A population-based study on the prevalence of NASH using scores validated against liver histology.

BACKGROUND & AIMS: Non-alcoholic steatohepatitis (NASH) is a leading cause of chronic liver disease in Western countries. Diagnosis of NASH requires a liver biopsy. We estimated the prevalence of NASH non-invasively in a population-based study using scores validated against liver histology. METHODS: Clinical characteristics, PNPLA3 genotype at rs738409, and serum cytokeratin 18 fragments were measured in 296 consecutive bariatric surgery patients who underwent a liver biopsy to discover and validate a NASH score ('NASH score'). We also defined the cut-off for NASH for a previously validated NAFLD liver fat score to diagnose NASH in the same cohort ('NASH liver fat score'). Both scores were validated in an Italian cohort comprising of 380, mainly non-bariatric surgery patients, who had undergone a liver biopsy for NASH. The cut-offs were utilized in the Finnish population-based D2D-study involving 2849 subjects (age 45-74 years) to estimate the population prevalence of NASH. RESULTS: The final 'NASH Score' model included PNPLA3 genotype, AST and fasting insulin. It predicted NASH with an AUROC 0.774 (0.709, 0.839) in Finns and 0.759 (0.711, 0.807) in Italians (NS). The AUROCs for 'NASH liver fat score' were 0.734 (0.664, 0.805) and 0.737 (0.687, 0.787), respectively. Using 'NASH liver fat score' and 'NASH Score', the prevalences of NASH in the D2D study were 4.2% (95% CI: 3.4, 5.0) and 6.0% (5.0, 6.9%). Sensitivity analysis was performed by taking into account stochastic false-positivity and false-negativity rates in a Bayesian model. This analysis yielded population prevalences of NASH of 3.1% (95% stimulation limits 0.2-6.8%) using 'NASH liver fat score' and 3.6% (0.2-7.7%) using 'NASH Score'. CONCLUSIONS: The population prevalence of NASH in 45-74 year old Finnish subjects is ∼ 5%.

Perceived sufficiency of physical activity levels among adults at high risk of type 2 diabetes: the FIN-D2D study.

BACKGROUND: Any increase from a low level of physical activity reduces the risk of type 2 diabetes. However, lack of awareness of one's physical activity level insufficiency may act as an obstacle to increased physical activity. PURPOSE: This study assessed the determinants of perceived physical activity levels (PALs) among adults at high risk of diabetes and the associations with self-reported physical activity. METHODS: In total, 10,149 adults participated in the FIN-D2D lifestyle intervention at baseline. Opportunistic screening was used in identifying high-risk individuals. Physical activity and perceived PAL sufficiency were assessed and compared. Key risk factors for diabetes and psychosocial and demographic characteristics were analyzed as determinants using logistic regression. RESULTS: PAL sufficiency was rated realistically by 73 % of men and 75 % of women. Perception of sufficient PAL was more likely among individuals with a smaller waist circumference, a higher level of perceived fitness, and no exercise intention. In men, a higher age, and in women, a lower education, and a lower occupational status, also increased the likelihood of perceiving PAL as sufficient. Out of all the participants, 65 % of men and 66 % of women were inactive. Among the inactive participants, 20 (men) and 16 % (women) overestimated their PAL sufficiency. In both genders, such overestimation was predicted by dyslipidemia, a lower waist circumference, a higher level of perceived fitness, and no exercise intention; also (among men) by a higher age and a family history of diabetes, and (among women) by a lower occupational status, and a lower BMI. CONCLUSIONS: In diabetes prevention, it is important to recognize the groups that perceive their PAL as sufficient since they may not see increased PAL as a tool for decreasing their risk of diabetes.

Association between vitamin b12 levels and melancholic depressive symptoms: a Finnish population-based study.

