Search

BACKGROUND: Vitamin D insufficiency is associated with risk of cardiovascular diseases (CVD) and cancer in observational studies, but evidence for benefits with vitamin D supplementation is limited. OBJECTIVES: To investigate the effects of vitamin D3 supplementation on CVD and cancer incidence. DESIGN: The study was a 5-year randomized placebo-controlled trial among 2495 male participants ≥ 60 years and post-menopausal female participants ≥ 65 years from a general Finnish population who were free of prior CVD or cancer. The study had three arms: placebo, 1600 IU/day or 3200 IU/day vitamin D3. Follow-up was by annual study questionnaires and national registry data. A representative sub-cohort of 551 participants had more detailed in-person investigations. The primary endpoints were incident major CVD and invasive cancer. Secondary endpoints included the individual components of the primary CVD endpoint (myocardial infarction, stroke, and CVD mortality), site-specific cancers and cancer death. RESULTS: During the follow-up, there were 41 (4.9%), 42 (5.0%) and 36 (4.3%) major CVD events in the placebo, 1600 IU/d (vs. placebo: hazard ratio (HR), 0.97;95% CI, 0.63,1.49; P = 0.89), and 3200 IU/d (HR, 0.84;95% CI, 0.54,1.31; P = 0.44) arms, respectively. Invasive cancer was diagnosed in 41 (4.9%), 48 (5.8%) and 40 (4.8%) participants in the placebo, 1600 IU/d (HR, 1.14;95% CI, 0.75,1.72; P = 0.55), and 3200 IU/d (HR, 0.95;95% CI, 0.61,1.47; P = 0.81) arms, respectively. There were no significant differences in the secondary endpoints or total mortality. In the sub-cohort, the mean (standard deviation) baseline serum 25-hydroxyvitamin D concentration was 75 (18) nmol/L. After 12 months, the concentrations were 73 (18) nmol/L, 100 (21) nmol/L and 120 (22) nmol/L in the placebo, 1600 IU/d and 3200 IU/d arms, respectively. CONCLUSIONS: Vitamin D3 supplementation did not lower the incidence of major CVD events or invasive cancer among older adults, possibly due to sufficient vitamin D status in most participants at baseline. Clinical Trial Registry number: ClinicalTrials.gov: NCT01463813, https://clinicaltrials.gov/ct2/show/NCT01463813. CC BY 4.0Virtanen, Jyrki K.(corresponding author)Published: 04 January 2022This study was supported by funding from the Academy of Finland (#137826), University of Eastern Finland, Juho Vainio Foundation, Medicinska Understödsföreningen Liv och Hälsa, Finnish Foundation for Cardiovascular Research, Finnish Diabetes Research Foundation, and Finnish Cultural Foundation.

The association between selenium status and risk of acute myocardial infarction was examined in a multicenter case-control study in 10 centers from Europe and Israel in 1991-1992. Selenium in toenails was assessed for 683 nonfatal male cases with first acute myocardial infarction and 729 controls less than 70 years of age. Median toenail selenium content was 0.553 microgram/g for cases and 0.590 microgram/g for controls. After adjustment for age, center, and smoking, the odds ratio for myocardial infarction in the highest quintile of selenium as compared with the lowest was 0.63 (95 percent confidence interval 0.37-1.07, p for trend = 0.08). The observed inverse trend was somewhat stronger when the authors adjusted for vitamin E status (p = 0.05). Analysis stratified for smoking habits showed an inverse association in former smokers (odds ratio for the 75th-25th percentile contrast = 0.63 (95 percent confidence interval 0.43-0.94)), but not in current smokers (odds ratio = 0.97 (0.71-1.32)) or in those who had never smoked (odds ratio = 1.55 (0.87-2.76)). Analysis stratified by center showed a significant inverse association between selenium levels and risk of myocardial infarction for Germany (Berlin) only (75th to 25th percentile odds ratio = 0.62 (95 percent confidence interval 0.42-0.91)), which was the center with the lowest selenium levels. It appears that the increased risk of acute myocardial infarction at low levels of selenium intake is largely explained by cigarette smoking; selenium status does not appear to be an important determinant of risk of myocardial infarction at the levels observed in a large part of Europe.

