APOE Genotypes, Lipid Profiles, and Associated Clinical Markers in a Finnish Population with Cardiovascular Disease Risk Factors.

INTRODUCTION: The APOE ε4 allele predisposes to high cholesterol and increases the risk for lifestyle-related diseases such as Alzheimer's disease and cardiovascular diseases (CVDs). The aim of this study was to analyse interrelationships of APOE genotypes with lipid metabolism and lifestyle factors in middle-aged Finns among whom the CVD risk factors are common. METHODS: Participants (n = 211) were analysed for APOE ε genotypes, physiological parameters, and health- and diet-related plasma markers. Lifestyle choices were determined by a questionnaire. RESULTS: APOE genotypes ε3/ε4 and ε4/ε4 (ε4 group) represented 34.1% of the participants. Genotype ε3/ε3 (ε3 group) frequency was 54.5%. Carriers of ε2 (ε2 group; ε2/ε2, ε2/ε3 and ε2/ε4) represented 11.4%; 1.9% were of the genotype ε2/ε4. LDL and total cholesterol levels were lower (p < 0.05) in the ε2 carriers than in the ε3 or ε4 groups, while the ε3 and ε4 groups did not differ. Proportions of plasma saturated fatty acids (SFAs) were higher (p < 0.01), and omega-6 fatty acids lower (p = 0.01) in the ε2 carriers compared with the ε4 group. The ε2 carriers had a higher (p < 0.05) percentage of 22:4n-6 and 22:5n-6 and a lower (p < 0.05) percentage of 24:5n-3 and 24:6n-3 than individuals without the ε2 allele. CONCLUSIONS: The plasma fatty-acid profiles in the ε2 group were characterized by higher SFA and lower omega-6 fatty-acid proportions. Their lower cholesterol values indicated a lower risk for CVD compared with the ε4 group. A novel finding was that the ε2 carriers had different proportions of 22:4n-6, 22:5n-6, 24:5n-3, and 24:6n-3 than individuals without the ε2 allele. The significance of the differences in fatty-acid composition remains to be studied.

Long-term outcomes of lifestyle intervention to prevent type 2 diabetes in people at high risk in primary health care.

AIMS: The Finnish National Diabetes Prevention Program (FIN-D2D) was the first large-scale diabetes prevention program in a primary health care setting in the world. The risk reduction of type 2 diabetes was 69% after one-year intervention in high-risk individuals who were able to lose 5% of their weight. We investigated long-term effects of one-year weight change on the incidence of type 2 diabetes, cardiovascular events, and all-cause mortality. METHODS: A total of 10,149 high-risk individuals for type 2 diabetes were identified in primary health care centers and they were offered lifestyle intervention to prevent diabetes. Of these individuals who participated in the baseline screening, 8353 had an oral glucose tolerance test (OGTT). Complete follow-up data during one-year intervention were available for 2730 individuals and those were included in the follow-up analysis. The long-term outcome events were collected from national health registers after the median follow-up of 7.4 years. RESULTS: Among individuals who lost weight 2.5-4.9% and 5% or more during the first year, the hazard ratio for the incidence of drug-treated diabetes was 0.63 (95% CI 0.49-0.81, p = 0.0001), and 0.71 (95% CI 0.56-0.90, p = 0.004), respectively, compared with those with stable weight. There were no significant differences in cardiovascular events or all-cause mortality among study participants according to one-year weight changes. CONCLUSIONS: High-risk individuals for type 2 diabetes who achieved a moderate weight loss by one-year lifestyle counseling in primary health care had a long-term reduction in the incidence of drug-treated type 2 diabetes. The observed moderate weight loss was not associated with a reduction in cardiovascular events.

APOE Genotype Disclosure and Lifestyle Advice in a Randomized Intervention Study with Finnish Participants.

