A tendency toward evening chronotype associates with less healthy diet among preschoolers: cross-sectional findings from the DAGIS study.

Study Objectives: Evidence suggests that adolescents and adults with a later chronotype have poorer sleep habits and are more susceptible to unhealthy behaviors, but little is known about these associations in younger children. The objective of the study was to (1) identify and compare individual chronotype tendencies among preschool-aged children and (2) investigate associations of sleep dimensions and chronotype with diet. Methods: Participants were 636 3-6 years old (mean ±â€…SD age: 4.74 ±â€…0.89 years, 49% girls) preschoolers from the cross-sectional Increased Health and Well-Being in Preschoolers (DAGIS) study in Finland. Sleep duration, sleep variability (in duration and midpoint), social jetlag, and midsleep on weekends adjusted for sleep debt (MSWEadj) were measured with 7-day actigraphy. Morning, intermediate, and evening chronotype tendencies were defined based on the lowest and highest 10th percentile cutoffs of MSWEadj. Food, energy, and macronutrient intake were assessed from 3-day records. Associations between sleep dimensions and diet were assessed with regression models. Results: MSWEadj was 1:13 ±â€…14 minutes for morning (n = 64), 2:25 ±â€…28 minutes for intermediate (n = 560), and 3:38 ±â€…15 minutes for evening (n = 64) chronotype tendency. Children with an evening chronotype tendency had greater social jetlag and sleep variability. Having an evening chronotype tendency was associated with higher added sugar, higher sugary food consumption, and lower vegetable consumption compared to intermediate tendency types. A later chronotype (MSWEadj) was associated with higher sugary food consumption, as well as lower vegetable and fiber intake. Sleep duration, social jetlag, and sleep variability were not associated with diet. Conclusions: Several less healthy sleep and diet behaviors were observed among children with later chronotypes. Future public health interventions aimed towards children would benefit from taking into account chronotype.

Building nutritionally meaningful classification for grocery product groups: the LoCard Food Classification process.

Analysing customer loyalty card data is a novel method for assessing nutritional quality and changes in a population's food consumption. However, prior to its use, the thousands of grocery products available in stores must be reclassified from the retailer's original hierarchical structure into a structure that is suitable for the use of nutrition and health research. We created LoCard Food Classification (LCFC) and examined how it reflects the nutritional quality of the grocery product groups. Nutritional quality was considered the main criterion guiding the reclassification of the 3574 grocery product groups. Information on the main ingredient of the product group, purpose of use and carbon footprint was also used at the more granular levels of LCFC. The main challenge in the reclassification was a lack of detailed information on the type of products included in each group, and some of the groups included products that have opposite health effects. The final LCFC has four hierarchical levels, and it is openly available online. After reclassification, the product groups were linked with the Finnish food composition database, and the nutrient profile was assessed by calculating the Nutrient-Rich Food Index (NRFI) for each product group. sd in NRFI decreased from 0·21 of the least granular level to 0·08 of the most granular level of LCFC indicating that the most granular level of LCFC has more homogeneous nutritional quality. Studies that apply LCFC to examine loyalty card data with health and environmental outcomes are needed to further demonstrate its validity.

Latent classes of unhealthy behaviours and their associations with subsequent sickness absence: a prospective register-linkage study among Finnish young and early midlife employees.

