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The transition towards more plant-based diets may pose risks for bone health such as low vitamin D and Ca intakes. Findings for the contribution of animal and plant proteins and their amino acids (AA) to bone health are contradictory. This 6-week clinical trial aimed to investigate whether partial replacement of red and processed meat (RPM) with non-soya legumes affects AA intakes and bone turnover and mineral metabolism in 102 healthy 20–65-year-old men. Participants were randomly assigned to diet groups controlled for RPM and legume intake (designed total protein intake (TPI) 18 E%): the meat group consumed 760 g RPM per week (25 % TPI) and the legume group consumed non-soya legume-based products (20 % TPI) and 200 g RPM per week, the upper limit of the Planetary Health Diet (5 % TPI). No differences in bone (bone-specific alkaline phosphatase; tartrate-resistant acid phosphatase 5b) or mineral metabolism (25-hydroxyvitamin D; parathyroid hormone; fibroblast growth factor 23; phosphate and Ca) markers or Ca and vitamin D intakes were observed between the groups (P > 0·05). Methionine and histidine intakes were higher in the meat group (P ≤ 0·042), whereas the legume group had higher intakes of arginine, asparagine and phenylalanine (P ≤ 0·013). Mean essential AA intakes in both groups met the requirements. Increasing the proportion of non-soya legumes by reducing the amount of RPM in the diet for 6 weeks did not compromise bone turnover and provided on average adequate amounts of AA in healthy men, indicating that this ecologically sustainable dietary change is safe and relatively easy to implement. [ABSTRACT FROM AUTHOR]

The role of legumes in healthy and sustainable diets is increasingly of interest. Few studies have investigated the association between legume consumption and the consumption of other food groups and the intake of nutrients. This study examined how legume consumption is associated with the consumption of other foods and the intake of nutrients among Finnish adults. Our study used cross-sectional data from the population-based FinHealth 2017 Study consisting of 2250 men and 2875 women aged ≥18 years. The associations between legume consumption (quartile classification), food groups and nutrients were analysed using multivariable linear regression. The models were initially adjusted for energy intake and additionally for age, educational level, smoking status, leisure-time physical activity and BMI. Legume consumption had a positive association with age, education level and leisure-time physical activity. The consumption of legumes was positively associated with the consumption of fruits and berries, vegetables, nuts and seeds and fish and fish products and inversely associated with the consumption of red and processed meat, cereals and butter and butter-based fat spreads. Furthermore, legume consumption was positively associated with the intake of protein, fibre, folate, thiamine and salt in both sexes and inversely associated with the intake of saturated fatty acids and sucrose (sucrose, women only). Thus, legume consumption appears to reflect overall healthier food choices. An increase in legume consumption could accelerate the transition to more sustainable diets. The confounding role of other foods and nutrients should be considered when studying associations between legume consumption and health outcomes. [ABSTRACT FROM AUTHOR]

Objective: The shift towards plant-based diets with less meat and more legumes is a global target and requires an understanding of the consequences of dietary adequacy on the population level. Our aim was to model the impact of partial replacement of red and processed meat with legumes on nutrient intakes and population shares below dietary reference intakes.Design: Modelling study with three scenarios anchored in meat cut-offs: ≤ 70 g/d (Finnish dietary guideline); ≤ 50 g/d (Danish dietary guideline); ≤ 30 g/d (EAT-Lancet recommendation). In all subjects, the amount of meat in grams over the cut-off was replaced with the same amount of legumes. The SPADE method was used to model usual intake distributions. Meaningful differences in average intakes and in population shares below dietary reference intakes compared to the reference (FinDiet) were evaluated based on non-overlapping 95 % CI.Setting: Finnish national food consumption survey (FinDiet 2017).Subjects: Finnish adults (n 1655) aged18-74 years (47 % men).Results: The scenarios introduced increases in the average intakes of fibre, folate, K, Mg, Cu and Fe, and decreases in intakes of saturated fat, niacin, vitamin B12, Se and Zn. Meaningful shifts of the usual intake distributions of fibre and folate towards improvement in intakes emerged already in 'scenario 70 g'. Overall, distribution shifts towards a higher probability of inadequate intakes of the studied nutrients were not observed.Conclusions: These results support the public health message to partly replace meat with legumes and may benefit nutrition policy actions towards sustainable diets in the Nordic countries and beyond. [ABSTRACT FROM AUTHOR]

Even though sunlight is viewed as the most important determinant of 25-hydroxyvitamin D (25(OH)D) status, several European studies have observed higher 25(OH)D concentrations among north-Europeans than south-Europeans. We studied the association between geographical latitude (derived from ecological data) and 25(OH)D status in six European countries using harmonised immunoassay data from 81 084 participants in the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project (male sex 48·9 %; median age 50·8 years; examination period 1984–2014). Quantile regression models, adjusted for age, sex, decade and calendar week of sampling and time from sampling to analysis, were used for between-country comparisons. Up until the median percentile, the ordering of countries by 25(OH)D status (from highest to lowest) was as follows: Sweden (at 65·6–63·8°N), Germany (at 48·4°N), Finland (at 65·0–60·2°N), Italy (at 45·6–41·5°N), Scotland (at 58·2–55·1°N) and Spain (at 41·5°N). From the 75th percentile and upwards, Finland had higher values than Germany. As an example, using the Swedish cohort as a comparator, the median 25(OH)D concentration was 3·03, 3·28, 5·41, 6·54 and 9·28 ng/ml lower in the German, Finnish, Italian, Scottish and Spanish cohort, respectively (P -value < 0·001 for all comparisons). The ordering of countries was highly consistent in subgroup analyses by sex, age, and decade and season of sampling. In conclusion, we confirmed the previous observation of a north-to-south gradient of 25(OH)D status in Europe, with higher percentile values among north-Europeans than south-Europeans. [ABSTRACT FROM AUTHOR]

