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Background Diet has a major influence on the human gut microbiota, which has been linked to health and disease. However, epidemiological studies on associations of a healthy diet with the microbiota utilizing a whole-diet approach are still scant. Objectives To assess associations between healthy food choices and human gut microbiota composition, and to determine the strength of association with functional potential. Methods This population-based study sample consisted of 4930 participants (ages 25–74; 53% women) in the FINRISK 2002 study. Intakes of recommended foods were assessed using a food propensity questionnaire, and responses were transformed into healthy food choices (HFC) scores. Microbial diversity (alpha diversity) and compositional differences (beta diversity) and their associations with the HFC score and its components were assessed using linear regression. Multiple permutational multivariate ANOVAs were run from whole-metagenome shallow shotgun–sequenced samples. Associations between specific taxa and HFC were analyzed using linear regression. Functional associations were derived from Kyoto Encyclopedia of Genes and Genomes orthologies with linear regression models. Results Both microbial alpha diversity (β/SD, 0.044; SE, 6.18 × 10−5; P  = 2.21 × 10−3) and beta diversity (R 2, 0.12; P  ≤ 1.00 × 10−3) were associated with the HFC score. For alpha diversity, the strongest associations were observed for fiber-rich breads, poultry, fruits, and low-fat cheeses (all positive). For beta diversity, the most prominent associations were observed for vegetables, followed by berries and fruits. Genera with fiber-degrading and SCFA-producing capacities were positively associated with the HFC score. The HFC score was associated positively with functions such as SCFA metabolism and synthesis, and inversely with functions such as fatty acid biosynthesis and the sulfur relay system. Conclusions Our results from a large, population-based survey confirm and extend findings of other, smaller-scale studies that plant- and fiber-rich dietary choices are associated with a more diverse and compositionally distinct microbiota, and with a greater potential to produce SCFAs. [ABSTRACT FROM AUTHOR]

Objectives: To assess the stability and determinants of total and context specific sitting in a follow-up of adults.Design: Longitudinal study.Methods: Participants in the DILGOM cohort (n=3735, men 45%), reported daily sitting in five contexts (work-related, in vehicle, at home by the TV, at home at the computer, and elsewhere) in 2007 and 2014. Sociodemographic background, lifestyle and health were assessed in 2007. Total sitting comprised the sum of context specific sitting. Changes in, and determinants of context specific sitting, stratified by baseline age into young middle-aged (<53 years); late middle-aged (53-68 years) and older-aged (>68 years) were estimated by generalized linear mixed models.Results: In 2007, total daily sitting was 7h 26min, 6h 16min, and 6h 3min in young middle-aged, late middle-aged and older-aged groups, respectively. Over 7 years, total sitting decreased on average by 26min. Sitting at the computer increased by 7-17min. The late middle-aged group also increased sitting by the TV, and decreased total, work-related, vehicle and elsewhere sitting. Occupational status determined context specific sitting, but somewhat differently in young and late middle-aged groups. Poor self-rated health determined less work-related and more sitting by the TV in the young, whereas good health determined less work-related sitting in the late middle-aged group.Conclusions: Self-reported sitting is a fairly stable behavior, with the exception for the late middle-aged group, where all context specific and total sitting changed significantly. Occupational status and health determined changes in sitting; however, somewhat differently by age group. [ABSTRACT FROM AUTHOR]

Background Food neophobia is considered a behavioral trait closely linked to adverse eating patterns and reduced dietary quality, which have been associated with increased risk of obesity and noncommunicable diseases. Objectives In a cross-sectional and prospective study, we examined how food neophobia is associated with dietary quality, health-related biomarkers, and disease outcome incidence in Finnish and Estonian adult populations. Methods The study was conducted based on subsamples of the Finnish DIetary, Lifestyle, and Genetic determinants of Obesity and Metabolic syndrome (DILGOM) cohort (n  = 2982; age range: 25–74 y) and the Estonian Biobank cohort (n  = 1109; age range: 18–83 y). The level of food neophobia was assessed using the Food Neophobia Scale, dietary quality was evaluated using the Baltic Sea Diet Score (BSDS), and biomarker profiles were determined using an NMR metabolomics platform. Disease outcome information was gathered from national health registries. Follow-up data on the NMR-based metabolomic profiles and disease outcomes were available in both populations. Results Food neophobia associated significantly (adjusted P  < 0.05) with health-related biomarkers [e.g. ω-3 (n–3) fatty acids, citrate, α1-acid glycoprotein, HDL, and MUFA] in the Finnish DILGOM cohort. The significant negative association between the severity of food neophobia and ω-3 fatty acids was replicated in all cross-sectional analyses in the Finnish DILGOM and Estonian Biobank cohorts. Furthermore, food neophobia was associated with reduced dietary quality (BSDS: β: −0.03 ± 0.006; P  = 8.04 × 10−5), increased fasting serum insulin (β: 0.004 ± 0.0013; P  = 5.83 × 10−3), and increased risk of type 2 diabetes during the ∼8-y follow-up (HR: 1.018 ± 0.007; P  = 0.01) in the DILGOM cohort. Conclusions In the Finnish and Estonian adult populations, food neophobia was associated with adverse alteration of health-related biomarkers and risk factors that have been associated with an increased risk of noncommunicable diseases. We also found that food neophobia associations with ω-3 fatty acids and associated metabolites are mediated through dietary quality independent of body weight. [ABSTRACT FROM AUTHOR]

