Diabetes and impaired glucose metabolism is associated with more cold-related cardiorespiratory symptoms.

AIMS: Diabetes and impaired glucose metabolism cause metabolic, neural and circulatory disturbances that may predispose to adverse cooling and related symptoms during the cold season. This study assessed the prevalence of cold-related cardiorespiratory symptoms in the general population according to glycaemic status. METHODS: The study population consisted of 2436 men and 2708 women aged 45-74years who participated in the National FINRISK cold sub-studies in 2002 and 2007. A questionnaire assessed cold-related symptoms (respiratory, cardiac, peripheral circulation). Glycaemic status was determined based on fasting blood glucose, oral glucose tolerance tests or reported diagnosis of diabetes and categorized into normal glucose metabolism, impaired fasting blood glucose, impaired glucose tolerance, screening-detected type 2 diabetes and type 2 diabetes. RESULTS: Type 2 diabetes was associated with increased odds for cold-related dyspnoea [Adjusted OR 1.72 (95% CI, 1.28-2.30)], chest pain [2.10 (1.32-3.34)] and respiratory symptoms [1.85 (1.44-2.38)] compared with normal glucose metabolism. Screened type 2 diabetes showed increased OR for cold-related dyspnoea [1.36 (1.04-1.77)], cough [1.41 (1.06-1.87)] and cardiac symptoms [1.51 (1.04-2.20)]. Worsening of glycaemic status was associated with increased odds for cold-related dyspnoea (from 1.16 in impaired fasting glucose to 1.72 in type 2 diabetes, P=0.000), cough (1.02-1.27, P=0.032), chest pain (1.28-2.10, P=0.006), arrhythmias (0.87-1.74, P=0.020), cardiac (1.11-1.99, P=0.000), respiratory (1.14-1.84, P=0.000) and all symptoms (1.05-1.66, P=0.003). CONCLUSIONS: Subjects with diabetes and pre-diabetes experience more cold-related cardiorespiratory symptoms and need instructions for proper protection from cold weather to reduce adverse health effects.

Serum parathyroid hormone and active vitamin D in chronic periodontitis.

OBJECTIVES: To study the association between periodontitis and serum parathyroid hormone (PTH) and the response of PTH to periodontal therapy in type 1 diabetic patients (T1DM). We also investigated the PTH-1,25(OH)2 D axis in the T1DM group. METHODS: Periodontal health status was recorded in 54 periodontitis patients and 30 periodontally healthy controls (case-control data). Data were also collected from patients with type 1 diabetes mellitus at the baseline (n = 76) and after periodontal therapy (intervention data) (n = 53). RESULTS: Periodontitis was not associated with serum PTH in the case-control data or at the baseline of the intervention data. A post-therapy increase in serum PTH was found in 61% of the T1DM patients; in patients with moderate or severe periodontitis (n = 26) the average increase was 0.6 pmol/l (p = 0.016) and in patients with no or mild periodontitis (n = 27) 0.2 pmol/l (p = 0.250). In 47% of the T1DM patients, an increase in PTH was associated with an increase in serum 1,25(OH)2 D. CONCLUSION: An association between serum PTH and periodontal infection was found only after periodontal therapy in T1DM patients. This post-treatment response in serum PTH may partly explain the previously reported increase in serum 1,25(OH)2 D.

Serum 1,25(OH)D level increases after elimination of periodontal inflammation in T1DM subjects.

