Nutritional guidelines for older people in Finland.

BACKGROUND: Ageing is associated with an increased risk of malnutrition, decreased nutrient intake, unintentional weight loss and sarcopenia, which lead to frailty, functional disabilities and increased mortality. Nutrition combined with exercise is important in supporting older people's health, functional capacity and quality of life. OBJECTIVE: To identify nutritional needs in various groups of older individuals and to present the nutritional guidelines for older people in Finland. DESIGN: A review of the existing literature on older people's nutritional needs and problems. The draft guidelines were written by a multidisciplinary expert panel; they were then revised, based on comments by expert organisations. The guidelines were approved by the National Nutritional Council in Finland. RESULTS: The heterogeneity of the older population is highlighted. The five key guidelines are: 1. The nutritional needs in different age and disability groups should be considered. 2. The nutritional status and food intake of older individuals should be assessed regularly. 3. An adequate intake of energy, protein, fiber, other nutrients and fluids should be guaranteed. 4. The use of a vitamin D supplement (20 µg per day) recommended. 5. The importance of physical activity is highlighted. In addition, weight changes, oral health, constipation, obesity, implementing nutritional care are highlighted. CONCLUSIONS: Owing to the impact that good nutrition has on health and well-being in later life, nutrition among older people should be given more attention. These nutritional guidelines are intended to improve the nutrition and nutritional care of the older population.

Determinants of long-term weight maintenance.

The aim of this paper is to discuss existing evidence on the determinants of weight maintenance by examining population based studies on weight gain as well as studies on weight loss maintenance. The data shows that disadvantaged groups are less likely to maintain healthy weight, and various social and economic problems starting from early in the life cycle may increase the risk of later weight gain. Long-term data on weight loss maintenance is still very limited. It is obvious that permanent behavioural changes that lead to reduced energy intake and/or increased energy expenditure are needed but otherwise the search for predictors in weight loss maintenance has been largely discouraging. In conclusion, since social and economic problems seem to increase the risk of weight gain more attention should be paid to environments that promote healthy weight maintenance.

Socio-economic status and abdominal obesity among Finnish adults from 1992 to 2002.

OBJECTIVE: To examine 10-year changes in waist circumference (WC) and identify socio-economic groups having higher WC than expected by their body mass index (BMI). DESIGN: Population based cross-sectional surveys carried out in four regions of Finland in 1992, 1997 and 2002. SUBJECTS: A total of 9026 women and 8173 men, aged 25-64 years. MEASUREMENTS: Waist circumference, BMI, socio-economic indicators (education, household income, employment status, marital status) and health behaviors (smoking, alcohol use, physical activity). RESULTS: In 2002, women had about 2.7 cm and men about 1.0 cm higher WC than subjects 10 years previously. Waist circumference increased more than BMI among women, especially among unemployed women. Higher WC among non-employed women was not explained by socio-economic indicators or health behaviors. Among men, smaller WC was associated with lower socio-economic status. However, associations partly disappeared after adjustment for health behaviors including physical activity at work. CONCLUSION: Socio-economic patterning of WC is divergent and gender-specific. More attention should be paid to increasing waistlines among women.

Psychosocial working conditions and weight gain among employees.

OBJECTIVE: To study the associations between psychosocial working conditions and weight gain. DESIGN, SUBJECTS AND MEASUREMENTS: Data from postal questionnaires (response rate 67%) sent to 40- to 60-y-old women (n=7093) and men (n=1799) employed by the City of Helsinki in 2000-2002 were analysed. Weight gain during the previous 12 months was the outcome variable in logistic regression analyses. Independent variables included Karasek's job demands and job control, work fatigue, working overtime, work-related mental strain, social support and the work-home interface. The final models were adjusted for age, education, marital status, physical strain and body mass index. RESULTS: In the previous 12 months, 25% of women and 19% of men reported weight gain. Work fatigue and working overtime were associated with weight gain in both sexes. Women who were dissatisfied with combining paid work and family life were more likely to have gained weight. Men with low job demands were less likely to have gained weight. All of these associations were independent of each other. CONCLUSIONS: Few work-related factors were associated with weight gain. However, our study suggests that work fatigue and working overtime are potential risk factors for weight gain. These findings need to be confirmed in prospective studies.

Intentional weight loss and smoking in young adults.

