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Background: Celiac disease (CD) is underdiagnosed and associated with diagnostic delays. This has long‐term consequences for the health and well‐being of people living with the condition. Little is known about the qualitative configurations of the assessment processes of people living with CD. Methods: Using a thematic network analysis of 24 in‐depth interviews, this study explored the experiences of people living with CD related to their assessment processes leading to being diagnosed. Results: A significant diagnostic delay (up to 26 years) was evident in many interviews. Factors contributing to diagnostic delay included limited knowledge about CD among general practitioners (GP) and in the general population, categorisations of symptoms as 'typical' or 'atypical' and psychosomatic explanations of symptoms. Diagnostic delay resulted in (1) decreased psychological well‐being due to severe symptoms, changes in self‐perception and self‐blame; (2) decreased physiological well‐being due to comorbidities; and (3) mistrust in the healthcare system, leading to an increase in informants' responsibility for expediting their assessment processes. This suggested the presence of a neoliberal tendency because informants felt they were primarily responsible for their assessment processes. Conclusions: We encourage the implementation of initiatives to increase awareness of CD among GPs as well as more consistent and frequent use of the screening guideline due to variations in its clinical presentation. Increased awareness and consistency could reduce variations in assessment processes given GPs' varying knowledge about the condition. Key points: Factors contributing to diagnostic delay included varying and inadequate knowledge about celiac disease (CD) among general practitioners (GP) and informants. This highlights the importance of ensuring more consistent and frequent use of existing clinical guidelines in GPs' screening for CD and implementing initiatives to increase public awareness of CD and its diverse symptoms.For informants, diagnostic delays resulted in mistrust in the healthcare system, decreased physiological well‐being and decreased psychological well‐being due to changes in self‐perception and self‐blame. This signals the importance of increasing GPs' awareness of approaching patients with understanding in a nonstigmatising manner. [ABSTRACT FROM AUTHOR]

Background and Aim: Functional somatic disorders (FSDs) are a unifying diagnosis that includes functional somatic syndromes (FSSs) as well as the unifying diagnostic construct of bodily distress syndrome (BDS). FSDs are characterized by persistent and troublesome physical symptoms that are prevalent across all medical settings and for which no clinical tests can establish a definitive diagnosis. The aim of this study was to explore associations between BDSs and objective measurements of body composition, cardiorespiratory health, and physical performance. Methods: Analyses are based on data from the Danish population-based cohort study, DanFunD, comprising data on 9656 participants aged 18–76 years and BDS case status, which was established using self-reported questionnaires. Adjusted multiple linear regression analysis was employed to evaluate associations between BDS and different measures of body composition, cardiorespiratory health, and physical performance assessed as part of a general health examination. Results: Compared to controls, individuals with single- or multi-organ BDS exhibited less optimal body compositions characterized by a higher BMI and fat percentage and larger waist circumference, as well as impaired cardiorespiratory health and reduced physical performance (lower maximal oxygen consumption and lower hand grip strength). Further, individuals categorized with multi-organ BDS had a less healthy body composition, lower cardiorespiratory health, and lower physical performance compared to individuals with single-organ BDS. Conclusions: In this cross-sectional study, we found BDS to be associated with suboptimal body composition, impaired cardiorespiratory health, and reduced physical performance. Individuals with multi-organ BDS tended to exhibit lower physical fitness or reduced cardiorespiratory health than individuals with single-organ BDS. [ABSTRACT FROM AUTHOR]

Purpose: Vitamin K is an activator of vitamin K dependent proteins, one of which is the potent inhibitor of vascular calcification, matrix Gla protein (MGP). The purpose of this study is to investigate the association between an inverse proxy of functional vitamin K status, plasma dephospho-uncarboxylated MGP (dp-ucMGP), and cardiovascular disease risk factors (CVDRFs)., Methods: In a cross-sectional population-based health examination study of 4,092 individuals aged 24-77 years, the vitamin K status was assessed using plasma dp-ucMGP. All participants were linked to Danish National Prescription Register to obtain information on the use of vitamin K antagonists. The associations between log2 transformed dp-ucMGP values and CVDRFs were determined using regression models adjusted for sex, age, lifestyle factors, kidney function and waist circumference., Results: Higher dp-ucMGP levels were associated with increased risk of central obesity (Odds Ratio (OR) 4.76, 95% Confidence Intervals (CI) 3.57-6.34), diabetes (OR 1.96, 95% CI 1.11-3.45), hyperlipidaemia (OR 1.43, 95% CI 1.01-2.03), and impaired kidney function (OR 9.83, 95% CI 5.49-17.59) per doubling in dp-ucMGP. Dp-ucMGP was not independently associated with hypertension or arterial stiffness., Conclusion: Higher dp-ucMGP levels were associated with central obesity, diabetes, hyperlipidaemia, and impaired kidney function. Prospective studies and intervention studies examining the effects of improving vitamin K status are needed to clarify the potential role of vitamin K in relation to these CVDRFs., Competing Interests: Declarations. Conflict of interest: A. Linneberg has received an unrestricted grant and investigational products from Kappa Bioscience A/S for an intervention trial (The InterVitaminK Trial; clinicatrials.gov identifier NCT05259046) using vitamin K supplements as the active intervention. The remaining other authors declare no personal or financial conflict of interest., (© 2024. The Author(s).)