OBJECTIVES: Unhealthy behaviours are associated with increased sickness absence (SA), but few studies have considered person-oriented approach in these associations. Using latent class analysis, we examined clustering of unhealthy behaviours among Finnish municipal employees and their associations with subsequent SA. DESIGN: A prospective register-linkage study. SETTING: Unhealthy behaviours (low leisure-time physical activity, non-daily fruit and vegetable consumption, insufficient sleep, excessive alcohol use and tobacco use) were derived from the Helsinki Health Study questionnaire survey, collected in 2017 among 19- to 39-year-old employees of the City of Helsinki, Finland. PARTICIPANTS: A total of 4002 employees (81% women) of the City of Helsinki, Finland. PRIMARY OUTCOME MEASURES: The questionnaire data were prospectively linked to employer's SA register through March 2020. Associations between latent classes of unhealthy behaviours and subsequent SA (1-7 days/8+ days/all lengths) were examined using negative binomial regression. RESULTS: Among women, a three-class latent class model was selected: (1) few unhealthy behaviours (84%), (2) excessive alcohol and tobacco use (12%) and (3) several unhealthy behaviours (5%). Women belonging to classes 2 and 3 had increased SA rates compared with those in class 1, regardless of the length of SA spells. Among men, a 2-latent class model was selected: (1) few unhealthy behaviours (53%) and (2) several unhealthy behaviours (47%). Men belonging to class 2 had increased rates of 1-7 days' SA compared with men in class 1. CONCLUSIONS: This study suggests that preventive actions aiming to reduce employees' SA should consider simultaneously several unhealthy behaviours. Targeted interventions may benefit of identifying the clustering of these behaviours among occupational groups.

Wealth and obesity in pre-adolescents and their guardians: A first step in explaining non-communicable disease-related behaviour in two areas of Nairobi City County.

The prevalence of non-communicable diseases is increasing in lower-middle-income countries as these countries transition to unhealthy lifestyles. The transition is mostly predominant in urban areas. We assessed the association between wealth and obesity in two sub-counties in Nairobi City County, Kenya, in the context of family and poverty. This cross-sectional study was conducted among of 9-14 years old pre-adolescents and their guardians living in low- (Embakasi) and middle-income (Langata) sub-counties. The sociodemographic characteristics were collected using a validated questionnaire. Weight, height, mid-upper arm circumference, and waist circumference were measured using standard approved protocols. Socioeconomic characteristics of the residential sites were accessed using Wealth Index, created by using Principal Component Analysis. Statistical analyses were done by analysis of variance (continuous variables, comparison of areas) and with logistic and linear regression models.A total of 149 households, response rate of 93%, participated, 72 from Embakasi and 77 from Langata. Most of the participants residing in Embakasi belonged to the lower income and education groups whereas participants residing in Langata belonged to the higher income and education groups. About 30% of the pre-adolescent participants in Langata were overweight, compared to 6% in Embakasi (p<0.001). In contrast, the prevalence of adults (mostly mothers) with overweight and obesity was high (65%) in both study areas. Wealth (ß = 0.01; SE 0.0; p = 0.003) and income (ß = 0.29; SE 0.11; p = 0.009) predicted higher BMI z-score in pre-adolescents. In, pre-adolescent overweight was already highly prevalent in the middle-income area, while the proportion of women with overweight/obesity was high in the low-income area. These results suggest that a lifestyle promoting obesity is high regardless of socioeconomic status and wealth in Kenya. This provides a strong justification for promoting healthy lifestyles across all socio-economic classes.

Wealth and Sedentary Time Are Associated With Dietary Patterns Among Preadolescents in Nairobi City, Kenya.

OBJECTIVE: The study aimed to compare dietary patterns in preadolescents in urban areas with different physical activity and socioeconomic profiles in Nairobi, Kenya. DESIGN: Cross-sectional. PARTICIPANTS: Preadolescents aged 9-14 years (n = 149) living in low- or middle-income areas in Nairobi. VARIABLES MEASURED: Sociodemographic characteristics were collected using a validated questionnaire. Weight and height were measured. Diet was assessed using a food frequency questionnaire and physical activity by accelerometer. ANALYSIS: Dietary patterns (DP) were formed through principal component analysis. Associations of age, sex, parental education, wealth, body mass index, physical activity, and sedentary time with DPs were analyzed with linear regression. RESULTS: Three DPs explained 36% of the total variance in food consumption: (1) snacks, fast food, and meat; (2) dairy products and plant protein; and (3) vegetables and refined grains. Higher wealth was associated with higher scores of the first DP (P < 0.05). CONCLUSIONS AND IMPLICATIONS: Consumption of foods often deemed unhealthy (eg, snacks and fast food) was more frequent among preadolescents whose families were wealthier. Interventions that seek ways to promote healthy lifestyles among families residing in urban areas of Kenya are warranted.