To examine the effects of betaine on serum lipid profile, plasma homocysteine concentration and hemostatic factors in healthy subjects.Altogether, 63 volunteers (27 ± 8 years, body mass index 22.6 ± 2.4 kg/m(2)) participated in a placebo-controlled, randomized, parallel double-blinded study. The intervention lasted for 6 months during which the subjects consumed mineral water 500 ml/day with (betaine group, n = 32) or without (control group, n = 31) a 4-g betaine supplementation.There was a significant interaction of time and group (general linear model) in serum total and low-density lipoprotein (LDL)-cholesterol concentrations and total-to-high-density lipoprotein (HDL)-cholesterol ratio without a significant difference between or within the groups. Concentrations of serum HDL-cholesterol, triglycerides or oxidized LDL did not change during the study. Plasma homocysteine concentration did not change in either of the groups. Plasma plasminogen activator inhibitor 1 concentration increased in the betaine group (P = 0.028) and decreased in the control group (P = 0.006). There was a significant interaction of time and group (general linear model) in plasma fibrinogen and blood hemoglobin concentration without a significant difference between or within the groups. There were no changes in parameters regarding the function of the liver or kidney.Betaine had no effect on serum lipid profile in long term in young healthy subjects. The lowering effect on plasma homocysteine concentration was weak.

A double-blind comparative study of 1 alpha-OHD3 and placebo was performed on 37 patients with osteoporotic hip fracture without clinical osteomalacia. 1 alpha-OHD3, in a dose of 1 microgram/day together with 2.5 g CaCO3, did not heal osteoporosis as judged from determinations of bone mineral density and histomorphometric analyses during four months of treatment. However, 1 alpha-OHD3 seemed to have an effect on fracture healing as concluded from the posttreatment alkaline phosphatase level. Hypercalcemia was common, occurring in six out of 19 patients treated with 1 alpha-OHD3. It is concluded that treatment of osteoporosis with 1 alpha-OHD3 and calcium is ineffective and potentially dangerous because it frequently causes hypercalcemia.

Eighty consecutive newly diagnosed non-insulin-dependent diabetic patients were randomly allocated into two groups to compare two different patient education regimens. One group received individual dietary instructions by a nurse and the other a short, written leaflet given by a doctor. The principal aim of the dietary instructions was weight reduction. A significant weight loss and improvement in the control of diabetes occurred in both groups, and these changes were similar in the two groups. At the end of one year's follow-up, however, only 25% of the patients were satisfactorily controlled (fasting blood glucose less than or equal to 6.0 mmol/l). The degree of weight loss correlated only weakly with the improvement in the metabolic control. The degree of obesity and insulin secretion capacity as measured at the beginning of the study did not predict the improvement of glycaemic control during the study. At the end of the study a significant improvement was observed in serum lipids of patients with good control (fasting blood glucose less than or equal to 6.0 mmol/l) or weight loss (greater than 5 kg). In conclusion, both brief, written and individual dietary instructions induced a significant weight loss as well as improved glucose and lipid metabolism in newly diagnosed non-insulin-dependent diabetic patients, but satisfactory metabolic control was achieved only in a minority of the patients.

This paper contains the description of a recommendation for dietary therapy in diabetes mellitus prepared by the Finnish Diabetes Association's Committee on Dietary Therapy in 1980.

Animal studies suggest that conjugated linoleic acid (CLA) may modulate the immune response, while studies in healthy human subjects have shown little effect and results are controversial. However, the effects of CLA may be more prominent in situations of immune imbalance, such as allergy. We studied the effects of the natural CLA isomer, cis-9, trans-11-CLA, on allergy symptoms and immunological parameters in subjects with birch pollen allergy. In a randomised, placebo-controlled study, forty subjects (20–46 years) with diagnosed birch pollen allergy received 2 g CLA/d in capsules, which contained 65·3 % cis-9, trans-11-CLA and 8·5 % trans-10, cis-12-CLA (n 20), or placebo (high-oleic acid sunflower-seed oil) (n 20) for 12 weeks. The supplementation began 8 weeks before the birch pollen season and continued throughout the season. Allergy symptoms and use of medication were recorded daily. Lymphocyte subsets, cytokine production, immunoglobulins, C-reactive protein, lipid and glucose metabolism and lipid peroxidation were assessed before and after supplementation. The CLA group reported a better overall feeling of wellbeing (P P in vitro production of TNF-α (P P P P P P 2α, a major F2-isoprostane (P 2α, a primary PGF2α metabolite (P cis-9, trans-11-CLA has modest anti-inflammatory effects in allergic subjects.

