Associations of plant-based foods, red and processed meat, and dairy with gut microbiome in Finnish adults.

PURPOSE: Population-based studies on the associations of plant-based foods, red meat or dairy with gut microbiome are scarce. We examined whether the consumption of plant-based foods (vegetables, potatoes, fruits, cereals), red and processed meat (RPM) or dairy (fermented milk, cheese, other dairy products) are related to gut microbiome in Finnish adults. METHODS: We utilized data from the National FINRISK/FINDIET 2002 Study (n = 1273, aged 25-64 years, 55% women). Diet was assessed with 48-hour dietary recalls. Gut microbiome was analyzed using shallow shotgun sequencing. We applied multivariate analyses with linear models and permutational ANOVAs adjusted for relevant confounders. RESULTS: Fruit consumption was positively (beta = 0.03, SE = 0.01, P = 0.04), while a dairy subgroup including milk, cream and ice-creams was inversely associated (beta=-0.03, SE 0.01, P = 0.02) with intra-individual gut microbiome diversity (alpha-diversity). Plant-based foods (R2 = 0.001, P = 0.03) and dairy (R2 = 0.002, P = 0.01) but not RPM (R2 = 0.001, P = 0.38) contributed to the compositional differences in gut microbiome (beta-diversity). Plant-based foods were associated with several butyrate producers/cellulolytic species including Roseburia hominis. RPM associations included an inverse association with R. hominis. Dairy was positively associated with several lactic producing/probiotic species including Lactobacillus delbrueckii and potentially opportunistic pathogens including Citrobacter freundii. Dairy, fermented milk, vegetables, and cereals were associated with specific microbial functions. CONCLUSION: Our results suggest a potential association between plant-based foods and dairy or their subgroups with microbial diversity measures. Furthermore, our findings indicated that all the food groups were associated with distinct overall microbial community compositions. Plant-based food consumption particularly was associated with a larger number of putative beneficial species.

Exploring tradeoffs among diet quality and environmental impacts in self-selected diets: a population-based study.

PURPOSE: Proposed sustainable diets often deviate dramatically from currently consumed diets, excluding or drastically reducing entire food groups. Moreover, their environmental sustainability tends to be measured only in terms of greenhouse gases emissions. The aim of this study was to overcome these limitations and identify a cluster of already adopted, relatively healthy diets with substantially lower environmental impacts than the average diet. We also aimed to estimate the reduction in multiple environmental impacts that could be achieved by shifting to this diet cluster and highlight possible tradeoffs among environmental impacts. METHODS: The diet clusters were identified by applying energy-adjusted multiple factor analysis and hierarchical clustering to the dietary data of the National FinHealth 2017 Study (n = 5125) harmonized with life cycle assessment data on food products from Agribalyse 3.0 and Agri-Footprint using nutrient intakes and global warming potential, land use, and eutrophication of marine and freshwater systems as the active variables. RESULTS: We identified five diet clusters, none of which had the highest overall diet quality and lowest impact for all four environmental indicators. One cluster, including twenty percent of the individuals in the sample was identified as a "best compromise" diet with the highest diet quality and the second lowest environmental impacts of all clusters, except for freshwater eutrophication. The cluster did not exclude any food groups, but included more fruits, vegetables, and fish and less of all other animal-source foods than average. Shifting to this cluster diet could raise diet quality while achieving significant reductions in most but not all environmental impacts. CONCLUSION: There are tradeoffs among the environmental impacts of diets. Thus, future dietary analyses should consider multiple sustainability indicators simultaneously. Cluster analysis is a useful tool to help design tailored, socio-culturally acceptable dietary transition paths towards high diet quality and lower environmental impact.

Partial substitution of red meat or processed meat with plant-based foods and the risk of colorectal cancer.

