Prevention of diabetes and cardiovascular diseases in occupational health care: feasibility and effectiveness.

AIMS: To evaluate feasibility and effectiveness of lifestyle counseling in occupational setting on decreasing risk for diabetes and cardiovascular disease. METHODS: A health check-up including physical examination, blood tests, questionnaires and health advice was completed on 2312 employees of an airline company. Participants with elevated risk for type 2 diabetes based on FINDRISC score and/or blood glucose measurement (n=657) were offered 1-3 additional lifestyle counseling sessions and 53% of them agreed to participate. After 2.5 years, 1347 employees of 2199 invited participated in a follow-up study. RESULTS: Among women and men with low baseline diabetes risk, cardiovascular risk factors increased slightly during follow-up. Larger proportion of the men who attended interventions lost weight at least 5% compared with the non-attendees (18.4% vs. 8.4%, p=0.031) and their FINDRISC score increased less (0.6 vs. 1.5, p=0.037). Older age associated with participation in follow-up and higher baseline FINDRISC score and presence of clinical and lifestyle risk factors and problems in sleep and mood increased attendance in interventions. CONCLUSIONS: Identification of employees with cardiovascular and diabetes risk, and the low intensity lifestyle intervention were feasible in occupational health-care setting. However, the health benefits were modest and observed only for men with increased risk.

Diet and nutrient intake in young adults born preterm at very low birth weight.

OBJECTIVE: To assess dietary intake in young adults born preterm at very low birth weight (VLBW) (≤ 1500 g). STUDY DESIGN: We studied 151 young adults aged 19-27 years who were born at VLBW and 156 term-born controls, group-matched for age, sex, and birth hospital. Participants completed a 3-day food record, which was checked by a nutritionist. Food and nutrient intakes were calculated with use of a dietary analysis program. Data were analyzed by multiple linear regression, adjusted for age, sex, body mass index, height, living at parental home, daily smoking, and highest parental education. RESULTS: Compared with controls, VLBW subjects had lower mean (SD) daily intake of vegetables, fruits, and berries (183 [150] g vs 241 [168] g, P = .002] and milk products (343 [242] g vs 427 [316] g, P = .003). Energy intake from carbohydrates, protein, and fat was similar, as was salt intake. VLBW participants had lower daily intake of calcium (858 [389] mg vs 1080 [514] mg, P < .0001), vitamin D (3.7 [2.6] µg vs 4.4 [3.6] µg, P = .02), and cholesterol (189 [74] mg vs 227 [105] mg, P = .002], whereas intake of essential fatty acids was higher (4.3 [1.5] mg vs 4.0 [1.5] mg, P = .01). CONCLUSIONS: Lower consumption of vegetables, fruits, berries, and milk products combined with lower calcium and vitamin D intake in VLBW participants offers a target for reducing the risk of osteoporosis and cardiovascular diseases in persons of VLBW.

Occupational health care identifies risk for type 2 diabetes and cardiovascular disease.

AIMS: To assess the risk for type 2 diabetes (T2D) and cardiovascular disease (CVD) among employees of a Finnish airline; to study the association of shift work with T2D and CVD risk; and to test the feasibility of risk screening in occupational health care setting. METHODS: Altogether 4169 employees were invited for a health check-up and 2312 participated in this study. The check-up included physical examinations, questionnaires on working hours, sleep, and lifestyle, diabetes risk score FINDRISC, and blood tests. Lifestyle counselling was offered for those with increased T2D risk. RESULTS: Altogether 15% of participants had a high T2D risk (FINDRISC≥15 and/or elevated, but non-diabetic blood glucose), and a further 15% had a moderate T2D risk (FINDRISC 10-14 and normal blood glucose). Of those 60% agreed to attend lifestyle counselling. Metabolic syndrome was more common, lipid profile more unfavorable and hsCRP higher by increasing FINDRISC score category. Risk factor profiles linked to shift work status were not self-evident. CONCLUSIONS: The renewed health check-up process effectively identified those employees with increased T2D and CVD risk who would benefit from lifestyle intervention. The use of FINDRISC questionnaire was a feasible first-step screening method in occupational health care setting.

Reducing the risk of type 2 diabetes with nutrition and physical activity - efficacy and implementation of lifestyle interventions in Finland.

BACKGROUND: The prevalence of type 2 diabetes has been increasing in Finland, in parallel with a gradual increase in overweight and obesity during the past decades. The expanding prevalence of type 2 diabetes brings along complications, most importantly CVD. Therefore, it is extremely important to implement activities to prevent type 2 diabetes. OBJECTIVE: In the present paper, the clinical evidence for the prevention of type 2 diabetes is presented with the Finnish diabetes prevention study. In addition, the paper discusses the practical implementation of prevention of type 2 diabetes using three different types of prevention programmes as examples: FIN-D2D, including risk-screening and repeated consultation in primary health-care; FINNAIR, a workplace-targeted intervention project involving airline employees; and the good ageing in Lahti region (GOAL) programme, a community-based prevention programme. CONCLUSIONS: FIN-D2D, the FINNAIR project and the GOAL programme have shown that screening for type 2 diabetes risk and implementing large-scale lifestyle intervention in primary health-care are feasible. However, the crucial questions still are whether it is possible to replicate the results concerning effectiveness of lifestyle intervention in primary and occupational health-care systems. Furthermore, it remains to be shown whether it is possible to achieve the same results in different health-care settings, cultures, regions and age groups, especially in adolescents and young adults among whom the increase in the incidence has been the highest. In addition, the importance of co-operation among all sections of society, citizens' awareness of healthy lifestyles and the social inequalities in health must be emphasised because the diabetes epidemic cannot be solved only by concentrating on preventive actions carried out by health-care systems.

Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study.

BACKGROUND: Lifestyle interventions can prevent the deterioration of impaired glucose tolerance to manifest type 2 diabetes, at least as long as the intervention continues. In the extended follow-up of the Finnish Diabetes Prevention Study, we assessed the extent to which the originally-achieved lifestyle changes and risk reduction remain after discontinuation of active counselling. METHODS: Overweight, middle-aged men (n=172) and women (n=350) with impaired glucose tolerance were randomly assigned to intensive lifestyle intervention or control group. After a median of 4 years of active intervention period, participants who were still free of diabetes were further followed up for a median of 3 years, with median total follow-up of 7 years. Diabetes incidence, bodyweight, physical activity, and dietary intakes of fat, saturated fat, and fibre were measured. FINDINGS: During the total follow-up, the incidence of type 2 diabetes was 4.3 and 7.4 per 100 person-years in the intervention and control group, respectively (log-rank test p=0.0001), indicating 43% reduction in relative risk. The risk reduction was related to the success in achieving the intervention goals of weight loss, reduced intake of total and saturated fat and increased intake of dietary fibre, and increased physical activity. Beneficial lifestyle changes achieved by participants in the intervention group were maintained after the discontinuation of the intervention, and the corresponding incidence rates during the post-intervention follow-up were 4.6 and 7.2 (p=0.0401), indicating 36% reduction in relative risk. INTERPRETATION: Lifestyle intervention in people at high risk for type 2 diabetes resulted in sustained lifestyle changes and a reduction in diabetes incidence, which remained after the individual lifestyle counselling was stopped.