BACKGROUND: The APOE ε4 allele is associated with higher risks of cardiovascular diseases and Alzheimer disease than ε3 and ε2. OBJECTIVES: We studied the effectiveness of dietary and lifestyle guidance and personal genetic risk information [ε4 carrier (ε4+); ε4 noncarrier (ε4-)] as motivators for a healthier lifestyle. METHODS: A total of 188 healthy Finnish volunteers (82.4% women; mean ± SD age: 51.0 ± 5.6 y; BMI: 26.0 ± 3.6 kg/m2; total cholesterol: 5.2 ± 0.9 mmol/L) participated in our randomized intervention study. The participants were genotyped for APOE and divided into intervention (INT; INTε4+, n = 33; INTε4-, n = 57) and control groups (CTRL; CTRLε4+, n = 36; CTRLε4-, n = 62). Blood samples, measured observations, and questionnaire data were obtained at baseline and at 1 and 1.5 y. INT participants received their ε4 carrier status at baseline. Monthly Internet-based guidance based on the Finnish Dietary guidelines was provided for all. RESULTS: The proportion of SFAs in plasma over time fluctuated less in INTε4+ than in the other groups (P-interaction < 0.05; primary outcome). The lifestyle guidance increased vegetable consumption from 3.5 to 3.6 portions/d, improved the dietary fat quality score by 5.3%, increased the plasma n-3 (ω-3) FA proportion by 7.3%, and decreased the consumption of high-fat/high-sugar foods from 7.3 to 6.5 portions/wk and total- and LDL-cholesterol concentrations by 4.3% and 6.1%, respectively, in the entire participant population (P < 0.05; secondary outcome). Compared with the ε4- participants, ε4+ participants had 2.4% higher plasma n-6 (ω-6) FA, lower C-peptide (3.9 compared with 4.2 nmol/L × h) and sensitive C-reactive protein values, and decreased plasma malondialdehyde concentrations over time (P < 0.05; secondary outcome). CONCLUSIONS: Lifestyle guidance given to healthy Finnish participants yielded small but beneficial changes. The INTε4+ group did not seem markedly more responsive to the guidance than the other groups.This trial was registered at clinicaltrials.gov as NCT03794141.

Genetic Variants in SGLT1, Glucose Tolerance, and Cardiometabolic Risk.

BACKGROUND: Loss-of-function mutations in the SGLT1 (sodium/glucose co-transporter-1) gene result in a rare glucose/galactose malabsorption disorder and neonatal death if untreated. In the general population, variants related to intestinal glucose absorption remain uncharacterized. OBJECTIVES: The goal of this study was to identify functional SGLT1 gene variants and characterize their clinical consequences. METHODS: Whole exome sequencing was performed in the ARIC (Atherosclerosis Risk in Communities) study participants enrolled from 4 U.S. communities. The association of functional, nonsynonymous substitutions in SGLT1 with 2-h oral glucose tolerance test results was determined. Variants related to impaired glucose tolerance were studied, and Mendelian randomization analysis of cardiometabolic outcomes was performed. RESULTS: Among 5,687 European-American subjects (mean age 54 ± 6 years; 47% male), those who carried a haplotype of 3 missense mutations (frequency of 6.7%)-Asn51Ser, Ala411Thr, and His615Gln-had lower 2-h glucose and odds of impaired glucose tolerance than noncarriers (ß-coefficient: -8.0; 95% confidence interval [CI]: -12.7 to -3.3; OR: 0.71; 95% CI: 0.59 to 0.86, respectively). The association of the haplotype with oral glucose tolerance test results was consistent in a replication sample of 2,791 African-American subjects (ß = -16.3; 95% CI: -36.6 to 4.1; OR: 0.39; 95% CI: 0.17 to 0.91) and an external European-Finnish population sample of 6,784 subjects (ß = -3.2; 95% CI: -6.4 to -0.02; OR: 0.81; 95% CI: 0.68 to 0.98). Using a Mendelian randomization approach in the index cohort, the estimated 25-year effect of a reduction of 20 mg/dl in 2-h glucose via SGLT1 inhibition would be reduced prevalent obesity (OR: 0.43; 95% CI: 0.23 to 0.63), incident diabetes (hazard ratio [HR]: 0.58; 95% CI: 0.35 to 0.81), heart failure (HR: 0.53; 95% CI: 0.24 to 0.83), and death (HR: 0.66; 95% CI: 0.42 to 0.90). CONCLUSIONS: Functionally damaging missense variants in SGLT1 protect from diet-induced hyperglycemia in multiple populations. Reduced intestinal glucose uptake may protect from long-term cardiometabolic outcomes, providing support for therapies that target SGLT1 function to prevent and treat metabolic conditions.

