Dietary Saturated Fat and Bone Health in Young Adults: The Young Finns Cohort.

Previous studies suggest that saturated fat (SFA) intake may negatively impact on bone. However, few human studies on the topic exist. Women and men aged 31-46 years from the Cardiovascular Risk in Young Finns study attended the peripheral quantitative computed tomography and ultrasound bone measurements in 2008 (n = 1884-1953, ~ 56% women). In addition, fracture diagnoses in 1980-2018 were searched for the national health care registers and 431 participants had at least one fracture. Food consumption was gathered with the 48-h dietary recall interviews and food frequency questionnaire in 1980-2007. In the present study, radial, tibial, and calcaneal bone traits, and fractures were examined relative to the long-term intake of SFA. No consistent associations were seen between bone outcomes and SFA intake that would have replicated in both women and men. The only evidence for differential distributions was seen in cortical density and cortical-to-total area ratio at the radial shaft, and speed of sound at the calcaneus, which were 0.1-0.4% higher in women in the lowest tertile of SFA intake compared with the highest tertile. In addition, among men, the odds ratio (OR) of fractures was greater in the second (OR 1.86, 95% confidence interval (CI) 1.03-3.33) and third tertile of SFA intake (OR 2.45, 95% CI 1.38-4.36) compared with the lowest tertile, independently of many risk factors of osteoporosis. In this observational study, we found no robust evidence of the associations of dietary long-term SFA intake with bone outcomes. Therefore, additional studies are needed to confirm the association of dietary SFA with bone health in humans.

Increase in adiposity from childhood to adulthood predicts a metabolically obese phenotype in normal-weight adults.

Normal weight is associated with a favorable cardiometabolic risk profile and low risk of type 2 diabetes and cardiovascular disease. However, some normal-weight individuals-the "metabolically obese normal weight" (MONW)-show a cardiometabolic risk profile similar to the obese. Previous studies have shown that older age, central body fat distribution, and unfavorable lifestyle increase the risk of MONW. However, the role of early-life factors in MONW remains unknown. We examined the associations of early-life factors with adult MONW in 1178 individuals from the Cardiovascular Risk in Young Finns study who were followed up from childhood to adulthood. The strongest early predictor for adult MONW was an increase in BMI from childhood to adulthood (p = 3.1 × 10-11); each 1 SD increase in BMI z-score from childhood to adulthood led to a 2.56-fold increase in the risk of adult MONW (CI 95% = 1.94-3.38). Other significant predictors of adult MONW were male sex (OR = 2.38, 95% = 1.63-3.47, p = 7.0 × 10-6), higher childhood LDL cholesterol (OR = 1.41 per 1 SD increase in LDL cholesterol, CI 95% = 1.14-1.73, p = 0.001), and lower HDL cholesterol (OR = 1.51 per 1 SD decrease in HDL cholesterol, CI 95% = 1.23-1.85, p = 5.4 × 10-5). Our results suggest that an increase in adiposity from childhood to adulthood is detrimental to cardiometabolic health, even among individuals remaining normal weight.

Education as a moderator of genetic risk for higher body mass index: prospective cohort study from childhood to adulthood.

