Infant and childhood growth and frailty in old age: the Helsinki Birth Cohort Study.

BACKGROUND: Evidence from life course studies highlights the importance of infant and childhood growth as risk factors for adulthood chronic diseases. METHODS: In this sub-study of the Helsinki Birth Cohort Study, we studied 1078 individuals who had both information on body size from birth to 12 years of age and who were assessed for frailty according to the Fried criteria at the mean age of 71 years. RESULTS: Greater BMI gain between 2 and 11 years in boys was associated with frailty in old age (age-adjusted RRR 2.36, 95% CI 1.21, 4.63). No similar associations were observed in girls. CONCLUSIONS: Men who were frail in old age experienced accelerated BMI gain in childhood compared with those men who were not frail. This was not observed in women, which suggests that the patterns of early growth predisposing to frailty may vary by sex.

Early life stress and frailty in old age: the Helsinki birth cohort study.

BACKGROUND: Evidence suggests that early life stress (ELS) may extend its effect into adulthood and predispose an individual to adverse health outcomes. We investigated whether wartime parental separation, an indicator of severe ELS, would be associated with frailty in old age. METHODS: Of the 972 participants belonging to the present sub-study of the Helsinki Birth Cohort Study, 117 (12.0%) had been evacuated abroad unaccompanied by their parents in childhood during World War II. Frailty was assessed at a mean age of 71 years according to Fried's criteria. RESULTS: Thirteen frail men (4 separated and 9 non-separated) and 20 frail women (2 separated and 18 non-separated) were identified. Compared to the non-separated men, men who had been separated had an increased relative risk ratio (RRR) of frailty (age-adjusted RRR 3.93, 95% CI 1.02, 15.11) that persisted after adjusting for several confounders. No associations were observed among women (RRR 0.62; 95% CI 0.13, 2.94). CONCLUSIONS: These preliminary results suggest that ELS might extend its effects not just into adulthood but also into old age, and secondly, that men may be more vulnerable to the long-term effects of ELS.

Early life determinants of frailty in old age: the Helsinki Birth Cohort Study.

BACKGROUND: there is evidence suggesting that several chronic diseases have their origins in utero and that development taking place during sensitive periods may affect the aging process. We investigated whether early life determinants would be associated with frailty in old age. METHODS: at a mean age of 71 years, 1,078 participants belonging to the Helsinki Birth Cohort Study were assessed for frailty according to the Fried frailty criteria. Early life measurements (birth weight, length, mother body mass index [BMI] and parity) were obtained from birth, child welfare and school health records. Multinomial regression analysis was used to assess the association between early life determinants and frailty in old age. RESULTS: weight, length and BMI at birth were all inversely associated with frailty in old age. A 1 kg increase in birth weight was associated with a lower relative risk ratio (RRR) of frailty (age and sex-adjusted RRR = 0.40, 95% CI: 0.19, 0.82) compared to non-frailty. Associations persisted after adjusting for several confounding factors. Compared to cohort members in the upper middle class, those who as adults worked as manual workers or belonged to the lower middle class, were at an increased risk of frailty. CONCLUSIONS: those who were small at birth were at an increased risk of developing frailty in old age, suggesting that frailty is at least partly programmed in early life. A less privileged socioeconomic status in adulthood was associated with an increased risk of frailty in old age.

Relationship between physical activity and physical performance in later life in different birth weight groups.

There is strong evidence that physical activity (PA) has an influence on physical performance in later life. Also, a small body size at birth has been associated with lower physical functioning in older age and both small and high birth weight have shown to be associated with lower leisure time physical activity. However, it is unknown whether size at birth modulates the association between PA and physical performance in old age. We examined 695 individuals from the Helsinki Birth Cohort Study born in Helsinki, Finland between 1934 and 1944. At a mean age of 70.7 years PA was objectively assessed with a multisensory activity monitor and physical performance with the Senior Fitness Test (SFT). Information on birth weight and gestational age was retrieved from hospital birth records. The study participants were divided in three birth weight groups, that is <3000 g, 3000-3499 g and ⩾3500 g. The volume of PA was significantly associated with the physical performance in all birth weight groups. However, the effect size of the association was large and significant only in men with a birth weight <3000 g (ß 0.59; 95% confidence interval 0.37-0.81, P<0.001). Our study shows that the association between PA and physical performance is largest in men with low birth weight. Our results suggest that men with low birth weight might benefit most from engaging in PA in order to maintain a better physical performance.

Childhood growth predicts higher bone mass and greater bone area in early old age: findings among a subgroup of women from the Helsinki Birth Cohort Study.