OBJECTIVES: Shifting from animal-based to plant-based diets could reduce colorectal cancer (CRC) incidence. Currently, the impacts of these dietary shifts on CRC risk are ill-defined. Therefore, we examined partial substitutions of red or processed meat with whole grains, vegetables, fruits or a combination of these in relation to CRC risk in Finnish adults. METHODS: We pooled five Finnish cohorts, resulting in 43 788 participants aged ≥ 25 years (79% men). Diet was assessed by validated food frequency questionnaires at study enrolment. We modelled partial substitutions of red (100 g/week) or processed meat (50 g/week) with corresponding amounts of plant-based foods. Cohort-specific hazard ratios (HR) for CRC were calculated using Cox proportional hazards models and pooled together using random-effects models. Adjustments included age, sex, energy intake and other relevant confounders. RESULTS: During the median follow-up of 28.8 years, 1124 CRCs were diagnosed. We observed small risk reductions when red meat was substituted with vegetables (HR 0.97, 95% CI 0.95 - 0.99), fruits (0.97, 0.94 - 0.99), or whole grains, vegetables and fruits combined (0.97, 0.95 - 0.99). For processed meat, these substitutions yielded 1% risk reductions. Substituting red or processed meat with whole grains was associated with a decreased CRC risk only in participants with < median whole grain intake (0.92, 0.86 - 0.98; 0.96, 0.93 - 0.99, respectively; pinteraction=0.001). CONCLUSIONS: Even small, easily implemented substitutions of red or processed meat with whole grains, vegetables or fruits could lower CRC risk in a population with high meat consumption. These findings broaden our insight into dietary modifications that could foster CRC primary prevention.

Whole grain intake, diet quality and risk factors of chronic diseases: results from a population-based study in Finnish adults.

OBJECTIVES: Better diet quality of whole grain consumers could contribute to the associations between whole grain intake and chronic disease risk factors. We examined whole grain intake in relation to diet quality and chronic disease risk factors (anthropometrics, blood pressure, cholesterol, triglycerides, C-reactive protein and glucose) and the role of diet quality in whole grains' associations with each risk factor. METHODS: Our data included 5094 Finnish adults who completed a validated food frequency questionnaire and participated in a health examination within the National FinHealth 2017 Study. We assessed diet quality by the modified Baltic Sea Diet Score. P trends were calculated across whole grain intake quintiles by linear regression analysis. Interactions were assessed by including an interaction term in the analyses. RESULTS: Higher whole grain intake was associated with slightly better diet quality compared with lower intakes in both sexes (P < 0.001). Whole grain intake was inversely associated with body mass index (P < 0.001), waist circumference (P < 0.001) and total cholesterol (P = 0.02) in men. Adjusting for medication use attenuated the inverse associations with diastolic blood pressure (P = 0.06) and HDL cholesterol (P = 0.14) in men. We observed no associations in women. Diet quality did not modify the associations between whole grain intake and chronic disease risk factors. CONCLUSIONS: Our results suggest that whole grain intake was associated with small improvements in the chronic disease risk factors in men, regardless of diet quality. The sex differences may arise from varying health associations of whole grains from different cereal sources.

Trends in the prevalence rates and predictive factors of coeliac disease: A long-term nationwide follow-up study.

BACKGROUND: The prevalence of coeliac disease doubled in Finland from 1980 to 2000. AIMS: To investigate whether this increase is continuing and if there are specific patient-related factors predicting the development of coeliac disease at a population level. METHODS: We elicited comprehensive health data in the nationwide Health 2000 and Health 2011 surveys. Serum samples were taken for the measurement of tissue transglutaminase antibodies (TGA); subjects who were seropositive were tested for endomysial antibodies (EmA). Coeliac disease was defined either as a reported diagnosis or as positive TGA and EmA. The surveys comprised, respectively, 6379 and 4056 individuals, forming representative samples for 2,946,057 and 2,079,438 Finnish adults. Altogether 3254 individuals participating in both surveys comprised a prospective follow-up cohort. RESULTS: Prevalence of coeliac disease was 2.12% in 2000 and 2.40% in 2011 (p = 0.156). In the prospective cohort, 16 out of the 3254 (0.49%) subjects developed coeliac disease during follow-up from 2000 to 2011, with an annual incidence rate of 45 per 100,000 persons. Positive TGA without EmA (OR: 133, 95% CI: 30.3-584), TGA values in the upper normal range (51.1, 16.0-163), and after adjusting for TGA, previous autoimmune co-morbidity (8.39, 4.98-35.9) in 2000 increased the likelihood of subsequent coeliac disease. CONCLUSIONS: The nationwide prevalence of coeliac disease kept on rising from 2.12% in 2000 to 2.40% in 2011 in Finland. Positive TGA without EmA, TGA titres in the upper normal range and a pre-existing autoimmune disease predisposed to coeliac disease during the 10-year follow-up.