OBJECTIVES: The aim of the present study was to investigate associations between serum concentrations of vitamin D metabolites, 25-hydroxyvitamin D [25(OH)D], and its active form, 1,25-dihydroxyvitamin D [1,25(OH)D], and the severity of chronic periodontitis. SUBJECTS AND DESIGN: Presence of dental plaque, probing pocket depth (PD), and attachment level in 80 type 1 diabetes mellitus subjects were recorded. The serum levels of 25(OH)D, 1,25(OH)D, ultrasensitive C-reactive protein, IL-6, TNF-α, high-density lipoprotein cholesterol, and glycosylated hemoglobin (percentage) were determined. Multivariate regression models were used to explore the associations between serum 25(OH)D (nanomoles per liter) and 1,25(OH)D (picomoles per liter) levels and periodontal health status. INTERVENTION: Antiinfective periodontal therapies were delivered and the clinical examination and laboratory analyses were repeated 8 weeks after the therapies. RESULTS: A statistically significant association was found between the serum level of 1,25(OH)D (odds ratio 1.06, 95% confidence interval 1.02-1.11) and periodontal health at the baseline; subjects with a high level were more likely to belong to the group of no or mild periodontitis. The serum level of 1,25(OH)D showed a statistically significant increase after antiinfective periodontal therapy in both no or mild (P = .001) and moderate or severe periodontitis (P < .001) subjects. The association between serum 25(OH)D level and periodontal health was negligible. CONCLUSION: This study has shown a significant positive association between the serum 1,25(OH)D level and periodontal health status. To what extent this association is causal in nature remains to be confirmed.

Serum osteoprotegerin and periodontal destruction in subjects with type 1 diabetes mellitus.

AIM: Besides their role in bone metabolism, receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) are also known to be associated with inflammation. We explored associations between the extent/severity of periodontitis and circulating levels of sRANKL and OPG and their ratio using a cross-sectional study design. SUBJECTS & METHODS: The extent of periodontal inflammation and tissue destruction and the serum levels of sRANKL (pg/ml) and OPG (pg/ml) were determined in 80 subjects with type 1 diabetes mellitus (T1DM). Plaque-, age-, gender-, smoking-, HbA1c- and body mass index-adjusted associations between periodontal parameters and serum sRANKL, OPG and their ratio were studied using multiple linear regression analysis. RESULTS: Adjusted regression analyses of all the subjects indicated a significant positive association between AL ≥ 4 mm and severity of periodontitis and the level of serum OPG. A major drop in the strength and statistical significance of the above association was observed when the analyses included only non-smokers. Serum sRANKL level and sRANKL/OPG ratio were not associated with periodontitis. CONCLUSION: Our observations suggest that serum OPG may be an indicator of periodontal tissue destruction in T1DM.

Ten-year natural course of habitual snoring and restless legs syndrome in a population aged 61-63 years at the baseline.

PURPOSE: We investigated the prevalence, natural course, and associated risk factors of habitual snoring (HS) and restless legs syndrome (RLS) over a period of 10 years among an aging population from their early sixties to their seventies. METHODS: A population-based follow-up study among all persons born in 1935 and living in the city of Oulu in northern Finland was conducted. In this study, we examined subjects who had participated in two subsequent surveys conducted in 1996-1998 and 2007-2008. The data were gathered by questionnaires, as well as by laboratory and clinical measurements. RESULTS: Altogether 457 (55%) of the 838 eligible subjects participated in both surveys. The prevalence of both RLS and HS decreased during the 10 years from 21% to 15% and from 26% to 19%, respectively. Half of those who snored in 1996-1998 stopped snoring in 10 years time, and half of those who suffered from restless legs at least three times per week in 1996-1998 suffered from this syndrome never or less than once a week in 2007-2008. The 10-year incidence of new cases of both HS and RLS was 7%. Male gender predicted best the incidence of new HS in 10 years, while the Zung sum score as a marker of depressive symptoms and waist circumference predicted RLS. CONCLUSIONS: Overall, the prevalence of both HS and RLS seems to diminish during aging. The causes behind this still remain unknown and should be investigated with more sophisticated methods.

Season of the first trimester of pregnancy predicts sensitisation to food allergens in childhood: a population-based cohort study from Finland.

