Production and properties of health-promoting proteins and peptides from bovine colostrum and milk.

The high nutritive value and diverse functional properties of milk proteins are well known. Beyond these qualities, milk proteins have attracted growing scientific and commercial interest as a source of biologically active molecules. Such proteins are found in abundance in colostrum which is the initial milk secreted by mammalian species during late pregnancy and the first few days after birth of the offspring. The best characterized colostrum-based bioactive proteins include alpha-lactalbumin, beta-lactoglobulin, immunoglobulins, lactoferrin, lactoperoxidase and growth factors. All of them can nowadays be enriched and purified on an industrial scale from bovine colostral whey or cheese whey. These native proteins exhibit a wide range of biological activities that are known to affect the digestive function, metabolic responses to absorbed nutrients, growth and development of organs and disease resistance. Also, some of these proteins may prove beneficial in reduction of the risks of chronic human diseases reflected by the metabolic syndrome. It is speculated that such potentially beneficial effects are partially attributed to bioactive peptides derived from intact proteins. These peptides can be liberated during gastrointestinal digestion or fermentation of milk by starter cultures. The efficacy of a few peptides has been established in animal and human studies and the number of commercial products supplemented with specific milk peptides is envisaged to increase on global markets. Bovine colostrum appears as a highly potential source of biologically active native proteins and peptide fractions for inclusion as health-promoting ingredients in various food applications.

International Quit and Win 1996: comparative evaluation study in China and Finland.

OBJECTIVES: To compare background and process variables, as well as follow up status, of the participants in the International Quit and Win '96 contests of China and Finland, and analyse factors contributing to sustained maintenance. DESIGN: A standardised 12 month follow up was conducted in both countries with random samples of participants. The sample sizes were 3119 in China and 1448 in Finland, with response rates of 91.2% and 65.2%, respectively. INTERVENTIONS: The International Quit and Win '96 contest was the second coordinated, multinational smoking cessation campaign targeted at adult daily smokers. Altogether 25 countries participated, including China with 15 000 and Finland with 6000 smokers registered. MAIN OUTCOME MEASURES: Conservative (considering all non-respondents relapsed) and non-conservative (based on respondents only) estimates were calculated for one month abstinence, 12 month continuous abstinence, and point abstinence at the time point of follow up. RESULTS: Great differences were found in the background and process variables, as well as in the outcome measures. At one year follow up, the conservative continuous abstinence rates show that the Chinese participants maintained their abstinence better (38%) compared to the Finnish ones (12%). In China women reached higher abstinence rate (50%) than men (36%), whereas in Finland men achieved a better result (14%) than women (9%). CONCLUSIONS: The Quit and Win contest is a mass smoking cessation method feasible in countries showing great variance in smoking habits and rates. However, in countries with different stages of anti-smoking development, such as China and Finland, different practical implementation strategies may be needed.

Blood pressure levels and obesity trends in hypertensive and normotensive Finnish population from 1982 to 1997.

OBJECTIVE: To assess the trends in blood pressure (BP) and in body mass index (BMI) in the hypertensive and normotensive population in Finland during 1982-1997. DESIGN: Four independent cross-sectional standardized population surveys were conducted in 1982, 1987, 1992 and 1997. SETTING: The provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in southwestern Finland. PARTICIPANTS: Men and women aged 25-64 years were selected randomly from the national population register. The participants were classified into four groups according to their BP level and treatment status: normotensive, unaware hypertensive, aware but untreated hypertensive and treated hypertensive. The total number of participants was 24,083. MAIN OUTCOME MEASURES: The means of systolic BP (SBP), diastolic BP (DBP) and BMI, as well as the distribution of BMI among the four study groups were measured. RESULTS: Mean SBP decreased significantly in all groups. The fall in DBP was significant only in drug-treated hypertensive men and women (P< 0.001). Mean BMI increased significantly in all groups except in aware hypertensive women receiving no antihypertensive drug treatment The proportion of obese subjects (BMI > 30 kg/ m2) increased most in aware hypertensive men and in drug-treated hypertensive women. CONCLUSIONS: The prevalence of obesity has increased significantly in normotensive and particularly in hypertensive Finns during the past 15 years. There is an urgent need for more effective measures for weight reduction in obese hypertensive patients in primary healthcare, and for the prevention and control of obesity in the whole population.