High dietary intakes of tomato products are often associated with a reduced risk of CVD, but the atheroprotective mechanisms have not been established. This study was conducted to investigate the effects of increased dietary intake of tomato products on plasma lipids and LDL oxidation. The diet intervention included a baseline period, a 3-week low tomato diet (no tomato products allowed) and a 3-week high tomato diet (400 ml tomato juice and 30 mg tomato ketchup daily). Twenty-one healthy study subjects participated in the study. Total cholesterol concentration was reduced by 5·9 (sd10) % (P = 0·002) and LDL cholesterol concentration by 12·9 (sd17·0) % (P = 0·0002) with the high tomato diet compared to the low tomato diet. The changes in total and LDL cholesterol concentrations correlated significantly with the changes in serum lycopene (r0·56,P = 0·009;r0·60,P = 0·004, total and LDL, respectively), β-carotene (r0·58,P = 0·005;r0·70,P r0·64,P = 0·002;r0·64,P = 0·002). The level of circulating LDL to resist formation of oxidized phospholipids increased 13 % (P = 0·02) in response to the high tomato diet. In conclusion, a high dietary intake of tomato products had atheroprotective effects, it significantly reduced LDL cholesterol levels, and increased LDL resistance to oxidation in healthy normocholesterolaemic adults. These atheroprotective features associated with changes in serum lycopene, β-carotene and γ-carotene levels.

Objective To evaluate the relation between intake and adipose tissue composition of fatty acids and acute myocardial infarction in Portuguese men. Design Case-control study. Diet was assessed using a semiquantitative food frequency questionnaire. In 49 case and 49 control subjects, adipose tissue composition was assessed by gas-liquid chromatography. Subjects/Setting Population-based; subjects were 297 consecutively admitted cases of first acute myocardial infarction in a tertiary care hospital who were aged ≥40 years. Three hundred ten community controls were selected by random-digit dialing. Main Outcome Measure Odds ratio (OR). Statistical Analysis Performed Logistic regression, adjusting for age, education, family history of acute myocardial infarction, smoking, physical activity, body mass index, and energy intake. Results Total fat intake (OR 0.45, fourth quartile, P =0.02), lauric acid (OR 0.44, fourth quartile, P =0.02), palmitic acid (OR 0.58, fourth quartile, P= 0.03), and oleic acid (OR 0.42, fourth quartile, P =0.03) were inversely associated with acute myocardial infarction. No significant effects were found for the remaining fatty acids. In the adipose tissue composition data, the adjusted risk estimates of acute myocardial infarction for the highest vs the lowest tertile were 0.16, 0.14, and 0.04 for lauric, oleic, and trans -fatty acids, respectively. A significant direct association was found for palmitic and linoleic acids (adjusted ORs for the highest tertile were 9.02 and 3.63, respectively). Conclusions Low intake of total fat and lauric acid from dairy products was associated with acute myocardial infarction. The association of polyunsaturated fatty acids with risk of acute myocardial infarction was nonsignificant after adjustment for energy intake and confounders. Recommendations on fatty acid intake should aim for both an upper and lower limit.

Trans fatty acids (TFA) comprise a variety of positional isomers, mainly with 18 carbon atoms and one double bond (C18:1). They are found in foods of ruminant animal origin and in partially hydrogenated vegetable oils. The isomeric composition of TFA in animal and vegetable foods differs, but no definite differences have been documented between the metabolic and health effects of the different isomers. In the Nordic countries the intake of TFA has declined during the past 1015 years, mainly through reduced use of partially hydrogenated vegetable oils. TFA are mainly found in foods that contain far higher amounts of saturated fatty acids (SFA). The proportion of SFA plus TFA should be kept to one-third of total dietary fatty acids. The problem of excessive consumption of these unfavourable fatty acids should be managed with food-based dietary guidelines in agreement with the Nordic Nutrition Recommendations.

ObjectiveTo examine the efficacy and safety of foods fortified with calcium in the adult population in Finland.DesignA simulation study based on the FINDIET 2002 Survey, which estimated habitual food consumption, dietary supplement use and nutrient intakes using 48-hour recall and two 3-day food records, and an Internet survey of the consumption of fortified foods and dietary supplements.Setting/participantsParticipants of FINDIET 2002 were 25–64 years old from five areas (n= 2007). Participants of the Internet-based survey (n= 1537) were over 15 years of age from all over the country.ResultsIf all potentially fortifiable foods were to be fortified with calcium, the proportion of participants with calcium intake below the recommended level (−1) would decrease from 20.3% to 3.0% in men and from 27.8% to 5.6% in women compared with the situation where no foods were fortified. At the same time, the proportion of participants with calcium intake above the tolerable upper intake level (UL, >2500 mg day−1) would increase from 0.6% to 12.7% in men and from 0.1% to 3.8% in women. However, in a probability-based model (11% of all fortifiable foods to be fortified with calcium) the proportion of participants with calcium intake below the recommended level would be 15.7% in men and 23.2% in women. The proportion with intake above the UL in this model would be 1.2% in men and 0.7% in women.ConclusionsFood fortification would be a relatively effective and safe way to increase the calcium intake of the Finnish adult population.