Background: A systematic vitamin D fortification of fluid milk products and fat spreads was started in 2003 in Finland to improve vitamin D status. Objective: We investigated the effects of the vitamin D fortification policy on vitamin D status in Finland between 2000 and 2011. Design: Serum 25-hydroxyvitamin D [S-25(OH)D] concentrations of a nationally representative sample comprising 6134 and 4051 adults aged ≥30 y from the Health 2000 and Health 2011 surveys, respectively, were standardized according to the Vitamin D Standardization Program with the use of liquid chromatography--tandem mass spectrometry. Linear and logistic regression models were used to assess the change in S-25(OH)D concentrations. Results: Between 2000 and 2011, the mean S-25(OH)D increased from 48 nmol/L (95% CI: 47, 48 nmol/L) to 65 nmol/L (95% CI: 65, 66 nmol/L) (P < 0.001). The prevalence of vitamin D supplement users increased from 11% to 41% (P < 0.001). When analyzing the effect of fortification of fluid milk products, we focused on supplement nonusers. The mean increase in S-25(OH)D in daily fluid milk consumers (n = 1017) among supplement nonusers was 20 nmol/L (95% CI: 19, 21 nmol/L), which was 6 nmol/L higher than nonconsumers (n = 229) (14 nmol/L; 95% CI: 12, 16 nmol/L) (P < 0.001). In total, 91% of nonusers who consumed fluid milk products, fat spreads, and fish based on Finnish nutrition recommendations reached S-25(OH)D concentrations >50 nmol/L in 2011. Conclusions: The vitamin D status of the Finnish adult population has improved considerably during the time period studied. The increase is mainly explained by food fortification, especially of fluid milk products, and augmented vitamin D supplement use. Other factors, such as the difference in the ultraviolet radiation index between 2000 and 2011, may partly explain the results. When consuming vitamin D sources based on the nutritional recommendations, vitamin D status is sufficient [S-25(OH)D ≥50 nmol/L], and supplementation is generally not needed. [ABSTRACT FROM AUTHOR]

Background: Healthy dietary patterns that conform to national dietary guidelines are related to lower chronic disease incidence and longer life span. However, the precise mechanisms involved are unclear. Identifying biomarkers of dietary patterns may provide tools to validate diet quality measurement and determine underlying metabolic pathways influenced by diet quality. Objective: The objective of this study was to examine the correlation of 4 diet quality indexes [the Healthy Eating Index (HEI) 2010, the Alternate Mediterranean Diet Score (aMED), the WHO Healthy Diet Indicator (HDI), and the Baltic Sea Diet (BSD)] with serum metabolites. Design: We evaluated dietary patterns and metabolites in male Finnish smokers (n = 1336) from 5 nested case-control studies within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study cohort. Participants completed a validated food-frequency questionnaire and provided a fasting serum sample before study randomization (1985-1988). Metabolites were measured with the use of mass spectrometry. We analyzed cross-sectional partial correlations of 1316 metabolites with 4 diet quality indexes, adjusting for age, body mass index, smoking, energy intake, education, and physical activity. We pooled estimates across studies with the use of fixed-effects meta-analysis with Bonferroni correction for multiple comparisons, and conducted metabolic pathway analyses. Results: The HEI-2010, aMED, HDI, and BSD were associated with 23, 46, 23, and 33 metabolites, respectively (17, 21, 11, and 10 metabolites, respectively, were chemically identified; r-range: 20.30 to 0.20; P = 6 × 10-15 to 8 × 10-6). Food-based diet indexes (HEI-2010, aMED, and BSD) were associated with metabolites correlated with most components used to score adherence (e.g., fruit, vegetables, whole grains, fish, and unsaturated fat). HDI correlated with metabolites related to polyunsaturated fat and fiber components, but not other macro- or micronutrients (e.g., percentages of protein and cholesterol). The lysolipid and food and plant xenobiotic pathways were most strongly associated with diet quality. Conclusions: Diet quality, measured by healthy diet indexes, is associated with serum metabolites, with the specific metabolite profile of each diet index related to the diet components used to score adherence. [ABSTRACT FROM AUTHOR]