Multiple socioeconomic circumstances and trajectories of fruit and vegetable consumption: the Helsinki Health Study.

AIMS: Fruit and vegetable consumption is essential in disease prevention. Socioeconomic differences in consumption have been observed but evidence from longitudinal studies incorporating multiple socioeconomic indicators is lacking. We examined long-term fruit and vegetable consumption trajectories and multiple socioeconomic circumstances as their determinants. METHODS: We used survey data from the Helsinki Health Study (phase 1 in 2000-2002, N=8960, response rate 67%; phases 2-4 in 2007, 2012 and 2017) among initially 40- to 60-year-old employees of City of Helsinki, Finland. Fruit and vegetable consumption was measured by a food frequency questionnaire and consumption times per month were calculated. Childhood (parental education, economic difficulties), conventional (own education, occupational class, household income) and material (housing tenure, wealth, current economic difficulties) socioeconomic circumstances were included. We used group-based trajectory modelling for identifying fruit and vegetable consumption trajectories and multinomial logistic regression for examining associations between socioeconomic circumstances and the trajectories. RESULTS: Four fruit and vegetable consumption trajectories were identified: increasing higher (12%), decreasing higher (10%), stable moderate (43%) and stable low (35% of participants). Childhood, conventional and material socioeconomic circumstances were all associated with the trajectories: belonging to a lower socioeconomic group was associated with belonging to the stable low and moderate trajectories. In multivariate models, the strongest associations were found for occupational class and household wealth. CONCLUSIONS: Disadvantageous childhood and adulthood socioeconomic circumstances were associated with lower long-term fruit and vegetable consumption. Socioeconomic circumstances should be considered in attempts to promote fruit and vegetable consumption, and people with disadvantageous circumstances need to be targeted in future interventions.

Applying Mendelian randomization to appraise causality in relationships between nutrition and cancer.

Dietary factors are assumed to play an important role in cancer risk, apparent in consensus recommendations for cancer prevention that promote nutritional changes. However, the evidence in this field has been generated predominantly through observational studies, which may result in biased effect estimates because of confounding, exposure misclassification, and reverse causality. With major geographical differences and rapid changes in cancer incidence over time, it is crucial to establish which of the observational associations reflect causality and to identify novel risk factors as these may be modified to prevent the onset of cancer and reduce its progression. Mendelian randomization (MR) uses the special properties of germline genetic variation to strengthen causal inference regarding potentially modifiable exposures and disease risk. MR can be implemented through instrumental variable (IV) analysis and, when robustly performed, is generally less prone to confounding, reverse causation and measurement error than conventional observational methods and has different sources of bias (discussed in detail below). It is increasingly used to facilitate causal inference in epidemiology and provides an opportunity to explore the effects of nutritional exposures on cancer incidence and progression in a cost-effective and timely manner. Here, we introduce the concept of MR and discuss its current application in understanding the impact of nutritional factors (e.g., any measure of diet and nutritional intake, circulating biomarkers, patterns, preference or behaviour) on cancer aetiology and, thus, opportunities for MR to contribute to the development of nutritional recommendations and policies for cancer prevention. We provide applied examples of MR studies examining the role of nutritional factors in cancer to illustrate how this method can be used to help prioritise or deprioritise the evaluation of specific nutritional factors as intervention targets in randomised controlled trials. We describe possible biases when using MR, and methodological developments aimed at investigating and potentially overcoming these biases when present. Lastly, we consider the use of MR in identifying causally relevant nutritional risk factors for various cancers in different regions across the world, given notable geographical differences in some cancers. We also discuss how MR results could be translated into further research and policy. We conclude that findings from MR studies, which corroborate those from other well-conducted studies with different and orthogonal biases, are poised to substantially improve our understanding of nutritional influences on cancer. For such corroboration, there is a requirement for an interdisciplinary and collaborative approach to investigate risk factors for cancer incidence and progression.