Added sugar intake has been associated with several health issues, but few studies have examined its association with overall diet quality. We aimed at examining the association between added sugar intake and overall diet quality in Finnish adults. Associations between added sugar intake and sociodemographic factors, lifestyle factors, and BMI were also explored. Our data comprised 5094 adults residing in Finland who participated in the National FinHealth 2017 Study. Dietary intake was assessed by a validated FFQ. Food consumption and nutrient intakes were calculated using the Finnish national food composition database. Added sugar intake was estimated based on food categorisation and identifying naturally occurring sugar sources. Overall diet quality was assessed by the modified Baltic Sea Diet Score. The average added sugar intake was 7·6 E % in women and 8·3 E % in men in this study population. Added sugar intake was inversely associated with education (P = 0·03 women; P = 0·001 men), physical activity (P < 0·0001), and BMI in men (P = 0·003), and directly with smoking (P = 0·002 women; P < 0·0001 men). Added sugar intake was inversely associated with overall diet quality in both sexes (P < 0·0001). No interactions were found except for men's physical activity subgroups, the inverse association being stronger among active men than moderately active or inactive men (Pfor interaction = 0·005). Our findings suggest that high added sugar intake is associated with several unhealthy dietary and lifestyle habits, including poor-quality diets, smoking and leisure-time inactivity in Finnish adults. Efforts to improve diet quality should consider added sugar intake equally in the whole population. [ABSTRACT FROM AUTHOR]

The validity of grocery purchase data as an indicator of food consumption is uncertain. This paper investigated (1) the associations between food consumption and grocery purchases using automatically accumulated purchase data and (2) whether the strength of the associations differed in certain sub-populations. The participants filled in a FFQ, and a major Finnish retailer issued us with their loyalty-card holders' grocery purchase data covering the 1- and 12-month periods preceding the FFQ. We used gamma statistics to study the association between thirds/quarters of FFQ and grocery purchase data (frequency/amount) separately for eighteen food groups among the 11 983 participants. Stratified analyses were conducted for subgroups based on sex, family structure, educational level, household income and self-estimated share of purchases from the retailer. We also examined the proportion of participants classified into the same, adjacent, subsequent and opposite categories using the FFQ and purchase data. The gammas ranged from 0·12 (cooked vegetables) to 0·75 (margarines). Single households had stronger gammas than two-adult families, and participants with > 60 % of purchases from the retailer had stronger gammas. For most food groups, the proportion of participants classified into the same or adjacent category was > 70 %. Most discrepancies were observed for fresh/cooked vegetables, berries and vegetable oils. Even though the two methods did not categorise all food groups similarly, we conclude that grocery purchase data are able to describe food consumption in an adult population, and future studies should consider purchase data as a resource-saving and moderately valid measure in large samples. [ABSTRACT FROM AUTHOR]

From health and sustainability perspectives, reduction in the consumption of animal-based foods, especially red meat, is a key strategy. The present study examined the prevalence, sociodemographic and lifestyle factors, food consumption and food choice motives of vegetarians and consumers of low and high amounts of red and processed meat (RPM) among Finnish adults. We applied the data from three national health studies: FINRISK 2007 (n 4874), FINRISK 2012 (n 4812) and FinHealth 2017 (n 4442). Participants addressed their food consumption with a FFQ and answered other questionnaires about sociodemographic and lifestyle factors, as well as food choice motives. The prevalence of vegetarianism increased from 0·7 % in 2012 to 1·8 % in 2017, and median daily RPM consumption decreased from 128 g in 2007 to 119 g in 2012 and to 96 g in 2017. Vegetarians and members of the low-RPM group were more often women, younger and more highly educated than the high-RPM group, both in 2007 and 2017. Still, the importance of sex for the probability of a vegetarian diet decreased, while its importance for high-RPM consumption increased. Vegetarians consumed more fruit, vegetables, legumes, nuts and seeds than either the low- or high-RPM groups. The high-RPM group had the lowest scores in several aspects of healthy and sustainable diet, healthy food choice motives and healthy lifestyle. Vegetarians and groups differing in their RPM consumption levels might benefit from differing interventions and nutrition information taking into account their other dietary habits, food choice motives and lifestyle factors. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether vitamin D status predicts weight gain or increase in waist circumference during the 11-year follow-up in general adult population.Design: A population-based longitudinal study.Setting: The study was conducted using data from the nationally representative Health 2000/2011 Survey. The analyses were based on regression models adjusted for sociodemographic and lifestyle factors.Participants: Weight, waist circumference and vitamin D status (serum 25-hydroxyvitamin D concentration analysed with radioimmunoassay) were measured from 2924 participants aged 30-64 years at baseline.Results: In men, low vitamin D status at baseline predicted ≥10 % increase in waist circumference during the follow-up when adjusted for age only (OR for sufficient v. deficient S-25(OH)D 0·41; 95 % CI 0·25, 0·67; P for trend <0·01), but the association with weight gain was only borderline significant. After adjustment for potential confounders, low vitamin D status remained a significant predictor of increase in waist circumference, but the association with weight gain was further attenuated. In women, vitamin D status at baseline did not predict weight gain or increase in waist circumference.Conclusions: Our results suggest that vitamin D insufficiency may be a risk factor of abdominal obesity among men but not among women. In men, it may also increase the risk of weight gain. Further studies are required to confirm these findings and examine potential mechanisms behind them. There is also a possibility that vitamin D is a biomarker of healthy lifestyle rather than an independent risk factor for obesity. [ABSTRACT FROM AUTHOR]

The insulin-like growth factor (IGF) axis may be involved in the development of type 2 diabetes. We examined the associations of IGF-I and IGF binding proteins (IGFBP)-1 and -3 with diabetes risk and evaluated macronutrient intakes related to the observed associations. In a nested case–control study of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study of Finnish male smokers aged 50–69 years, the IGF variables were measured from baseline serum samples for a random sample of 310 men with diabetes diagnosed during a 12-year follow-up and for 310 controls matched by age, recruitment day and intervention group. Diet at baseline was assessed using a validated FFQ. The associations of IGF proteins with diabetes risk were estimated using conditional logistic regression and the associations with macronutrient intakes using linear regression. IGF-I and IGFBP-3 were not associated with the incidence of diabetes. Higher IGFBP-1 was associated with lower diabetes risk in an unadjusted crude model (OR 0·25; 95 % CI 0·15, 0·42 in the highest quartile compared with the lowest), but not after adjustment for BMI (corresponding OR 0·76; 95 % CI 0·41, 1·40). Intakes of carbohydrates, plant protein and milk protein associated positively and intake of meat protein and fat negatively with IGFBP-1 (P <0·005). IGFBP-1 was inversely associated with diabetes risk, but the association was substantially dependent on BMI. The associations between macronutrient intakes and IGFBP-1 may reflect influences of nutrients or foods on insulin concentrations. [ABSTRACT FROM AUTHOR]