OBJECTIVES: The life-course development of body mass index (BMI) may be driven by interactions between genes and obesity-inducing social environments. We examined whether lower parental or own education accentuates the genetic risk for higher BMI over the life course, and whether diet and physical activity account for the educational differences in genetic associations with BMI. SUBJECTS/METHODS: The study comprised 2441 participants (1319 women, 3-18 years at baseline) from the prospective, population-based Cardiovascular Risk in Young Finns Study. BMI (kg/m2) trajectories were calculated from 18 to 49 years, using data from six time points spanning 31 years. A polygenic risk score for BMI was calculated as a weighted sum of risk alleles in 97 single-nucleotide polymorphisms. Education was assessed via self-reports, measured prospectively from participants in adulthood and from parents when participants were children. Diet and physical activity were self-reported in adulthood. RESULTS: Mean BMI increased from 22.6 to 26.6 kg/m2 during the follow-up. In growth curve analyses, the genetic risk score was associated with faster BMI increase over time (b=0.02, (95% CI, 0.01-0.02, P<0.001)). The association between the genetic risk score and BMI was more pronounced among those with lower educational level in adulthood (b=-0.12 (95% CI, -0.23-0.01); P=0.036)). No interaction effect was observed between the genetic risk score and parental education (b=0.05 (95% CI, -0.09-0.18; P=0.51)). Diet and physical activity explained little of the interaction effect between the genetic risk score and adulthood education. CONCLUSIONS: In this prospective study, the association of a risk score of 97 genetic variants with BMI was stronger among those with low compared with high education. This suggests lower education in adulthood accentuates the risk of higher BMI in people at genetic risk.

Maternal and fetal genetic contribution to gestational weight gain.

BACKGROUND: Clinical recommendations to limit gestational weight gain (GWG) imply high GWG is causally related to adverse outcomes in mother or offspring, but GWG is the sum of several inter-related complex phenotypes (maternal fat deposition and vascular expansion, placenta, amniotic fluid and fetal growth). Understanding the genetic contribution to GWG could help clarify the potential effect of its different components on maternal and offspring health. Here we explore the genetic contribution to total, early and late GWG. PARTICIPANTS AND METHODS: A genome-wide association study was used to identify maternal and fetal variants contributing to GWG in up to 10 543 mothers and 16 317 offspring of European origin, with replication in 10 660 mothers and 7561 offspring. Additional analyses determined the proportion of variability in GWG from maternal and fetal common genetic variants and the overlap of established genome-wide significant variants for phenotypes relevant to GWG (for example, maternal body mass index (BMI) and glucose, birth weight). RESULTS: Approximately 20% of the variability in GWG was tagged by common maternal genetic variants, and the fetal genome made a surprisingly minor contribution to explain variation in GWG. Variants near the pregnancy-specific beta-1 glycoprotein 5 (PSG5) gene reached genome-wide significance (P=1.71 × 10-8) for total GWG in the offspring genome, but did not replicate. Some established variants associated with increased BMI, fasting glucose and type 2 diabetes were associated with lower early, and higher later GWG. Maternal variants related to higher systolic blood pressure were related to lower late GWG. Established maternal and fetal birth weight variants were largely unrelated to GWG. CONCLUSIONS: We found a modest contribution of maternal common variants to GWG and some overlap of maternal BMI, glucose and type 2 diabetes variants with GWG. These findings suggest that associations between GWG and later offspring/maternal outcomes may be due to the relationship of maternal BMI and diabetes with GWG.

Longitudinal physical activity trajectories from childhood to adulthood and their determinants: The Young Finns Study.

Determining lifelong physical activity (PA) trajectories and their determinants is essential to promote a physically active lifestyle throughout the life-course. We aimed to identify PA trajectories from childhood to midlife and their determinants in a longitudinal population-based cohort. This study is a part of the Cardiovascular Risk in Young Finns Study. From 1980, a population-based cohort (N = 3596; 1764 boys/1832 girls, age 3-18 years) has been followed up for 31 years. PA indices were formed based on self-reported data (between age 9-49 years) on frequency, duration, and intensity of leisure (during childhood) or high-intensity (at later age) PA and on sports club participation/competitions. PA trajectories were analyzed using group-based trajectory modeling. Childhood (age 12 years), young adulthood (age 24 years), and early midlife (age 37 years) determinants were analyzed. Five PA trajectories were identified: persistently active (6.6%), decreasingly active (13.9%), increasingly active (13.5%), persistently low active (51.4%, reference group), persistently inactive (14.6%). In childhood, rural residential area (OR 0.45, 95% CI 0.21-0.96) and high academic performance (OR 2.18; 95% CI 1.58-3.00) associated with persistently active group. In early midlife, smoking (OR 1.66; 95% CI 1.07-2.58) associated with persistently inactive group, regular alcohol drinking (OR 2.91; 95% CI 1.12-7.55) with persistently active group and having children (OR 2.07; 95% CI 1.27-3.38) with decreasingly active group. High adulthood education associated with both decreasingly (OR 1.87; 95% CI 1.05-3.35) and increasingly (OR 2.09; 95% CI 1.19-3.68) active groups. We identified five PA trajectories from childhood into midlife. Most prominent determinants were academic achievement, education, having children and health habits (i.e. smoking/alcohol use).