OBJECTIVE: To examine whether the season of birth or season of the early phase of gestation is associated with sensitisation to food allergens in children, with special reference to mothers' pollen exposure in spring. DESIGN: A population-based cohort study linking information from a questionnaire survey to allergy tests performed on the target population and regional pollen counts. POPULATION: Children born in 2001-6 who were resident in the province of South Karelia, Finland, at the time of the survey (N=5920). MAIN OUTCOME MEASURES: A positive result in any food allergy test or food-specific immunoglobulin E test (sIgE). RESULTS: The cumulative incidence of a positive food allergy test up to the age of 4 years was highest among children born in October-November (10%) and lowest among those born in June-July (5%), and correspondingly highest among children who were in their 11th gestational week in April-May (11%), the season of high concentrations of birch and alder pollen, and lowest among those reaching that stage in December-January (6%). The amplitude of seasonal variation in any test, estimated as the relative ratio between the peak and trough of the smoothed incidence curve over the year, was 2.03 (95% CI 1.52 to 2.76). The amplitudes of positive sIgE were especially pronounced for milk (3.07; 95% CI 1.81 to 5.50) and egg (3.03; 95% CI 1.86 to 5.18). CONCLUSIONS: Children having their early gestational period in the pollen season for broad-leafed trees are more prone to sensitisation to food allergens than other children.

Serum high-density lipoprotein cholesterol level associated with the extent of periodontal inflammation in type 1 diabetic subjects.

AIM: High-density lipoprotein (HDL) cholesterol is known for its anti-inflammatory and antioxidant activities in protection against cardiovascular diseases. We investigated whether a protective association also exists between serum HDL and periodontal inflammation in type 1 diabetic subjects (T1DM). METHODS: Plaque and periodontal inflammation (bleeding and PD ≥ 4 mm) were examined in 80 subjects with T1DM. The serum levels of glycosylated haemoglobin (HbA1c, %) and HDL (mmol/l) were determined. Adjusted associations between inflammation and serum HDL were analysed using linear regression analysis. To study the linearity of the association, the subjects were categorized into HDL tertiles (I-III). RESULTS: A statistically significant negative association was observed between serum HDL level and the extent of bleeding and PD ≥ 4 mm. Subjects in HDL tertiles II and III (high HDL) presented significantly fewer inflamed sites when compared with the subjects in tertile I (low HDL), whereas no significant difference in the number of inflamed sites was observed between tertiles II and III. CONCLUSIONS: Based on the finding of a negative association between serum HDL and periodontal inflammation, HDL may be considered a marker of susceptibility to periodontal inflammation. A longitudinal study is needed to verify possible causal relationship between serum HDL and inflammation.

Serum interleukin-6 may modulate periodontal inflammation in type 1 diabetic subjects.

AIMS: To evaluate the associations between serum inflammatory biomarkers and periodontal inflammation in subjects with type 1 diabetes mellitus (T1DM). Our hypothesis was that local host responses may be modulated by the serum inflammatory mediators. MATERIAL AND METHODS: Plaque, bleeding on probing and probing pocket depth (PD) were examined in 80 T1DM subjects at the baseline and in 58 subjects 8 weeks after periodontal therapy. The levels of glycosylated haemoglobin, serum interleukin (IL)-6, ultrasensitive C-reactive protein and the lipid profile were measured at the baseline and after therapy. Stratification of the sample separately by smoking and body mass index (BMI) was performed. Adjusted associations between the levels of systemic biomarkers and periodontal parameters were studied using multiple regression models. RESULTS: The level of serum IL-6 was associated with the extent of bleeding and PD≥4 mm at the baseline in non-smokers and in subjects with BMI≤26 kg/m(2). These associations were also evident after periodontal therapy. Subjects with a high after-therapy IL-6 level presented poorer periodontal healing than those with a low level. CONCLUSIONS: The observed associations may be considered to be suggestive of a modulatory effect of IL-6 on host responses in T1DM subjects.

Real-life epidemiology of food allergy testing in Finnish children.