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.

Association between overall diet quality and postmenopausal breast cancer risk in five Finnish cohort studies.

There is limited evidence for any dietary factor, except alcohol, in breast cancer (BC) risk. Therefore, studies on a whole diet, using diet quality indices, can broaden our insight. We examined associations of the Nordic Diet (mNDI), Mediterranean diet (mMEDI) and Alternative Healthy Eating Index (mAHEI) with postmenopausal BC risk. Five Finnish cohorts were combined including 6374 postmenopausal women with dietary information. In all, 8-9 dietary components were aggregated in each index, higher total score indicating higher adherence to a healthy diet. Cox proportional hazards regression was used to estimate the combined hazard ratio (HR) and 95% confidence interval (CI) for BC risk. During an average 10-year follow-up period, 274 incident postmenopausal BC cases were diagnosed. In multivariable models, the HR for highest vs. lowest quintile of index was 0.67 (95 %CI 0.48-1.01) for mNDI, 0.88 (0.59-1.30) for mMEDI and 0.89 (0.60-1.32) for mAHEI. In this combined dataset, a borderline preventive finding of high adherence to mNDI on postmenopausal BC risk was found. Of the indices, mNDI was more based on the local food culture than the others. Although a healthy diet has beneficially been related to several chronic diseases, the link with the etiology of postmenopausal BC does not seem to be that obvious.

Association between social jet lag, quality of diet and obesity by diurnal preference in Finnish adult population.

The evening type has been associated with unhealthy behaviors and adverse health outcomes, such as unhealthy dietary habits and obesity. Misalignment between biological and social rhythms, referred to as social jet lag (SJL), has been considered to explain these outcomes, because evening types are more prone to SJL. However, the existing evidence has been inconsistent and SJL by diurnal preference has hardly been examined. We examined the associations between SJL, the quality of the diet, and the prevalence of obesity by diurnal preference. This dataset included 6779 Finns (55% women, aged 25-74 years) from the National FINRISK 2012 and DILGOM 2014 studies. Diurnal preference was assessed with a shortened version of the Morningness-Eveningness Questionnaire (MEQ). SJL was calculated with the sleep-corrected formula (SJLsc). SJL was divided into three groups by the degree of SJL (<1h, ≥1h but <2h and ≥2h). The dietary intake was assessed with a validated food frequency questionnaire (FFQ) and the quality of the diet with the Baltic Sea Diet Score. Body weight, height, and waist circumference (WC) were measured, and the body mass index (BMI) was calculated (kg/m2). Analysis of covariance (ANCOVA) followed by Bonferroni multiple comparison post-hoc tests and logistic regression models were used to analyze the differences between the lowest and the highest SJL groups by diurnal preference. In the highest SJL group (≥2h), there were more evening types than morning types (7%-points, p < .001). Overall, those in the highest SJLsc group were on average younger than those in the lowest SJLsc group (p< .001). Also, those in the highest SJLsc group tended to have lower adherence to the Baltic Sea Diet compared to the participants in the lowest SJLsc group, but this difference reached significance only in morning types (p = .006). Furthermore, morning types in the highest SJLsc group had higher BMI and WC compared to the morning types in the lowest SJLsc group (BMI, p = .016; WC, p = .012). In conclusion, evening types had on average more SJL than morning types, but the degree of SJL was associated with the quality of the diet and obesity only in the morning types.

The contribution of physical working conditions to sickness absence of varying length among employees with and without common mental disorders.