Background: The nonessential amino acid cysteine is known to be involved in many antioxidant and anticarcinogenic pathways. Cysteinylglycine is a pro-oxidant metabolite of glutathione and a precursor of cysteine. Objective: To examine the relation between serum cysteine and cysteinylglycine and risk of gastric adenocarcinomas, esophageal squamous cell carcinomas, and head and neck squamous cell carcinomas, we conducted a nested case-control study within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention study of male Finnish smokers aged 50-69 y at baseline. Design: In total, 170 gastric adenocarcinomas, 68 esophageal squamous cell carcinomas, and 270 head and neck squamous cell carcinomas (identified from the Finnish Cancer Registry) were matched one-to-one with cancer-free control subjects on age and the date of serum collection. We calculated ORs and 95% CIs with the use of a multivariate-adjusted conditional logistic regression. Results: Cysteine had a U-shaped association with gastric adenocarcinomas; a model that included a linear and a squared term had a significant global P-test (P = 0.036). Serum cysteinylglycine was inversely associated with adenocarcinomas of the gastric cardia (OR for above the median compared with below the median: 0.07; 95% CI: 0.01, 0.70; n = 38 cases) but not for other sites. Both cysteine and cysteinylglycine were not associated with esophageal squamous cell carcinoma or head and neck squamous cell carcinoma. Conclusions: We observed associations between serum cysteine and cysteinylglycine with upper gastrointestinal cancer risk. Future studies are needed to replicate these findings. This trial was registered at clininicaltrials.gov as NCT00342992. [ABSTRACT FROM AUTHOR]

Background: Suboptimal nutrition during fetal life and early childhood may be important in early programming of health and disease. Preterm infants born with very low birth weight (VLBW; <1500 g) frequently receive inadequate neonatal nutrition; the long-term consequences are poorly known. Objective: We evaluated the association between early macronutrient intake and body composition in young adults born with VLBW. Methods: We collected comprehensive information on daily nutritional intake during the initial hospital stay for 127 participants of the Helsinki Study of Very Low Birth Weight Adults. We calculated mean daily intakes of energy, protein, fat, and carbohydrate during the first 9wk of life. At the mean age of 22.5 y, the subjects underwent measurements of weight, height, body composition by dual-energy X-ray absorptiometry, and resting energy expenditure. The associations were examined by linear regression. Results: We found that energy, protein, and fat intakes during the first 3 wk of life, all below current recommendations, predicted adult body composition. When adjusted for sex, age, birth weight SD score, and gestational age, a 1 g ⋅ kg-1 ⋅ d-1 higher protein intake predicted 11.1% higher lean body mass (LBM) (95% CI: 3.7%, 18.9%) and 8.5% higher resting energy expenditure (REE) (95% CI: 0.2%, 17.0%). Among those born before 28 wk of gestation, the numbers were 22.5% (95% CI: 1.9%, 47.4%) for LBM and 22.1% (95% CI: 3.6%, 44.0%) for REE. Similar associations were seen with energy (P = 0.01, P = 0.05) and fat (P < 0.01, P = 0.03) but not with carbohydrate. Energy intake was also associated with BMI (P = 0.01) and fat intake with BMI (P < 0.01) and percentage body fat (P = 0.05). The results were little changed when adjusted for prenatal and postnatal characteristics. Conclusions: At relatively low neonatal protein intake levels, additional protein intake is reflected in a healthier body composition, accompanied by a higher metabolic rate, in young adults born with VLBW 20 y earlier. [ABSTRACT FROM AUTHOR]

Background: High fructose intake has been suggested to be a key factor that induces nonalcoholic fatty liver disease (NAFLD), but the evidence from large epidemiologic studies is lacking. Objective: We examined the cross-sectional association between fructose intake and NAFLD by using the Fatty Liver Index (FLI) and the NAFLD liver fat score. Design: The Helsinki Birth Cohort Study investigated 2003 Finnish men and women born in 1943-1944 in Helsinki who participated in a clinical health examination in the years 2001-2004. Trained study nurses measured weight, height, and waist circumference, and body mass index was calculated. Laboratory staff drew fasting blood for measurements of triglycerides and γ-glutamyl-transferase. The FLI and the NAFLD liver fat score were calculated on the basis of these measurements. Habitual fructose and other dietary intake over the past year were assessed by using validated and standardized 131-item food-frequency questionnaires. Data were analyzed in a cross-sectional manner by using logistic regression modeling with statistical software. Results: In a model adjusted for age, sex, and energy intake, participants in the highest fructose intake quartile (range: 29.2-88.0 g/d) had lower risk of NAFLD assessed by using the FLI (OR: 0.56; 95% CI: 0.42, 0.75; P-trend < 0.001) and NAFLD liver fat score (OR: 0.72; 95% CI: 0.53, 0.99; P-trend < 0.001) than that of the lowest intake quartile (range: 2.2-15.2 g/d). This association remained after adjustment for educational attainment, smoking, physical activity, and other dietary variables only for the FLI (OR: 0.68; 95% CI: 0.47, 0.84; P-trend < 0.05). Conclusion: Our cross-sectional results did not support the current hypothesis that high intake of fructose is associated with a higher prevalence of NAFLD as assessed by using the FLI and NAFLD liver fat score. [ABSTRACT FROM AUTHOR]