The effect of age and gender on the genetic regulation of serum 25-hydroxyvitamin D - the FIN-D2D population-based study.

In addition to sunlight and dietary sources, several genes in the metabolic pathway of vitamin D affect serum 25-hydroxyvitamin D (25OHD) concentration. It is not known whether this genetic regulation is influenced by host characteristics. We investigated the effect of age and gender on the genetic regulation of serum 25OHD concentration. In total, 2868 Finnish men and women aged 45-74 years participated in FIN-D2D population-based health survey in 2007. Of the 2822 participants that had serum 25OHD concentration available, 2757 were successfully genotyped. Age and gender-dependent association of SNPs with serum 25OHD concentration was studied in 10 SNPs with previously found association with vitamin D metabolites. Associations of 3 SNPs with serum 25OHD concentration were dependent on age with greater effects on younger (≤60 y) than older (>60 y) adults (rs10783219 in VDR, rs12512631 in GC and rs3794060 in NADSYN1/DHCR7; pinteraction = 0.03, 0.02 and 0.01, respectively). The results suggested a novel association between serum 25OHD concentration and rs8082391 in STAT5B gene in men but not in women (pinteraction = 0.01). After multiple testing correction with false discovery rate method, two age-dependent interactions (rs3794060 in NADSYN1/DHCR7 gene and rs12512631 in GC gene) remained statistically significant. This is the first study to suggest that genetic regulation of serum 25OHD concentration is age-dependent. Our results also indicated a novel association between serum 25OHD concentration and SNP in STAT5B gene in men. The results need to be confirmed in future studies preferably in a larger sample.

A Long-Term Follow-Up Study on Disclosing Genetic Risk Information (APOE) to Promote Healthy Lifestyles in Finland.

AIM: This observational follow-up study was designed to assess the long-term behavioural and clinical effects of receiving personal genetic risk information. The information disclosed was the carrier status of the apolipoprotein E (APOE)alleles, which differentially contribute to the genetic risk for cardiovascular disease (CVD) and Alzheimer's disease. METHODS: This study forms a continuum with a previous 1-year intervention (2010-2011) monitoring the effects of disclosing the carrier status of the APOE ε4risk allele. The follow-up measurements, performed 5.5 years post-intervention, included clinical measurements (blood values and anthropomorphic parameters) and questionnaires (psychological and behavioural factors). The participants were healthy adult volunteers, aged 26-73 years (n = 70) who had participated in the previous intervention, and received their APOE allele status either at the beginning (former test group) or the end of the intervention (former control group). RESULTS: Personal genetic risk information resulted in a moderate health-conscious change in diet and had a slight positive long-term effect on clinical factors, particularly the serum lipids. These improvements were subsequent to the disclosure of genetic information and occurred mainly in the APOE ε4-positive members of the former control group, that is, those who were at increased genetic risk for CVD but had not been informed of their status before the end of the intervention. In contrast, changes in the values and health behaviour of the APOE ε4-positive individuals in the former test group, who had already changed their health behaviour during the previous intervention as a result of being informed of their carrier status, varied more: some continued to improve, some remained at their previously improved level, and some relapsed slightly. Both groups had nonetheless displayed an improvement immediately subsequent to the disclosure of their personal genetic risk. CONCLUSION: Receiving information on increased personal genetic risk (carrier status of APOE ε4)for CVD provided the motivation for improvements in health behaviour. The resulting changes, while modest, in most cases remained visible even after a number of years.

[Update on current care guidelines. Current care guideline: Acute lower respiratory tract infection in adults]. / Kaypa hoite-suosituksen paivitystiivistelma. Alahengitystieinfektiot (aikuiset).