The effect of alpha-lactalbumin and beta-lactoglobulin hydrolysates on the metabolic activity of Escherichia coli JM103.

Bovine milk proteins alpha-lactalbumin (alpha-la) and beta-lactoglobulin (beta-lg) were hydrolysed with seven different proteolytic enzymes, and the effect of various hydrolysates on a genetically modified luminous Escherichia coli JM103 was tested in vitro with a bioluminescence assay for bacterial growth and metabolism. Undigested proteins did not inhibit the activity of tested E. coli JM103 at a concentration as high as 0.1 g ml-1. At the same concentrations, alpha-la hydrolysed with pepsin or trypsin and beta-lg hydrolysed with alcalase, pepsin or trypsin, showed a lower metabolic activity during the first 8 h of growth. The activity of E. coli JM103 in the presence of 25 mg ml-1 alpha-la or beta-lg hydrolysed with pepsin and trypsin was only 21% of the control after incubation for 6 h. The preliminary results indicated that ultrafiltration through 10 kDa and 1 kDa molecular mass cut-off membranes may be used to enrich bacteriostatic properties.

Is the effect of smoking on the risk for coronary heart disease even stronger than was previously thought?

OBJECTIVE: To assess the extent to which smoking cessation among cohort members during the follow-up affects the estimated association between smoking and coronary heart disease (CHD) risk in an observational study with a single determination of the smoking status at baseline. DESIGN: Cross-sectional trend and prospective cohort analyses. SETTINGS: North Karelia and Kuopio provinces in eastern Finland. SUBJECTS: Men (n = 13542) aged 30-59 years who participated in risk factor surveys between 1972 and 1992. Of these, 3937 men belonged to the 1972 cohort with the prospective follow-up. MAIN OUTCOME MEASUREMENTS: Smoking prevalence, CHD mortality, non-CHD mortality, and total mortality. RESULTS: Smoking prevalence in the population decreased from 53% to 37% between 1972 and 1992. In the follow-up of the 1972 study cohort, the association between baseline smoking status and CHD weakened markedly when the follow-up time from the baseline measurement was extended. The risk ratio of cumulative CHD mortality associated with smoking was 6.96 in the first 2-year follow-up and it decreased gradually to 2.06 at the 20-year follow-up. A similar decrease in the risk ratio was observed when the analysis was performed during periods of the follow-up. The association between smoking and non-CHD mortality weakened only slightly when the follow-up time became longer. CONCLUSION: The results from prospective observational studies conducted in populations with a decreasing smoking prevalence may be biased by the misclassification of study subjects during the follow-up as a result of smoking cessation. This results in an underestimation of the risk of CHD caused by smoking. Thus, smoking may be even more harmful for health than the estimates from prospective studies suggest.

Quit and Win campaigns as a long-term anti-smoking intervention in North Karelia and other parts of Finland.

OBJECTIVE: To evaluate Quit and Win campaigns repeated in North Karelia and rest of Finland. DESIGN: Repeated comparisons of participation rates, abstinence rates, and other measures between North Karelia and the rest of Finland. SUBJECTS: Adult daily smokers in Finland participating in the Quit and Win contests in 1986-1997. INTERVENTIONS: Quit and Win smoking cessation campaigns targeted at adult daily smokers throughout Finland in 1986, 1989, 1994, 1996, and 1997, including more intensive activities in North Karelia. MAIN OUTCOME MEASURES: Participation rates, self reported six-month abstinence rates, other effectiveness measures (% of smokers who attended, intended, tried, and succeeded in cessation). RESULTS: North Karelia's participation rates were significantly higher in each campaign compared with the rest of Finland. The abstinence rates in North Karelia were also higher, the difference being significant in 1986 and 1994 (p < 0.05). In the target population in 1996 over 75% of smokers in North Karelia, compared with 40% of smokers surveyed elsewhere, reported awareness of the campaign (p < 0.001). Approximately 9% of the smokers in North Karelia and 6% elsewhere intended to participate (p = NS). Over 2% in North Karelia, compared with less than 1% elsewhere, tried to quit (p < 0.001). Among the targeted group, 0.3% of North Karelian smokers were complete abstainers throughout the 12 months of follow up, compared with an average of 0.1% in other areas (p < 0.001). CONCLUSIONS: The Quit and Win campaign is a feasible cessation method in long-term community-wide programmes. Intensified community activities are associated with higher success. In repeat campaigns, high participation and abstinence rates can be maintained.