Background: Vitamin D status may influence a spectrum of health outcomes, including osteoporosis, arthritis, cardiovascular disease, and cancer. Vitamin D-binding protein (DBP) is the primary carrier of vitamin D in the circulation and regulates the bioavailability of 25-hydroxyvitamin D. Epidemiologic studies have shown direct DBP-risk relations and modification by DBP of vitamin D-disease associations. Objective: We aimed to characterize common genetic variants that influence the DBP biochemical phenotype. Design: We conducted a genome-wide association study (GWAS) of 1380 men through linear regression of single-nucleotide polymorphisms (SNPs) in the Illumina HumanHap500/550/610 array on fasting serum DBP, assuming an additive genetic model, with adjustment for age at blood collection. Results: We identified 2 independent SNPs located in the gene encoding DBP, GC, that were highly associated with serum DBP: rs7041 (P = 1.42 x 10-246) and rs705117 (P = 4.7 x 10-91). For both SNPs, mean serum DBP decreased with increasing copies of the minor allele: mean DBP concentrations (nmol/L) were 7335, 5149, and 3152 for 0, 1, and 2 copies of rs7041 (T), respectively, and 6339, 4280, and 2341, respectively, for rs705117 (G). DBP was also associated with rs12144344 (P = 5.9 x 10-7) in ST6GALNAC3. Conclusions: In this GWAS analysis, to our knowledge the first to examine this biochemical phenotype, 2 variants in GC--one exonic and one intronic--were associated with serum DBP concentrations at the genome-wide level of significance. Understanding the genetic contributions to circulating DBP may provide greater insights into the vitamin D binding, transport, and other functions of DBP and the effect of vitamin D status on health outcomes. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention clinical trial was registered at clinicaltrials.gov as NCT00342992. [ABSTRACT FROM AUTHOR]

Abstract: Background: Overweight or weight development related to pregnancy has been associated with number of deliveries (ie, parity). Objective: This study evaluates 10-year changes in associations between obesity and parity. Methods: The data were from the National FINRISK Study on women 25–64 years of age. The study included a questionnaire and anthropometric measurements in 1997 (N = 4193) and 2007 (N = 3578). Women whose body mass index (BMI) was ≥30 kg/m2 were considered obese, and women whose waist circumference was ≥88 cm were considered viscerally obese. Women with no pregnancies were categorized as nulliparous, those with 1–2 deliveries as parous, and those with ≥3 deliveries as multiparous. Logistic regression models were used to estimate separately the odd ratios (ORs) and 95% CIs for BMI and waist circumference. Linear regression models were used to evaluate the main effect of parity on obesity and visceral obesity. Results: Women with 1 or 2 children were less often obese (OR = 0.75; 95% CI, 0.64–0.88) or viscerally obese (OR = 0.98; 95% CI, 0.85–1.14) than nulliparous or multiparous women. Multiparous women had more visceral obesity in 2007 (OR = 1.36; 95% CI, 1.16–1.60) than other parity groups. Multiparous women had the highest BMI or waist circumference even after adjusting for age, study year, and education. The year 2007 was significantly associated with visceral obesity (OR = 2.07; 95% CI, 1.87–2.30) and obesity (OR = 1.13; 95% CI, 1.01–1.28) when compared with 1997. Conclusion: Parity is an important determinant of visceral obesity, which is more prevalent in younger age groups than a decade ago. Women with ≥3 deliveries were more often obese or viscerally obese than other women. [Copyright &y& Elsevier]

Abstract: Background and Objective: The validity of food frequency questionnaires (FFQs) in measuring food consumption and nutrient intake has to be assessed. The objective of this study was to assess the validity of a 128-item FFQ in specific subgroups of Finnish adults. Methods: The study included 294 subjects (137 men and 157 women). A 3-day food record was used as the reference method. Results: The mean intake of all nutrients except alcohol was higher measured with the FFQ than with the food records. In general, the Pearson correlations for energy adjusted nutrients between the FFQ and the food records were higher in women than in men. The correlations ranged from 0.14 (retinol) to 0.66 (fiber and alcohol) in men, and from 0.20 (long-chain n−3 fatty acids) to 0.70 (alcohol) in women. The results in subgroups showed that measuring nutrient intakes is more difficult among younger (30–50 years) women and overweight men and women than among others. Conclusions: The study showed that the FFQ is a useful tool in epidemiologic studies in measuring the diet of Finnish adults given that the problems among specific subgroups are taken into account in interpretation. [Copyright &y& Elsevier]

