Nutritional guidelines for older people in Finland.

BACKGROUND: Ageing is associated with an increased risk of malnutrition, decreased nutrient intake, unintentional weight loss and sarcopenia, which lead to frailty, functional disabilities and increased mortality. Nutrition combined with exercise is important in supporting older people's health, functional capacity and quality of life. OBJECTIVE: To identify nutritional needs in various groups of older individuals and to present the nutritional guidelines for older people in Finland. DESIGN: A review of the existing literature on older people's nutritional needs and problems. The draft guidelines were written by a multidisciplinary expert panel; they were then revised, based on comments by expert organisations. The guidelines were approved by the National Nutritional Council in Finland. RESULTS: The heterogeneity of the older population is highlighted. The five key guidelines are: 1. The nutritional needs in different age and disability groups should be considered. 2. The nutritional status and food intake of older individuals should be assessed regularly. 3. An adequate intake of energy, protein, fiber, other nutrients and fluids should be guaranteed. 4. The use of a vitamin D supplement (20 µg per day) recommended. 5. The importance of physical activity is highlighted. In addition, weight changes, oral health, constipation, obesity, implementing nutritional care are highlighted. CONCLUSIONS: Owing to the impact that good nutrition has on health and well-being in later life, nutrition among older people should be given more attention. These nutritional guidelines are intended to improve the nutrition and nutritional care of the older population.

Parental and childhood overweight in sedentary and active adolescents.

We studied whether the prevalence of overweight since age 2 years differed in sedentary and active adolescents (N=346). Further, we analyzed the energy intake of sedentary and active adolescents across 12 years. BMI was assessed annually since birth, energy intake since age 13 months and parents' BMI from the time their child was 7 months old in a longitudinal atherosclerosis prevention study. Data on physical activity were collected at age 13 years (N=560). Sedentary and Active groups were formed by upper and lower physical activity tertile cut-points. Girls Sedentary at 13 years were more often overweight than Active peers already since age 2 years (P=0.048). Activity habits were not associated with energy intake. Conversely, among boys, activity habits in adolescence were not associated with childhood overweight, while the energy intake of Active boys was higher than that of Sedentary boys (P=0.008). Parental overweight was not associated with the physical activity of children; however, Sedentary girls more often had an overweight mother than Active girls (P=0.021). In conclusion, overweight during early years of life is more common among girls who are Sedentary as adolescents than in Active peers. Overweight mothers more often have Sedentary daughters than normal-weight mothers. A healthy lifestyle right from early childhood requires active support.

Migration and differences in dietary habits-a cross sectional study of Finnish twins in Sweden.

OBJECTIVE: To compare dietary habits between Finnish twin migrants to Sweden and their co-twins always living in Finland, and to analyse how migration influenced food consumption patterns in the migrants. SUBJECTS/METHODS: Same-sexed twin pairs born in Finland below 75 years of age, with at least one twin migrating to Sweden (n=1083 pairs). Dietary habits were assessed by a food frequency questionnaire included in a comprehensive mailed questionnaire (response rate 71%). For 76 male twin pairs, information was also collected by a dietary history interview inquiring the habitual diet during the previous year. RESULTS: Migrant twins in Sweden had a lower intake of typical Finnish foods like dark bread and berries, and an increased consumption of fresh fruit compared with co-twins living in Finland. The migrants consumed less potatoes and more rice and pasta. Sweet pastries were consumed less often by the migrants and they also tended to more often cut out visible fat of meat and on the other hand add salt to dishes. Among men the migrants had a lower alcohol intake than their co-twins living in Finland. CONCLUSIONS: Migration from Finland to Sweden is associated with differences in the food pattern that reflect population differences in eating habits between the two countries. The differences include a reduced consumption of typical Finnish foods like dark bread and berries and are of bidirectional nature from the point of view of cardiovascular health.

Leisure-time physical activity of 13-year-old adolescents.

The leisure-time physical activity of 13-year-old Finnish adolescents was assessed in the prospective STRIP study. A self-administered questionnaire (N=565) was used. The leisure-time physical activity index (PAI; MET h/week) was calculated on the basis of reported exercise intensity, duration and frequency (N=558; 53% boys). The participants were divided into Sedentary, Moderately Active and Active groups by PAI tertiles. A subpopulation (N=197) also used a heart rate monitor (3 days, >/=8 h/day) to assess the time spent on different activity intensities. The median male PAI was 31.3 (inter-quartile range (IQR) 44.2) MET h/week and female 19.5 (IQR 26.3) MET h/week (P=0.0002). The cutoff points of the PAI tertiles were similar for the Active girls (31.3 MET h/week) and boys (32.6 MET h/week), but for the Sedentary boys it was 19.5 MET h/week and only 5.0 MET h/week for the Sedentary girls. High self-reported leisure-time physical activity associated poorly with time spent on moderate or vigorous exercise measured by heart rate monitoring. Active mothers had more often Active daughters or sons. In conclusion, the amount of leisure-time physical activity of one-third of 13-year-old girls is extremely low. Sedentary adolescents, especially girls, should therefore be put into focus for active efforts to increase their leisure-time physical activity. Parental models may be important.