OBJECTIVE: To investigate whether current smoking and lifetime snuff use are associated with a lifetime history of major (>/=5 kg) intentional weight loss in young adults, and to examine the dependence of this association on familial factors. DESIGN: Cross-sectional population-based questionnaire survey of young adult Finnish twins participating in the fourth wave of the longitudinal FinnTwin-16-study in 2000-2002. SUBJECTS: A total of 4521 young adult Finnish twins aged 23-27 y. MEASUREMENTS: Questionnaire data on the number of intentional weight-loss episodes and on body mass index (BMI), cigarette smoking and snuff use, educational level, and number of subjects' own children. RESULTS: Current daily smoking was strongly associated with a history of two or more intentional major weight-loss episodes (lost >/=5 kg twice or more lifetime) both in women odds ratio (OR 1.87; 95%; confidence interval (CI) 1.39-2.50) and in men (OR 2.00; 95% CI 1.37-2.90). Frequent lifetime snuff use was statistically significantly associated with recurrent intentional weight loss episodes in men (OR 1.51; 95% CI 1.08-2.13). Among the twin pairs discordant for daily smoking, the smoking twin was more likely than the nonsmoking co-twin to have recurrent intentional weight-loss episodes (OR 1.57; 95% CI 1.03-2.41). These episodes were also strongly associated with high BMI. Education was inversely related to recurrent intentional weight-loss episodes in men. CONCLUSION: Tobacco use is strongly associated with a lifetime history of recurrent intentional major weight-loss episodes in early adulthood. This represents a major challenge to existing attitudes on smoking prevention and the promotion of healthful weight control.

The association between thinness and socio-economic disadvantage, health indicators, and adverse health behaviour: a study of 28 000 Finnish men and women.

OBJECTIVE: To examine how thinness is associated with indicators of socio-economic disadvantage, health-related behaviours, and health indicators including mortality. DESIGN: Independent risk factor surveys carried out in four geographic areas in Finland in 1982, 1987, 1992, and 1997, with mortality follow-up to the end of the year 2001. SUBJECTS: A total of 13 389 men and 14 770 women aged 25-64 y at baseline, and 2077 deaths during the follow-up when subjects who have died during the first 5 y were excluded. METHODS: A self-administrative questionnaire data on socio-economic status, health behaviour, and perceived health, together with measured height, weight, and metabolic indicators using standardised protocol. Mortality data by Statistics Finland were linked to the baseline surveys. RESULTS: Thin men (BMI

Weight satisfaction and self-esteem among teenagers in Helsinki, Moscow and Tallinn.

OBJECTIVE: Information on weight satisfaction in Eastern Europe is limited. This study compares relative weight, weight satisfaction and self-esteem of teenagers living in two post-Soviet capitals, Moscow and Tallinn, and a western capital Helsinki. METHOD: Classroom surveys including data about weight and height, weight satisfaction and self-4 esteem among 15-18-year-old girls (n = 911) and boys (n = 650) collected in 1994-95. RESULTS: Body mass index and self-esteem were highest in Helsinki. Nevertheless, feelings of over-weight were most common among Tallinn girls and feelings of over- and underweight among Muscovite girls. Boys were mostly satisfied with their current weight with no differences between cities. Low self-esteem was associated with feelings of overweight among girls and underweight among boys. DISCUSSION: Somewhat unexpectedly, girls grown in non-western cultures were more dissatisfied with their weight than girls in Helsinki. These findings may partly be attributable to rapid economic and cultural transformations that were occurring in these countries during the study period.

Food insecurity is associated with past and present economic disadvantage and body mass index.

Fears and experiences of food restriction influence eating behavior but the association between past and present economic disadvantage, food insecurity and body size is poorly understood. Therefore, we examined these associations in a nationwide, representative sample of 25- to 64-y-old Finnish men and women (n = 6506). The respondents were classified by their body mass index (BMI) into four groups: thin, normal, overweight and obese. Economic disadvantage was assessed by three indicators including low household income, unemployment during past 5 y and long-term economic problems in childhood. Food insecurity was assessed by five separate items concerning economic fears and experiences related to sufficient supply of food during the past 12 mo, and a combined scale in which those with affirmative responses to four to five items were classified as hungry. Multivariable logistic regression analyses were conducted using both the BMI grouping and indicators of economic disadvantage as independent variables to predict food insecurity, controlling simultaneously for age, educational attainment and sex. The results showed that low household income, recent unemployment and economic problems in childhood were all predictors of food insecurity. Thin people were most likely to be hungry and showed most food insecurity in five separate items. In addition, obese people reported more buying cheaper food due to economic problems and fears or experiences of running out of money to buy food than did normal weight subjects. In conclusion, both past and present economic disadvantage is associated with various aspects of food insecurity. The association between food insecurity and BMI is curvilinear.

A descriptive study of weight loss maintenance: 6 and 15 year follow-up of initially overweight adults.