Pneumonia is recognised in patients suffering from acute cough or deteriorated general condition. Patients with acute cough without pneumonia-related symptoms or clinical findings do not benefit from antimicrobial treatment. Those with suspected or confirmed pneumonia are treated with antibiotics, amoxicillin being the first choice. Most patients with pneumonia can be treated at home. Those with severe symptoms are referred to hospital. Patients are always encouraged to contact his/her physician if the symptoms worsen or do not ameliorate within 2-3 days. Patients aged 50 years or older and smokers are controlled by thoracic radiography in 6-8 weeks.

Changes in lifestyle modestly reduce the estimated cardiovascular disease risk in one-year follow-up of the Finnish diabetes prevention program (FIN-D2D).

AIMS: The purpose of this study was to assess whether changes in self-rated physical activity and diet during a type 2 diabetes (T2D) prevention program were associated with changes in estimated 10-year risk for cardiovascular disease (CVD) events and mortality in people at high risk for T2D. METHODS: Individuals were identified and offered lifestyle counseling as part of the Finnish diabetes prevention program. Ten-year risk for estimated CVD events and mortality were calculated with Framingham Risk Score (FRS) and Systematic Coronary Risk Evaluation (SCORE) formula. FRS was available for 774 men and 1474 women and SCORE for 961 men and 1766 women. RESULTS: During the one-year follow-up, 9.6% of the men reported both an increase in physical activity and improved dietary pattern, 4.1% an increase in physical activity, 39.3% an increase in improved dietary pattern, while 47.0% reported no lifestyle changes. Corresponding numbers for women were 14.2%, 3.8%, 39.2% and 42.7%. Estimated 10-year risk for CVD events decreased 3.5% in men and 1.5% in women reporting an increase in physical activity and improvement in diet, compared to an increase of 0.15% in men (p<0.001, between groups) and decrease of 0.43% (p=0.027, between groups) in women with no lifestyle changes after adjustment for age and baseline FRS. Numbers needed to treat to prevent one CVD event by lifestyle changes were 25 for men and 59 for women. Lifestyle changes had no effect on estimated CVD mortality risk. CONCLUSIONS: Lifestyle counseling offered in primary health care for one year results in favorable changes in lifestyle, and lowered the estimated 10-year risk for CVD events.

An intervention study of individual, apoE genotype-based dietary and physical-activity advice: impact on health behavior.

AIM: To assess the behavioral effects of receiving personal genetic information, using apoE genotypes as a tool for promoting lifestyle changes. apoE was chosen because it has a significant impact on lipid metabolism and cholesterol absorption, both factors in cardiovascular disease. METHODS: This study was a 1-year intervention study of healthy adults aged 20-67 years (n = 107). Their behavioral changes were measured by diet (e.g., fat quality, as well as consumption of vegetables, berries, fruits, and fatty and sugary foods), alcohol consumption, and exercise. Health and taste attitudes were assessed with the Health and Taste Attitude Scales (HTAS). The measurements were performed 4 times: at baseline (T0), as well as 10 weeks (T1), 6 months (T2), and 12 months after baseline (T3). These behavioral effects were assessed for three groups: a high-risk (Ɛ4+; n = 16), a low-risk (Ɛ4-; n = 35), and a control group (n = 56). RESULTS: Personal genetic information affected health behavior. Dietary fat quality improved more in the Ɛ4+ group than in the Ɛ4- and control groups after personal, genotype-based health advice. This change differed significantly between the Ɛ4+ and the control group (p < 0.05), but only for a short time. CONCLUSION: Personal genetic information, based on apoE, may affect dietary fat quality. More research is required to determine how to utilize genotype-based health information and how to efficiently achieve long-term changes in the prevention of lifestyle-related diseases.

Associations of chronotype and sleep with cardiovascular diseases and type 2 diabetes.