BACKGROUND: An association between vitamin B12 levels and depressive symptoms (DS) has been reported in several epidemiological studies. The purpose of this study was to evaluate vitamin B12 levels in population-based samples with melancholic or non-melancholic DS as the relationship between vitamin B12 levels and different subtypes of DS has not been evaluated in previous studies. METHODS: Subjects without previously known type 2 diabetes, aged 45-74 years were randomly selected from the National Population Register as a part of the Finnish diabetes prevention programme (FIN-D2D). The study population (N = 2806, participation rate 62%) consisted of 1328 men and 1478 women. The health examinations were carried out between October and December 2007 according to the WHO MONICA protocol. The assessment of DS was based on the Beck Depression Inventory (BDI, cut-off ≥10 points). A DSM-IV- criteria based summary score of melancholic items in the BDI was used in dividing the participants with DS (N = 429) into melancholic (N = 138) and non-melancholic DS (N = 291) subgroups. In the statistical analysis we used chi-squared test, t-test, permutation test, analysis of covariance, multivariate logistic regression analysis and multinomial regression model. RESULTS: The mean vitamin B12 level was 331±176 pmol/L in those without DS while the subjects with non-melancholic DS had a mean vitamin B12 level of 324 ± 135 pmol/L, and those with melancholic DS had the lowest mean vitamin B12 level of 292±112 pmol/L (p < 0.001 after adjusted for age, sex, use of antidepressive medication and chronic diseases sum index). The adjusted difference of vitamin B12 levels between the non-melancholic and the melancholic group was 33 pmol/L (95%CI 8 to 57, p = 0.008). Melancholic DS and vitamin B12 levels showed an independent linearly inverse association. The relative risk ratio (RRR) for melancholic DS was 2.75 (95%CI 1.66 to 4.56) in the lowest vitamin B12 level tertile versus the highest (p for linearity <0.001) when those without DS formed the reference group. The RRR in the non-melancholic subgroup was nonsignificant. CONCLUSIONS: The vitamin B12 level was associated with melancholic DS but not with non-melancholic DS.

Lifetime leisure-time physical activity and the risk of depressive symptoms at the ages of 65-74 years: the FIN-D2D survey.

OBJECTIVES: To investigate the association between lifetime leisure-time physical activity (LTPA) and depressive symptoms (DS) based on the population-based FIN-D2D cross-sectional survey conducted in 2007. METHODS: Nine hundred twenty seven randomly selected Finnish men and women aged 65-74 years were included in this study. DS were determined with the Beck Depression Inventory (≥10 points), and lifetime historical LTPA frequency from age 15 years onwards was recalled retrospectively. RESULTS: The frequency of LTPA was highest at the ages of 15-24 years in both the DS present and not present groups (14.6 times per month). LTPA frequency was significantly lower among those with DS compared with those without DS at the age of 45-54 (10.0 vs. 11.3, p=0.041), 55-64 (9.6 vs. 12.6, p<0.001), and 65-74 (8.6 vs. 11.9, p<0.001). Also the prevalence of somatic diseases was higher for those with DS compared with participants without DS. CONCLUSIONS: This study reveals lifetime LTPA variation and its potential consequences. The relationship found between reduced lifetime LTPA and the occurrence of DS suggest that promoting LTPA throughout one's lifetime would be beneficial in terms of DS and somatic diseases in older age.

Relationships between depressive symptoms and self-reported unintentional injuries: the cross-sectional population-based FIN-D2D survey.

BACKGROUND: There is a lack of knowledge on the influence of different levels of physical activity (PA) on unintentional injuries among those with depressive symptoms (DS). The aim of this study was to evaluate the relationship between PA categories and unintentional injuries among participants with and without DS based on a cross-sectional population-based FIN-D2D survey conducted in 2007. METHODS: Out of 4500, 2682 participants (60%) aged 45-74 years attended in this study. The unintentional injuries over the past year were captured in a questionnaire. DS were determined with the Beck Depression Inventory (≥ 10 points) and PA with the International Physical Activity Questionnaire. The statistical significance between DS and unintentional injury categories was evaluated by using t-test, chi-square test, or permutation test, analysis of covariance, or regression models. The factors related to unintentional injuries were estimated by univariate and multivariate logistic regression models. RESULTS: The proportion of subjects with unintentional injuries was higher among those with DS (17%) compared to those without DS (10%) (age- and gender-adjusted p = 0.023). The median (range) number of activity-loss days after injury was 22 (0-365) in participants with DS and 7 (0-120) in participants without DS ( p = 0.009). The percentage of subjects with unintentional injuries was not significantly different between PA categories in participants with DS and without DS. A stepwise multivariate logistic regression analysis showed that DS, functional ability, and musculoskeletal diseases were related to unintentional injuries. CONCLUSIONS: PA level was not related to unintentional injuries, whereas those with DS had a higher prevalence of unintentional injuries and prolonged activity-loss after injury. These results underline the importance of injury prevention, especially among those who have DS and additional risk factors.

Perceived need to increase physical activity levels among adults at high risk of type 2 diabetes: a cross-sectional analysis within a community-based diabetes prevention project FIN-D2D.