Geographic origin as a determinant of left ventricular mass and diastolic function - the Cardiovascular Risk in Young Finns Study.

AIMS: Eastern Finns have higher risk of coronary heart disease (CHD) and carotid intima-media thickness than western Finns although current differences in CHD risk factors are minimal. Left ventricular (LV) mass and diastolic function predict future cardiovascular events but their east-west differences are unknown. We examined the association of eastern/western baseline origin with LV mass and diastolic function. METHODS: The study population included 2045 subjects of the Cardiovascular Risk in Young Finns Study with data from the baseline survey (1980) and the latest follow-up (2011) when echocardiography was performed at the age of 34-49 years. RESULTS: Subjects with eastern baseline origin had in 2011 higher LV mass (139±1.0 vs. 135±1.0 g, p=0.006) and E/e'-ratio indicating weaker LV diastolic function (4.86±0.03 vs. 4.74±0.03, p=0.02) than western subjects. Results were independent of age, sex, area of examination and CHD risk factors such as blood pressure and BMI (LV mass indexed with height: p<0.0001; E/e'-ratio: p=0.01). LV end-diastolic volume was higher among subjects with eastern baseline origin (135±0.9 vs. 131±0.9 ml, p=0.0011) but left atrial end-systolic volume, also indicating LV diastolic function, was not different between eastern and western subjects (43.4±0.5 vs. 44.0±0.5 ml, p=0.45). Most of the subjects were well within the normal limits of these echocardiographic measurements. CONCLUSIONS: In our healthy middle-aged population, geographic origin in eastern Finland associated with higher LV mass compared to western Finland. Higher E/e'-ratio suggests that subjects with eastern baseline origin might have higher prevalence of diastolic dysfunction in the future than western subjects.

Changes in BMI and physical activity from youth to adulthood distinguish normal-weight, metabolically obese adults from those who remain healthy.

Highlights: Adults with MONW have a lower BMI during youth until young adulthood, but higher BMI after this than adults with metabolically healthy normal weight. Adults with MONW have a greater decrease in physical activity from youth to adulthood than other adults. Healthy lifestyle is important in the prevention of metabolic disorders, particularly in individuals who are slim in childhood. Background: Individuals with metabolically obese normal-weight (MONW) have higher risk of cardiovascular events than those with obesity but a metabolically healthy status. Etiological factors leading to MONW are not well known. We hypothesized distinct trajectories of changes in BMI and physical activity may modify metabolic risk and distinguish individuals with MONW from those who remain healthy. Methods: We compared the mean levels of BMI and physical activity at eight time points (1980, 1983, 1986, 1989, 1992, 2001, 2007, 2011) between MONW and healthy normal-weight adults using linear mixed-model analysis. The analyses included 1180 participants of the Cardiovascular Risk in Young Finns study, a population-based study that represents six different age cohorts 3, 6, 9, 12, 15 and 18 years of age at baseline. Results: Individuals with adult MONW had significantly lower BMI in childhood and young adulthood, but their BMI increased more than in other adults after this age (p<0.001for interaction between time and MONW status). Physical activity decreased relatively more since youth in individuals with adult MONW (p<0.001). Conclusions: Relative leanness in youth and subsequent weight gain in young adulthood, and a gradual decrease in physical activity levels from youth to adulthood, predispose normal-weight individuals to metabolic impairments. The results highlight the importance of a healthy lifestyle in the prevention of metabolic disorders, particularly in individuals who are slim in childhood.