Aims: The aim was to examine whether the contribution of physical work exposures to the risk of sickness absence (SA) is different between those with and without common mental disorders (CMD). Methods: We used questionnaire data on four work exposures and CMD from 6159 participants of the Helsinki Health Study cohort with 12,458 observations from three surveys (2000-2002, 2007 and 2012). We formed combination exposures for the work exposures (hazardous exposures, physical workload, computer and shift work) with CMD. Associations with SA of different length were examined with negative binomial regression models. Results: We observed stronger associations for CMD with SA than for the individual work exposures. The strength of the associations for hazardous exposures and physical workload increased with length of SA, especially when the participant also had CMD. The strongest associations for the combined exposures were observed for SA ⩾15 days, the rate ratios being 2.63 (95% CI 2.27-3.05) among those with hazardous exposure and CMD, and 3.37 (95% CI 2.93-3.88) among those with heavy physical workload and CMD. Conclusions: Employees with hazardous exposures or physical workload combined with CMD were at the highest risk of SA compared with those without these exposures or with only one exposure.

Birth weight modifies the association between a healthy Nordic diet and office blood pressure in old age.

A healthy diet reduces risk for high blood pressure. A small body size at birth increases risk for high blood pressure. Our aim was to study whether birth weight modifies the association between a healthy Nordic diet, characterized by high intake of Nordic vegetables, fruits, and berries, whole-grain rye, oat, and barley, and rapeseed oil, and blood pressure. Finnish men and women (n = 960) born in 1934-1944 attended clinical visits including clinical measurements, and questionnaires in 2001-2004 and 2011-2013. Linear regression was applied to investigate the interactions between birth weight and Nordic diet (measured by the Baltic sea diet score (BSDS)) on blood pressure change during the 10-year follow-up. Baseline Nordic diet and birth weight showed a significant interaction on systolic blood pressure (SBP) (p = 0.02), and pulse pressure (PP) (p < 0.01) over a 10-year follow-up. In the lowest birth weight category (women < 2951 g, men < 3061 g), predicted SBP decreased across BSDS thirds (lowest (T1): 155 mmHg, highest (T3): 145 mmHg, p for linearity = 0.01) as did predicted PP (T1: 71 mmHg, T3: 63 mmHg, p < 0.01). In the middle birth weight category, predicted SBP increased across BSDS thirds (T1: 151 mmHg, T3: 155 mmHg, p = 0.02) as did predicted PP (T1: 67 mmHg, T3: 71 mmHg, p < 0.01). In the highest birth weight category, no associations were found. Higher adherence to a healthy Nordic diet was associated with lower SBP and PP in individuals with low birth weight but with higher SBP and PP in those with average birth weight.

Maternal pre-pregnancy overweight and gestational diabetes and dietary intakes among young adult offspring.

BACKGROUND/OBJECTIVES: Maternal pre-pregnancy overweight/obesity and gestational diabetes (GDM) are associated with increased fat deposition in adult offspring. The purpose of this study was to identify if maternal pre-pregnancy overweight (body mass index (BMI) ≥ 25 kg/m2) or GDM are associated with dietary quality or intake in adult offspring. SUBJECTS/METHODS: Participants (n = 882) from two longitudinal cohort studies (ESTER Maternal Pregnancy Disorders Study and the Arvo Ylppö Longitudinal Study) completed a validated food-frequency questionnaire at a mean age of 24.2 years (SD 1.3). Diet quality was evaluated by a Recommended Finnish Diet Index (RDI). The study sample included offspring of normoglycaemic mothers with pre-pregnancy overweight/obesity (ONO = 155), offspring of mothers with GDM regardless of BMI (OGDM = 190) and offspring of mothers with normal weight and no GDM (controls; n = 537). RESULTS: Among men, daily energy and macronutrient intakes were similar in ONO and controls. However, after adjusting for current offspring characteristics, including BMI, daily carbohydrate intake relative to total energy intake was higher in ONO-men [2.2 percentages of total energy intake (95% confidence interval 0.4, 4.0)]. In ONO-women, macronutrient intakes relative to total energy intake were similar with controls, while total daily energy intake seemed lower [-587.2 kJ/day (-1192.0, 4.4)]. After adjusting for confounders, this difference was attenuated. Adherence to a healthy diet, as measured by RDI, was similar in ONO and controls [mean difference: men 0.40 (-0.38, 1.18); women 0.25 (-0.50, 1.00)]. In OGDM vs. controls, total energy and macronutrient intakes were similar for both men and women. Also adherence to a healthy diet was similar [RDI: men 0.09 (-0.62, 0.80); women -0.17 (-0.93, 0.59)]. CONCLUSIONS: Our study suggested higher daily carbohydrate intake in male offspring exposed to maternal pre-pregnancy overweight/obesity, compared with controls. Prenatal exposure to GDM was not associated with adult offspring dietary intakes.