Studies indicate that the healthy Nordic diet may improve heart health, but its relation to weight change is less clear. We studied the association between the adherence to the healthy Nordic diet and long-term changes in weight, BMI and waist circumference. Furthermore, the agreement between self-reported and measured body anthropometrics was examined. The population-based DIetary, Lifestyle and Genetic Determinants of Obesity and Metabolic syndrome Study in 2007 included 5024 Finns aged 25–75 years. The follow-up was conducted in 2014 (n 3735). One-third of the participants were invited to a health examination. The rest were sent measuring tape and written instructions along with questionnaires. The Baltic Sea Diet Score (BSDS) was used to measure adherence to the healthy Nordic diet. Association of the baseline BSDS and changes in BSDS during the follow-up with changes in body anthropometrics were examined using linear regression analysis. The agreement between self-reported and nurse-measured anthropometrics was determined with Bland–Altman analysis. Intra-class correlation coefficients between self-reported and nurse-measured anthropometrics exceeded 0·95. The baseline BSDS associated with lower weight (β=−0·056, P=0·043) and BMI (β=−0·021, P=0·031) over the follow-up. This association was especially evident among those who had increased their BSDS. In conclusion, both high initial and improved adherence to the healthy Nordic diet may promote long-term weight maintenance. The self-reported/measured anthropometrics were shown to have high agreement with nurse-measured values which adds the credibility of our results. [ABSTRACT FROM AUTHOR]

Associations between sugar intake and the remaining diet are poorly described in modern food environments. We aimed at exploring associations of high naturally occurring and added sugar intakes with sociodemographic characteristics, intake of macronutrients, fibre and selected food groups. Our data comprised 4842 Finnish adults aged 25-74 years, who participated in the population-based DIetary, Lifestyle and Genetic determinants of Obesity and Metabolic syndrome (DILGOM) study. Diet was assessed by a validated 131-item FFQ. The food item disaggregation approach was used to estimate sucrose and fructose intakes from natural sources (naturally occurring sugar) and all other sources (added sugar). Sex-specific trends in macronutrient, fibre and food group intakes across sugar type quartiles were determined with general linear modelling adjusting for age, energy intake, leisure-time physical activity, smoking, education and BMI. Overall, results were similar across sexes. Young age was found to be a determinant of higher added sugar and lower naturally occurring sugar intakes (P < 0·0001). High added sugar intake was associated with low fibre intake (P < 0·0001) accompanied with lower fruit (P < 0·0001 women; P = 0·022 men) and vegetable consumption (P < 0·0001) and higher wheat consumption (P = 0·0003 women; P < 0·0001 men). Opposite results were found for naturally occurring sugar. Butter consumption increased by 28-32% (P < 0·0001) when shifting from the lowest to the highest added sugar intake quartile, while a decrease of 26-38% (P < 0·0001) was found for naturally occurring sugar. Therefore, the associations of sugar types with dietary carbohydrate and fat quality seem opposing. Proper adjustments with dietary variables are needed when studying independent relationships between sugar and health. [ABSTRACT FROM AUTHOR]

Objective: Finland is known for a sharp decrease in the intake of saturated fat and cardiovascular mortality. Since 2000, however, the consumption of butter-containing spreads -- an important source of saturated fats -- has increased. We examined social and health-related predictors of the increase among Finnish men and women. Design: An 11-year population follow-up. Setting: A representative random sample of adult Finns, invited to a health survey in 2000. Subjects: Altogether 5414 persons aged 30-64 years at baseline in 2000 were re-invited in 2011. Of men 1529 (59 %) and of women 1853 (66 %) answered the questions on bread spreads at both time points. Respondents reported the use of bread spreads by choosing one of the following alternatives: no fat, soft margarine, butter--vegetable oil mixture and butter, which were later categorized into margarine/no spread and butter/butter--vegetable oil mixture (= butter). The predictors included gender, age, marital status, education, employment status, place of residence, health behaviours, BMI and health. Multinomial regression models were fitted. Results: Of the 2582 baseline margarine/no spread users, 24.6% shifted to butter. Only a few of the baseline sociodemographic or health-related determinants predicted the change. Finnish women were more likely to change to butter than men. Living with a spouse predicted the change among men. Conclusions: The change from margarine to butter between 2000 and 2011 seemed not to be a matter of compliance with official nutrition recommendations. Further longitudinal studies on social, behavioural and motivational predictors of dietary changes are needed. [ABSTRACT FROM AUTHOR]

Epidemiological studies have shown that a number of nutrients are associated with better physical performance. However, little is still known about the role of the whole diet, particularly a healthy Nordic diet, in relation to physical performance. Therefore, we examined whether a healthy Nordic diet was associated with measures of physical performance 10 years later. We studied 1072 participants from the Helsinki Birth Cohort Study. Participants' diet was assessed using a validated 128-item FFQ at the mean age of 61 years, and a priori-defined Nordic diet score (NDS) was calculated. The score included Nordic fruits and berries, vegetables, cereals, PUFA:SFA and trans-fatty acids ratio, low-fat milk, fish, red and processed meat, total fat and alcohol. At the mean age of 71 years, participants' physical performance was measured using the Senior Fitness Test (SFT), and an overall SFT score was calculated. Women in the highest fourth of the NDS had on average 5 points higher SFT score compared with those in the lowest fourth (Pfor trend 0·005). No such association was observed in men. Women with the highest score had 17% better result in the 6-min walk test, 16% better arm curl and 20% better chair stand results compared with those with the lowest score (all P values <0·01). In conclusion, a healthy Nordic diet was associated with better overall physical performance among women and might help decrease the risk of disability in old age. [ABSTRACT FROM AUTHOR]