BACKGROUND: The cumulative incidence of parental-reported symptoms of food allergy (FA) during the first years of life is estimated to exceed 30%. However, the occurrence and determinants of FA testing in a general child population have remained unknown. METHODS: The study population comprised all 5920 children aged 0-4 yr in the province of South Karelia, Finland, identified from the nationwide population register. The study included a questionnaire survey and a retrospective collection of FA test results (skin prick tests, IgE antibodies, or open food challenges) from the patient records of the entire study population. The questionnaire and patient record data were linked together on an individual basis with the parents' permission. RESULTS: A total of 5849 FA tests had been performed on 961 children. By the age of 4 yr, the cumulative incidence of FA testing was 18% for any food item; 17% for essential items (milk, egg, cereals) and 9% for other food items. Essential food items had been tested in 90% of children who reportedly had a physician-diagnosed FA for these. The incidence of testing was 30% higher in boys than in girls and twofold higher among the offspring whose either or both parents reportedly had some allergic manifestation. CONCLUSIONS: A large proportion of children are subjected to FA testing in their early years. This result shows the need to evaluate the financial burden of FA testing and to improve current testing practices.

SKARP--A population-based cohort study of childhood food-associated symptoms perceived by parents and food allergies diagnosed by physicians: design, methods and participation.

BACKGROUND: Few epidemiological studies exist on food-associated symptoms and allergies in large unselected child populations. AIMS: To describe the design, methods and participation rate of the South Karelian Allergy Research Project (SKARP), a population-based epidemiological study on food-associated symptoms and physician-diagnosed food allergies. METHODS: The study population of 5,973 children born between 2001 and 2006 and resident in the province of South Karelia, Finland, was identified from the nationwide population register. The parents received a questionnaire to be returned at their child's annual visit to the child health clinic, where supplementary interviews were performed. Results of allergy tests (skin prick tests, immunoglobulin E antibodies and open food challenges) performed on participants and non-participants were collected from the relevant health care units in the area. RESULTS: Participation rates in the questionnaire study were 54% (644/1,194) among the parents of neonates and 69% (3308/4,779) among those of the children aged 1 to 4 years. Cooperation with the child health clinics and mailing of a reminder questionnaire improved participation by 8 and 10 percentage points, respectively. The final participation rate seemed to be unaffected by whether the child had or had not been tested for suspected allergy. CONCLUSIONS: A reasonably good participation rate and almost complete coverage of allergy tests were achieved thanks to successful cooperation with the child health clinics and test laboratories. This baseline study forms a representative database to estimate the occurrence of food-associated symptoms, physician-diagnosed food allergies and allergy testing in the general population.

Heredity of food allergies in an unselected child population: an epidemiological survey from Finland.

The heredity of food allergies (FA) has not previously been addressed in a large unselected child population. Our target population comprised all children born from April 2001 to March 2006 resident in one province of South-East Finland (n c. 6000), as identified from the national population register. In a questionnaire survey conducted in 2005-2006, data were obtained on allergic manifestations (FA symptoms, atopic rash, allergic asthma, hay fever/pollen allergy, or animal allergy) in the biologic parents of 3800 children (64% of the total). Concurrently with the survey but independently of it, results of specific immunoglobulin E antibodies (sIgE), skin prick tests (SPT), and open food challenges (OFC) in the offspring were collected from patient records throughout the province. Up to the age of 4 yr, the incidences of any positive FA test, a positive SPT or sIgE for food items, and a positive OFC in these children were threefold higher if both parents reported having an allergic manifestation and twofold higher if either mother or father had such a manifestation when compared with children whose parents did not report any of these conditions. The estimated risk of any positive FA test increased by a factor of 1.3 (95% CI 1.2-1.4) for each additional allergic manifestation in the parents. Positive FA tests in the offspring were relatively strongly associated with the reports of allergic phenotypes and the number of these phenotypes in their biologic parents.

Occurrence of parent-reported food hypersensitivities and food allergies among children aged 1-4 yr.