Objective: Health effects of different physical activity domains (ie, during leisure time, work and transport) are generally considered positive. Using Active Worker consortium data, we assessed independent associations of occupational and leisure-time physical activity (OPA and LTPA) with all-cause mortality., Design: Two-stage individual participant data meta-analysis., Data Source: Published and unpublished cohort study data., Eligibility Criteria: Working participants aged 18-65 years., Methods: After data harmonisation, we assessed associations of OPA and LTPA with all-cause mortality. In stage 1, we analysed data from each study separately using Cox survival regression, and in stage 2, we pooled individual study findings with random-effects modelling., Results: In 22 studies with up to 590 497 participants from 11 countries, during a mean follow-up of 23.1 (SD: 6.8) years, 99 743 (16%) participants died. Adjusted for LTPA, body mass index, age, smoking and education level, summary (ie, stage 2) hazard ration (HRs) and 95% confidence interval (95% CI) for low, moderate and high OPA among men (n=2 96 134) were 1.01 (0.99 to 1.03), 1.05 (1.01 to 1.10) and 1.12 (1.03 to 1.23), respectively. For women (n=2 94 364), HRs (95% CI) were 0.98 (0.92 to 1.04), 0.96 (0.92 to 1.00) and 0.97 (0.86 to 1.10), respectively. In contrast, higher levels of LTPA were inversely associated with mortality for both genders. For example, for women HR for low, moderate and high compared with sedentary LTPA were 0.85 (0.81 to 0.89), 0.78 (0.74 to 0.81) and 0.75 (0.65 to 0.88), respectively. Effects were attenuated when adjusting for income (although data on income were available from only 9 and 6 studies, for men and women, respectively)., Conclusion: Our findings indicate that OPA may not result in the same beneficial health effects as LTPA., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To describe the natural history of inhibin B throughout life according to sex, age, and pubertal development., Methods: Based on serum samples from 2707 healthy controls aged 0 to 80 years, sex- and age-specific reference ranges of inhibin B concentrations were constructed. Concentrations were evaluated according to pubertal development and use of oral contraceptives (OCs). Also, measurements from 42 patients with Klinefelter syndrome were included., Results: In both sexes, inhibin B concentrations were high during minipuberty, decreased in childhood, and increased significantly from Tanner stages B1 to B3 (peak: B4) in females and from G1 to G3 (peak: G3) in males. Despite variations in menstruating females, inhibin B concentrations remained relatively constant after puberty, until becoming unmeasurable at menopause. Despite a modest decrease, the inhibin B concentration in males remained relatively high from puberty onwards. At any age, males had highest concentrations. Inhibin B standard deviation (SD) scores were lower in OC-users (median SD score = -0.88) than in non-users (SD score = 0.35), p < 0.001. In patients with Klinefelter syndrome, inhibin B concentrations spanned the reference range until around 15 years of age, where they decreased to subnormal or unmeasurable levels., Conclusion: Valuable sex- and age-specific reference data for inhibin B concentrations were provided. In OC-users, decreased concentrations of inhibin B underlined the ovaries as the only place of inhibin B production. In patients with Klinefelter syndrome, the decline in inhibin B concentrations at puberty underlined the shift in regulation of inhibin B production at pubertal onset., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms.)

Introduction: The population-based Inter99 cohort has contributed extensively to our understanding of effects of a systematic screening and lifestyle intervention, as well as the multifactorial aetiology of type 2 diabetes (T2D) and cardiovascular disease. To understand causes, trajectories and patterns of early and overt cardiometabolic disease manifestations, we will perform a combined clinical deep phenotyping and registry follow-up study of the now 50-80 years old Inter99 participants., Methods and Analysis: The Inter99 cohort comprises individuals aged 30-60 years, who lived in a representative geographical area of greater Copenhagen, Denmark, in 1999. Age-stratified and sex-stratified random subgroups were invited to participate in either a lifestyle intervention (N=13 016) or questionnaires (N=5264), while the rest served as a reference population (N=43 021). Of the 13 016 individuals assigned to the lifestyle intervention group, 6784 (52%) accepted participation in a baseline health examination in 1999, including screening for cardiovascular risk factors and prediabetic conditions. In total, 6004 eligible participants, who participated in the baseline examination, will be invited to participate in the deep phenotyping 20-year follow-up clinical examination including measurements of anthropometry, blood pressure, arterial stiffness, cardiometabolic biomarkers, coronary artery calcification, heart rate variability, heart rhythm, liver stiffness, fundus characteristics, muscle strength and mass, as well as health and lifestyle questionnaires. In a subsample, 10-day monitoring of diet, physical activity and continuous glucose measurements will be performed. Fasting blood, urine and faecal samples to be stored in a biobank. The established database will form the basis of multiple analyses. A main purpose is to investigate whether low birth weight independent of genetics, lifestyle and glucose tolerance predicts later common T2D cardiometabolic comorbidities., Ethics and Dissemination: The study was approved by the Medical Ethics Committee, Capital Region, Denmark (H-20076231) and by the Danish Data Protection Agency through the Capital Region of Denmark's registration system (P-2020-1074). Informed consent will be obtained before examinations. Findings will be disseminated in peer-reviewed journals, at conferences and via presentations to stakeholders, including patients and public health policymakers., Trial Registration Number: NCT05166447., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)