Comparison of nutrient intake data calculated on the basis of two different databases. Results and experiences from a Swedish-Finnish study.

BACKGROUND AND OBJECTIVE: In international surveys of food consumption and nutrient intake, it is essential that the dietary data are comparable when different databases and calculation programs are used. The aim of the present analysis was to examine the comparability of nutrient intake data calculated on the basis of the Swedish food composition database PC-kost and the Finnish food composition database Nutrica. SUBJECTS AND METHODS: A total of 20 male adults currently living in Sweden were selected from a group of Finnish twins of the Finnish Twin Cohort Study. Food consumption data were collected by means of diet history interviews. The estimated intakes of 30 nutrients calculated on the basis of PC-kost were compared to the corresponding estimates calculated on the basis of Nutrica. The calculation procedures were standardised. RESULTS: No statistically significant differences were observed in the mean intakes of energy, total fat, saturated fat, carbohydrates, dietary fibre, alcohol, cholesterol, vitamin A, retinol, beta-carotene, vitamin D, alpha-tocopherol, riboflavin, niacin, vitamin B(12), vitamin C or phosphorus. PC-kost yielded a 20% higher intake (NS) for vitamin D and 23% higher intake (P<0.001) for thiamine than Nutrica, which is mainly attributed to the differences in the enrichment of foodstuffs between Sweden and Finland. Conversely, PC-kost yielded 53% lower values (P<0.001) for selenium than Nutrica, owing to the increased selenium content in many Finnish foodstuffs as a result of the addition of selenium to fertilisers. Statistically significant differences were found for protein, monounsaturated fatty acids, vitamin B(6), iron and sodium (5-9% higher values from PC-kost) and for polyunsaturated fatty acids, folate, zinc, calcium, magnesium and potassium (4-10% lower values from PC-kost). The variation in the intake of these nutrients between the two methods may be explained by the differences in foodstuff-specific nutrient values (eg product formulations), or differences in the sources of data, recipes or calculation procedures. The correlation coefficient was > or =0.81 for most nutrients. At least 85% of the subjects in each PC-kost quintile were classified into the same or adjacent Nutrica quintile for all nutrients. CONCLUSIONS: Our results indicate that, for a dominant part of the examined nutrients, the estimated intakes calculated by means of standardised procedures using the PC-kost and Nutrica databases are comparable between Sweden and Finland. Differences observed for some nutrients reflect either actual differences in foods between the two countries or methodological differences in the assessment of nutrient intakes.

Consumption of black currants, lingonberries and bilberries increases serum quercetin concentrations.

OBJECTIVE: To study serum quercetin concentrations of subjects consuming berries or habitual Finnish diets. DESIGN: Randomized parallel dietary intervention. SUBJECTS: Forty healthy men (age 60 y). INTERVENTION: Twenty subjects consumed 100 g/day of berries (black currants, lingonberries and bilberries) for 8 weeks. Twenty subjects consuming their habitual diets served as controls. Fasting blood samples were obtained 2 weeks prior to the study, at baseline, and at 2, 4 and 8 weeks. Intake of quercetin was assessed from 3 day food records collected at baseline and at 8 weeks. RESULTS: The serum quercetin concentrations were significantly higher in the subjects consuming berries compared to the control group (P=0.039 ANCOVA with repeated measures). During the berry consumption period the mean serum concentrations of quercetin ranged between 21.4 and 25.3 micro g/l in the berry group, which was 32-51% higher compared with the control group. According to 3 day food records, there was no difference in quercetin intake at baseline, but at 8 weeks the intake was 12.3+/-1.4 mg/day (mean+/-s.e.m.) in the berry group and 5.8+/-0.6 mg/day in the control group (P=0.001). CONCLUSIONS: The results indicate that the berries used in this study are a good source of bioavailable quercetin.

Acquired preference especially for dietary fat and obesity: a study of weight-discordant monozygotic twin pairs.