Food allergies (FAs) and hypersensitivities (FHSs) have rarely been studied in large unselected child populations. This population-based cross-sectional survey estimated the occurrence of FHS as perceived by parents and that of FA diagnosed by a physician among children aged 1-4 yr in south-eastern Finland. Before the scheduled annual follow-up visit to the local child health clinic, the parents of children who were born between 1 April, 2001 and 31 March, 2005, and living in the Province of South Karelia (data from Finnish Population Register) were mailed a questionnaire containing items on the child's background, physician-diagnosed FAs and FHSs perceived by the parents. The questionnaires were returned during the visit. Three thousand three hundred and eight (69%) out of the 4779 questionnaires were returned. The lifetime prevalence of physician-diagnosed FAs was 9%. In an additional 21%, FHSs were perceived by the parents only. In a further 19% at least one food item had been eliminated from the diet without any perception of symptoms, this proportion having a downward trend by age. Physician-diagnosed FAs were more common in boys than in girls. Cow's milk was the most commonly reported cause of food-associated symptoms (13% of all children). One-third of the children aged 1-4 yr suffered from food-associated symptoms, and in an additional fifth at least one food item had been eliminated from their diet, implying that every other child had possibly been subjected to some form of elimination diet.

Resolution of periodontal inflammation does not guarantee improved glycemic control in type 1 diabetic subjects.

OBJECTIVE: The aim of this study was to find out if periodontal therapy has any effect on glycemic control of type 1 diabetes mellitus (DM). SUBJECTS AND METHODS: The periodontal health status of 65 type 1 diabetic subjects was assessed at the baseline and 8 weeks after completion of periodontal therapy. Glycemic control was assessed on both visits by measuring the percentage of glycosylated haemoglobin (GHbA1c). The change in HbA1c (DeltaHbA1c) was assessed by using both a positive or negative change >or=0.5% and any change in HbA1c. RESULTS: The mean HbA1c level (+/-SD) of the whole study group was 8.6% (+/-1.5) at the baseline and 8.5% (+/-1.5) after treatment. Glycemic control improved during the study period in 23 subjects (35%) and worsened in 18 subjects (28%). Approximately 78% of the bleeding sites and 87% of the sites with probing depth >or=4 mm presented healing. DeltaHbA1c associated significantly with baseline HbA1c but not with baseline periodontal health status or periodontal healing. CONCLUSION: Regardless of a significant resolution of periodontal infection, a great majority of the subjects did not present any improvement in their glycemic control.

IL-6(-174) genotype associated with the extent of periodontal disease in type 1 diabetic subjects.

AIM: The aim of this study was to investigate whether genetic polymorphism in certain cytokine and receptor molecule genes and diabetic status associate with the extent of periodontal disease in type 1 diabetes mellitus (DM). MATERIAL AND METHODS: Eighty patients with type 1 DM participated. Visible plaque, bleeding on probing (BOP), probing pocket depth (PD) and attachment level (AL) were examined clinically and glycosylated haemoglobin (HbA1c) levels were used to assess the glycemic control of DM. CD-14, IL-6, TNF-alpha, IL-10, IL-1alpha, IL-1beta and TLR-4 gene polymorphisms were studied using the polymerase chain reaction (PCR). RESULTS: The 3-year HbA1c was good (<7.5%) in 16%, acceptable (7.5-8.5%) in 36% and poor (>8.5%) in 48% of the subjects. IL-6(-174) genotype and 3-year GHbA1c associated significantly with BOP and PD>or=4 mm, subjects with the GG genotype of the IL-6(-174) exhibiting more severe periodontal disease than those with the GC/CC genotype. After stratification by IL-6 genotype, associations between the extent of periodontal disease and 3-year HbA1c levels remained significant in subjects carrying the GC/CC but not the GG genotype. CONCLUSIONS: In addition to the HbA1c level, the IL-6(-174) genotype is a significant susceptibility factor for periodontal disease among type 1 diabetics.

Association of abnormal glucose tolerance with self-reported sleep apnea among a 57-year-old urban population in Northern Finland.

