Iron deficiency and dietary factors in Finland.

In connection with a multiphasic screening program carried out in Finland, over 7,000 persons participated in a dietary survey. The method was a diet history interview concerning food consumption and habits during the previous year. The mean intake of meat products was lower in anemic women (Hb less than 12.0 g/100 ml or PCV less than 36 vol%) than in the others and in the intake of liquid milk products was higher in the anemic women. The meat product intake was lower in anemic men (Hb less than 13.0 g/100 ml or PCV less than 41 vol %) than in other men, but the milk consumption of the groups was almost equal. The intake of meat products in iron-deficient women )serum iron less than 50 mu g/100 ml or TIBC larger than or equal to 400 mu g/100 ml) was lower and the intake of milk products higher than in the other women. The intake of meat products in iron-deficient men (serum iron less than 50 mu g/100 ml or TIBC larger than or equal to 400 mu g/100 ml) was lower than in the other men and the milk consumption was almost equal. The results support earlier studies that dietary habits are significant in the etiology of iron deficiency. In the light of this population study the intake of vitamin C also seems to influence iron metabolism.

Iron deficiency in the elderly population in Finland.

In connection with a large multiphasic screening programme carried out in Finland the prevalence rate of anaemia and iron deficiency were studied. Hb was under 130 g/l in 7.9 per cent of the men aged 65 years or over and under 120 g/l in 3.8 per cent of the women in the same age range. Transferrin saturation was under 15 per cent in 6.4 per cent of the men and in 7.7 per cent of the women. Iron deficiency was especially common in the rural population. A dietary study showed that iron deficient persons consumed less meat products and more liquid milk products than the others. The dietary factors are significant in the etiology of iron deficiency.

Prevalence of intermittent claudication and its effect on mortality.

The prevalence of symptoms of intermittent claudication and their association with 5-year mortality were examined in a population study in Finland. A number of 5738 men and 5224 women, aged 30-59 years, from 4 geographic areas of the country were studied. According to a structured interview, 2.1% of the men and 1.8% of the women reported typical symptoms of intermittent claudication. Claudication was most prevalent in East Finland and among persons with agricultural occupations. The symptoms were more frequent in diabetics and persons with symptoms and signs of coronary heart disease (CHD) than in persons without these diseases. High serum cholesterol and smoking were associated with these symptoms but high blood pressure was not. The risk of death from cardiovascular causes was nearly 3-fold in men with claudication compared to men without claudication. Symptoms of chest pain and smoking increased significantly the mortality risk of male claudicants. The validity of symptoms was poorer in women than in men and they were also less reliable predictors of death in women. A small part of the effect of claudication on mortality was due to its association with conventional CHD risk factors. However, after adjusting for symptoms and signs of CHD, claudication had no independent effect on mortality in men.

Hyperuricemia as a risk factor for cardiovascular mortality.

The value of hyperuricemia as a risk factor for cardiovascular mortality was investigated in 3195 men and 3160 women aged 40-69 years in Finland. Hyperuricemia was associated with obesity, impaired glucose tolerance, hypertension and history of heart disease. The total mortality of hyperuricemic men and women in 5 years was significantly higher than the mortality of normouricemics. Cardiovascular mortality was not higher in hyperuricemics than in normouricemics. However, in hyperuricemic women without known heart disease cardiovascular mortality was significantly increased in the follow-up period between 5 and 12 years. Total and cardiovascular mortality rates were significantly higher in hyperuricemic men with known heart disease than in corresponding normouricemic men. A rise of serum uric acid may be secondary to more advanced atherosclerosis. Thus, hyperuricemia may be associated with more advanced heart disease and it is not an independent cause of cardiovascular diseases.

Sonography and computed tomography in hepatic haemangioma.

Seven patients suffering from hepatic haemangioma were investigated by sonography and computed whole-body tomography (CT). In addition, percutaneous fine-needle biopsy was performed in 3 cases. All the patients had typical angiographic features of hepatic haemangioma. Histological confirmation was obtained in five cases. Sonography showed lesions of sonodense and mixed predominant sonolucent features. CT showed typical peripheral post-contrast enhancement. Fine needle biopsy was successful and diagnostic in two cases. No complications occurred with the procedure. Sonography overlooked one tiny lesion, and CT two. It seems that sonographic appearances are not reliable in the diagnosis of hepatic haemangioma, though CT may be diagnostic. In doubtful situations other diagnostic procedures, such as angiography and/or fine-needle biopsy, may be necessary.

Prevalence of hemochromatosis in Finland.

Transferrin saturation was determined in 11,431 men and 10,639 women aged 15 or more drawn from different areas in southern and central Finland and attending a multiphasic health screening examination in 1967-1972. All the 163 men and 66 women with transferrin saturation greater than or equal to 70% at the initial examination and still alive at the end of 1983 were invited to a re-examination. Of the invited persons, 76% attended the re-examination. Transferrin saturation and serum ferritin were the initial screening methods in the re-examination. All persons with suspected hemochromatosis were clinically examined and a laparoscopy was performed. Four men and four women were found with unequivocal hemochromatosis. Only one of these cases was diagnosed beforehand. According to these data the prevalence of hemochromatosis in Finland is about 50/100,000.