Background: An analysis of dietary patterns or combinations of foods may provide insight regarding the influence of diet on the risk of colon and rectal cancer. Objective: A primary aim of the Dietary Patterns and Cancer (DIETSCAN) Project was to develop and apply a common methodologic approach to study dietary patterns and cancer in 4 European cohorts: the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study (Finland-ATBC), the Netherlands Cohort Study (NLCS) on Diet and Cancer, the Swedish Mammography Cohort (SMC), and the Ormoni e Dieta nella Eziologia dei Tumori (Italy-ORDET). Three cohorts (ATBC, NLCS, and SMC) provided data on colon and rectal cancer for the present study. Design: The cohorts were established between 1985 and 1992; follow-up data were obtained from national cancer registries. The participants completed validated semiquantitative food-frequency questionnaires at baseline. Results: Exploratory factor analysis, conducted within each cohort, identified 3-5 stable dietary patterns. Two dietary patterns-Vegetables and Pork, Processed Meats, Potatoes (PPP)-were common across all cohorts. After adjustment for potential confounders, PPP was associated with an increased risk of colon cancer in the SMC women(quintile 4multivariate relative risk: 1.62;95%CI: 1.12, 2.34; P for trend=0.01). PPP was also associated with an increased risk of rectal cancer in the ATBC men (quintile 4multivariate relative risk: 2.21; 95% CI: 1.07, 4.57; P for trend=0.05). Neither pattern was associated with the risk of colon or rectal cancer in the NLCS women and men. Conclusion: Although certain dietary patterns may be consistent across European countries, associations between these dietary patterns and the risk of colon and rectal cancer are not conclusive. [ABSTRACT FROM AUTHOR]

Background: Although abdominal obesity has been shown to be an important risk factor for cardiovascular disease and a variety of other diseases, secular changes in fat distribution in populations have rarely been documented. Objective: Our objective was to assess trends in waist-to-hip ratio (WHR) in the Finnish population during a 10-y period. In addition, we investigated the associations of WHR with body mass index (BMI), age, education, and lifestyle factors. Design: Three independent cross-sectional surveys were carried out at 5-y intervals between 1987 and 1997. Altogether, 15096 randomly selected men and women aged 25-64 y participated in these surveys. Results: The WHR increased in both men and women during the 10-y period (P < 0.0001). In men, the strongest upward trend took place in the first 5-y period and then seemed to plateau; in women, the WHR continued to increase into the 1990s. In both sexes, the most prominent increase was observed in subjects aged ≥45 y. The WHR increased in all education-level groups, the lowest WHR being among those with the highest education. Age (18% in men, 12% in women) and BMI (33% in men, 25% in women) accounted for most of the variation in WHR, whereas only 3% was explained by education and lifestyle factors. Conclusions: Abdominal obesity is a growing problem in Finland, especially in persons aged =45 y. These adverse changes in body shape continued to take place, particularly in women, in the 1990s. [ABSTRACT FROM AUTHOR]

Alcoholic liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD) are the major causes for nonviral liver cirrhosis in the population. Whereas the typical NAFLD patient is one with abdominal obesity, metabolic syndrome (MetS), and no or minimal alcohol use, the patient with pure alcoholic liver cirrhosis has, according to cohort studies, typically consumed >5–10 daily alcohol drinks for several years.1 However, both alcohol use and components of the MetS are continuous variables and, as such, not dichotomic. Recent evidence suggests harmful synergistic effects of obesity, MetS, and alcohol intake for the risk of future liver disease.2 Consequently, given an increasing population prevalence of overweight and obese alcohol users, expectedly, there will be many patients that do not fit either the typical NAFLD or typical ALD phenotype, but share features of both disease entities. Current case-finding strategies focusing on either pure NAFLD or pure ALD3,4 may underestimate the true risk in individuals who will develop liver disease as the result of interaction between alcohol and metabolic disorders.1 [ABSTRACT FROM AUTHOR]

Purpose: We identify the individual and joint contributions of excess weight and cigarette smoking to national-level type II diabetes (T2D) incidence and to educational and gender disparities therein filling an important gap in T2D epidemiology.Methods: Based on the FINRISK surveys conducted in 1997, 2002, and 2007 and linked to the Finnish National Drug Reimbursement Register through 2011, we used a regression-counterfactual approach to estimate the percentage of diagnosed drug-treated incident T2D cases attributable to excess body weight and cigarette smoking. Body mass index (BMI) and waist circumference were evaluated.Results: T2D incidence was 10.24 in men and 7.04 in women per 1000 person-years. Excess baseline BMI (≥25.0 kg/m2) explained 69% and 63%, and smoking explained 9% and 14% of T2D incidence, in men and women, respectively. Most of the gender difference was explained by the risk factors. Approximately 90% in men and 98% in women of the higher T2D incidence among those in the lower versus upper third of the educational distribution was explained by excess BMI. The results were similar for waist circumference and lifetime maximum BMI.Conclusions: Excess body weight is the main risk factor contributing to national-level T2D incidence and disparities by educational attainment and gender in a high-income population. [ABSTRACT FROM AUTHOR]