Genetic Associations of Chronotype in the Finnish General Population.

Individuals with a later chronotype (evening types) tend to have unhealthier behaviors and increased morbidity and mortality as compared with those with an earlier chronotype (morning types). However, the role of genetics in explaining evening types' adverse health and health behavior is unclear. Our aim was to study genetic associations of chronotype among 8433 Finns from the cross-sectional National FINRISK 2007 and 2012 studies. First, we studied associations between chronotype and 20 key clock genes with a candidate-gene approach and then performed a full genome-wide association study (GWAS) of chronotype. We also developed a genetic risk score (GRS) for chronotype based on 313 single nucleotide polymorphisms (SNPs) that have previously been associated with chronotype. Chronotype was assessed with a shortened version of Horne and Östberg's Morningness-Eveningness Questionnaire (sMEQ), and for comparison, we also used the single self-evaluation question on chronotype from the questionnaire. Linear and logistic regression was used for statistical analysis assuming additive effects. The clock gene analysis revealed 1 independent association signal within NR1D2 (lead SNP rs4131403) that was associated with chronotype (p < 0.05; as based on both chronotype assessment methods). The GWAS analysis did not yield any genome-wide significant associations (p > 5 × 10-8). However, higher GRS was associated with evening chronotype (p < 0.001; as based on both chronotype assessment methods). In conclusion, our findings indicated novel genetic associations between chronotype and the NR1D2 clock gene, which has previously been associated with carbohydrate and lipid metabolism. Furthermore, the GRS was able to capture the genetic aspect of chronotype in our study population. These findings expand our knowledge of the genetic basis of chronotype.

Body Mass Index Trajectory-Specific Changes in Economic Circumstances: A Person-Oriented Approach Among Midlife and Ageing Finns.

Economic disadvantage is related to a higher risk of adulthood obesity, but few studies have considered whether changes in economic circumstances depend on a person's body mass index (BMI) trajectory. We identified latent BMI trajectories among midlife and ageing Finns and captured individual-level changes in economic circumstances within the BMI trajectories utilizing sequence analysis. We used the Helsinki Health Study cohort data of initially 40-60-year-old Finnish municipal employees, with four survey questionnaire phases (2000-2017). Each survey included identical questions on height and weight, and on economic circumstances incorporating household income and current economic difficulties. Based on computed BMI, we identified participants' (n = 7105; 82% women) BMI trajectories over the follow-up using group-based trajectory modeling. Four BMI trajectories were identified: stable healthy weight (34% of the participants), stable overweight (42%), overweight to class I obesity (20%), and stable class II obesity (5%). Lower household income level and having economic difficulties became more common and persistent when moving from lower- to higher-level BMI trajectories. Differences in household income widened over the follow-up between the trajectory groups, whereas economic difficulties decreased equally in all trajectory groups over time. Our study provides novel information on the dynamic interplay between long-term BMI changes and economic circumstances.