We examined the associations between childhood growth and bone properties among women at early old age. Early growth in height predicted greater bone area and higher bone mineral mass. However, information on growth did not improve prediction of bone properties beyond that predicted by body size at early old age. INTRODUCTION: We examined the associations between body size at birth and childhood growth with bone area, bone mineral content (BMC), and areal bone mineral density (aBMD) in early old age. METHODS: A subgroup of women (n = 178, mean 60.4 years) from the Helsinki Birth Cohort Study, born 1934-1944, participated in dual-energy X-ray absorptiometry (DXA) measurements of the lumbar spine and hip. Height and weight at 0, 2, 7, and 11 years, obtained from health care records, were reconstructed into conditional variables representing growth velocity independent of earlier growth. Weight was adjusted for corresponding height. Linear regression models were adjusted for multiple confounders. RESULTS: Birth length and growth in height before 7 years of age were positively associated with femoral neck area (p < 0.05) and growth in height at all age periods studied with spine bone area (p < 0.01). Growth in height before the age of 7 years was associated with BMC in the femoral neck (p < 0.01) and birth length and growth in height before the age of 7 years were associated with BMC in the spine (p < 0.05). After entering adult height into the models, nearly all associations disappeared. Weight gain during childhood was not associated with bone area or BMC, and aBMD was not associated with early growth. CONCLUSIONS: Optimal growth in height in girls is important for obtaining larger skeleton and consequently higher bone mass. However, when predicting bone mineral mass among elderly women, information on early growth does not improve prediction beyond that predicted by current height and weight.

[Panorama of diseases in Finland's Army during the Second World War]. / Sjukdomspanoramat i Finlands armé under Andra världskriget.

Given the circumstances the state of health in the Finnish Army during the war years was satisfactory. Despite the prolonged hostilities serious epidemics could be avoided, thanks to preventive instruction, vaccinations, and strict requirements as regards hygiene. The article reports the epidemic diseases, pulmonary, renal and cardiac diseases, and rheumatic disorders which occurred during the war. Inter alia a severe malaria epidemic broke out in summer 1944 which affected over 2,000 soldiers.

A new low molecular weight heparinoid Org 10172 as anticoagulant in hemodialysis.

A low molecular weight heparinoid (Org 10172) was compared with unfractionated heparin in 36 patients on chronic hemodialysis in an open randomized cross-over study with three anti-coagulant treatment regimens for a single hemodialysis session. The anti-coagulant regimens were: a) standard heparin (3250-4750 I.U. heparin at start of hemodialysis followed by continuous infusion of 2000-2700 I.U. per hour); b) Org 10172 administered as a single intravenous bolus of 2400 anti-Xa units at start of dialysis; c) Org 10172 administered as a single bolus of 3200 anti-Xa units at start of dialysis. Plasma anti-Xa activity during hemodialysis was highest in regimen; d) and significantly lower when heparin was used. Mean beta-thromboglobulin concentrations changed to the same extent in the three groups. Plasma platelet factor 4 concentrations were higher after the use of heparin. The extracorporeal circuit was maintained patent in all groups; the volume of blood retained in the dialyzers did not differ markedly. Org 10172 proved safe and its anticoagulant effect was sufficient at the dose levels studied.

Correction of haemodialysis-associated anaemia by deferoxamine. Effects on serum aluminum and iron overload.

Aluminium and iron overload is often seen among long-term haemodialysis patients. Untreated non-de-aluminized dialysis water or the intake of large amounts of aluminium hydroxide as phosphate binders are the most common reasons for hyper-aluminaemia. Iron overload is mainly a result of multiple blood transfusions given to correct renal anaemia. In chronic dialysis patients, hypochromic anaemia is one of the clinical manifestations of a long-term overload of aluminium and perhaps of other metals, e.g. iron. We used deferoxamine (DFO) to chelate aluminium and excessive iron in 17 patients on chronic haemodialysis. Two grams of DFO was administered weekly in the form of an i.v. infusion during the last hour of the dialysis session. The mean serum aluminum concentration decreased from 407.3 micrograms/l to 184.2 micrograms/l within 3 years of treatment, the mean serum ferritin concentration from 1,563 micrograms/l to 487 micrograms/l within 2 years. Anaemia was corrected concomitantly with an increase in the haemoglobin level, which rose from 71.7 g/l to 80.8 g/l. The mean corpuscular volume increased from 83.8 fl to 91.3 fl. The need for blood transfusion also decreased significantly in all patients after the institution of DFO therapy. The clinical manifestations of aluminium and iron overload disappeared and the quality of life improved. No major side-effects were observed.

Acute transverse myelopathy successfully treated with plasmapheresis and prednisone in a patient with primary Sjögren's syndrome.

We report a case of acute transverse myelopathy in a patient with primary Sjögren's syndrome of 3 years duration. Our patient's acute transverse myelopathy developed within 1 week and resulted in complete paraparesis below the mamillary level. Extensive laboratory investigation ruled out viral, bacterial, and fungal etiology, Guillain-Barré syndrome, poliomyelitis, and multiple sclerosis. At diagnosis, treatment was initiated immediately with prednisone (80 mg/day) and plasmapheresis, which was performed as a first-aid measure. Improvement was noted as early as 10 days after the start of therapy. Within 5 1/2 months of the first symptoms of paralysis, the patient walked without difficulty and returned to her normal activities. A causal relationship between plasmapheresis/prednisone therapy and recovery has not been proven but merits further consideration.