Smoking cessation advice from health professionals: process evaluation of a community-based program.

The study assessed whether exposure to advice to quit smoking from health care professionals was greater in North Karelia, an area with a community-based, long-term intervention integrated within the health care structure, than in the rest of Finland. Data were collected by health behavior surveys during 1978-1995. Adult regular smokers and those who had quit during the preceding 12 months were surveyed. We measured exposure to cessation advice by questioning, whether the person had been advised by a doctor or public health nurse to give up smoking at least once during the year preceding the survey. Men from the intervention area had a significantly higher likelihood of having been advised to quit than those elsewhere in Finland. The same trend emerged among women, but it was not significant. It is concluded that a community-based intervention program can encourage health professionals to increase their smoking cessation advice.

Cardiovascular diseases and risk factors in Finland.

We summarize here the evidence from the 1960s and 1970s of exceptionally high risk of cardiovascular disease (CVD) in Finland. In parallel with voluntary and governmental prevention programs, the level of risk factors and CVD attack rates have shown dramatic improvement in the past 25 years, but the decline has slowed in recent years. This experience strongly supports population-wide strategies for primary prevention, and it also highlights the continued need for primordial prevention directed toward youth in high-risk societies.

Impact of mass media and interpersonal health communication on smoking cessation attempts: a study in North Karelia, 1989-1996.

This article summarizes an impact evaluation of the North Karelia Project (Finnish CINDI program) on smoking cessation attempts. During the period 1989-1996, data were collected by annual surveys, with response rates varying from 66% to 76%. This study included 1,694 adult current smokers or persons who had quit smoking during the past year, out of a total of 6,011 respondents. Smoking cessation attempts during the past 12 months were examined as a dependent variable. Reported exposures to mass media and interpersonal health communication were examined as possible determinants of smoking cessation. Weekly exposure to mass media health messages was significantly associated with cessation attempts among men only. In contrast, interpersonal health communication, or social influence, was a significant determinant of cessation attempts among both sexes. Exposure to both mass media and interpersonal health communication had an even stronger impact on cessation attempts. Thus, interpersonal communication appears to be an important catalyst of community programs, and its inclusion should be emphasized to obtain a higher impact with community programs.

Evaluation of a national Quit and Win contest: determinants for successful quitting.

BACKGROUND: Within the CINDI framework, a European "Quit and Win" contest was organized in 1994. In Finland the number of participants was 5,879 (0.6% of smokers). In the CINDI demonstration area, North Karelia (NK), the participants numbered 618 (2.0% of smokers). This study compared abstinence maintenance among the participants in NK with the rates found elsewhere in Finland and analyzed determinants for successful quitting. METHODS: A follow-up study was conducted 12 months after the quit date with a sample of 2,114 participants. Response rates of 67-68% were achieved (n = 1,419). The abstinence was assessed at 1, 6, and 12 months. Two estimates are presented: (1) the proportion of abstainers among the respondents and (2) the proportion of abstainers among the sample, considering all nonrespondents smokers. The determinants for maintenance of smoking cessation were analyzed with logistic regression. RESULTS: Using the first estimate, the rates at 1/6/12 months were 75/36/28% in NK and 70/28/21% elsewhere (P < 0.01). Using the second estimate, the corresponding rates were 50/24/19% in NK and 46/19/14% elsewhere. The most significant determinants for successful quitting were sex, age, marital status, level of withdrawal symptoms, previous quitting attempts, and support received. CONCLUSIONS: The recruitment of smokers and the maintained cessation were more successful in the demonstration area. The difference between areas was explained by differences in the combined professional and lay support and by the sex and age distributions.