OBJECTIVE: To determine the independent associations of dietary preference for fat with obesity without the confounding by genetic effects. DESIGN: Descriptive comparison of the responses of monozygotic twins discordant for obesity to questions concerning current and past preference for dietary fat, current overconsumption of fatty items and recalled food consumption compared to the co-twin. SETTING: The Research and Development Centre of the Social Insurance Institution, Finland. SUBJECTS: Twenty-three healthy monozygotic twin pairs who were discordant for obesity (BMI difference at least 3 kg/m(2)). MAIN OUTCOME MEASURES: Obesity status of the twin, as a function of the current and recalled dietary preferences and selected psychosocial variables. RESULTS: The obese twins reported current preference for fatty foods three times more frequently than the lean co-twin. Moreover, when comparing recalled taste for fat at the time the twins left their parental homes, both the obese and lean co-twins consistently recalled that the obese twin had greater preference for fatty foods in young adulthood, and that the lean twin had less. Psychological characteristics of lean and obese co-twins did not differ. CONCLUSION: Acquired preference for fatty foods is associated with obesity, independent of genetic background. Modification of fat preferences may be an important step in the prevention of obesity in the general population.

Partial resistance of low density lipoprotein to oxidation in vivo after increased intake of berries.

BACKGROUND AND AIM: The health-promoting effects of fruit- and vegetable-based diets are known to be associated with their antioxidative components. We found in our preliminary in vitro laboratory tests that extracts of many common Finnish edible berries are potent scavengers of peroxyl radicals and inhibitors of lipid peroxidation. We therefore designed the current study to evaluate both the long-term (8 weeks) and short-term (5 hours) effects of increased intake of three berries on antioxidant potential and lipid peroxidation. METHODS AND RESULTS: Healthy 60-year-old men were randomized to berry, supplement and control groups (20 men in each group). The berry group ate, in addition to their normal diet, a 100 g portion of deep-frozen berries (bilberries, lingonberries, or black currants) daily for 8 weeks. The other groups ingested daily 100 mg of alpha-tocopherol and 500 mg of ascorbic acid (supplement group) or 500 mg of calcium gluconate (control group). In the short-term experiment 6 men ate 80 g of each of the three berries in one go. Serum ascorbate concentrations increased significantly in both the berry and the supplement group. Serum alpha-tocopherol levels and the antioxidant potential (TRAP) in low density lipoprotein (LDL) increased in the supplement group only. In the berry group, slightly lowered LDL diene conjugation (p = 0.074) and slightly increased total serum TRAP (p = 0.084) values were observed. No changes were found in these measures in the supplement or the control group. In the short-term experiment, LDL TRAP showed a small increase (about 10%, p = 0.039) during five hours after the intake of 240 g berries. CONCLUSIONS: The effects of consumption of berries on antioxidant potential and diene conjugation in LDL particles in vivo appear to be small.

Environmental factors in the development of obesity in identical twins.

OBJECTIVE: To study environmental factors promoting obesity when genetic factors are identical. DESIGN: Monozygotic (MZ) twins discordant for overweight were examined during a 3-day stay in an inpatient setting. SUBJECTS: The subjects were selected from the Finnish Twin Cohort. The study sample consisted of 23 healthy adult MZ twin pairs (14 female, nine male) with a difference of at least 3 kg/m2 in BMI. The mean BMI was 29.5 kg/m2 for the overweight twins and 22.9 kg/m2 for their lean co-twins. MEASUREMENTS: Interviews and standardized questionnaires were used to obtain information about energy and nutrient intake, eating behaviour, physical activity history, smoking and other background factors. RESULTS: The overweight co-twins had higher disinhibition scores (P = 0.007) and hunger scores (P = 0.005) in the 3-Factor Eating Questionnaire than their lean co-twins. Among women the mean daily energy intake was higher in the overweight twins than in their lean co-twins (8.8 vs 7.4 MJ; P = 0.045). In the twins discordant for smoking the mean BMI was higher in non-smokers than in smokers (BMI 29.7 +/- 4.4kg/m2 vs 23.8 +/- 3.1 kg/m2; P = 0.031). CONCLUSIONS: Difficulty in controlling eating in both sexes and high energy intake in women were related to overweight, independent of genetic background. Smoking explained the BMI difference among smoking discordant pairs. It is probable that individual twin pairs had different reasons behind the variation in weight gain resulting in non-significant intrapair differences in single obesity-promoting factors. Difference in living conditions (e.g. family-and work-related factors) may have promoted different living habits, especially eating behaviour, and may have led to different weight gain in identical twins.

Comparison between tracheal tubes for orotracheal fibreoptic intubation.