Introduction: Inconsistent results regarding the association between the components of metabolic syndrome and Parkinson's disease (PD) have been reported. We investigated whether the metabolic syndrome or its components, or serum total cholesterol, predict PD incidence in a prospective cohort study design.Methods: The study was based on the Mini-Finland Health Survey including 6641 individuals aged 30-79 and free from PD at baseline (1978-1980). During 30 years of follow-up, 89 incident PD cases occurred.Results: After adjustment for sociodemographic and lifestyle factors, the relative risk (RR) of PD was 0.50 (95% confidence interval (CI): 0.30, 0.83) for individuals with the metabolic syndrome compared to those without. This association was especially due to elevated serum triglyceride concentration (≥1.7 vs.<1.7 mmol/L, RR = 0.52, 95%CI: 0.30-0.89, P for trend 0.02) and elevated plasma fasting glucose concentration (≥5.6 vs.<5.6 mmol/L, RR = 0.56 0.32, 0.98, P for trend 0.05). Elevated serum triglyceride and plasma fasting glucose concentration predicted lower PD risk even after excluding the first 10 years of follow-up. After this exclusion and further adjustment for other components of the metabolic syndrome, a suggestively increased PD risk was observed in overweight individuals (≥25 kg/m(2) vs.<25 kg/m(2), RR = 1.75, 95%CI: 1.00, 3.07, P for trend 0.22). Blood pressure, serum HDL cholesterol, or serum total cholesterol carried no prediction of PD risk.Conclusion: Elevated serum triglyceride and plasma fasting glucose concentrations predict low PD incidence whereas high BMI seems to be suggestively related to an increased PD risk. [ABSTRACT FROM AUTHOR]

Current screening strategies for chronic liver disease focus on detection of subclinical advanced liver fibrosis but cannot identify those at high future risk of severe liver disease. Our aim was to develop and validate a risk prediction model for incident chronic liver disease in the general population based on widely available factors. Multivariable Cox regression analyses were used to develop prediction models for liver-related outcomes with and without laboratory measures (Model lab and Model non-lab) in 25,760 individuals aged 40–70 years. Their data were sourced from the Finnish population-based health examination surveys FINRISK 1992-2012 and Health 2000 (derivation cohort). The models were externally validated in the Whitehall II (n = 5,058) and Copenhagen City Heart Study (CCHS) (n = 3,049) cohorts. The absolute rate of incident liver outcomes per 100,000 person-years ranged from 53 to 144. The final prediction model included age, sex, alcohol use (drinks/week), waist–hip ratio, diabetes, and smoking, and Model lab also included gamma-glutamyltransferase values. Internally validated Wolbers' C-statistics were 0.77 for Model lab and 0.75 for Model non-lab , while apparent 15-year AUCs were 0.84 (95% CI 0.75-0.93) and 0.82 (95% CI 0.74-0.91). The models identified a small proportion (<2%) of the population with >10% absolute 15-year risk for liver events. Of all liver events, only 10% occurred in participants in the lowest risk category. In the validation cohorts, 15-year AUCs were 0.78 (Model lab) and 0.65 (Model non-lab) in the CCHS cohort, and 0.78 (Model non-lab) in the Whitehall II cohort. Based on widely available risk factors, the C hronic Liv er D isease (CLivD) score can be used to predict risk of future advanced liver disease in the general population. Liver disease often progresses silently without symptoms and thus the diagnosis is often delayed until severe complications occur and prognosis becomes poor. In order to identify individuals in the general population who have a high risk of developing severe liver disease in the future, we developed and validated a C hronic Liv er D isease (CLivD) risk prediction score, based on age, sex, alcohol use, waist-hip ratio, diabetes, and smoking, with or without measurement of the liver enzyme gamma-glutamyltransferase. The CLivD score can be used as part of health counseling, and for planning further liver investigations and follow-up. [Display omitted] • Liver disease tends to develop silently without symptoms and thus the diagnosis is often delayed. • To improve early risk prediction, we developed and validated the CLivD score for use in the general population. • The CLivD score is based on age, sex, alcohol use, waist-hip ratio, diabetes, smoking, with or without GGT values. • The CLivD score provides accurate predictions of 15-year risk for future severe liver disease. • The CLivD score could be used as part of health counseling, and for planning further liver investigations and follow-up. [ABSTRACT FROM AUTHOR]