Alcohol intake and subjective health.

This cross-sectional analysis examined associations between alcohol intake and subjective health in a random sample (n = 6,040) drawn from the general population aged 25-64 years in Finland in 1992. Self-reported health was good for 3,375 persons and average or poor (suboptimal) for 2,665 persons. Crude odds ratios suggested a U-shaped pattern between alcohol intake and suboptimal health. The pattern took more of a J-shape after data were controlled for sex, age, education, marital status, lack of close friends, being on a disability pension, smoking, being an ex-drinker, and having decreased one's alcohol intake during the past 12 months because of health problems. An interaction was found between alcohol and smoking. The pattern of alcohol odds ratios showed a J-shaped association among never smokers, and a similar pattern was suggested among ex-smokers and current smokers. Among never smokers, the lowest risk was found at the alcohol consumption level of 100-199 g/week (odds ratio (OR) = 0.58, 95% confidence interval (CI) 0.38-0.89). The highest risk was found among persons who regularly smoked > or = 20 cigarettes per day and drank > or = 300 g/week (OR = 4.44, 95% CI 2.36-8.36). The risk for ex-drinkers did not differ from that for lifelong abstainers (OR = 0.89, 95% CI 0.62-1.28), but persons who had decreased their alcohol intake during the past 12 months because of health problems had a higher risk (OR = 1.21, 95% CI 1.05-1.39). The authors conclude that moderate alcohol intake is related to a self-perception of good health.

Importance of risk factor clustering in coronary heart disease mortality and incidence in eastern Finland.

BACKGROUND: Smoking, a high serum cholesterol level and elevated blood pressure are the most important risk factors for coronary disease. Each of these major risk factors contributes independently to the risk of coronary disease, and clustering of the risk factors may increase the risk more than any of the factors alone. METHODS: This study is a 12-year prospective follow-up of 7928 men and 8530 women examined in eastern Finland. Risk factor categories were created by combining smoking status and dichotomized values of serum cholesterol level and blood pressure. Endpoints for the follow-up were either coronary death or a first coronary event (fatal or non-fatal). The effect of risk factor clustering was analyzed by assessing relative risks, mortality and incidence, and population-attributable risks in each of the risk-factor categories. RESULTS: The relative risks for coronary death and first coronary event in men with all three risk factors (smoking, serum cholesterol > or = 6.5 mmol/l and either systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg) were 11.8 and 7.3 respectively, compared with men with none of these factors. The corresponding risk ratios for women were 9.6 and 8.6. The 12-year coronary mortality varied between 10.0 deaths per 10000 person-years in men with none of the risk factors to 98.9 per 10000 person-years in men with all three risk factors. The 12-year incidences in men were 37.4 and 206.3 per 10000 person-years, respectively. The coronary mortality in women varied between 3.4 and 27.9 deaths per 10000 person-years and the incidence between 13.3 and 110.8 per 10000 person-years. Most of the population-attributable risk in men was associated with the combination of smoking with a high serum cholesterol level with elevated blood pressure. CONCLUSION: The results illustrate the public-health importance of these major risk of cardiovascular diseases.

Smoking and oral health: a population survey in Finland.

