 to evaluate the European guidelines for cardiovascular disease, they found something truly amazing: Norway, which according to the World Health Organization has one of the healthiest populations in the world, appeared to be populated by people with an elevated risk of developing cardiovascular disease. Something was wrong.“The conclusion that we came to was that the new European guidelines for evaluating the risk of heart and cardiovascular diseases are neither sustainable nor responsible. This naturally created unease and debate both in the medical community and the outside world,” Getz said.

Yet the sheer power of HUNT’s numbers, and the quality of the data, gave the researchers’ findings considerable strength, she added. Letters poured into the British Medical Journal, where the researchers’ findings were published in August, 2005. And while the medical community debated the significance of what Getz and her co-workers had published, no one challenged the validity of the HUNT database. “From a worldwide perspective, there are few population databases with a standard comparable to HUNT,” Getz said.

Dividends from the Biobank
HUNT’s extensive database can also be linked Norway’s personal identity number, which can combine information from the HUNT database with other available medical information, such as the country’s register of births, cancer register and hospital databases. At the same time, a new high-tech biobank has been created to store roughly 3 to 4 million new blood samples and other biological material expected from the research project.“Using the information from the biobank, we can find detailed biological explanations for illnesses and the body’s workings, what our heritage and the environment can mean for the development of disease and how our genes come to be expressed,” said Steinar Krokstad, director of the HUNT 3 project. “The possibilities in HUNT are enormous.”

Go to HUNT's website

FACTS ABOUT HUNT

HUNT (Nord-Trøndelag Health Study) is one of the world’s largest national health studies, and is composed of HUNT 1 (1984-1987), HUNT 2 (1995-1997) and HUNT 3 (2006-2008). Altogether more than 100 000 Norwegians from Nord-Trøndelag county have participated in the first two studies, with 45 000 of those involved in both studies. An additional 10 000 teenagers were studied in Young HUNT 1 and Young HUNT 2. Roughly 130 studies have been designed to take advantage of HUNT 3, which was officially launched on 3 October 2006.

Research topics:
Cancer, heart and cardiovascular disease, dementia, obesity, diabetes, lung and respiratory illnesses, allergies, psychiatric problems, and muscular and skeletal problems.

International research:
Some of the top medical universities in the world cooperate with HUNT 3. In Europe, there is Erasmus University, Rotterdam and the University of Leiden. In the US there is the University of California in San Diego(UCSD) and in Los Angeles (UCLA), and Harvard University.

Organization:
The HUNT research programme officially became a part of the Faculty of Medicine at NTNU and what is now the Department of Public Health and General Practice in 2001. It was previously administered by the Norwegian Institute of Public Health.

Administration:
Principal investigator, Jostein Holmen; HUNT 3 project director, Steinar Krokstad; Young HUNT 3 project director, Turid Lingaas Holmen; Biobank director, Kristian Hveem

Employees:
65 at the HUNT research centre in Verdal, and 12 at the Levanger biobank.

Budget:
HUNT 3 has a basic budget of NOK 120 million and is financed by NTNU with support from Central Norway Regional Health Authority, Nord-Trøndelag county, the main municipalities in Nord-Trøndelag, the Norwegian Institute of Public Health, the Ministry of Health and Care Services, as well as Nord-Trøndelag Energiverk, Sparebank 1 Midt-Norge and Statoil.

Contact:
Email: hunt@medisin.ntnu.no