BACKGROUND: Increased physical activity is a cornerstone of type 2 diabetes prevention. The perception of a need to change is considered essential in behaviour change processes. However, the existing literature on individuals' perceived need to change health behaviour is limited. In order to improve understanding of diabetes prevention through increased physical activity levels (PAL), we assessed factors associated with perceiving a need to increase PAL among adults at high risk of diabetes. METHODS: Opportunistic screening was used within a primary-care based lifestyle intervention covering 10 149 men and women at high risk of type 2 diabetes. Data were obtained at baseline visits. The explored determinants were demographic, anthropometric/clinical, behavioural and psychosocial characteristics, along with four categories of PAL awareness. Logistic regression was used in the analysis. RESULTS: 74% of men (n = 2 577) and 76% of women (n = 4 551) perceived a need to increase their PAL. The participants most likely to perceive this need were inactive, had a larger waist circumference, rated their PAL as insufficient, and were at the contemplation stage of change. Smoking, elevated blood pressure, dyslipidaemia, and a family history of diabetes were not associated with this perception. The likelihood was also greater among women with less perceived fitness and less education. Demographic factors other than education did not determine participants' perceived need to increase PAL. PAL overestimators were less likely to perceive the need to increase their PAL than realistic inactive participants. CONCLUSIONS: Subjective rather than objective health factors appear to determine the perception of a need to increase PAL among adults at high risk of diabetes. Client perceptions need to be evaluated in health counselling in order to facilitate a change in PAL. Practical descriptions of the associations between metabolic risk factors, PAL, and diabetes are needed in order to make the risk factors concrete for at-risk individuals.

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

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

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

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

Metabolically healthy and unhealthy obesity phenotypes in the general population: the FIN-D2D Survey.

BACKGROUND: The aim of this work was to examine the prevalence of different metabolical phenotypes of obesity, and to analyze, by using different risk scores, how the metabolic syndrome (MetS) definition discriminates between unhealthy and healthy metabolic phenotypes in different obesity classes. METHODS: The Finnish type 2 diabetes (FIN-D2D) survey, a part of the larger implementation study, was carried out in 2007. The present cross-sectional analysis comprises 2,849 individuals aged 45-74 years. The MetS was defined with the new Harmonization definition. Cardiovascular risk was estimated with the Framingham and SCORE risk scores. Diabetes risk was assessed with the FINDRISK score. Non-alcoholic fatty liver disease (NAFLD) was estimated with the NAFLD score. Participants with and without MetS were classified in different weight categories and analysis of regression models were used to test the linear trend between body mass index (BMI) and various characteristics in individuals with and without MetS; and interaction between BMI and MetS. RESULTS: A metabolically healthy but obese phenotype was observed in 9.2% of obese men and in 16.4% of obese women. The MetS-BMI interaction was significant for fasting glucose, 2-hour plasma glucose, fasting plasma insulin and insulin resistance (HOMA-IR)(p < 0.001 for all). The prevalence of total diabetes (detected prior to or during survey) was 37.0% in obese individuals with MetS and 4.3% in obese individuals without MetS (p < 0.001). MetS-BMI interaction was significant (p < 0.001) also for the Framingham 10 year CVD risk score, NAFLD score and estimated liver fat %, indicating greater effect of increasing BMI in participants with MetS compared to participants without MetS. The metabolically healthy but obese individuals had lower 2-hour postload glucose levels (p = 0.0030), lower NAFLD scores (p < 0.001) and lower CVD risk scores (Framingham, p < 0.001; SCORE, p = 0.002) than normal weight individuals with MetS. CONCLUSIONS: Undetected Type 2 diabetes was more prevalent among those with MetS irrespective of the BMI class and increasing BMI had a significantly greater effect on estimates of liver fat and future CVD risk among those with MetS compared with participants without MetS. A healthy obese phenotype was associated with a better metabolic profile than observed in normal weight individuals with MetS.

Socio-economic differences in dysglycemia and lifestyle-related risk factors in the Finnish middle-aged population.

BACKGROUND: The aim of this study was to investigate the association of socio-economic status (SES) with dysglycemia and the lifestyle-related risk factors, and to analyze to which extent known risk factors explain socio-economic differences in diabetes risk. METHODS: Two population-based cross-sectional surveys in Finland including 1696 men and 1946 women aged 45-64 years who participated in a health examination in 2004 or 2007. Dysglycemia was determined by an oral glucose tolerance test. Total type 2 diabetes (including previously known and screen-detected type 2 diabetes), impaired glucose tolerance and impaired fasting glucose formed the category of total dysglycemia. Questionnaires and clinical examination were completed to assess risk factors for dysglycemia. SES was defined by education and household income. RESULTS: In both genders, the prevalence of total dysglycemia differed statistically significantly between educational groups. Low education was statistically significantly associated with higher risk of total type 2 diabetes in women. The household income level was inversely associated with total type 2 diabetes in women and with total dysglycemia in men. Obesity, unhealthy diet and smoking were all inversely related to SES in both men and women. The observed association between education and dysglycemia was slightly attenuated after adjustment for obesity and other risk factors for diabetes. CONCLUSIONS: Low education was associated with an increased risk of dysglycemia more strongly than the low household income. Risk factors, especially obesity, explained only partly the observed associations between dysglycemia and education.