Vitamin D has been suggested to protect against depression, but epidemiological evidence is scarce. The present study investigated the relationship of serum 25-hydroxyvitamin D (25(OH)D) with the prevalence of depressive and anxiety disorders. The study population consisted of a representative sample of Finnish men and women aged 30–79 years from the Health 2000 Survey. The sample included 5371 individuals, of which 354 were diagnosed with depressive disorder and 222 with anxiety disorder. Serum 25(OH)D concentration was determined from frozen samples. In a cross-sectional study, a total of four indicators of depression and one indicator of anxiety were used as dependent variables. Serum 25(OH)D was the risk factor of interest, and logistic models used further included sociodemographic and lifestyle variables as well as indicators of metabolic health as confounding and/or effect-modifying factors. The population attributable fraction (PAF) was estimated. Individuals with higher serum 25(OH)D concentrations showed a reduced risk of depression. The relative odds between the highest and lowest quartiles was 0·65 (95 % CI 0·46, 0·93; P for trend = 0·006) after adjustment for sociodemographic, lifestyle and metabolic factors. Higher serum 25(OH)D concentrations were associated with a lower prevalence of depressive disorder especially among men, younger, divorced and those who had an unhealthy lifestyle or suffered from the metabolic syndrome. The PAF was estimated to be 19 % for depression when serum 25(OH)D concentration was at least 50 nmol/l. These results support the hypothesis that higher serum 25(OH)D concentrations protect against depression even after adjustment for a large number of sociodemographic, lifestyle and metabolic factors. Large-scale prospective studies are needed to confirm this finding. [ABSTRACT FROM PUBLISHER]

ObjectiveThe health-related effects of the Nordic diet remain mostly unidentified. We created a Baltic Sea Diet Score (BSDS) for epidemiological research to indicate adherence to a healthy Nordic diet. We examined associations between the score and nutrient intakes that are considered important in promoting public health. We also examined the performance of the BSDS under two different cut-off strategies.DesignThe cross-sectional study included two phases of the National FINRISK 2007 Study. Diet was assessed using a validated FFQ. Food and nutrient intakes were calculated using in-house software. Nine components were selected for the score. Each component was scored according to both sex-specific consumption quartiles (BSDS-Q) and medians (BSDS-M), and summed to give the final score values.SettingA large representative sample of the Finnish population.SubjectsMen (n 2217) and women (n 2493) aged 25 to 74 years.ResultsIn the age- and energy-adjusted model, adherence to the diet was associated with a higher intake of carbohydrates (E%), and lower intakes of SFA (E%) and alcohol (E%, where E% is percentage of total energy intake; P < 0·01). Furthermore, the intakes of fibre, Fe, vitamins A, C and D, and folate were higher among participants who adhered to the diet (P < 0·05). After further adjustments, the results remained significant (P < 0·05) and did not differ remarkably between BSDS-Q and BSDS-M.ConclusionsThe BSDS can be used as a measure of a healthy Nordic diet to assess diet–health relationships in public health surveys in Nordic countries. [ABSTRACT FROM AUTHOR]

The aim of the present study was to compare the lifestyle (leisure-time physical activity, smoking habits and alcohol consumption) and dietary (energy-yielding nutrients, dietary fibre and foods) factors of Finns with a new syndrome called normal-weight obesity (NWO) with those of lean and overweight Finns. The representative population-based study included 4786 participants (25–74 years) from the National FINRISK 2007 Study with a health examination and questionnaires. Food intake was assessed using a validated FFQ. NWO was defined to include those with a normal BMI ( < 25 kg/m2) but excessive body fat (for men ≥ 20 % and for women ≥ 30 %) according to WHO definitions. The proportion of participants with a normal BMI was 28 % in men and 42 % in women. Of these, 34 % of the men and 45 % of the women had the NWO syndrome (among all the participants, 10 and 19 %, respectively). The waist circumference of the NWO participants was between that of the lean and overweight participants. Some potential risk factors, such as physical inactivity, (ex)-smoking and alcohol consumption, were related to NWO. In general, the intakes of energy-yielding nutrients were not associated with NWO. Instead, some healthy dietary factors (e.g. low intakes of meat and soft drinks) as well as unhealthy factors (e.g. low intakes of root vegetables, cereals and fish and high intake of confectionery) were related to NWO. The findings might explain why the NWO participants were of normal weight, but had an excessive body fat percentage. In conclusion, the proportion of normal-weight participants with an excessive body fat percentage was surprisingly high. The identification of NWO people may be of importance because although they appear lean, they have some unhealthy lifestyle and dietary habits related to obesity and overall health. [ABSTRACT FROM PUBLISHER]

We have examined the associations between dietary glycaemic index (GI), substitutions of total, low-, medium- and high-GI carbohydrates for fat and the risk of CHD. The study consisted of 21 955 male smokers, aged 50–69 years, within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. The diet was assessed at baseline using a validated FFQ. During a 19-year follow-up, 4379 CHD cases (2377 nonfatal myocardial infarctions and 2002 CHD deaths) were identified from national registers. Relative risks (RR) and CI for CHD were analysed using Cox proportional hazards modelling, and multivariate nutrient density models were applied to examine the associations between the substitutions of macronutrients and the risk of CHD. Dietary GI was inversely associated with CHD risk: multivariate RR in the highest v. lowest quintile was 0·89 (95% CI 0·81, 0·99). Replacement of higher-GI carbohydrates with lower-GI carbohydrates did not associate with the risk. Replacing saturated and trans-fatty acids with carbohydrates was associated with decreased CHD risk: RR for substitution of 2% of energy intake was 0·97 (95% CI 0·94, 0·99). On the contrary, replacing MUFA with carbohydrates was associated with an increased risk: RR for substitution of 2% of energy intake was 1·08 (95% CI 1·01, 1·16). We conclude that in the present study population, contrary to the hypothesis, a lower GI does not associate with a decreased risk of CHD. The associations of carbohydrates with CHD risk depend on the fatty acid composition of the diet. [ABSTRACT FROM AUTHOR]