AIMS: We examined the associations between glucose tolerance and sleep apnea in a 57-year-old unselected urban population in Northern Finland, taking into account some determinants of sleep apnea. METHODS: A population-based health survey was conducted in a population of 555 women and 438 men born in 1945 and living in the city of Oulu in 2001. Glucose status was determined with a standard 2-h oral glucose tolerance test. Sleeping disorders were recorded on the Epworth Sleepiness Scale (ESS) and a questionnaire including 5 questions about sleeping and snoring. The Zung Self-rated Depression Scale (ZSDS) was used to assess depressive symptoms. Logistic regression was used in the estimation of odds ratios (OR) for the associations of sleep apnea with the covariates. RESULTS: Sleep apnea was found to be associated with type 2 diabetes (OR 2.56, 95% CI 1.20-5.47) and newly diagnosed type 2 diabetes (OR 2.42 95% CI 1.01-5.82), but the estimated association with impaired glucose regulation (IGR) was coupled with a wide margin of error (OR 0.91, 95% CI 0.43-1.93) when adjusted for the following covariates: gender, current smoking, hypertension, hs-CRP, physical activity, waist circumference, and Zung depression scale. CONCLUSIONS: There seems to be a positive association between sleep apnea and type 2 diabetes, and even with newly diagnosed type 2 diabetes, but we could not establish an association with IGR.

Coffee consumption and mortality in a 14-year follow-up of an elderly northern Finnish population.

The present study assessed the relationship between coffee consumption and mortality in a home-dwelling elderly population. A population-based cohort of 817 men and women born in 1920 or earlier and living in northern Finland provided complete data on daily coffee consumption and other variables at the baseline examination in 1991-1992. Deaths were monitored through to the end of 2005 by national death certificates, resulting in 6960 person-years of follow-up. Hazard rate ratios for mortality by daily coffee intake were estimated by Poisson regression models adjusted for some known predictors of mortality. During 14.5 years of follow-up, 623 deaths occurred. The total mortality rate was inversely related to the number of cups (average volume, 125 ml) of coffee consumed daily. After adjustment for age, sub-period of follow-up, sex, marital status, basic educational level, previous occupational group, current smoking, BMI, history of myocardial infarction, self-rated health and presence of diabetes, cognitive impairment or physical disability, the estimated relative risk reduction of total mortality per an increment of one more cup of coffee per d reported at baseline was 4 (95% CI 0, 8) %. The observed associations between coffee consumption and mortality from CVD, cancer, and other or unknown causes, respectively, were qualitatively similar to that of total mortality but the estimates were less precise. The effect of coffee consumption at baseline appeared to attenuate after 10 years since the start of follow-up. The present study provides evidence for daily (caffeine-containing) coffee intake being inversely associated with mortality in the elderly.

Obesity and low-grade inflammation among young Finnish men with early-onset alopecia.

BACKGROUND: Previous investigations have revealed an association of androgenetic alopecia (AGA), especially in younger subjects with severe early-onset AGA, with ischemic heart disease. OBJECTIVE: To examine the possible association between early-onset alopecia and low-grade inflammation measured by high-sensitivity C-reactive protein (hs-CRP) that has been recommended for the assessment of the cardiovascular disease (CVD) risk. METHODS: The study population consisted of young men (n = 727, aged 25-34 years) participating in a national survey. The grade of alopecia was assessed by a trained nurse using the Norwood/Hamilton Classification Scale. RESULTS: Men with moderate to extensive alopecia (17%) had a higher body mass index and larger waist, upper arm, hip and waist circumference than those with little to no alopecia (p < 0.05), and statistically insignificant differences were seen in the waist-to-hip circumference ratio (WHR), diastolic blood pressure and hs-CRP. With increasing hs-CRP, the mean WHR increased, but only among men with moderate to extensive alopecia (p = 0.043). CONCLUSION: Our findings show a relation between moderate to extensive alopecia and low-grade inflammation--a predictor of a future CVD--especially combined with central obesity, among men younger than 35 years.