Effects of partial replacement of red and processed meat with non-soya legumes on bone and mineral metabolism and amino acid intakes in BeanMan randomised clinical trial.

The transition towards more plant-based diets may pose risks for bone health such as low vitamin D and Ca intakes. Findings for the contribution of animal and plant proteins and their amino acids (AA) to bone health are contradictory. This 6-week clinical trial aimed to investigate whether partial replacement of red and processed meat (RPM) with non-soya legumes affects AA intakes and bone turnover and mineral metabolism in 102 healthy 20-65-year-old men. Participants were randomly assigned to diet groups controlled for RPM and legume intake (designed total protein intake (TPI) 18 E%): the meat group consumed 760 g RPM per week (25 % TPI) and the legume group consumed non-soya legume-based products (20 % TPI) and 200 g RPM per week, the upper limit of the Planetary Health Diet (5 % TPI). No differences in bone (bone-specific alkaline phosphatase; tartrate-resistant acid phosphatase 5b) or mineral metabolism (25-hydroxyvitamin D; parathyroid hormone; fibroblast growth factor 23; phosphate and Ca) markers or Ca and vitamin D intakes were observed between the groups (P > 0·05). Methionine and histidine intakes were higher in the meat group (P ≤ 0·042), whereas the legume group had higher intakes of arginine, asparagine and phenylalanine (P ≤ 0·013). Mean essential AA intakes in both groups met the requirements. Increasing the proportion of non-soya legumes by reducing the amount of RPM in the diet for 6 weeks did not compromise bone turnover and provided on average adequate amounts of AA in healthy men, indicating that this ecologically sustainable dietary change is safe and relatively easy to implement.

Associations of EAT-Lancet Planetary Health Diet or Finnish Nutrition Recommendations with changes in obesity measures: a follow-up study in adults.

Background: Knowledge on the association between the EAT-Lancet Planetary Health Diet (PHD) or the Finnish Nutrition recommendations (FNR) and anthropometric changes is scarce. Especially, the role of the overall diet quality, distinct from energy intake, on weight changes needs further examination. Objectives: To examine the association between diet quality and weight change indicators and to develop a dietary index based on the PHD adapted for the Finnish food culture. Methods: The study population consisted of participants of two Finnish population-based studies (n = 4,371, 56% of women, aged 30-74 years at baseline). Dietary habits at the baseline were assessed with a validated food frequency questionnaire including 128-130 food items. We developed a Planetary Health Diet Score (PHDS) (including 13 components) and updated the pre-existing Recommended Finnish Diet Score (uRFDS) (including nine components) with energy density values to measure overall diet quality. Weight, height, and waist circumference (WC), and the body mass index (BMI) were measured at the baseline and follow-up, and their percentual changes during a 7-year follow-up were calculated. Two-staged random effects linear regression was used to evaluate ß-estimates with 95% confidence intervals. Results: Adherence to both indices was relatively low (PHDS: mean 3.6 points (standard deviation [SD] 1.2) in the range of 0-13; uRFDS: mean 12.7 points (SD 3.9) in the range of 0-27). We did not find statistically significant associations between either of the dietary indices and anthropometric changes during the follow-up (PHDS, weight: ß -0.04 (95% CI -0.19, 0.11), BMI: ß 0.05 (-0.20, 0.10), WC: ß -0.08 (-0.22, 0.06); uRFDS, weight: ß 0.01 (-0.04, 0.06), BMI: ß 0.01 (-0.04, 0.06), WC: ß -0.02 (-0.07, 0.03)). Conclusion: No associations between overall diet quality and anthropometric changes were found, which may be at least partly explained by low adherence to the PHD and the FNR in the Finnish adult population.

The impacts of partial replacement of red and processed meat with legumes or cereals on protein and amino acid intakes: a modelling study in the Finnish adult population.