Parental and childhood overweight in sedentary and active adolescents.

We studied whether the prevalence of overweight since age 2 years differed in sedentary and active adolescents (N=346). Further, we analyzed the energy intake of sedentary and active adolescents across 12 years. BMI was assessed annually since birth, energy intake since age 13 months and parents' BMI from the time their child was 7 months old in a longitudinal atherosclerosis prevention study. Data on physical activity were collected at age 13 years (N=560). Sedentary and Active groups were formed by upper and lower physical activity tertile cut-points. Girls Sedentary at 13 years were more often overweight than Active peers already since age 2 years (P=0.048). Activity habits were not associated with energy intake. Conversely, among boys, activity habits in adolescence were not associated with childhood overweight, while the energy intake of Active boys was higher than that of Sedentary boys (P=0.008). Parental overweight was not associated with the physical activity of children; however, Sedentary girls more often had an overweight mother than Active girls (P=0.021). In conclusion, overweight during early years of life is more common among girls who are Sedentary as adolescents than in Active peers. Overweight mothers more often have Sedentary daughters than normal-weight mothers. A healthy lifestyle right from early childhood requires active support.

Dietary and lifestyle counselling reduces the clustering of overweight-related cardiometabolic risk factors in adolescents.

AIM: The aim of this study was to evaluate the impact of individualised dietary and lifestyle counselling, primarily aimed to decrease serum low-density lipoprotein cholesterol, on the clustering of overweight-related cardiometabolic risk factors in children. DESIGN AND PARTICIPANTS: The 7-month-old study children were randomized either to counselling (n = 540) or control group (n = 522). MAIN OUTCOME MEASURES: The 5- to 15-year-old participants who fulfilled the international criteria were classified as overweight. Being in the highest [lowest for high-density lipoprotein (HDL) cholesterol] age- and gender-specific quintile of body mass index (BMI), blood pressure, serum triglycerides, HDL cholesterol or glucose was considered a risk factor. A cluster was defined as having high BMI and > or = 2 other risk factors. RESULTS: The counselling did not reduce the prevalence of overweight in 5- to 15-year-old participants. From age 7 onwards, the proportion of children with > or = 2 risk factors was lower in the intervention than in the control group (p = 0.005). At the age of 15 years, 13.0% of girls and 10.8% of boys in the intervention group and 17.5% of girls and 18.8% of boys in the control group had the risk factor cluster (p = 0.046 for main effect of the study group). Having even one risk factor at the age of 5 years predicted the clustering of risk factors at the age of 15 years (OR: 3.8, p < 0.001). CONCLUSION: Repeated, individualized dietary and lifestyle counselling may reduce the clustering of overweight-related cardiometabolic risk factors in adolescents even though the counselling is not intense enough to prevent overweight.

Longitudinal trends in consumption of vegetables and fruit in Finnish children in an atherosclerosis prevention study (STRIP).

OBJECTIVE: To assess prospectively the consumption of fruit and vegetables and its' correlation to the parental consumption in boys and girls taking part in an atherosclerosis prevention study (Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) study). HYPOTHESIS: Nutrition counselling focused on cardiovascular health effects vegetable and fruit consumption. DESIGN: A prospective, randomised, clinical trial. SUBJECTS: Children were recruited to the STRIP study between 1989 and 1992. At the age of 7 months, children were randomised to the intervention (n = 540) or the control group (n = 522) and were followed up until the age of 11 years. INTERVENTION: Families in the intervention group have, since randomisation, received biannual individualised dietary counselling aimed at reduction of cardiovascular risk factors, especially saturated fat intake. Food records were used to assess fruit and vegetable consumption of children and parents. RESULTS: The percentage of total energy intake provided by fruit and vegetables decreased when the children grew older (P for age <0.001). The 1- to 10-year-old intervention boys consumed more vegetables (mean difference 3.18 g/day; CI 1.48-4.86; P < 0.001) and fruit (mean difference 10.1 g/day; CI 5.28-14.94; P < 0.001) than did the control. Mother's consumption correlated with the consumption of their daughters and sons, whereas father's consumption correlated only with the consumption of their sons. CONCLUSIONS: Finnish children taking part in the atherosclerosis prevention study had a remarkably low fruit and vegetable consumption, which furthermore decreased with age. The children's consumption correlated with the parental consumption, except between boys and mothers. A slight intervention effect was present only among boys.