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

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

Leisure-time physical activity and metabolic syndrome plus depressive symptoms in the FIN-D2D survey.

OBJECTIVE: To examine the association between leisure-time physical activity (LTPA) and simultaneous presence of metabolic syndrome (MetS) and depressive symptoms (DS) based on a population-based FIN-D2D cross-sectional survey conducted in 2007. METHODS: 4500 randomly selected Finnish men and women aged 45-74 years were initially enrolled; 2868 (64%) attended a health examination. Participants with complete information (n=2778) were grouped into three LTPA categories: low, moderate and high. MetS was based on the National Cholesterol Education Program criteria and DS on the Beck Depression Inventory (≥10 points). RESULTS: The prevalence of MetS and DS were 53% and 15%, respectively; the prevalence of simultaneous MetS and DS was 10%. The proportion of subjects with MetS, DS and simultaneous presence of MetS and DS increased with decreasing LTPA (p<0.001). On multivariate ordered analysis, LTPA was related to education years, household income, smoking, and the presence of MetS only, DS only and simultaneous MetS and DS. CONCLUSION: The prevalence of simultaneous MetS and DS was higher in participants with low LTPA compared with participants with high LTPA. Furthermore, LTPA level was associated with socioeconomic status and other health related outcomes, outlining the importance of LTPA as part of the general health promotion.

Non-alcoholic and alcoholic fatty liver disease - two diseases of affluence associated with the metabolic syndrome and type 2 diabetes: the FIN-D2D survey.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is known to be associated with the metabolic syndrome (MetS) and abnormal glucose tolerance. Whether alcoholic fatty liver disease (AFLD) is associated with similar metabolic abnormalities has not been examined in a population-based study. We aimed at assessing the prevalences of NAFLD and AFLD, and to examine to what extent these conditions are associated with MetS and abnormal glucose tolerance. METHODS: The cohort included 2766 Finnish subjects (45-74 years) from the population-based FIN-D2D survey. Features of insulin resistance, components of the MetS, glucose tolerance status by oral glucose tolerance test, serum liver enzyme concentrations, and daily alcohol consumption were assessed. RESULTS: Subjects with NAFLD and AFLD were equally obese and had similar fasting and insulin concentrations. The prevalences of NAFLD and AFLD were 21% (95% CI: 19%-22%) and 7% (95% CI: 6%-8%). The MetS was slightly more prevalent in AFLD (73%) than in NAFLD (70%, p = 0.028), and type 2 diabetes was similarly prevalent in NAFLD and AFLD (24-25%). The MetS and type 2 diabetes were more prevalent in subjects with NAFLD or AFLD compared to subjects with normal LFTs (53% and 14%, p < 0.0001 for both). DISCUSSION AND CONCLUSION: In Finnish middle-aged population, the prevalence of NAFLD is 3-fold higher than that of AFLD. The prevalences of MetS and type 2 diabetes are, however, significantly increased in both NAFLD and AFLD compared to subjects with normal LFTs. Subjects with AFLD are thus similarly metabolically unhealthy as subjects with NAFLD.

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

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

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

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

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

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

Alternative strategies to evaluate the cost-effectiveness of peritoneal dialysis and hemodialysis.

BACKGROUND: Dialysis treatment requires considerable resources and it is important to improve the efficiency of care. METHODS: Files of all adult end-stage renal disease (ESRD) patients who entered dialysis therapy between 1991 and 1996, were studied and all use of health care resources was recorded. A total of 138 patients started with in-center hemodialysis (HD) and 76 patients with continuous ambulatory peritoneal dialysis (CAPD). Four alternative perspectives were applied to assess effectiveness. An additional analysis of 68 matched CAPD-HD pairs with similar characteristics was completed. RESULTS: Cost-effectiveness ratios (CER; cost per life-year gained) were different in alternative observation strategies. If modality changes and cadaveric transplantations were ignored, annual first three years' CERs varied between $41220-61465 on CAPD and $44540-85688 on HD. If CAPD-failure was considered as death, CERs were $34466-81197 on CAPD. When follow-up censored at transplantation but dialysis modality changes were ignored, CERs were $59409-95858 on CAPD and $70042-85546 on HD. If observation censored at any change of primarily selected modality, figures were $57731-66710 on CAPD and $74671-91942 on HD. There was a trend of lower costs and better survival on CAPD, the only exception was the strategy in which technical failure of modality was considered as death. Figures of the matched CAPD-HD pairs were very close to the figures of the entire study population. CONCLUSIONS: Compared to HD, CERs were slightly lower on CAPD.