Nephritis among young Finnish men.

During an eight-year period (1975-1982) 174 military conscripts (out of a total of 314,000) were submitted to Helsinki University Central Hospital, Fourth Department of Medicine, on suspicion of renal disease. Eighty-four had isolated hematuria, 61 hematuria and concomitant proteinuria and 29 persistent proteinuria. In 100 of them the urinary abnormality was an incidental finding, 62 suffered from symptoms of infection and the rest had other complaints. A renal biopsy was performed, yielding a representative sample in 171 cases, after other causes of the urinary abnormality had been excluded. Morphological analysis showed that 131 patients had glomerulonephritis, IgA nephropathy being the most common type (70 patients). Tubulo-interstitial nephritis was seen in two cases, and nephrocalcinosis in one. Among 37 cases with apparently normal glomeruli under light microscopy, immunofluorescence analysis revealed glomerular deposits other than IgA in 19 cases and no deposits in 15 (three were inadequate for this analysis). On the basis of the figures in this study the average number of annually detected cases of nephritis was 48 per 100,000 Finnish conscripts. During the same period an annual average of 46 per 100,000 young men were exempted from military service because of nephritis, giving an overall figure of 94 cases of nephritis detected annually per 100,000 young Finnish men.

Transformation of membranous glomerulonephritis into crescentic glomerulonephritis with glomerular basement membrane antibodies. Serial determinations of anti-GBM before the transformation.

This case report describes a patient who initially had a pleuritis and arthalgias. During the follow-up he developed first a membranous glomerulonephritis with nephrotic syndrome and subsequently a crescentic, rapidly progressive glomerulonephritis with glomerular basement membrane antibodies (anti-GBM). An analysis of the serum samples obtained during the follow-up revealed no infections at the onset of renal failure. However, anti-GBM could be demonstrated in the serum samples obtained 2 months before the deterioration of the renal function. The anti-GBM did not react with alveolar BM and the patient had no signs of pulmonary hemorrhage. The etiology and the sequence of the pathological events of rapidly progressive glomerulonephritis is discussed in the light of these observations.

Mycoplasmal pneumonia associated with mesangiocapillary glomerulonephritis type II (dense deposit disease).

A 20-year-old man developed pneumonia and glomerulonephritis concomitantly with significantly rising Mycoplasma pneumoniae complement-fixing antibody titres. Renal biopsy showed mesangiocapillary glomerulonephritis type II (dense deposit disease). Attempts to demonstrate mycoplasmal antigen in the glomeruli failed. This is the third of five previously reported cases of glomerulonephritis associated with Mycoplasma pneumoniae and exhibiting dense deposit disease.

Renal biopsy findings in orthostatic proteinuria.

Percutaneous renal biopsy was performed on 15 patients with orthostatic proteinuria and 6 control subjects without proteinuria in order to investigate possible renal alterations. The light-microscopic findings were either normal or showed slight mesangial proliferation in the orthostatic group but were normal in the control subjects, while the immunofluorescence-microscopic study revealed mesangial, capillary or arteriolar deposits of complement C3 and/or immunoglobulins in 10 out of 12 cases with orthostatic proteinuria; complement C3 was seen in only one control subject. The electron-microscopic findings were similar in the two groups, showing slight subepithelial, intramembranous and mesangial alterations. Focal loss of the epithelial foot processes was seen in only one case with orthostatic proteinuria. It is concluded that there are no histological, electron microscopical or immunohistochemical alterations specific for orthostatic proteinuria. A finding of complement in the glomeruli in about half and of immunoglobulin in some of the patients with orthostatic proteinuria is in favour of an association to present or previous glomerulonephritis.

Prevalence and causes of proteinuria in 20-year-old Finnish men.

The prevalence and causes of proteinuria were studied in a cohort of 36147 men aged 20 (born in 1956). Proteinuria was found in 139 men (0.4%) at the initial screening or examination. Further investigations reduced the number of proteinuria cases to 72 (0.2%). Persistent proteinuria was demonstrated in 46 men (0.13% of the series) and orthostatic proteinuria in 26 (0.07%). Urography revealed anomalies in 18 of 104 cases. Elevated blood pressure and reduced glomerular filtration rate were observed in a few men, mainly from the group with persistent proteinuria. Renal biopsy was performed in 61 cases--38 with persistent proteinuria, 12 with orthostatic proteinuria and 11 without proteinuria at the time of examination. Light microscopy gave normal findings or showed only slight mesangial or focal glomerulonephritis in the great majority of cases. Membranous, mesangiocapillary or chronic proliferative glomerulonephritis was present in one-fourth of the men with persistent proteinuria. This was the only group with such lesions.