BACKGROUND: A shift towards more plant-based diets is considered healthy and environmentally sustainable but may cause a concern regarding protein and amino acid intakes. This modelling study aimed to assess the impacts of partial replacement of red and processed meat with legumes or cereals on the protein and indispensable amino acid intakes in the Finnish adult population. MATERIALS AND METHODS: We used the cross-sectional data of the National FinDiet 2017 Survey (two non-consecutive 24-h recalls, n = 1655, 47% men, aged 18-74 years). Six replacement scenarios were created in which the amount of red and processed meat exceeding 70 g/day (Finnish nutrition recommendation), or 30 g/day (EAT-Lancet recommendation) was replaced with the same amounts of legumes, cereals or their combination. Differences to the reference diet were evaluated based on non-overlapping 95% confidence intervals. Population shares (%) below estimated average requirements (EAR) were calculated using the usual intake modelling methodology (SPADE). RESULTS: The replacement scenarios decreased the protein and indispensable amino acid intakes depending on gender and age. At the 70-g level, decreases were observed only in men aged 18-64 years. At the 30-g level, decreases were observed in other gender and age groups except women aged 65-74 years. In the scenarios, the mean daily protein intake was 15-18% of total energy intake (E%) (reference 17-18 E%), and the proportions below the EAR were 7-10% in men and 8-10% in women aged 18-64 years (reference 5-7%) and 20-25% in men and 16-20% in women aged 65-74 years (reference 14-17%). For total indispensable amino acids, the proportions below the EAR were <5% in the reference diet and the scenarios. CONCLUSIONS: The mean daily protein intake remained sufficient when red and processed meat was partially replaced with legumes or cereals in the Finnish adult population. However, protein adequacy in the elderly population warrants attention and more research.

This modelling study supports global efforts towards more plant-based diets, essential to human and planetary health, by providing insight into the impacts of partial replacement of red and processed meat with legumes or cereals on protein and indispensable amino acid intakes in the Finnish adult population.In general, the mean daily protein and indispensable amino acid intakes decreased but remained sufficient also when substantial amounts of red and processed meat were replaced with legumes or cereals.Some elderly men and women, however, had protein intake below the estimated average requirement, which needs to be considered particularly in the transition towards more plant-based and sustainable diets.

Associations of food motives with red meat and legume consumption in the population-based DILGOM study.

PURPOSE: To improve human health and environmental sustainability, red meat consumption should decrease and legume consumption increase in diets. More information on food motives, however, is required when developing more tailored and effective interventions targeting legume and meat consumption. We aimed to examine the associations between food motives and red meat and legume consumption, and whether these associations differ between different subgroups (gender, age groups, marital status, education, BMI). METHODS: Ten food motives (health, mood, convenience, sensory appeal, natural content, price-cheap, price-value, weight control, familiarity and ethical concern measured with Food Choice Questionnaire) were studied in 3079 Finnish adults in the population-based DILGOM study. Food consumption was assessed with Food Frequency Questionnaire. The adjusted estimates from multivariable regression models are reported. RESULTS: Higher relative importance of natural content (ß = - 0.275, 95% CI - 0.388; - 0.162) and ethical concern (ß = - 0.462, 95% CI - 0.620; - 0.305) were associated with lower red meat consumption, and higher appreciation of sensory appeal (ß = 0.482, 95% CI 0.347; 0.616) and price-cheap (ß = 0.190, 95% CI 0.099; 0.281) with higher red meat consumption. Higher importance of health (ß = 0.608, 95% CI 0.390; 0.825) was associated with higher legume consumption, and higher appreciation of convenience (ß = - 0.401, 95% CI - 0.522; - 0.279), price-value (ß = - 0.257, 95% CI - 0.380; - 0.133) and familiarity (ß = - 0.278, 95% CI - 0.393; - 0.164) with lower legume consumption. The associations of particularly ethical concern, weight control, sensory appeal and mood varied according to gender, age, marital status or BMI. CONCLUSION: The development and implementation of actions to decrease red meat and increase legume consumption should focus on several food motives across different subgroups.

Longitudinal Associations of Dietary Sugars and Glycaemic Index with Indices of Glucose Metabolism and Body Fatness during 3-Year Weight Loss Maintenance: A PREVIEW Sub-Study.