In this study, the authors analyzed whether chronotypes, sleep duration, and sleep sufficiency are associated with cardiovascular diseases and type 2 diabetes by using the National FINRISK Study 2007 data (N = 6258), being a representative sample of the population aged 25 to 74 living in five areas of Finland. Health status assessments and laboratory measurements from the participants (N = 4589) of the DILGOM substudy were used for the detailed analysis of chronotype. Evening types had a 2.5-fold odds ratio for type 2 diabetes (p < .01) as compared with morning types, the association being independent of sleep duration and sleep sufficiency. Evening types had a 1.3-fold odds ratio for arterial hypertension (p < .05 after controlling for sleep duration or sleep sufficiency), a faster resting heart rate and a lower systolic blood pressure (both p < .01), and lower levels of serum total cholesterol and low-density lipoprotein cholesterol (both p < .0001) than morning types. There were significant 1.2- to 1.4-fold odds ratios for arterial hypertension among those with long or short sleep durations or reduced sleep sufficiency. To conclude, the behavioral trait towards eveningness is suggested to predispose individuals to type 2 diabetes in particular, whereas compromised sleep is robustly associated with arterial hypertension.

Financial satisfaction and its relationship to depressive symptoms in middle-aged and older adults: results from the FIN-D2D survey.

BACKGROUND: Studies using traditional measures of socio-economic position, such as education, income and occupation, have found inequalities in depressive symptoms, but less is known about the association between financial satisfaction and depressive symptoms. AIMS: To examine the association of depressive symptoms with financial satisfaction in Finnish adults in a population-based cross-sectional FIN-D2D survey. METHODS: Four thousand, five hundred randomly selected individuals aged 45-74 years were invited to the study. Participation rate for health examinations was 64%. Complete information on depressive symptoms and financial satisfaction was available for 2,819 individuals. Financial satisfaction was asked using a questionnaire. Depressive symptoms were measured by Beck Depression Inventory (≥ 10) and/or use of antidepressants. RESULTS: Altogether 11.6% of individuals who were satisfied with their financial situation had depressive symptoms. Corresponding figures for individuals who were somewhat satisfied or dissatisfied were 20.6% and 42.6%, respectively. Individuals who were less satisfied with their financial situation were more likely to suffer from depressive symptoms even after adjusting for gender, age, marital status, number of chronic diseases, smoking, binge drinking, physical activity, education and household income. CONCLUSIONS: Instead of more traditional measures of socio-economic position, financial dissatisfaction seems to be associated with depressive symptoms in Finnish adults.

Do statins interfere with lifestyle intervention in the prevention of diabetes in primary healthcare? One-year follow-up of the FIN-D2D project.

OBJECTIVES: To examine whether the use of statins is associated with the incidence of type 2 diabetes (T2D) and changes in glucose metabolism among individuals at high risk for T2D participating in 1-year lifestyle intervention in primary healthcare setting. DESIGN: Prospective follow-up study. SETTING: In all, 400 primary healthcare centres and occupational healthcare clinics in Finland. PARTICIPANTS: We screened altogether 10 149 individuals at increased risk for T2D; of these, 2798 non-diabetic individuals verified by a 2 h glucose tolerance test participated in the 1-year follow-up. INTERVENTIONS: Lifestyle intervention (individual and/or group-based counselling). PRIMARY OUTCOME MEASURES: Incidence of T2D and fasting and 2 h glucose measured at baseline and follow-up. RESULTS: A total of 484 individuals (17.3%) used statins at the baseline. Of them 31 (7.5%) developed T2D during the follow-up, compared to 126 (6.5%) of statin non-users (OR 1.17, 95% CI 0.78 to 1.76, p=0.442). Interestingly, fasting glucose increased by 0.08 mmol/l in statin users, but remained unchanged in non-users, the difference being 0.074 mmol/l (95% CI 0.014 to 0.134) and remained significant even after adjustment for age, sex, baseline fasting glucose, the presence of cardiovascular disease (CVD), use of antihypertensive and/or coronary artery disease medication, weight and 1-year weight change (adjusted p=0.042). CONCLUSIONS: The incidence of T2D did not differ between the statin users and non-users. The finding that fasting glucose slightly increased in statin users in spite of lifestyle interventions suggests the view that the use of statins might have unfavourable effects on glucose metabolism and that statins might hamper beneficial effects of lifestyle intervention in people at high risk of T2D.