OBJECTIVES: A survey was conducted to study smokers' oral health behaviors and attitudes, and to determine if smokers were advised by their dentists to quit smoking. METHODS: A random sample of 1,200 adults 15 to 64 years of age living in the province of North Karelia, Finland, was selected in each of two study years (1990 and 1991) and surveyed using a mail questionnaire. The 102-item questionnaire solicited information on smoking status, oral health behaviors, missing teeth, perceptions of tobacco's harmful effects on oral health, smoking status and quitting, and advice on smoking cessation provided by dentists. Variations in behaviors and opinions according to smoking status were analyzed. RESULTS: Nonsmokers reported more frequent healthy oral health behaviors than did daily smokers, with the exception that no difference in toothbrushing frequencies existed among women. Daily smoking was associated with increased use of sugar in tea or coffee, and with more frequent alcohol consumption. Daily smoking was correlated with the number of missing teeth in bivariate analyses, but not in multivariate analyses. Fewer daily smokers than nonsmokers considered smoking to have harmful effects on oral health. The majority of daily smokers, however, wanted to quit. Eight percent of daily smokers reported that they had been advised by their dentist to quit. CONCLUSIONS: Dentists need to provide patients with counseling on tobacco use because of the desire of many smokers to quit. Counseling of smokers by the oral health team requires special attention and skills, because smokers' health behaviors and attitudes appear to be less favorable to oral health compared to nonsmokers.

Twenty-year trends in coronary risk factors in north Karelia and in other areas of Finland.

BACKGROUND: The North Karelia Project, a major demonstration programme for coronary heart disease (CHD) prevention, began in the eastern province of North Karelia in Finland in 1972. A number of other national CHD prevention activities have also been undertaken particularly since 1977. In the 1980s, a national strategy was developed for CHD prevention. This paper reports the 20-year changes in risk factors in North Karelia and in the original reference area of the project and the 10-year changes in a third area in southwestern Finland. METHODS: The results are based on comparable surveys of cross-sectional population samples, aged 30-59 years, every fifth year since 1972. RESULTS: During the first 5 years total cholesterol and blood pressure fell more in North Karelia than in the reference area, but subsequently changes have been about the same in both areas. The decline levelled off between the 1982 and 1987 surveys. This resulted in new nationwide preventive activities and during the last 5 years major declines in both serum total cholesterol and blood pressure have been observed. Smoking reduced more during the first 10 years in North Karelia than in Kuopio province. During the last 10 years a small decline has been observed in both areas. No change in smoking has occurred in southwestern Finland in the last 10 years. CONCLUSIONS: A major decline in cardiovascular disease risk factors has been observed in the last 20 years in Finland. This decline was associated with the launch of the national demonstration project in North Karelia in the 1970s and with subsequent major national activities thereafter.

Trends in cardiovascular disease risk factor clustering in eastern Finland: results of 15-year follow-up of the North Karelia Project.

BACKGROUND: The study describes 15-year cardiovascular disease risk factor clustering trends in eastern Finland and assesses the degree to which high levels of the risk factors are clustering in the same individuals. METHODS: Four independent cross-sectional surveys in randomly selected population samples (in 1972, 1977, 1982, and 1987) have been carried out in two provinces in eastern Finland (North Karelia and Kuopio) to assess the level of cardiovascular disease risk factors and the impact of a community-based prevention program. Each survey included a self-administered questionnaire, blood pressure measurements, and determination of serum cholesterol. Blood pressure and serum cholesterol values were dichotomized. All subjects were classified as either current smokers or nonsmokers. The total sample size was 30,118 and the participation rate varied between 77 and 94%. The common age range in all four surveys was 30 to 59 years. RESULTS: The proportion of individuals with a combination of two or three risk factors decreased markedly during the survey period. However, smoking tended to cluster increasingly with the other risk factors in 1987 compared with that seen in 1972. Among men, the proportion of smokers having either high blood pressure or high serum cholesterol levels, or both, is still high. CONCLUSIONS: The observed clustering of cardiovascular disease risk factors, particularly among men, underlines the importance of assessing other risk factors in persons with a high level of one risk factor and the need for a multifactorial approach in primary prevention. It is possible that high-risk behaviors, like smoking and high consumption of saturated fat and salt, were normal in 1972, but in 1987 they were declining, though they remained clustered among a particular segment of the population.

[Changes in the panorama of risk factors in heart and vascular diseases]. / Förändringar i riskfaktorpanoramat för hjärt- och kärlsjukdomar i Finland.