OBJECTIVE: To describe factors associated with long-term maintenance of weight loss. DESIGN AND SUBJECTS: We identified initially overweight individuals (body mass index >27 kg/m2, n=911) from the nationwide Finnish Twin Cohort and studied those who lost at least 5% of their body weight between 1975 and 1981. Subjects who had maintained weight loss until 1990 (38 men, 17 women) were compared to both regainers (28 men, 26 women) and the other overweight subjects in the cohort. MEASUREMENTS: Self-report data on weight, height, health behaviours and perceived well-being; self-report and register-based data on health status and use of medication. RESULTS: Only 6% of all overweight individuals lost and maintained at least 5% weight loss. In men weight loss maintenance was associated with a low level of stress and health-promoting behaviours but also with medical problems. Failure to maintain weight loss seemed to be associated with stressful life and past high alcohol intake. In women weight loss maintenance was associated with low initial well-being and health-compromising behaviours that improved after weight loss. CONCLUSION: Long-term weight loss maintenance is rare. Predictors of weight loss maintenance are different between women and men. International Journal of Obesity (2000)24, 116-125

The association of body mass index with social and economic disadvantage in women and men.

BACKGROUND: Although an inverse relationship between socioeconomic status and body mass index (BMI) is well documented, broad population studies focusing on the association between BMI and various forms of disadvantage such as unemployment, low income or social isolation are rare. METHODS: A nationwide, representative sample of 25-64-year-old Finnish subjects (n = 6016) was classified according to their BMI into four groups: 'thin' (BMI < 20), 'normal' (BMI 20-24.9), 'overweight' (BMI 25-29.9) and 'obese' (BMI > or = 30). Multivariable analyses using logistic regression were conducted with this BMI-grouping as an independent variable to predict social and economic disadvantage, controlling simultaneously for age, educational attainment, region of residence, and limiting long-standing illness. RESULTS: In women, overweight was associated with current unemployment and obesity with long-term unemployment as well as absence of close friends outside the family circle. Both overweight and obesity were associated with low individual earnings. Obese women were also most likely to have low household disposable and individual incomes; a similar pattern was seen among thin women. A small subgroup of thin men were socially and economically disadvantaged with all our indicators whereas excess body weight was not problematic for men. CONCLUSIONS: Deviant body weight is associated with social and economic disadvantage in a gender-specific and partly curvilinear way. In particular, obese women face multiple social and economic disadvantage.

Weight loss maintenance: determinants of long-term success.

To analyse determinants of long-term weight maintenance we studied energy expenditure, dietary intake, eating behaviour and psychological symptoms of 9 women (SS, BMI = 26.6) who reached their ideal weight during 1985-86 and were still an average 16.2 kg below their original weight in 1993. Controls were 42 obese, non-reducing females (OC, BMI = 34.8). Dietary intake was calculated from four-day food records. Dietary restraint was assessed by the Three-Factor Eating Questionnaire (TFEQ) and symptoms of bulimia or binge eating by Bulimic Investigatory Test, Edinburgh (BITE). Physical exercise was estimated by open interviews, resting metabolic rate (RMR) by indirect calorimetry and body composition by bioelectrical impedance. Psychological characteristics were studied using the Defense Style Questionnaire (DSQ), Beck Depression Inventory (BDI) and Symptom Checklist (SCL-90). SS had lower RMR (1320 kcal vs. 1540 kcal, p = 0.004), lower daily energy intake (1208 kcal vs. 1525 kcal, p = 0.020) and higher scores for dietary restraint (14.6 vs. 8.4, p = 0.002) than OC. Restraint scores correlated negatively with energy intake and RMR in both groups, especially in SS (r = -0.75, p = 0.021 and r = -0.87, p = 0.002, respectively). Attempts to incorporate habitual physical activities to daily life (89% vs. 39%, p = 0.011) and weekly sports hobbies (67% vs. 13%, p = 0.002) were more often reported by SS. The scores of BITE, DSQ, BDI and SCL-90 were within normal range in both groups but SS had higher scores in most measures, especially for anxiety (16.4 vs. 14.3, p = 0.045). In conclusion, long-term maintenance of weight loss was associated with highly restrained eating, regular physical activity, and perhaps with increased anxiety.

Psychosocial factors and quality of life in obesity.

It can be expected that the quality of life in obesity is impaired since obesity is severely stigmatized in affluent societies and also increases the risk of disability, mortality and morbidity. In addition, the fact that obesity in inversely related to socioeconomic status in women and is associated with both downward social mobility and lower levels of socioeconomic attainment may further impair the quality of life in obesity. However, relatively little is known about the quality of life in obesity.

Employed problem drinkers: a nutritional risk group?

Nutritional assessment was made in 26 employed Finnish men drinking excessively and in 49 control men. Because of their greater alcohol consumption, daily intake of energy of case men significantly exceeded that of control men; other dietary differences were negligible. Compared with control men, case men had thicker fatfolds but reduced mean body mass and arm muscle circumference. Mean circulating levels of vitamin C and alpha-tocopherol were normal and equal in case and control men, but serum retinol was raised and beta-carotene was reduced in case men. Serum concentration and 24-h urinary excretion of selenium were significantly lower in case than in control men. Serum levels of magnesium and zinc were similar in both groups, but urinary excretions were higher in case men. Heavy drinking does not result in florid nutritional deficiencies in socially intact men, but its role in subtle nutritional alterations deserves further studies.