BACKGROUND: Dietary sugars are often linked to the development of overweight and type 2 diabetes (T2D) but inconsistencies remain. OBJECTIVE: We investigated associations of added, free, and total sugars, and glycaemic index (GI) with indices of glucose metabolism (IGM) and indices of body fatness (IBF) during a 3-year weight loss maintenance intervention. DESIGN: The PREVIEW (PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World) study was a randomised controlled trial designed to test the effects of four diet and physical activity interventions, after an 8-week weight-loss period, on the incidence of T2D. This secondary observational analysis included pooled data assessed at baseline (8), 26, 52, 104 and 156 weeks from 514 participants with overweight/obesity (age 25-70 year; BMI ≥ 25 kg⋅m-2) and with/without prediabetes in centres that provided data on added sugars (Sydney and Helsinki) or free sugars (Nottingham). Linear mixed models with repeated measures were applied for IBF (total body fat, BMI, waist circumference) and for IGM (fasting insulin, HbA1c, fasting glucose, C-peptide). Model A was adjusted for age and intervention centre and Model B additionally adjusted for energy, protein, fibre, and saturated fat. RESULTS: Total sugars were inversely associated with fasting insulin and C-peptide in all centres, and free sugars were inversely associated with fasting glucose and HbA1c (Model B: all p < 0.05). Positive associations were observed between GI and IGM (Model B: fasting insulin, HbA1c, and C-peptide: (all p < 0.01), but not for added sugars. Added sugar was positively associated with body fat percentage and BMI, and GI was associated with waist circumference (Model B: all p < 0.01), while free sugars showed no associations (Model B: p > 0.05). CONCLUSIONS: Our findings suggest that added sugars and GI were independently associated with 3-y weight regain, but only GI was associated with 3-y changes in glucose metabolism in individuals at high risk of T2D.

Different carbohydrate exposures and weight gain-results from a pooled analysis of three population-based studies.

BACKGROUND: The role of carbohydrate quantity and quality in weight gain remains unsolved, and research on carbohydrate subcategories is scarce. We examined total carbohydrates, dietary fiber, total sugar, and sucrose intake in relation to the risk of weight gain in Finnish adults. METHODS: Our data comprised 8327 adults aged 25-70 years in three population-based prospective cohorts. Diet was assessed by a validated food frequency questionnaire and nutrient intakes were calculated utilizing the Finnish Food Composition Database. Anthropometric measurements were collected according to standard protocols. Two-staged pooling was applied to derive relative risks across cohorts for weight gain of at least 5% by exposure variable intake quintiles in a 7-year follow-up. Linear trends were examined based on a Wald test. RESULTS: No association was observed between intakes of total carbohydrate, dietary fiber, total sugar or sucrose and the risk of weight gain of at least 5%. Yet, total sugar intake had a borderline protective association with the risk of weight gain in participants with obesity (RR 0.63; 95% CI 0.40-1.00 for highest vs. lowest quintile) and sucrose intake in participants with ≥10% decrease in carbohydrate intake during the follow-up (RR 0.78; 95% CI 0.61-1.00) after adjustments for sex, age, baseline weight, education, smoking, physical activity, and energy intake. Further adjustment for fruit consumption strengthened the associations. CONCLUSIONS: Our findings do not support an association between carbohydrate intake and weight gain. However, the results suggested that concurrent changes in carbohydrate intake might be an important determinant of weight change and should be further examined in future studies.

The associations of self-reported salt-intake and spot urine sodium with home blood pressure.

Purpose: A limited number of studies have suggested a nonlinear association between spot urine (SU) sodium concentration and office blood pressure (BP). We examined how SU sodium concentration and dietary salt obtained from a food frequency questionnaire are associated with more accurately measured home BP in a large, nationwide population sample.Materials and methods: We included 1398 participants in cross-sectional and 851 participants in 11-year longitudinal analyses. We investigated associations between baseline salt/sodium variables and (i) baseline and follow-up home BP; and (ii) prevalent and incident hypertension with linear and logistic regression models.Results: We observed positive associations (ß ± standard error) between salt/sodium variables and BP in unadjusted models. SU sodium concentration associated with baseline systolic (0.04 ± 0.01, p < 0.001) and diastolic (0.02 ± 0.01, p < 0.001) BP and follow-up systolic (0.03 ± 0.01, p = 0.003) and diastolic (0.02 ± 0.01, p < 0.001) BP. Dietary salt intake was associated with baseline (0.52 ± 0.19, p = 0.008) and follow-up (0.57 ± 0.20, p = 0.006) systolic BP. Compared to the lowest quintile of SU sodium concentration, the highest quintile had greater odds of prevalent hypertension (odds ratio [OR] 1.57, 95% confidence interval [CI] 1.12-2.19) and the second highest quintile with incident hypertension (OR 1.86, 95% CI 1.05-3.34). Unadjusted odds of incident hypertension were higher in the highest as compared to the lowest quintile of dietary salt intake (OR 1.83, 95% CI 1.01-3.35). After adjustments for sex, age, plasma creatinine concentration and alcohol intake, none of the aforementioned associations remained statistically significant. We found no evidence of a J-shaped association between the salt/sodium variables and BP or hypertension.Conclusion: SU sodium concentration and dietary salt intake are associated with home BP and hypertension only in some of the unadjusted models. Our results underscore that feasible estimation of sodium intake remains challenging in epidemiology.