Serum ionized calcium, intact PTH and novel markers of bone turnover in bedridden elderly patients.

Chronic immobilization could markedly affect calcium and bone metabolism in elderly people. To investigate this, and to test the theory of 'type II' osteoporosis in bedridden elderly patients with low vitamin D status, 55 such subjects were examined. Serum concentrations of ionized calcium (Ca++), intact parathyrin (PTH) and two novel markers of bone collagen formation (carboxyterminal propeptide of type I procollagen; PICP) and resorption (carboxyterminal crosslinked telopeptide of type I collagen; ICTP) were measured. The effects on these parameters after 40 weeks of supplementation with vitamin D (1000 IU d-1) and/or calcium (1 g d-1) were subsequently prospectively evaluated. Despite low (mean 11.6 nmoll-1) serum 25-hydroxyvitamin D levels (25-OHD), those of 1,25-dihydroxy-vitamin D (1,25-(OH)2D) were mostly normal. Neither correlated with Ca++ or PTH. PTH correlated negatively not only with Ca++ (r = -0.328, P < 0.05) but also with ICTP (r = -0.306, P < 0.05). Mean PICP was normal but ICTP was elevated and tended to correlate positively with Ca++ (r = 0.268, P = 0.06). Vitamin D supplementation did not change PICP or ICTP considerably, despite slightly increased 1,25-(OH)2D and slightly decreased PTH. Ca++ values were normal and remained stable. In conclusion, Ca++ and PTH are poor indicators of vitamin D status in chronically immobilized elderly subjects. Furthermore, the results suggest that the increased bone resorption is not due to 'type II' secondary hyperparathyroidism; rather the resorption is primarily increased. Correction of vitamin D deficiency does not seem to benefit ageing bones unless adequate mechanical loading is provided.

Body iron stores and risk of cancer.

A high level of available tissue iron may increase the risk of cancer through its contribution to the production of free oxygen radicals. Serum iron, total iron-binding capacity (TIBC) and transferrin saturation levels were studied for their prediction of different cancers in a cohort of 41,276 men and women aged 20-74 years and initially free from cancer. During a mean follow-up of 14 years, 2,469 primary cancer cases were diagnosed. Excess risks of colorectal and lung cancers were found in subjects with transferrin saturation level exceeding 60%. The relative risks, adjusted for age, sex and smoking, were 3.04 for colorectal cancer and 1.51 for lung cancer, in comparison with subjects having lower levels. The risk of lung cancer was inversely related to serum TIBC, with a relative risk between the highest and lowest quartiles of 0.69 for men and 0.19 for women. For the risk of stomach cancer, we detected inverse relationships with serum iron and with transferrin saturation and a positive relationship with TIBC, but these associations weakened when the cancer cases occurring during the 5 first years of follow-up were excluded. High iron stores may increase the risk of colorectal cancer, whereas low iron stores may be an early sign of occult stomach cancer.

Body iron stores, dietary iron intake and coronary heart disease mortality.

OBJECTIVES: To assess whether increased body iron stores and dietary iron intake are associated with an increased risk of coronary heart disease mortality. DESIGN: A prospective population study with a mean mortality follow-up time of 14 years. SETTING: Participants attending a health screening examination carried out in several localities in Finland. SUBJECTS: All 6086 men and 6102 women aged from 45 to 64 years at the baseline examination without known heart disease, who had had serum iron and total iron binding capacity (TIBC) assessed. In a random fifth of these people, dietary iron intake was assessed by a dietary history. INTERVENTIONS: The study was observational without any interventions. MAIN OUTCOME MEASURES: Mortality from coronary heart disease. RESULTS: Altogether, 739 of the men and 245 of the women died from coronary heart disease. No relationship between TIBC and coronary mortality was observed in the men; in the women, an inverse although not significant association was found. Transferrin saturation was inversely but not significantly associated with coronary mortality in men; in women, the relationship was U-formed with a higher mortality at both the lower and higher ends of the distribution. Adjustment for other risk factors did not alter the results. No association was found with dietary iron intake and coronary mortality. CONCLUSIONS: The results do not corroborate earlier findings that excess body iron stores and increased iron intake are associated with an elevated risk of coronary heart disease.

Effects of mitral valve replacement on ventilation, volumes, diffusing capacity and regional perfusion of lungs in patients with mitral valve disease.

The effects of mitral valve replacement on ventilation, lung volumes, diffusing capacity and regional perfusion of the lungs were studied in eight patients with long-standing mitral valve disease. Eight patients of the same age with coronary artery disease who underwent coronary bypass operation were tested as controls. Preoperatively, the patients with mitral valve disease had significantly higher perfusion of the upper lung fields and the ratio of residual volume to total lung capacity than the control patients. Vital capacity, forced expiratory volume in one second and maximal expiratory flow at 50% of vital capacity were lower in comparison with the control group. Seven days after open heart surgery the values of all the parameters mentioned above had decreased significantly from the preoperative levels in both groups. Three months post-operatively, the values returned to preoperative levels. The abnormal overperfusion of the upper lung fields and other derangements in the ventilatory pattern did not subside even though cardiac haemodynamics were corrected by mitral valve replacement.