National type 2 diabetes prevention programme in Finland: FIN-D2D.

OBJECTIVES: Current evidence shows that type 2 diabetes (T2D) can be prevented by life-style changes and medication. To meet the menacing diabetes epidemic, there is an urgent need to translate the scientific evidence regarding prevention of T2D into daily clinical practice and public health. In Finland, a national programme for the prevention of T2D has been launched. The programme comprises 3 concurrent strategies for prevention: the population strategy, the high-risk strategy and the strategy of early diagnosis and management. The article describes the implementation strategy for the prevention programme for T2D. METHODS: The implementation project, FIN-D2D, is being conducted in 5 hospital districts, covering a population of 1.5 million, during the years 2003-2007. The main actors in the FIN-D2D are primary and occupational health care providers. RESULTS: The goals of the project are (1) to reduce the incidence and prevalence of T2D and prevalence of cardiovascular risk factor levels; (2) to identify individuals who are unaware of their T2D; (3) to generate regional and local models and programmes for the prevention of T2D; (4) to evaluate the effectiveness, feasibility and costs of the programme; and (5) to increase the awareness of T2D and its risk factors in the population and to support the population strategy of the diabetes prevention programme. The feasibility, effectiveness and costs of the programme will be evaluated according to a specific evaluation plan. CONCLUSIONS: Current research evidence shows that the type 2 diabetes can be effectively prevented in high-risk subjects by life-style changes, which include increased physical activity and weight reduction. FIN-D2D explores ways to implement these methods on a national level.

Leisure-Time and Occupational Physical Activity in Early and Late Adulthood in Relation to Later Life Physical Functioning.

BACKGROUND: Physical activity (PA) has beneficial effects on older age physical functioning, but longitudinal studies with follow-ups extending up to decades are few. We investigated the association between leisure-time PA (LTPA) and occupational PA (OPA) from early to late adulthood in relation to later life performance-based physical functioning. METHODS: The study involved 1260 people aged 60 to 79 years who took part in assessments of physical functioning (Short Physical Performance Battery [SPPB] test, 10-m maximal walking test, and grip strength test). Participants' data on earlier life LTPA/OPA (age range 25 to 74 years) were received from the previous studies (average follow-up 13.4 years). Logistic, linear, and censored regression models were used to assess the associations between LTPA/OPA earlier in life and subsequent physical functioning. RESULTS: A high level of LTPA earlier in life was associated with a lower risk of having difficulties on the SPPB test (odds ratio [OR]: 0.37; 95% confidence interval [CI], 0.24-0.58) and especially on the chair rise test (OR: 0.42; 95% CI, 0.27-0.64) in old age. Heavy manual work predicted difficulties on SPPB (OR: 1.91; 95% CI, 1.22-2.98) and the chair rise test (OR: 1.75; 95% CI, 1.14-2.69) and poorer walking speed (ß = .10, P = .005). CONCLUSIONS: This study highlights the importance of LTPA on later life functioning, but also indicates the inverse effects that may be caused by heavy manual work.

The Relationship between Thyroid Function and Depressive Symptoms-the FIN-D2D Population-Based Study.

The association between thyroid function and depression is controversial. Both conditions express many similar symptoms, but the studies done give conflicting results. This study draws on a random, population-based sample of 4500 subjects aged 45-75 years old from Finland. The basic clinical study was done in 2007 for 1396 men and 1500 women (64% participation rate). Thyroid stimulating hormone (TSH), free thyroxine (F-T4), and free triiodothyronine (F-T3) were measured in 2013 from frozen samples. The 21-item Beck Depression Inventory (BDI-21) was applied to assess depressive symptoms (score ≥10 points). The prevalence of depressive symptoms was 17.5% in women and 12.5% in men. In women, the mean levels of TSH, F-T4, and F-T3 without depressive symptoms vs. with the presence of depressive symptoms were 1.92/1.97 mU/L, 13.1/13.1 pmol/L, and 3.91/3.87 pmol/L (NS), respectively. In men, the levels were 1.87/1.94 mU/L, 13.5/13.7 pmol/L, and 4.18/4.12 pmol/L (NS), respectively. In multiple regression analysis, TSH had no relationship to BDI-21 total score. We found no association between depressive symptoms and thyroid values.