ObjectiveRecently, the general public opinion is that nutritional recommendations promote obesity rather than prevent it. We created the Recommended Finnish Diet Score (RFDS) that illustrates the Finnish nutrition recommendations and assessed whether this score is associated with BMI, waist circumference (WC) and body fat percentage (BF%).DesignCross-sectional study included two phases of the National FINRISK 2007 Study. Diet was assessed using a validated FFQ. Height, weight, WC and BF% were measured, and BMI values were calculated. The RFDS was developed based on the national nutrition recommendations.SettingA large representative sample of the Finnish population.SubjectsMen (n 2190) and women (n 2530) aged 25–74 years.ResultsThe RFDS was inversely associated with WC in men (OR = 0·48, 95 % CI 0·28, 0·81, P < 0·05) and BF% in both men (OR = 0·44, 95 % CI 0·24, 0·82, P-trend < 0·05) and women (OR = 0·63, 95 % CI 0·37, 1·08, P-trend < 0·05). The inverse association of RFDS and BF% appeared stronger among older age groups (men: OR = 0·21 CI 0·07, 0·64, P-trend < 0·01; women: OR = 0·56, 95 % CI 0·25, 1·27, P-trend < 0·05) and among women with normal BMI (OR = 0·62, 95 % CI 0·36, 1·09, P-trend < 0·05). The RFDS was not associated with BMI.ConclusionsA diet following nutrition recommendations is likely to help to maintain normal WC and BF%. These findings could be useful for dietary counselling and the prevention of obesity. [ABSTRACT FROM AUTHOR]

ObjectiveA low socio-economic status (SES) is related to less healthy dietary habits, but the reasons for this remain unclear. We examined whether the absolute or relative importance of various food choice motives contributed to SES disparities in vegetable/fruit and energy-dense food intake.DesignWe analysed cross-sectional data from the FINRISK Study 2007 by means of structural equation modelling and used a shortened version of the Food Choice Questionnaire to assess the absolute importance of health, pleasure, convenience, price, familiarity and ethicality motives. We calculated the relative importance of each motive by dividing the participant's rating of it by his/her mean score on all motives. Dietary intake was measured with an FFQ.SettingA population-based survey in Finland.SubjectsMen (n 1691) and women (n 2059) aged 25–64 years.ResultsHigher education and income were related to a greater vegetable/fruit intake (β = 0·12, P < 0·001), while education was associated negatively with the consumption of energy-dense foods (β = −0·09, P < 0·001). Socio-economically disadvantaged individuals considered price and/or familiarity more important in their food choices in both absolute and relative terms. A higher income was related to a greater relative importance of health considerations. Relative motives were more strongly associated with vegetable/fruit and energy-dense food consumption than absolute motives and the relative importance of price, familiarity and health partly mediated the effects of the SES indicators on the consumption of these food items.ConclusionsIndividual priorities in food choice motives, rather than the absolute importance of single motives, play a role in producing SES disparities in diet. [ABSTRACT FROM AUTHOR]

Due to differences in food cultures, dietary quality measures, such as the Mediterranean Diet Score, may not be easily adopted by other countries. Recently, the Baltic Sea Diet Pyramid was developed to illustrate healthy choices for the diet consumed in the Nordic countries. We assessed whether the Baltic Sea Diet Score (BSDS) based on the Pyramid is associated with a decreased risk of obesity and abdominal obesity. The population-based cross-sectional study included 4720 Finns (25–74 years) from the National FINRISK 2007 study. Diet was assessed using a validated FFQ. The score included Nordic fruits and berries, vegetables, cereals, ratio of PUFA:SFA and trans-fatty acids, low-fat milk, fish, red and processed meat, total fat (percentage of energy), and alcohol. Height, weight and waist circumference (WC) were measured and BMI values were calculated. In a multivariable model, men in the highest v. lowest BSDS quintile were more likely to have normal WC (OR 0·48, 95 % CI 0·29, 0·80). In women, this association was similar but not significant (OR 0·65, 95 % CI 0·39, 1·09). The association appeared to be stronger in younger age groups (men: OR 0·23, 95 % CI 0·08, 0·62; women: OR 0·17, 95 % CI 0·05, 0·58) compared with older age groups. Nordic cereals and alcohol were found to be the most important BSDS components related to WC. No association was observed between the BSDS and BMI. The present study suggests that combination of Nordic foods, especially cereals and moderate alcohol consumption, is likely to be inversely associated with abdominal obesity. [ABSTRACT FROM PUBLISHER]

FFQ require validation as part of epidemiological research of diet–disease relationships. Studies exploring associations between carbohydrate type and chronic diseases are rapidly increasing, but information on the validity of carbohydrate fractions, dietary glycaemic index (GI) and the glycaemic load (GL) estimated by FFQ is scarce. Likewise, the effects of subject characteristics on FFQ validity have been poorly documented. The present study evaluates the relative validity of an 131-item FFQ in relation to two 3 d food records (FR) performed 6 months apart focusing on the intake of carbohydrate fractions, dietary GI and the GL. Furthermore, we assessed the extent to which subjects' age, education and BMI explain differences between these methods. The study sample comprised 218 men and 292 women aged 25–74 years participating in a large population-based survey in Finland. Energy-adjusted Spearman's rank correlations ranged from 0·27 (sugars) to 0·70 (lactose) for men and from 0·37 (sugars) to 0·69 (lactose) for women. On average, 73 % of the subjects were categorised into the same or adjacent distribution quintile based on the two methods. In general, the FFQ overestimated the intakes compared with FR. Especially in women, FFQ validity for some nutrients was associated with the level of intake, subjects' age and, to a lesser extent, education but not BMI. In conclusion, the FFQ appears to be reasonably valid in the assessment of carbohydrate exposure variables, but the findings show a need for adjustment of diet–disease relationships for subjects' age and education. [ABSTRACT FROM PUBLISHER]