Changes in fruit, vegetable and fish consumption after statutory retirement: a prospective cohort study.

Retirement is a major life transition affecting health and health behaviour, but evidence on how this transition contributes to changes in healthy food habits is scarce. We examined whether the consumption of fruit and vegetables as well as fish changes after transition into statutory retirement. The data were derived from the prospective Helsinki Health Study. At phase 1 in 2000-2002, all participants were 40- to 60-year-old employees of the City of Helsinki, Finland (n 8960, response rate 67 %). Follow-up surveys were conducted in 2007, 2012 and 2017 (response rates 79-83 %). Using the four phases, we formed three nested cohorts in which the participants either continued working or moved to statutory retirement. The final analytical sample consisted of 6887 participants (14 357 observations). Frequency of fruit, vegetable and fish consumption was calculated from a twenty-two-item FFQ. Analyses of repeated measures of food consumption before and after retirement transition were conducted with a negative binomial mixed model, adjusting for age, marital status, limiting long-standing illness and household income. During the follow-up, altogether 3526 participants retired. Transition to retirement was associated with a decrease in vegetable consumption among women and, contrarily, with an increase in fruit consumption among men (P < 0·05 for interaction between time and employment status). Fish consumption did not differ by the change in employment status. Statutory retirement can have mixed effects on healthy food habits, and these can differ between food groups and sex. Healthy food habits should be promoted among employees transitioning to retirement.

Physical working conditions and subsequent disability retirement due to any cause, mental disorders and musculoskeletal diseases: does the risk vary by common mental disorders?

PURPOSE: Physical work exposures and common mental disorders (CMD) have been linked to increased risk of work disability, but their joint associations with disability retirement due to any cause, mental disorders or musculoskeletal diseases have not been examined. METHODS: The data for exposures and covariates were from the Finnish Helsinki Health Study occupational cohort surveys in 2000-2002, 2007 and 2012. We used 12,458 observations from 6159 employees, who were 40-60 years old at baseline. CMD were measured by the General Health Questionnaire (GHQ-12, cut-off point 3+). Four self-reported work exposures (hazardous exposures, physical workload, computer and shift work) were combined with CMD and categorized as "neither", "work exposure only", "CMD only", and "both". Associations with register-based disability retirement were assessed with Cox proportional hazards models for sample survey data adjusting for confounders over 5-year follow-up. Additionally, synergy indices were calculated for the combined effects. RESULTS: Those reporting CMD and high physical workload had a greater risk of disability retirement due to any cause (HR 4.26, 95% CI 3.60-5.03), mental disorders (HR 5.41, 95% CI 3.87-7.56), and musculoskeletal diseases (HR 4.46, 95% CI 3.49-5.71) when compared to those with neither. Synergy indices indicated that these associations were synergistic. Similar associations were observed for CMD and hazardous exposures, but not for combined exposures to CMD and computer or shift work. CONCLUSIONS: Identification of mental health problems among employees in physically demanding jobs is important to support work ability and reduce the risk of premature exit from work due to disability.

Associations of changes in diet and leisure-time physical activity with employer's direct cost of short-term sickness absence.

Several unhealthy lifestyles are associated with increased sickness absence (SA). This study examined the associations of changes in diet and leisure-time physical activity (LTPA) with employer's direct cost of subsequent short-term (<10 working days) SA. The survey data from phases 1 (2000-2002) and 2 (2007) of the Helsinki Health Study (HHS), a longitudinal cohort study of initially 40-60-year-old employees of the City of Helsinki, Finland, were linked with SA register data. Final data consisted of 4157 employees. Dietary habits were inquired with a short food frequency questionnaire. Consumption of fruits (F) and vegetables (V) was used to indicate healthiness of diet. LTPA was measured with a series of questions on the intensity and the amount of LTPA. Data on short-term SA and salaries (2008-2012) were received from the employers' registers. A two-part model was used to analyse the associations. Those who improved their F&V consumption from non-daily to daily and persevered physically active got 620 € (95% CI -1194, -47) lower cost than those remaining non-daily F&V consumers and physically inactive. When examining LTPA only, those who persevered physically active or improved from moderately active to active got 19% less cost for the employer than those remaining inactive. Dietary changes were not independently associated with the cost. Improving employees' diet and LTPA may reduce employer's direct cost of SA. Although the associations of diet with SA cost were not statistically significant, improvements in diet may contribute to the beneficial associations of LTPA and employer's cost of SA.