We have compared impingement of the tracheal tube against the larynx using a standard preformed tube, warmed preformed tube or two flexible spiral-wound tracheal tubes with different tip designs, in 100 adult patients undergoing orotracheal fibreoptic intubation under general anaesthesia, in a prospective, randomized study. The rates of impingement were 20 of 30 with the standard tube, 12 of 30 with the warmed standard tube (P = 0.07) and eight of 20 with both spiral tubes. However, impingement with the spiral tubes took longer to overcome if a sharp tipped rather than an obtuse tipped tube was used. Manipulations after impaction led to oesophageal intubation in one patient, and in one patient fibreoptic intubation failed. We conclude that resistance to the tracheal tube occurred frequently when the spiral-wound tubes were used.

Massive blood transfusion exceeding 50 units of plasma poor red cells or whole blood: the survival rate and the occurrence of leukopenia and acidosis.

The survival rate after bleeding requiring massive blood transfusions exceeding 50 units has been reported to be low or zero. There seems to be no reports of leukopenia in connection with massive blood transfusion. This retrospective study was carried out to investigate the survival rate and the occurrence of leukopenia and acidosis in patients who were transfused with more than 50 units of plasma poor red cells or whole blood. The survival rate was 16 of 23. Three of the five patients with a blood transfusion of over 100 units survived. Pure component therapy was used on 18 occasions. All patients had a leukopenia, which lasted up to five days. All patients had an acidosis. The range of the lowest pH values in patients who did not survive was from 6.77 to 7.27 and in survivors from 6.87 to 7.28. The survival rate was considerably higher than reported in previous studies. Pure component therapy appeared to be particularly suited to massive transfusion. Leukopenia was a regular phenomenon. Severe acidosis did not predict a poor outcome.

Laryngoscopy and fibreoptic intubation in acromegalic patients.

Acromegaly is recognized as a cause of difficulty in airway management and tracheal intubation. We evaluated prospectively the conditions for laryngoscopy and fibreoptic intubation in 15 acromegalic patients. Each patient served as his or her own control. Ventilation of the lungs with a face mask was successful in all patients. In five of 15 patients the vocal cords could not be seen using the Macintosh laryngoscope with a size 5 blade. Difficult laryngoscopy was associated significantly with the number of attempts required to see the vocal cords with the fibrescope (P < 0.01, Spearman rank correlation). The larynx could not be seen with both techniques in one patient, and the trachea was intubated blindly with the help of an introducer. Our results showed that fibreoptic intubation may prove difficult or fail in acromegalic patients. Difficulties in seeing the vocal cords with a fibrescope were present most often in patients who also had probable intubation difficulties with a rigid laryngoscope.

Intubation difficulties in patients with rheumatoid arthritis. A retrospective analysis.

BACKGROUND: Fibreoptic intubation has been suggested to be the best method to manage a compromised airway. This retrospective study was designed to compare endotracheal intubation with the help of a rigid laryngoscope or a fibrescope in patients with rheumatoid arthritis. METHODS: Intubation difficulties with the laryngoscope and the fibrescope in patients with rheumatoid arthritis were investigated during a period of five and a half years. The anaesthesia records were used for analysis. The patients were divided into two groups (group I with 41 patients and group II with 37 patients) reflecting the change in the routine airway management in patients with rheumatoid arthritis in our hospital from the beginning of 1993. Before that time the patients were usually intubated orotracheally under general anaesthesia, but since 1993 rheumatoid patients with anticipated difficulties in endotracheal intubation have been preferably intubated fibreoptically awake under sedation and topical anaesthesia with a fibrescope. RESULTS: Major difficulties in endotracheal intubations were encountered in 13% of patients in group I and in 8% in group II. On two occasions in group I tracheostomy was needed. In one of these patients, emergency tracheostomy was performed. In the latter group, the main reason for prolonged fibreoptic intubations was lack of experience. CONCLUSION: The introduction of fibreoptic intubation technique has had a favourable influence on the safety in the airway management of surgical patients with rheumatoid arthritis.

The relevance of clinical and radiological measurements in predicting difficulties in fibreoptic orotracheal intubation in adults.

Resistance to the passage of the tracheal tube has been reported to occur in up to 36% of patients subjected to orotracheal fibreoptic intubation. In this prospective study we assessed five radiological measurements of the upper airway in an attempt to find anatomical causes of obstruction to passage of the tube. Forty-nine patients undergoing fibreoptic orotracheal intubation under general anaesthesia were studied. Pre-operatively, the Mallampati grade and the thyromental distance were assessed. The plain films, CT scans or MR images of the cervical spine were used for measurement of the position of the vocal cords, the length of the epiglottis and the size of the tongue. The resistance to the passage of the tube was graded as none, mild, moderate or severe. The length of the epiglottis and the size of the tongue, but not the position of the vocal cords, had positive correlations with the severity of impingement. The pre-operative bedside tests did not correlate with difficulties in fibreoptic intubation.