Socioeconomic position and effectiveness of lifestyle intervention in prevention of type 2 diabetes: one-year follow-up of the FIN-D2D project.

AIMS: Lifestyle intervention is effective in prevention of type 2 diabetes (T2D) in high-risk individuals. However, health behaviour and health outcomes are modified by socioeconomic position through various mechanisms. It is therefore possible that success in lifestyle intervention may be determined by factors such as level of education or occupation. In this study we assessed the impact of the level of education and occupation on the baseline anthropometric and clinical characteristics and their changes during a one-year follow-up in a cohort of Finnish men and women at high risk for T2D aged 20-64 years. METHODS: As part of a Finnish national diabetes prevention programme 2003-2007 (FIN-D2D), high-risk individuals were identified using opportunistic screening for lifestyle intervention in primary health care. 1,067 men and 2,122 women had one-year follow-up data. Education and occupation were used as factors of socioeconomic position. Measures of anthropometric and clinical characteristics included weight, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, total, HDL and LDL cholesterol, triglycerides, FINDRISC scores and glucose tolerance status. RESULTS: The effect of intervention was similar in all socioeconomic groups, but the level of education was related to glucose tolerance status in both genders. In addition, socioeconomic differences existed in blood pressure, weight, BMI, waist circumference and HDL cholesterol. CONCLUSIONS: Socioeconomic position did not seem to have any impact on the effectiveness of lifestyle intervention in individuals at high risk for T2D, which is encouraging from the point of view of reducing health inequalities.

Population-level effects of the national diabetes prevention programme (FIN-D2D) on the body weight, the waist circumference, and the prevalence of obesity.

BACKGROUND: The implementation project of the national diabetes prevention programme in Finland, FIN-D2D, was carried out in primary health care in the area of five hospital districts during 2003-2007. METHODS: The population strategy of FIN-D2D was primarily aimed at increasing the awareness of type 2 diabetes and preventing obesity. To investigate the effects of this strategy, we studied the changes in the prevalence of obesity, overweight, and central obesity among a random independent sample of individuals aged 45-74 years in the FIN-D2D area; and assessed whether they differed from a sample of individuals in the control area, which consisted of four geographical areas not participating in FIN-D2D (FINRISK study). Data was obtained for 5850/ 6406 (in the beginning/ in the end) individuals. The duration of the observation period varied from three to five years. RESULTS: The mean body weight decreased from 78.7 to 78.1 kg (p = 0.041) in the FIN-D2D area, and from 78.7 to 78.0 kg (p = NS) in the control area. The prevalence of obesity (BMI ≥30 kg/m(2)) decreased in the FIN-D2D area (26.5% vs. 24.4%, p = 0.015), and in the control area (28.4% vs. 25.2%, p = 0.005). The prevalence of morbid obesity (BMI ≥40 kg/m(2)) remained unchanged in the FIN-D2D area, but increased in the control area (1.2% vs. 2.3%, p = 0.007). The mean waist circumference remained unchanged in the FIN-D2D area, but increased in the control area (92.8 vs. 94.0 cm, p = 0.005). CONCLUSIONS: The prevalence of obesity may be decreasing among 45-74 year old Finns. We still need a longer time perspective and future studies to see whether this favourable trend can be sustained in Finland. The actions of this implementation project can at least partly explain the differences in the mean waist circumference and the prevalence of morbid obesity between the intervention and control areas.

Association of depressive symptoms with impaired glucose regulation, screen-detected, and previously known type 2 diabetes: findings from the Finnish D2D Survey.