Poor diet predicts periodontal disease development in 11-year follow-up study.

OBJECTIVE: To study whether diets based on the Nordic food culture and dietary recommendations are related to periodontal disease development. METHODS: The data were based on the Health 2000 and 2011 Surveys (BRIF8901). The participants were aged 30-49 in 2000, periodontally healthy, without diabetes or rheumatoid arthritis. Analyses were made in the total study population (n = 240) and among nonsmokers (n = 193) in 2011. Periodontal condition was determined in a clinical examination, and the number of teeth with deepened (≥4 mm) periodontal pockets in 2011 was used as an outcome. The diet was measured using a validated food frequency questionnaire and the quality of the diet using the Baltic Sea Diet Score (BSDS) and the Recommended Finnish Diet Score (RFDS) in 2000. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated using Poisson regression models. RESULTS: Low scores (indicating poor diet) in both the BSDS and the RFDS were associated with the development of deepened periodontal pockets. Among nonsmokers, the associations between low dietary scores and the number of teeth with deepened periodontal pockets were stronger than among the whole study population. CONCLUSIONS: Among middle-aged adults, poor-quality diet appears to be associated with the development of periodontal disease.

Associations between Childhood Disadvantage and Adult Body Mass Index Trajectories: A Follow-Up Study among Midlife Finnish Municipal Employees.

OBJECTIVE: Childhood disadvantage is associated with a higher risk of adult obesity, but little is known about its associations with body mass index (BMI) trajectories during adulthood. This study aimed first to identify adulthood BMI trajectories, and second to investigate how childhood disadvantage is associated with trajectory group membership. METHODS: Data from the Helsinki Health Study, a longitudinal cohort study of initially 40- to 60-year-old employees of the City of Helsinki in Finland, were used. The baseline survey was conducted in 2000-2002, and similar follow-up surveys in 2007, 2012, and 2017. Based on self-reported BMI, participants' (n =5,266; 83% women) BMI trajectories, including their retrospectively reported BMI at the age of 25 years, were examined. Data on childhood disadvantage, including parental education and 7 types of childhood adversity (their own serious illness; parental divorce, death, mental disorder, or alcohol problems; economic difficulties at home; and peer group bullying) before the age of 16 years, were obtained from the baseline survey. Group-based trajectory modeling was used to identify BMI trajectories, and multinomial logistic regression to analyze the odds for trajectory group membership for the disadvantage variables. RESULTS: Four ascending BMI trajectories in women and men were found: persistent normal weight (trajectory 1; women 35% and men 25%), normal weight to overweight (trajectory 2; women 41% and men 48%), normal weight to class I obesity (trajectory 3; women 19% and men 23%) and overweight to class II obesity (trajectory 4; women 5% and men 4%). Compared to trajectory 1, women with multiple adversities and repetitive peer bullying in childhood had greater odds of belonging to trajectories 3 and 4, whereas men with parental alcohol problems had greater odds of belonging to trajectory 4. For women and men, a low level of parental education was associated with a higher-level BMI trajectory. CONCLUSIONS: Low parental education for both genders, multiple adversities and repetitive peer bullying in childhood among women, and parental alcohol problems among men increased the odds of developing obesity during adulthood. Further studies are needed to clarify how gender differences modify the effects of childhood disadvantage on adult BMI trajectories.