Comparison between the Ovassapian intubating airway and the Berman intubating airway in fibreoptic intubation.

The most common indication for employing the fibreoptic technique for intubation is when a difficult intubation is anticipated. It may also be used when intubation unexpectedly proves difficult with a rigid laryngoscope in anaesthetized patients. However, failures with orotracheal fibreoptic intubation have been reported in up to 9.5% of cases, although only two possible equipment related causes of intubation difficulties have been identified. The Berman intubating airway and the Ovassapian intubation airway in fibreoptic orotracheal intubation have been compared in 65 patients. The study was randomized and for fibreoptic endoscopy each patient served as his or her own control. The results indicate that both airways can be used for orotracheal fibreoptic intubation in anaesthetized patients. The Berman airway offers easier visualization of the vocal cords than the Ovassapian airway, provided that the Berman airway is of an adequate size and positioned in the midline. Upon impingement of the intubation tube, completing the tracheal intubation is more difficult with the Berman airway than the Ovassapian airway.

Orotracheal fibreoptic intubation in children under general anaesthesia.

Orotracheal fibreoptic intubation under general anaesthesia in children was studied in eleven consecutive patients of three months to eight-years-of-age without anticipated intubation difficulties. One case report is also included. Three fibrescopes with a different diameter were used in the study. The fibrescope used was chosen so that it fitted snugly in the tracheal tube. The fibreoscopy was prolonged in one patient due to mucus and two tries were needed. Resistance to the tracheal tube upon intubation was encountered in five patients, only one of these patients was older than two years. Fibreoptic intubation succeeded in nine patients. Two patients were intubated with the Macintosh laryngoscope. The problems encountered in children during orotracheal fibreoptic intubation under general anaesthesia are the same as with adults: easy fibreoscopy is not always followed by easy tracheal intubation, there may be prolonged fibreoscopy and failed intubations. Manipulation of the tracheal tube can lead to successful tracheal intubation and resistance to the tube is more common in smaller children.

Effect of xylitol on dentin formation in molars of adult rats.

A xylitol-induced reduction in dentin formation has been observed in molars of post-weanling rats, but the effect in older animals with a slower rate of secondary dentinogenesis has not been investigated. We examined the effects of different concentrations of dietary xylitol on dentinogenesis in molars of young adult rats. The control group received a commercial basal diet, while for the other 3 groups, the same diet was supplemented with 5, 10 and 20% of xylitol. After 8 weeks, dentin thickness beneath the main fissures in the mandibular 1st and 2nd molars was measured. The final body weights did not differ between the groups. Dentin formation in the 1st molars of the 10 and 20% xylitol groups was significantly lower as compared to the controls, whereas no difference was found between these 2 groups. In conclusion, dietary xylitol reduces dentin formation in young adult rats in spite of the slow rate of dentinogenesis.

Microscopic analysis of the tips of thin spinal needles after subarachnoid puncture.

BACKGROUND AND OBJECTIVES: Foreign material may pass unrecognized with the spinal needle into the subarachnoid space. Therefore the tips of three clinically used types of spinal needles--Quincke (27-gauge), two-zone bevel (26-gauge), and Sprotte or pencil point (27-gauge)--were prepared for microscopic analysis after subarachnoid puncture in human cadavers. METHODS: Three cadavers were placed in the lateral position, the backs were scrubbed with disinfectant solution containing 0.1% fluorescein, and 12 needles of each type (half of them through an introducer) were inserted via interspaces L2-L5 into the subarachnoid space. Under visual control (spinal canal opened), the needle tips were cut and collected for fluorescence microscopy. Another eight needles of each type (half through an introducer) were inserted, the tips were collected into tubes filled with physiologic saline, and cytocentrifuged smears of the eluted material were made. RESULTS: On microscopy, only one of the two-zone bevel needles and two of the pencil point needles, placed through an introducer, were without attachments. All the others had variable amounts of fluorescence, and visible tissue particles adhered to the tip. The largest particles appeared on two of the Quincke needle tips. Bent tips were seen on 7 of the 12 two-zone bevel needles. The Quincke group had two and the pencil point group no bent needle tips. Clusters of epithelioid cells were seen in the cytocentrifugation smears of Quincke and two-zone bevel needle tips, but only very few cellular clusters were seen in the smears from the pencil point needle tips. CONCLUSIONS: Of the three needle types studied, the pencil point type has a tip that best withstands distortion and adherence of foreign material during experimental subarachnoid puncture.