OBJECTIVE: To study the association between impaired glucose regulation (IGR), screen-detected type 2 diabetes, and previously known diabetes and depressive symptoms. RESEARCH DESIGN AND METHODS: Altogether, 2,712 participants from three hospital districts in Finland attended a health examination. Cutoff scores ≥10 and ≥16 in the 21-item Beck Depression Inventory (BDI-21) were used for depressive symptoms. The participants were defined as having known diabetes if they reported diabetes. An oral glucose tolerance test was used to detect normal glucose regulation (NGR), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and screen-detected diabetes. The participants were defined as having IGR if they had IFG or IGT. RESULTS: Prevalence of depressive symptoms, defined as a BDI-21 cutoff score ≥10, was 14.4% for those with NGR, 13.7% for those with IGR, 14.8% for those with screen-detected diabetes, and 26.4% for those with previously known diabetes. The corresponding prevalences for a cutoff score ≥16 were 3.4, 3.4, 4.2, and 7.5%, respectively. Compared with NGR and adjusted for demographic, lifestyle, and biological factors, the odds ratios for IGR, screen-detected diabetes, and previously known diabetes were 0.91 (95% CI 0.69-1.20), 0.70 (0.45-1.08), and 1.35 (0.84-2.15), respectively, for a cutoff score ≥10. For a cutoff score ≥16, the corresponding odds ratios were 1.05 (0.62-1.76), 0.87 (0.40-1.90), and 1.56 (0.69-3.50), respectively. CONCLUSIONS: Participants with diagnosed diabetes had a higher prevalence of depressive symptoms than participants with NGR, IGR, and previously unknown diabetes. When potential confounding factors were included in the analysis, previously known diabetes was not significantly associated with depressive symptoms.

High prevalence of obesity, central obesity and abnormal glucose tolerance in the middle-aged Finnish population.

BACKGROUND: There is a worldwide increase in the prevalence of obesity and disturbances in glucose metabolism. The aim of this study was to assess the current prevalence of obesity, central obesity and abnormal glucose tolerance in Finnish population, and to investigate the associations between body mass index (BMI), waist circumference and abnormal glucose tolerance. METHODS: A cross-sectional population-based survey was conducted in Finland during October 2004 and January 2005. A total of 4500 randomly selected individuals aged 45-74 years were invited to a health examination that included an oral glucose tolerance test. The participation rate was 62% in men and 67% in women. RESULTS: The prevalence of obesity was 23.5% (95% Confidence Interval (CI) 21.1-25.9) in men, and 28.0% (95% CI 25.5-30.5) in women. The overall prevalence of abnormal glucose tolerance (including type 2 diabetes, impaired glucose tolerance, or impaired fasting glucose) was 42.0% (95% CI 39.2-44.8) in men and 33.4% (95% CI 30.9-36.0) in women. The prevalence of previously unknown, screen-detected type 2 diabetes was 9.3% (95% CI 7.7-11.0) in men and 7.3% (95% CI 5.9-8.7) in women. Central obesity was associated with abnormal glucose tolerance within each of the three BMI categories normal (< 25 kg/m2), overweight (25-29 kg/m2), and obese (>or= 30 kg/m2). CONCLUSION: In a population-based random sample of Finnish population, prevalences of obesity, central obesity and abnormal glucose tolerance were found to be high. A remarkably high number of previously undetected cases of type 2 diabetes was detected. Waist circumference is a predictor of abnormal glucose tolerance in all categories of obesity.

Leisure time physical activity in individuals with screen-detected type 2 diabetes compared to those with known type 2 diabetes.

AIMS: To investigate whether leisure time physical activity (LTPA) characteristics differ between individuals with previously undiagnosed (screen-detected) and those with previously diagnosed (known) type 2 diabetes. METHODS: A population-based random sample of 1364 (participation rate 61%) men and 1461 (65%) women aged 45-74 years participated in a cross-sectional health examination including an oral glucose tolerance test and physical activity assessment by a self-administered questionnaire. RESULTS: Women with screen-detected type 2 diabetes (n=110) were physically less active than those with known type 2 diabetes (n=68) with differences in the duration of physical activity sessions (multivariate-adjusted P=0.041) and the number of moderate to high intensity exercise sessions per week (multivariate-adjusted P=0.007). In men no differences in LTPA were observed between individuals with screen-detected (n=126) and with known type 2 diabetes (n=109). CONCLUSIONS: This study supplies indirect evidence that in women, but not in men, with diagnosed type 2 diabetes exercise counselling or other treatment related factors produces the desired increase in LTPA.