Our aim was to investigate whether fish consumption is associated with the consumption of other healthy foods. The study population consisted of 2605 men and 3199 women from the nationally representative Health 2000 survey and 114 professional fishermen and 114 fishermen's wives (the Fishermen substudy) in Finland. Dietary data were collected using a calibrated (i.e. determined to have relative validity) FFQ. Model-adjusted means for food consumption and P values for linear trend were calculated across fish consumption tertiles. Those with the highest fish consumption had the highest consumption of vegetables, fruit and berries, potatoes, oil and wine even after adjusting for other food groups. The consumption of red meat and sausages had a tendency to decrease across fish consumption tertiles but the associations were inconsistent in the study populations. In conclusion, fish consumption had a positive linear association with the consumption of some other healthy foods such as vegetables, fruit, berries, and oil both in the general population of Finland and in a population with high fish consumption. Additional adjustment for other food groups had a clear effect on some of the studied associations. Therefore, when evaluating the health effects of fish consumption, confounding by other foods characterising a healthy diet needs to be considered. [ABSTRACT FROM AUTHOR]

ObjectiveDietary fish is the main source of methylmercury (MeHg) for man, and fish consumption has been used as a measure of MeHg exposure. However, other dietary sources of exposure exist and MeHg metabolism may also be modified by nutritional factors. The aim of the present study was to examine the association between blood MeHg concentration and consumption of different foods in a Finnish population with high fish consumption.DesignBlood samples, a detailed FFQ and additional frequency data on fish consumption were collected. MeHg was analysed from whole blood by the isotope dilution method with high-resolution MS. The consumption of different foods was calculated by MeHg quartiles and tested for linear trend.SettingFinnish southern and south-western coast of the Baltic Sea.SubjectsTwo hundred and ninety-nine professional fishermen, their spouses and other family members.ResultsMean (range) blood MeHg concentration was 4·6 (0·21–22) μg/l among men and 2·8 (<0·15–20) μg/l among women. Fish had the strongest positive association with MeHg (P for linear trend <0·001 among both men and women). Among men, positive associations were also observed for fruit vegetables, wheat and wine. Among women, positive associations were observed for root vegetables, legumes, potato and game, but adjustment for fish consumption attenuated these trends.ConclusionsThe study shows that, besides fish, MeHg may have other dietary sources that should be taken into account in risk assessment studies. Due to the observed high blood MeHg concentration, a thorough exposure assessment among the general Finnish population is recommended. [ABSTRACT FROM AUTHOR]

Health and dietary monitoring has a long history in Finland. The aim of this review is to summarise the main sources of Finnish dietary information including food balance sheets, household budget survey data, questionnaires related to dietary behaviour and risk factors of main chronic diseases as well as dietary surveys. According to these sources, dietary behaviour and food choices have changed considerably during the last decades. For example, the total fat intake (E%) has decreased remarkably from nearly 40% in the late 1960s to close to 30% in 2007. Furthermore, the type of fat consumed has changed noticeably due to the increased popularity of oil used in cooking and the large variety of softer spreads available. There has also been a notable decrease in intake of salt, and a multiple increase in the consumption of fruits and vegetables since the 1970s. The future challenges of dietary monitoring include keeping the participation rates in dietary surveys at acceptable levels, controlling under/over-reporting of diet, developing a national monitoring system for children and adapting to international changes and requirements to harmonise dietary monitoring in Europe. [ABSTRACT FROM AUTHOR]

The present study describes the main actions in Finnish nutrition policy during the past decades. The main actor is the National Nutrition Council, which provides nutritional recommendations and action programmes, and sets up expert groups to solve nutritional problems in the population. The main fortification programmes have been the iodization of table salt, supplementation of selenium to fertilizers and the vitamin D fortification programme. As an example of national legislation, labelling the salt content of foods is described. Finnish nutrition policy is based on a good monitoring system of nutrition and risk factors of chronic diseases, as well as active epidemiological research. However, the authorities have not often taken proposed fiscal measures seriously but have instead considered agricultural and economic policies more important than health policy. [ABSTRACT FROM AUTHOR]

Objective: To assess to what extent the observed dietary changes and increased use of lipid-lowering medication can explain the almost 20% decline in serum cholesterol (referring to serum total cholesterol) level observed from 1982 to 2007 in Finland. Design: Predicted changes of serum cholesterol were calculated by the Keys' equation assuming the effect of trans fatty acids to be similar to SFA and using the dietary intake data of the national dietary surveys between 1982 and 2007. The effect of medication was estimated based on the information on use of lipid-lowering medication among survey participants. The predicted serum cholesterol levels were compared with observed changes in analysed serum cholesterol levels. Setting: Four cross-sectional population surveys, in 1982, 1992, 2002 and 2007, in the provinces of North Karelia, Northern Savo and Southwestern Finland. Subjects: A total of 2325 men and 2638 women aged 26-64 years selected randomly from the national population register for the four surveys. Results: Changes in dietary fat quality and cholesterol intake explain 0·70 mmol/l (65%) of the decrease in men and 0?65 mmol/l (60 %) of the decrease in women in all subjects. Decline in dietary SFA intake is the main explanatory factor (47% in men and 41% in women) for the changes. The impact of lipid-lowering medication on observed cholesterol levels was found to be 16% among men and 7% among women. Conclusions: The decrease in serum cholesterol levels in Finland can be explained mainly by dietary changes, especially changes in fat quality. The effect of lipid-lowering medication is less significant. [ABSTRACT FROM AUTHOR]

Objective: To investigate the associations of BMI and overweight in adulthood with consumption of sweets and sugar-sweetened soft drinks in childhood and with the change in consumption between childhood and adulthood. Design: Longitudinal 21-year follow-up study of Finnish children and adolescents from childhood to adulthood. Setting: The Cardiovascular Risk in Young Finns Study, comprising participants from both eastern and western Finland. Subjects: Boys (n 967) and girls (n 1172) aged 3-18 years at baseline in 1980. Results: The increase in consumption of sugar-sweetened soft drinks from childhood to adulthood was directly associated with BMI in adulthood in women (b=0.45, P=0.0001) but not in men. In women, BMI increased by 0.45 kg/m2 for every 10-unit increase per month. Consumption of sweets and sugar-sweetened soft drinks in childhood and adolescence was not associated with BMI in adulthood. The change in consumption of sweets was not associated with BMI in adulthood. The increase in the consumption of sugar-sweetened soft drinks from childhood to adulthood was associated with being overweight (OR=1.90, 95% CI 1.38, 2.61) in women, but not in men. No association was found between overweight (BMI≥25 kg/m2) in adulthood and consumption of sweets in childhood or the change in consumption from childhood to adulthood. Conclusions: We conclude that direct associations exist between adulthood overweight and BMI and an increase in consumption of sugar-sweetened soft drinks in women. Thus sugar-sweetened soft drinks consumption may be important when considering weight management in women. [ABSTRACT FROM AUTHOR]