What is known about the topicSome studies have suggested a non-linear association between spot urine sodium and blood pressure24-hour urinary sodium sampling is the gold standard method for assessing sodium intakeWhat this study addsMultiple fractional polynomials did not reveal evidence of a J-shaped association between spot urine sodium or dietary salt intake (measured by a questionnaire) and home blood pressurePrecise and yet feasible estimation of sodium intake remains challenging in epidemiology.

Poor health status before the COVID-19 pandemic is associated with unfavourable changes in health-related lifestyle.

AIMS: The effects of COVID-19 containment measures on health-related lifestyle have been both favourable and unfavourable for health. Factors predisposing to unfavourable changes are still poorly known. In this short communication, we aimed to examine which socioeconomic and health-related factors predicted unfavourable lifestyle changes based on data from the same individuals before (2017) the pandemic and during the second wave (2020) of the pandemic in Finland. METHODS: This individual-level follow-up study was based on a nationally representative, two-stage stratified cluster sample of Finnish adults from the FinHealth 2017 Study, conducted in Spring 2017, and its follow-up survey, conducted in Autumn 2020. A total of 3834 men and women aged 25-69 years at baseline had information of selected lifestyle factors (vegetable consumption, leisure-time physical activity, sleeping problems and nightmares) available at both time points. Odds ratios and 95% confidence intervals for unfavourable lifestyle changes (yes/no) according to socioeconomic and health-related factors were calculated using logistic regression models taking into account the sampling design and non-response. RESULTS: We found that those having poor health (i.e. psychological distress, poor self-rated health or chronic diseases) or disadvantaged socioeconomic background before the pandemic were prone to unfavourable lifestyle changes during the follow-up. CONCLUSIONS: Observed unfavourable lifestyle changes in vulnerable population groups may accelerate health inequalities. Targeted health promotion actions are needed to prevent this unfavourable development.

Partial substitution of red or processed meat with plant-based foods and the risk of type 2 diabetes.

High consumption of red and processed meat has been associated with increased type 2 diabetes (T2D) risk. These kinds of diets are also environmentally unsustainable. We examined a modeled association between a partial substitution of red meat or processed meat with plant-based foods (legumes, vegetables, fruit, cereals, or a combination of these) and T2D risk among Finnish adults. We used pooled data from five Finnish cohorts (n = 41,662, 22% women, aged ≥ 25 years, 10.9 years median follow-up with 1750 incident T2D cases). Diet was assessed by a validated food frequency questionnaire. In the substitution models, 100 g/week of red meat or 50 g/week of processed meat were substituted with similar amounts of plant-based substitutes. Cohort-specific hazard ratios (HRs) were estimated by Cox proportional hazards multivariable model and pooled using a two-staged random-effects model. We observed small, but statistically significant, reductions in T2D risk in men when red or processed meat were partially substituted with fruits (red meat: HR 0.98, 95% CI 0.97-1.00, P = 0.049, processed meat: 0.99, 0.98-1.00, P = 0.005), cereals (red meat: 0.97, 0.95-0.99, P = 0.005, processed meat: 0.99, 0.98-1.00, P = 0.004) or combination of plant-based foods (only processed meat: 0.99, 0.98-1.00, P = 0.004) but not with legumes or vegetables. The findings of women were similar but not statistically significant. Our findings suggest that even small, easily implemented, shifts towards more sustainable diets may reduce T2D risk particularly in men.

The relation of whole grain surrogate estimates and food definition to total whole grain intake in the Finnish adult population.