Social and environmental factors and dysthymic disorder in old age.

This community-based epidemiological survey is concerned with relationships between social and environmental factors and dysthymic disorder (long-lasting depression according to the DSM-III classification) in a Finnish population aged 60 years or over. A greater proportion of dysthymic than non-depressed men had retired and did not work at all. The occurrence of dysthymic disorders in both men and women was related to retirement because of sickness rather than age, a small number of rooms in their homes, lack of intimate friendships and the occurrence of many long-standing and current social stress factors. The dysthymic women had lived at their present place of residence for a shorter period than had the non-depressed women. A positive association of dysthymic disorders with moving house due to poor health and living in institutions was also found in the men, and with a low number of hobbies and poor social participation in the women. In addition, the dysthymic women felt their relationships with their spouse, children, daughters-in-law and friends to be more distant than did their non-depressed counterparts. The dysthymic women also felt that elderly people were not appreciated. The log-linear models showed three interactions for the dysthymic men and six for the dysthymic women. The dysthymic persons reported a significantly larger number of detrimental events of an interpersonal nature than did the non-depressed persons.

Depressive disorder as a predictor of physical disability in old age.

OBJECTIVES: To determine whether the occurrence of depression predicts physical disability in older people. DESIGN: A longitudinal epidemiological study with a follow-up of 5 years. SETTING: A comparison between depressed and nondepressed participants. PARTICIPANTS: The series consisted of the persons who participated in the longitudinal epidemiological study on depression in old age performed in Ahtari, Finland. The first round of interviews and examinations was performed in 1984/1985 and the second round in 1989/1990. The study series (N = 786) was composed of persons functionally independent in activities of daily living (ADLs) during the first round and alive and participating in both rounds. MEASUREMENTS: Depression was determined according to DSM-III criteria. Physical functional abilities were measured with self-assessments of ability to manage ADLs. RESULTS: In bivariate analyses, depression at the baseline did not predict lowering of functional abilities during follow-up, but the occurrence of depression with a long-term or relapsing course during follow-up and the onset of depression during follow-up in persons not depressed at the baseline predicted lowering of functional abilities during follow-up. The logistic regression analyses showed the presence of the following variables measured during the first round--older age, low basic education, poor self-perceived health, and occurrence of a physical disease--and the onset of the following diseases during follow-up--any physical disease, neurological disease, cerebrovascular disease, or depressive symptoms (in persons nondepressed at the baseline)--predicted lowered functional abilities after a follow-up of 5 years. CONCLUSION: Depression that developed during the follow-up in previously nondepressed persons was associated with an increased risk for lowering of functional abilities, even when controlling for age, sociodemographic factors, physical diseases, and baseline disabilities. Depressed older people are at high risk for physical disability, and an individually planned program to maintain their functional abilities by training in ADLs and instrumental activities of daily living (IADLs) and physical exercise should be included in their treatment.

Factors explaining the referral of the elderly to home nursing or home help.

Factors explaining the referral of the elderly to home nursing or home help or both were studied in a population (n = 1358) aged 60 years or over and living in the commune of Ahtäri, a semi-industrialized community in middle-western Finland, using social and health care registers and questionnaires in collecting data. The clients of home nursing and of combined home nursing and home help were predominantly women, whereas men were in the majority among those referred to home help. A stepwise regression analysis showed old age, living alone, low self-perceived health, low education and few visiting contacts to explain home nursing or home help among men. Among women, the most important variables explaining home nursing or home help in the regression model were old age, low self-perceived health, low standard of housing, high amount of symptoms and lowered functional capacity. The poor availability of social support is more important a factor explaining the referral to home care among elderly men than among women. On the other hand, low health status and poor functional capacity, as well as poor availability of physical support are more important factors among women than men.