Objectives: To identify and describe dietary patterns in a cohort of pregnant women and investigate whether the dietary patterns are associated with dietary intake and sociodemographic factors.Design: Mothers entering the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) Nutrition Study in 1997-2002 were retrospectively asked to complete a food-frequency questionnaire concerning their diet during pregnancy. Principal components analysis was used to identify dietary patterns.Setting: Finland.Subjects: Subjects were 3730 women with a newborn infant carrying increased genetic susceptibility to type 1 diabetes mellitus.Results: Seven factors were identified and named. Energy intake correlated positively with 'Healthy', 'Fast food', 'Traditional bread', 'Traditional meat' and 'Coffee' patterns and inversely with the 'Alcohol and butter' pattern. Intake of dietary fibre correlated positively with 'Healthy', 'Traditional bread' and 'Low-fat foods' patterns and inversely with the 'Alcohol and butter' pattern. The seven dietary patterns seemed to account for relatively large proportions of the variance in energy and nutrient intakes except for the intake of vitamin D, vitamin C, carotenoids and calcium. Maternal age and higher level of education were associated with higher scores on 'Healthy', 'Low-fat foods' and 'Alcohol and butter' patterns.Conclusion: Principal components analysis produced seven dietary patterns which may be useful for further research concerning maternal diet and health outcomes among both mothers and their offspring. [ABSTRACT FROM AUTHOR]

Free sugars, especially in the form of sugar-sweetened beverages, easily provide excess energy leading to increased risk of obesity and various NCDs. Free sugar intake below 10 E% is a public health nutrition target established in international (WHO) and many national nutrition recommendations across Europe. However, representative population-based data on free sugar intakes from the overall diet (i.e. free sugars from both liquid and solid foods) remain sparse. Besides mean intakes, the usual intake distributions of free sugar intake overall and in sociodemographic groups are infrequently reported. We aimed to study the intake of free sugars in the Finnish adults, and evaluate the proportion of the population reaching the recommendation. We used the data of the nationally representative FinDiet 2017 Survey consisting of two non-consecutive 24-hour dietary recalls obtained from 1655 subjects aged 18–74 years (53% participation rate). Weighing factors were used to correct non-participation bias. Assessment of daily free sugar intake was based on a food disaggregation procedure utilizing the national food composition database Fineli® (including standard recipes and ingredient level values for all different monosaccharides and disaccharides). Usual intake distribution modelling was performed using the SPADE program (RIVM, the Netherlands). We used SAS version 9.3 and R statistical software version 3.4.1 for the analyses. P-values < 0.05 were considered statistically significant.The mean intake of free sugars was 9.2 E% in men (n = 780) (P25: 6.4 E%, P50: 8.7 E%, P75: 11.5 E%), and 9.3 E% in women (n = 875) (P25: 6.6 E%, P50: 8.8 E%, P75: 11.4 E%). However, the recommendation (free sugars < 10 E%) was not reached by 37% of the population. Across the age groups (18–24, 25–44, 45–64, 65–74 years, respectively), the proportion of not reaching the recommendation varied between 28%−40% (men) and 44%−32% (women). Regarding educational groups (categories: low, middle, high), mean free sugar intake in men was higher in the lowest educational group (9.9 E%) compared with the highest educational group (8.8 E%) (P-value: 0.01). In women, free sugar intake did not differ between the educational groups. Overall, despite mean free sugar intakes below 10 E%, at least one third of Finnish adults did not reach the recommendation. Population groups with high free sugar intakes and the determinants of intake deserve further studying. Such information is needed in targeting interventions and policy actions to improve and sustain an optimal free sugar intake in all population groups. [ABSTRACT FROM AUTHOR]

Using short-term assessment methods to study diet provide too wide population intake distributions leading to overestimation of tail probabilities. Usual intake modelling reduces the variation in the distribution. The objective of this study was to evaluate the amount of bias in proportions of population under average requirement (AR) or recommended intake (RI) using the mean intake of two days compared to usual intake distribution. The FinDiet 2017 Survey was carried out in a nationally representative sample from the population register including adults aged 18–74 years. The data included two non-consecutive 24-hour dietary recalls from 1 655 participants (response rate 53%). Weighing factors were used to correct for non-participation bias. Usual intake was estimated using statistical program SPADE (RIVM, The Netherlands). The proportions of the population below AR or RI (when AR is not available) according to NNR 2012 were evaluated using two days mean intake and the usual intake distribution. These were further compared to evaluate the bias in two days mean intake. The bias associated with two days mean intakes was substantial in some of the nutrients. For example, for vitamin C and D intakes the difference between the proportions using two days mean and usual intake was over 10 percentage points. For vitamin C intake from food the proportions below AR (60 mg/day for men, 50 mg/day for women) were 38% for men and 20% for women using two days mean but 13 percentage points smaller for both sexes based on usual intake. The proportions below AR (7.5 μg/day) for vitamin D from food were 25% for men and 40% for women using two days mean and 14% for men and 30% for women using usual intake. When taking the intake from supplements into account, the proportions for vitamin D intake were 16% for men and 21 % for women based on two days mean but only 7% for both sexes using usual intake. For calcium intake from food the proportion below AR (500 mg/day) was small (7% for men and 8% for women) using two days mean but more than 50% smaller using usual intake (3% for both sexes). Using two days mean intake to estimate nutritional adequacy can lead to considerable biased results due to extraneous day-to-day variation in the intake distribution. Therefore, usual intake modelling should always be applied to intakes derived from short-term dietary assessment methods when evaluating nutritional adequacy. [ABSTRACT FROM AUTHOR]