OBJECTIVES: Challenges in estimating total whole grain intake have led to the use of surrogate estimates, of which accuracy has not been assessed. We examined the suitability of five potential surrogates (dietary fiber; bread; rye bread; rye, oat and barley combined; rye) and a whole grain food definition to measure total whole grain intake in the Finnish adult population. METHODS: Our data comprised 5094 Finnish adults participating in the national FinHealth 2017 Study. Dietary intake was assessed by a validated FFQ. Food and nutrient intakes, including total whole grain, were calculated utilizing the Finnish Food Composition Database. The Healthgrain Forum whole grain food definition was applied to examine definition-based whole grain intake. Spearman correlations and quintile cross-classifications were calculated. RESULTS: Definition-based whole grain intake and consumption of rye, oat and barley combined had consistently the strongest correspondence with total whole grain intake. Rye and rye bread consumption also corresponded well with total whole grain intake. The correspondences of dietary fiber and bread with total whole grain were lower and more affected by the exclusion of energy under-reporters. Furthermore, their correlations with total whole grain intake varied the most between population subgroups. CONCLUSIONS: Rye-based estimates, especially rye, oat and barley combined, and definition-based whole grain intake appeared suitable surrogate estimates of total whole grain intake for epidemiological research of Finnish adults. The variation between surrogate estimates in their correspondence with total whole grain intake demonstrated the need for further evaluation of their accuracy in different populations and regarding specific health outcomes.

Association between legume consumption and the intake of other foods and nutrients in the Finnish adult population.

The role of legumes in healthy and sustainable diets is increasingly of interest. Few studies have investigated the association between legume consumption and the consumption of other food groups and the intake of nutrients. This study examined how legume consumption is associated with the consumption of other foods and the intake of nutrients among Finnish adults. Our study used cross-sectional data from the population-based FinHealth 2017 Study consisting of 2250 men and 2875 women aged ≥18 years. The associations between legume consumption (quartile classification), food groups and nutrients were analysed using multivariable linear regression. The models were initially adjusted for energy intake and additionally for age, educational level, smoking status, leisure-time physical activity and BMI. Legume consumption had a positive association with age, education level and leisure-time physical activity. The consumption of legumes was positively associated with the consumption of fruits and berries, vegetables, nuts and seeds and fish and fish products and inversely associated with the consumption of red and processed meat, cereals and butter and butter-based fat spreads. Furthermore, legume consumption was positively associated with the intake of protein, fibre, folate, thiamine and salt in both sexes and inversely associated with the intake of saturated fatty acids and sucrose (sucrose, women only). Thus, legume consumption appears to reflect overall healthier food choices. An increase in legume consumption could accelerate the transition to more sustainable diets. The confounding role of other foods and nutrients should be considered when studying associations between legume consumption and health outcomes.

Partial replacement of red and processed meat with legumes: a modelling study of the impact on nutrient intakes and nutrient adequacy on the population level.

OBJECTIVE: The shift towards plant-based diets with less meat and more legumes is a global target and requires an understanding of the consequences of dietary adequacy on the population level. Our aim was to model the impact of partial replacement of red and processed meat with legumes on nutrient intakes and population shares below dietary reference intakes. DESIGN: Modelling study with three scenarios anchored in meat cut-offs: ≤ 70 g/d (Finnish dietary guideline); ≤ 50 g/d (Danish dietary guideline); ≤ 30 g/d (EAT-Lancet recommendation). In all subjects, the amount of meat in grams over the cut-off was replaced with the same amount of legumes. The SPADE method was used to model usual intake distributions. Meaningful differences in average intakes and in population shares below dietary reference intakes compared to the reference (FinDiet) were evaluated based on non-overlapping 95 % CI. SETTING: Finnish national food consumption survey (FinDiet 2017). SUBJECTS: Finnish adults (n 1655) aged18-74 years (47 % men). RESULTS: The scenarios introduced increases in the average intakes of fibre, folate, K, Mg, Cu and Fe, and decreases in intakes of saturated fat, niacin, vitamin B12, Se and Zn. Meaningful shifts of the usual intake distributions of fibre and folate towards improvement in intakes emerged already in 'scenario 70 g'. Overall, distribution shifts towards a higher probability of inadequate intakes of the studied nutrients were not observed. CONCLUSIONS: These results support the public health message to partly replace meat with legumes and may benefit nutrition policy actions towards sustainable diets in the Nordic countries and beyond.