Changes in the oral health of adolescents treated by the Finnish public dental services between the ages of 13 and 15 years.

Oral cavity health was monitored in 2422 young people aged 13-15 years attending four health centres in Finland between 1992 and 1995. Assessments were made in terms of DMF, D and CPITN indices at clinical examinations. Of those who had no carious teeth at the initial examination, 60% did not develop cavities during the whole period, whereas half of those who had at least two carious teeth at the initial examination developed at least three new carious teeth. The treatment time needed by the latter accounted for half of the total time expended by the researchers until the end of the period. Costs can be saved or new patients brought into the dental care system by reorganizing the treatment of the patients who suffer from abundant caries and by reducing the resources devoted to the treatment of healthy patients.

Clinician-rated symptoms and signs of depression in aged Finns.

The study describes symptoms and signs of depression in elderly (60 years or over) Finns. Lists of symptoms and signs assessed by the examining physicians in a population study were used in rating, and the symptoms and signs of persons diagnosed as depressed were compared to those of persons who were not depressed. The commonest symptoms both in men and women were sleep disturbances, fatiguability, loss of interest, depressed mood, loss of activity, pains, pessimism and sense of uselessness. In addition, worry was a common symptom in women. Hallucinations and other delusions than those about unforgivable behaviour were very uncommon. Loss of libido did not strongly indicate occurrence of depression, and in persons aged 70 years or over it could not be included in symptoms of depression. Sex differences in the commonest symptoms of depression were evident: worry, crying spells, helplessness, loneliness, suicidal ideas and pains were more common in depressed women than in depressed men. Some age differences in symptoms were also found both in men and in women. Sad expression was a common sign of depression in both sexes. In addition, slow movements, scarcity of gestures and slow speech were quite common signs in depressed men and stooping posture was quite common in depressed women.

Sedentary behaviours and obesity in adults: the Cardiovascular Risk in Young Finns Study.

OBJECTIVE: Sedentary behaviour may contribute to the development of obesity. We investigated the relations between different types of sedentary behaviour and adiposity markers in a well-characterised adult population after controlling for a wide range of potential confounders. DESIGN: Cross-sectional study. SETTING: The Cardiovascular Risk in Young Finns Multicenter Study. Participants Sedentary time (TV viewing, computer time, reading, music/radio listening and other relaxation) was assessed with a questionnaire for 1084 women and 909 men aged 30-45 years. Other study variables included occupational and leisure-time physical activity, sleep duration, socioeconomic status, smoking, alcohol consumption, energy intake, adherence to the recommended diet, multiple individual food items, age and genetic variants associated with body mass index (BMI). Primary outcome measures BMI in kg/m(2) and waist circumference (WC in cm). RESULTS: Of the different sedentary behaviour types, TV viewing was most consistently related to higher BMI and WC, both in men and women. One additional daily TV hour was associated with a 1.81±0.44 cm larger WC in women and 2 cm±0.44 cm in men (both p<0.0001). The association with TV was diluted, but remained highly significant after adjustments with all measured covariates, including several potentially obesogenic food items associated with TV viewing. The intakes of food items such as sausage, beer and soft drinks were directly associated with TV viewing, while the intakes of oat and barley, fish, and fruits and berries were associated indirectly. After these adjustments, non-TV sedentary behaviour remained associated with adiposity indices only in women. CONCLUSIONS: Out of the different types of sedentary behaviour, TV viewing was most consistently associated with adiposity markers in adults. Partial dilution of these associations after adjustments for covariates suggests that the obesogenic effects of TV viewing are partly mediated by other lifestyle factors.