Recent studies have shown that some four in ten cancers are attributable to a few key risk factors. The aim of this study was to estimate cohort-based population attributable fractions (PAFs) in Finland for potentially modifiable cancer risk factors. Data from eight health studies including 253,953 subjects with 29,802 incident malignant solid tumors were analysed using Bayesian multivariate regression model with multiplicative risk factor effects. We estimated the effects of smoking, excess body weight, alcohol consumption, physical activity, parity and education on cancer incidence and related PAFs by cancer site, accounting for competing mortality. PAF for all cancer sites and exposures combined was 34% (95% credible interval 29%−39%) in men and 24% (19%−28%) in women. In men, 23% (21%−27%) and in women 8% (6%−9%) of all cancers were attributed to smoking. PAF related to excess body weight was 4% (2%−6%) in men and 5% (2%−7%) in women, to alcohol 7% (3%−10%) in men and 4% (0%−7%) in women, and to excess body weight and alcohol combined 10% (6%−15%) in men and 9% (4%−13%) in women. Smoking was the most important factor contributing to cancer burden in Finnish men and women over the last 40 years. The contribution of excess body weight and alcohol consumption together outweighed the role of smoking in women. As the prevalence of overweight is expected to increase, more efficient public health measures supporting adherence to healthy weight are essential to reduce cancer burden. • We estimated the fractions of cancers attributable to key lifestyle risk factors. • The key factors were responsible for 34% of all cancers in men and 24% in women. • 10% of cancers were attributable to overweight and alcohol use together. • Overweight and alcohol use together outweighed the role of smoking in women. • Supporting healthy weight is essential to reduce future cancer burden. [ABSTRACT FROM AUTHOR]

Diet has a major impact on a person's health. However, limited information exists on the long-term role of the whole diet on disability. We investigated the association of the healthy Nordic diet and the Mediterranean diet with incident disability 10 years later. Longitudinal, with a follow-up of 10 years. A total of 962 home-dwelling men and women from the Helsinki Birth Cohort Study, mean age 61.6 years, who were free of disability at baseline. At baseline, 2001-2004, the Nordic diet score (NDS) and modified Mediterranean diet score (mMDS) were calculated using a validated 128-item food-frequency questionnaire. Higher scores indicated better adherence to the diet. Participants' incident disability was assessed during 2011-2013 by a self-reported questionnaire and was based on mobility limitations and difficulties to perform self-care activities. Analyses were performed using logistic regression and adjusted for potential confounding factors. In total, 94 participants (9.8%) developed mobility limitations and 45 participants (4.7%) developed difficulties in self-care activities during 10 year follow-up. The likelihood of having mobility limitations (odds ratio (OR) 0.42, 95% confidence interval (CI) 0.22–0.80) and difficulties in self-care activities (OR 0.38, 95% CI 0.15–0.94) were lower among those in the highest NDS tertile than among those in the lowest NDS tertile. Greater mMDS was associated with a lower disability incidence; however, the association was not statistically significant. Adherence to the healthy Nordic diet predicts 10-year incidence of mobility limitations and difficulties to perform self-care activities in old age and may thus be protective against disability in Nordic population. [ABSTRACT FROM AUTHOR]

Evidence on the nature of the relationship between obesity and the quality of diet remains controversial. Likewise, the possible effect of dieting attempts on this association is poorly understood. This study investigates the possible modifying effect of dieting attempts on the association between the quality of diet and obesity. The authors hypothesize that among dieters the association may be biased. The study was based on a Finnish cohort, including 5910 men and women aged 30 to 99 years, with information on diet and body mass index (BMI). Using data from a food frequency questionnaire (FFQ), an Alternate Healthy Eating Index (AHEI) applicable to the Finnish regimen was formed. Obesity was defined as a BMI ≥30 kg/m 2 . Information on dieting attempts was collected using a questionnaire. The statistical analyses were based on linear and logistic regression. We found a positive association between the quality of the diet and obesity, the relative odds of obesity between the highest and lowest quintiles of AHEI being 1.48 (95% CI, 1.20-1.82) after adjustment for confounding factors. However, in the interaction analysis of dieting attempts and AHEI, no association was observed in non-dieters (OR, 0.92; 95% CI, 0.69-1.24) but among dieters a slightly elevated risk was found (OR, 1.40; 95% CI, 0.98-1.98). We found no association between a high quality diet and obesity among non-dieters, but a tendency for a positive association in dieters. Dieting thus seems to modify the association between diet and obesity, which should be further studied using a longitudinal design. [ABSTRACT FROM AUTHOR]