Disparities in Nutritional Adequacy of Diets between Different Socioeconomic Groups of Finnish Adults.

Information on dietary adequacy is needed to assess food and nutrition security in a modern society, especially in the transition towards climate-friendly food systems. In this study, differences in the nutritional adequacy of diets among Finnish adults were evaluated in population groups of different education, income and urbanisation levels. The study used data from the FinDiet 2017 Survey (n = 1655, 18-74 years). Modelled usual intakes of foods and nutrients were evaluated relative to food-based dietary guidelines issued by the National Nutrition Council of Finland (FNNC) and with respect to nutrient adequacy following the Nordic Nutrition Recommendations and FNNC. For about half of the nutrients studied, intakes were found to be adequate. Intakes of protein, fat, saturated fatty acids and salt were estimated to be high. By contrast, inadequate intakes were seen in folate and vitamins A, D, B1, B2 and C in almost all groups studied. Groups with a higher education and income, groups that lived in urban areas and, in particular, women adhered more closely to recommended food consumption and nutrient intakes than others. However, major challenges posed by the Finnish diet are common to all groups studied, and only certain dietary features evaluated in view of nutritional adequacy are associated with socioeconomic differences.

Vegetarians and different types of meat eaters among the Finnish adult population from 2007 to 2017.

From health and sustainability perspectives, reduction in the consumption of animal-based foods, especially red meat, is a key strategy. The present study examined the prevalence, sociodemographic and lifestyle factors, food consumption and food choice motives of vegetarians and consumers of low and high amounts of red and processed meat (RPM) among Finnish adults. We applied the data from three national health studies: FINRISK 2007 (n 4874), FINRISK 2012 (n 4812) and FinHealth 2017 (n 4442). Participants addressed their food consumption with a FFQ and answered other questionnaires about sociodemographic and lifestyle factors, as well as food choice motives. The prevalence of vegetarianism increased from 0·7 % in 2012 to 1·8 % in 2017, and median daily RPM consumption decreased from 128 g in 2007 to 119 g in 2012 and to 96 g in 2017. Vegetarians and members of the low-RPM group were more often women, younger and more highly educated than the high-RPM group, both in 2007 and 2017. Still, the importance of sex for the probability of a vegetarian diet decreased, while its importance for high-RPM consumption increased. Vegetarians consumed more fruit, vegetables, legumes, nuts and seeds than either the low- or high-RPM groups. The high-RPM group had the lowest scores in several aspects of healthy and sustainable diet, healthy food choice motives and healthy lifestyle. Vegetarians and groups differing in their RPM consumption levels might benefit from differing interventions and nutrition information taking into account their other dietary habits, food choice motives and lifestyle factors.

Association between added sugar intake and overall diet quality in the Finnish adult population.

Added sugar intake has been associated with several health issues, but few studies have examined its association with overall diet quality. We aimed at examining the association between added sugar intake and overall diet quality in Finnish adults. Associations between added sugar intake and sociodemographic factors, lifestyle factors, and BMI were also explored. Our data comprised 5094 adults residing in Finland who participated in the National FinHealth 2017 Study. Dietary intake was assessed by a validated FFQ. Food consumption and nutrient intakes were calculated using the Finnish national food composition database. Added sugar intake was estimated based on food categorisation and identifying naturally occurring sugar sources. Overall diet quality was assessed by the modified Baltic Sea Diet Score. The average added sugar intake was 7·6 E % in women and 8·3 E % in men in this study population. Added sugar intake was inversely associated with education (P = 0·03 women; P = 0·001 men), physical activity (P < 0·0001), and BMI in men (P = 0·003), and directly with smoking (P = 0·002 women; P < 0·0001 men). Added sugar intake was inversely associated with overall diet quality in both sexes (P < 0·0001). No interactions were found except for men's physical activity subgroups, the inverse association being stronger among active men than moderately active or inactive men (Pfor interaction = 0·005). Our findings suggest that high added sugar intake is associated with several unhealthy dietary and lifestyle habits, including poor-quality diets, smoking and leisure-time inactivity in Finnish adults. Efforts to improve diet quality should consider added sugar intake equally in the whole population.