Obesity is a major risk factor of type 2 diabetes (T2D). Accordingly, weight loss is being used to reduce this risk. Intervention studies have shown a T2D risk reduction due to weight loss in populations with an elevated risk. Data on the prediction of intentional weight loss (IWL) on diabetes occurrence at population level is, however, sparse. Since in observational studies IWL has been shown to predict later weight gain, possibly leading to adverse consequences, this study examined the prediction of IWL on T2D occurrence in a general population. Data from the representative Finnish Health 2000 Survey conducted in 2000–2001 was used. The study sample consisted of 1962 men and 2308 women, aged 30–69. Information on IWL during the previous year was collected with a questionnaire. Data for the covariates was collected with a health examination, interviews and questionnaires. Incident T2D cases during a 15-year follow-up were drawn from national health registers covering information on medication use, hospitalization, and cause of death. The Cox model was used to estimate strength of association between IWL and T2D occurrence. During the follow-up, 417 individuals developed a T2D. After adjusting for socio-demographic and lifestyle factors and the components of metabolic syndrome, IWL predicted an increased risk of T2D occurrence (HR 1.44; 95% CI 1.11–1.87) compared to individuals without IWL. Moreover, in interaction analyses, the risk in individuals with IWL compared to those without IWL was pronounced in younger age group and in those with the lowest quality diet. Furthermore, an elevated risk was consistently found in persons with IWL and overweight (BMI ≥ 25 kg/m2), also in combination with different aspects of poor health (i.e. mental health, self-perceived health, metabolic health). In the present cohort, IWL predicted an increased subsequent risk of developing T2D. This may be due to that in long-term at population level IWL causes an elevated risk of T2D e.g. by acting as a promotor for weight gain or by causing weight cycling resulting in unfavorable changes in metabolic health indicators. Alternatively, it cannot be excluded, that individuals reporting IWL already are at a greater risk of T2D and pursue IWL in response to that. Greater emphasis should be put on the initial prevention of weight gain and on the support on the weight maintenance after weight loss. Further cohort studies with repeated measurements on dieting behavior and changes in weight are needed. [ABSTRACT FROM AUTHOR]

Introduction: Individuals with a later timing of circadian rhythms (evening types) tend to have unhealthier behaviors compared to those with an earlier timing (morning types). Previous studies have shown that evening types have unhealthier diets and later eating times than morning types. Furthermore, evening types bear higher odds for type 2 diabetes and weight gain (women). Circadian rhythms are controlled by clock genes which have an important role in regulating energy homeostasis. Thus far, a number of single nucleotide polymorphisms (SNP) of clock genes have been associated with metabolic disturbances, obesity and dietary habits (e.g., breakfast skipping and macronutrient intakes). Our aim was to examine chronotype associations with SNPs of the 20 known key clock genes which could help to clarify the underlying mechanisms behind chronotype phenotype. Methods: Our data included 8558 participants (aged 25–74 years, 52% of women) from the cross-sectional population-based National FINRISK 2007 and 2012 surveys. Chronotype was assessed with a shortened six-item version of Horne and Östberg's Morningness-Eveningness Questionnaire (sMEQ) accounting for 83% of the total variance of the original questionnaire. For comparison we used a single self-evaluation question on chronotype from the questionnaire. Genotyping was done using Illumina arrays (HumanCoreExome, Omniexpress and 610K). Linear and logistic regression was used for statistical analysis with the additive genetic model. The analyses were adjusted for age, sex, batch effects and five principal components to account for population structure. The false discovery rate method by the Benjamini-Yekutieli procedure was applied to correct for multiple comparisons. Results: We found 27 SNPs in two clock genes that were significantly (P < 0.05) associated with chronotype when assessed with the single question. Minor allele carriers of the NR1D2 (Rev-erbβ) polymorphisms (rs4131403A, rs4858095T, rs6794922G, rs4619734A, rs4589882A, rs4321479C, rs6779476A, rs6790557A, rs13095392A, rs4858098G, rs4858567C, rs11717862G, rs7431301A, rs5023610G, rs5847265C, rs5847266G, rs6550823A, rs9882735C, rs7371944A, rs55792500G) were associated with evening type, whereas minor allele carriers of the NFIL3 polymorphisms (rs2482704T, rs2989836T, rs2482356C, rs2440589T, rs9409419G, rs2482702G, rs2482357A) were more likely morning types. Findings were similar when chronotype was assessed with sMEQ but did not reach statistical significance. Discussion: Our findings indicated novel genetic associations of chronotype with two clock genes that have previously been associated with carbohydrate and lipid metabolism (NR1D2), and with lipid absorption and export in intestinal epithelial cells and hepatic gluconeogenesis (NFIL3). These results expand our knowledge of the genetic basis of chronotype and warrant further studies to replicate these findings. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence and sociodemographic factors related to vegetarians according to different definitions in Finland and to compare the consumption of selected foodstuffs and nutritional intakes among vegetarians and omnivores., Design: Information about subjects' identification as vegetarians in a survey was used as a basis for self-defined vegetarianism. Foodstuffs consumed and their frequencies of consumption were obtained, and the reported consumption frequencies of meat, fish, milk and eggs or food portions containing these foodstuffs were used as a basis for an operationalized definition of different types of vegetarianism. Reported consumption was used to estimate foodstuff and nutritional intakes., Setting: Three large nationwide surveys in Finland., Subjects: In total, 24 393 participants aged between 18 and 79 years were included., Results: The proportion of self-identified vegetarians was 3.3 % of the total population in Finland. According to responses to questions on consumption frequency, 1.4 % of the population were pesco-lacto-ovo-vegetarians, 0.43 % were vegans, lacto-vegetarians or lacto-ovo-vegetarians, and 0.18 % were vegans or lacto-vegetarians. Eighty per cent of the self-identified vegetarians did not follow a vegetarian diet according to the operationalized definition, but they consumed fewer meat products (P < 0.01).ConclusionSome self-defined vegetarians do consume red meat, poultry or fish, but they follow a healthier diet than self-defined omnivores. In the same sample self-identification indicated more than double the incidence of vegetarianism than the operationalized definition. Therefore self-identification is not a good method for observing the prevalence of vegetarianism.