Sleep duration is associated with an increased risk for the prevalence of type 2 diabetes in middle-aged women - The FIN-D2D survey.

OBJECTIVE: To examine the association between sleep duration with type 2 diabetes and abnormal glucose tolerance among middle-aged men and women in Finland. METHODS: The FIN-D2D survey is a population-based cross-sectional multicentre study in Finland, with 1336 men and 1434 women aged 45-74 participating in the survey during 2004 and 2005. A health examination including an oral glucose tolerance test and sleep questionnaire was performed for all participants. RESULTS: There was an independent association between abnormal sleeping times and type 2 diabetes in middle-aged women. Even after adjustments for age, body mass index, sleep apnea probability, smoking, physical activity, and central nervous system-affecting medication, sleep duration of 6h or less or 8h or longer was independently associated with type 2 diabetes. There was no increase in the prevalence of diabetes in middle-aged men with abnormal sleeping times. CONCLUSION: Short (< or = 6h) or long (> or = 8h) sleep duration is related to an increased risk of type 2 diabetes in middle-aged women but not in men.

The Finnish national asthma programme: communication in asthma care--quality assessment of asthma referral letters.

AIMS AND OBJECTIVES: The Finnish National Asthma Programme, which was launched in year 1994, considered the management of asthma as a community problem. The role of the primary health care in the management of asthma was emphasized. Optimal asthma management includes good communication between health care professionals. Referral letters are an accepted tool for evaluation of the communication process. The aim of this study was to assess the quality of asthma-related referral letters. METHODS: All non-acute referral letters (n=3176) to three pulmonary departments were screened in 2001 and all those related to asthma were included (n=1289). The 14 previously derived asthma-specific criteria were applied: occupation, smoking, known allergies, current medication, other diseases, onset of symptoms, wheezing, dyspnoea, specified dyspnoea, cough, specified cough, use of asthma medication, peak-flow follow-up or spirometry with bronchodilatation test as an attachment. The study group was prepared to accept the maximum of 30% of the referral letters to be of poor quality. RESULTS: Twenty-one per cent of the referral letters were graded good, 34% satisfactory and 45% poor. Information on wheezing, smoking habits and current medication was mentioned in 44%, 42% and 41% of asthma letters respectively. CONCLUSIONS: The Finnish National Asthma Programme calls for optimizing communication between doctors. The proportion of poor letters was 50% higher than the preset standard and clearly indicates a need for improvement. We found several issues, which need to be better communicated (smoking, lung function tests, wheezing, medication) when referring a patient with suspected asthma.

Stronger symptoms of depression predict high coronary heart disease mortality in older men and women.

BACKGROUND: Most cohort studies have found depressive symptoms to be associated with increased cardiovascular mortality in the elderly, but follow-up times have often been short and study populations small. OBJECTIVES: To describe associations between stronger symptoms of depression and the risk of death from coronary heart disease (CHD) or myocardial infarction (MI) in elderly Finnish subjects free of CHD at the baseline. METHODS: This study is a prospective population-based epidemiological and clinical twelve-year follow-up study in Lieto Health Centre, Finland. The basic population consisted of 1196 elderly (64 years of age or older) persons who lived in the municipality of Lieto in southwestern Finland in 1990. The occurrence of CHD was determined on the basis of electrocardiographic (ECG) findings, Rose questionnaire and the diagnoses in medical records. The persons with CHD were excluded from the study population. Symptoms of depression at the baseline were measured with the Zung Self-rating Depression Scale (ZSDS). Mortality was followed up for about 12 years. RESULTS: The Kaplan-Meier survival curves showed stronger symptoms of depression to be related to high risks of mortality from CHD or MI among men and women. According to the Cox model for men significant predictors for higher risk of CHD or MI mortality were stronger symptoms of depression, higher age and a large number of medications in use. When women were examined, significant predictors were stronger symptoms of depression and a large number of medications in use. CONCLUSIONS: Stronger symptoms of depression are an independent risk factor for high CHD or MI mortality in aged Finnish men and women free of CHD at baseline.