The level of risk factors associated with cardiovascular disease has dropped markedly in Finland during the past 20 years. In a follow-up covering eastern Finland, serum cholesterol and blood pressure values were found to have improved manifestly during the 1970s, and the number of smokers to have decreased. The beneficial trend appeared to have levelled off at the beginning of the 1980s, but the past five years have witnessed a manifest lowering of the risk factor level, particularly regarding serum cholesterol values, and the differences in the incidence of risk factors between different parts of the country have diminished.

Does community-wide prevention of cardiovascular diseases influence cancer mortality?

The North Karelia Project, a community-based demonstration project for prevention of cardiovascular diseases since 1972 in Finland, was successful in reducing the population levels of the major cardiovascular risk factors. A net decline in risk factors and coronary heart disease mortality was observed in North Karelia in the 1970s. Thereafter, the mortality from coronary heart disease has declined markedly in all of Finland. The aim of the study was to find out how the cancer mortality has changed in North Karelia during this longer follow-up period. Age-adjusted mortality trends were calculated for the male population aged between 35 and 64 years in the province of North Karelia, and in all of Finland for the period 1969-91, using the official mortality data. The trends and the changes were calculated using general linear model procedures. During the 20-year period, cancer mortality declined in North Karelia by 45.4% and in all of Finland by 32.7% (P = 0.006 for difference). The greater decline in North Karelia occurred particularly in the second decade of the follow up, and lung cancer. The results support the hypothesis that reduction in the population levels of the cardiovascular risk factors lead to beneficial changes in cancer mortality rates, but such changes take longer time to manifest than for coronary heart disease.

Hypertriglyceridemia in different degrees of glucose intolerance in a Finnish population-based study.

OBJECTIVE: To determine the prevalence of hypertriglyceridemia and the mean serum triglyceride concentrations in different degrees of glucose tolerance--non-insulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), and normal glucose tolerance (NGT). In addition, we analyzed the correlates of serum triglyceride concentration to explain why it is more prevalent in diabetic subjects. RESEARCH DESIGN AND METHODS: This study was a cross-sectional survey of 4000 people aged 45-64 yr randomly drawn from the population register of the Finnish population of the provinces of North Karelia and Kuopio in eastern Finland and Turku/Loimaa area in southwestern Finland and stratified by four 10-yr age- and sex groups. The final material comprised 96 subjects with NIDDM, 102 subjects with IGT, and 323 subjects with normal glucose tolerance classified on the basis of two 2-h oral glucose tolerance tests. The prevalence of hypertriglyceridemia by the glucose tolerance status and the variation in serum triglycerides associated with selected life-style and biochemical factors were executed as the main outcome measures. RESULTS: The prevalence of hypertriglyceridemia (greater than or equal to 2.3 mM) was 47.6% (95% confidence interval [CI] 32.5-62.7%) in NIDDM men, 21.9% (95% CI 7.6-36.2%) in IGT men, and 15.4% (95% CI 9.3-21.5%) in NGT. In women, hypertriglyceridemia was found in 51.9% (95% CI 38.6-65.2%) among those with NIDDM, 25.7% (95% CI 15.5-35.9%) among those with IGT, and 10.7% (95% CI 6.3-15.1%) in women with NGT. After adjusting for body mass index (BMI) and age, the difference in the prevalence of hypertriglyceridemia between the glucose tolerance groups remained significant in both men (P = 0.008) and women (P = 0.0001). High serum total cholesterol, high BMI, high waist-hip ratio, and low high-density lipoprotein (HDL) cholesterol were significantly associated with high serum triglycerides in all glucose tolerance groups. No synergistic effect between these parameters and glucose tolerance status was found. In multiple linear regression analyses, fasting plasma insulin, diabetes status, and serum uric acid were significant predictors of serum triglyceride concentration after taking into account age, BMI, and HDL and total cholesterol. The association between BMI and serum triglycerides in the regression analysis was significant only when plasma insulin was not included in the model. CONCLUSIONS: Hypertriglyceridemia is common in subjects with NIDDM and IGT and is often associated with low HDL cholesterol, high total cholesterol, hyperinsulinemia, and elevated serum uric acid concentration.