Background Folate and vitamin B 12 are essential for maintaining DNA integrity and may influence prostate cancer (PCa) risk, but the association with clinically relevant, advanced stage, and high-grade disease is unclear. Objective To investigate the associations between circulating folate and vitamin B 12 concentrations and risk of PCa overall and by disease stage and grade. Design, setting, and participants A study was performed with a nested case–control design based on individual participant data from six cohort studies including 6875 cases and 8104 controls; blood collection from 1981 to 2008, and an average follow-up of 8.9 yr (standard deviation 7.3). Odds ratios (ORs) of incident PCa by study-specific fifths of circulating folate and vitamin B 12 were calculated using multivariable adjusted conditional logistic regression. Outcome measurements and statistical analysis Incident PCa and subtype by stage and grade. Results and limitations Higher folate and vitamin B 12 concentrations were associated with a small increase in risk of PCa (ORs for the top vs bottom fifths were 1.13 [95% confidence interval (CI), 1.02–1.26], p trend = 0.018, for folate and 1.12 [95% CI, 1.01–1.25], p trend = 0.017, for vitamin B 12 ), with no evidence of heterogeneity between studies. The association with folate varied by tumour grade ( p heterogeneity < 0.001); higher folate concentration was associated with an elevated risk of high-grade disease (OR for the top vs bottom fifth: 2.30 [95% CI, 1.28–4.12]; p trend = 0.001), with no association for low-grade disease. There was no evidence of heterogeneity in the association of folate with risk by stage or of vitamin B 12 with risk by stage or grade of disease ( p heterogeneity > 0.05). Use of single blood-sample measurements of folate and B 12 concentrations is a limitation. Conclusions The association between higher folate concentration and risk of high-grade disease, not evident for low-grade disease, suggests a possible role for folate in the progression of clinically relevant PCa and warrants further investigation. Patient summary Folate, a vitamin obtained from foods and supplements, is important for maintaining cell health. In this study, however, men with higher blood folate levels were at greater risk of high-grade (more aggressive) prostate cancer compared with men with lower folate levels. Further research is needed to investigate the possible role of folate in the progression of this disease. [ABSTRACT FROM AUTHOR]

Background Epidemiological studies have associated long-term exposure to ambient particulate matter with increased mortality from cardiovascular and respiratory disorders. Systemic inflammation is a plausible biological mechanism behind this association. However, it is unclear how the chemical composition of PM affects inflammatory responses. Objectives To investigate the association between long-term exposure to elemental components of PM and the inflammatory blood markers high-sensitivity C-reactive protein (hsCRP) and fibrinogen as part of the European ESCAPE and TRANSPHORM multi-center projects. Methods In total, 21,558 hsCRP measurements and 17,428 fibrinogen measurements from cross-sections of five and four cohort studies were available, respectively. Residential long-term concentrations of particulate matter < 10 μm (PM 10 ) and < 2.5 μm (PM 2.5 ) in diameter and selected elemental components (copper, iron, potassium, nickel, sulfur, silicon, vanadium, zinc) were estimated based on land-use regression models. Associations between components and inflammatory markers were estimated using linear regression models for each cohort separately. Cohort-specific results were combined using random effects meta-analysis. As a sensitivity analysis the models were additionally adjusted for PM mass. Results A 5 ng/m 3 increase in PM 2.5 copper and a 500 ng/m 3 increase in PM 10 iron were associated with a 6.3% [0.7; 12.3%] and 3.6% [0.3; 7.1%] increase in hsCRP, respectively. These associations between components and fibrinogen were slightly weaker. A 10 ng/m 3 increase in PM 2.5 zinc was associated with a 1.2% [0.1; 2.4%] increase in fibrinogen; confidence intervals widened when additionally adjusting for PM 2.5 . Conclusions Long-term exposure to transition metals within ambient particulate matter, originating from traffic and industry, may be related to chronic systemic inflammation providing a link to long-term health effects of particulate matter. [ABSTRACT FROM AUTHOR]

Abstract: The objective of this study was to measure the concentrations of organotin compounds in the whole blood of Finnish male fishermen (n =133), their wives (n =94), and other family members (n =73), and to investigate their associations with background variables. The concentrations were generally low, less than the limit of quantification (LOQ) for the vast majority of compounds and samples. Of the organotin compounds (mono-, di-, and tributyltin, mono-, di-, and triphenyltin, and dioctyltin), only triphenyltin was detected in more than just a few samples (in 37 of 300 samples, LOQ=0.04 ng/ml). These were mainly the samples of fishermen (26/37) and their wives (10/37). For statistical analysis, concentrations of triphenyltin were divided into two categories, LOQ. Of the different background variables, age and fish consumption contributed the most to the triphenyltin concentrations. When age and fish consumption (g/day) were divided into three categories, odds ratios comparing the highest with the lowest category were 3.88 for age (95% CI 1.36–11.09) and 3.48 for fish consumption (1.36–8.94), respectively. Compared with females, males had an odds ratio of 1.51 of having the concentration of triphenyltin >LOQ (0.72–3.14). To the best of our knowledge, this study confirmed for the first time with human samples that fish consumption can be associated with triphenyltin concentration in whole blood. [Copyright &y& Elsevier]