Objective— To assess the effects of dietary modifications on oxidized low-density lipoprotein (LDL). Methods and Results— Thirty-seven healthy women were fed two diets. Both diets contained a reduced amount of total and saturated fat. In addition, one diet was low in vegetables and the other was high in vegetables, berries, and fruit. The dietary intake of total fat was 70 g per day at baseline and decreased to 56 g (low-fat, low-vegetable diet) and to 59 g (low-fat, high-vegetable diet). The saturated fat intake decreased from 28 g to 20 g and to 19 g, and the amount of polyunsaturated fat intake increased from 11 g to 13 g and to 19 g (baseline; low-fat, low-vegetable; low-fat, high-vegetable; respectively). The amount of oxidized LDL in plasma was determined as the content of oxidized phospholipid per ApoB-100 using a monoclonal antibody EO6 (OxLDL-EO6). The median plasma OxLDL-EO6 increased by 27% ( P P P P= 0.01), respectively. Conclusion— Alterations in the dietary fat intake resulted in increased plasma concentrations of lipoprotein(a) and OxLDL-EO6.

This longitudinal study reports the patterning of the burnout symptoms and the changes in employees' job conditions, personal resources, and psychological health 4 months after a rehabilitation intervention. The data were gathered by means of questionnaires before and after a rehabilitation period. Four patterns were identified: not burned out (n = 55), exhausted and cynical (n = 36), burned out (n = 26), and low professional efficacy (n = 18). These patterns differed in terms of job resources, personal resources, and depression. There were both positive and negative changes detected in participants' psychological health and job resources at the follow-up. The study shows the importance of identifying different burnout patterns in order to focus rehabilitation activities more effectively.

Background: Dietary fat has been reported to influence insulin sensitivity. Objective: The objective of the study was to determine how identical weight loss (target: loss of 8% of body weight over 3–6 mo) in women taking orlistat or placebo combined with a hypocaloric diet influences body composition and insulin sensitivity. Design: Forty-seven obese women [body mass index (in kg/m 2 ): 32.1 0.4] were randomly assigned to receive either orlistat (120 mg 3 times daily; n 23) or placebo (n 24) with a hypocaloric diet. Whole-body insulin sensitivity (insulin clamp technique), serum fatty acids, and body composition (magnetic resonance imaging) were measured before and after weight loss. Results: The groups did not differ significantly at baseline with respect to age, body weight, intraabdominal and subcutaneous fat volumes, or insulin sensitivity. Weight loss did not differ significantly between the orlistat (7.3 0.2 kg, or 8.3 0.1%) and placebo (7.4 0.2 kg, or 8.2 0.1%) groups. Insulin sensitivity improved significantly (P 0.001) and similarly after weight loss in the orlistat (from 4.0 0.3 to 5.1 0.3 mg kg fat-free mass 1 min 1 ) and placebo (from 4.4 0.4 to 5.4 0.4 mg kg fat-free mass 1 min 1 ) groups. Intraabdominal fat and subcutaneous fat decreased significantly in both groups, but the ratio of the 2 decreased significantly only in the orlistat group. The proportion of dihomo--linolenic acid (20:3n6) in serum phospholipids was inversely related to insulin sensitivity both before ( r 0.48, P 0.001) and after (r 0.46, P 0.001) weight loss, but it did not change significantly in either group. Conclusions: Weight loss rather than inhibition of fat absorption enhances insulin sensitivity. A decrease in fat absorption by orlistat appears to favorably influence the ratio between intraabdominal and subcutaneous fat, which suggests that exogenous fat or its composition influences fat distribution. Am J Clin Nutr 2004;79: 22–30.

OBJECTIVE—To study cross-sectional associations of dietary fiber intake with insulin resistance, insulin secretion, and glucose tolerance in a population at high risk for type 2 diabetes. RESEARCH DESIGN AND METHODS—The subjects consisted of 248 male and 304 female adult nondiabetic relatives of patients with type 2 diabetes. Dietary intake was measured by means of two 3-day food records. Associations of total, water-insoluble, and water-soluble fiber with measures of glucose metabolism based on an oral glucose tolerance test, were analyzed by multiple linear regression analysis adjusting for sex, age, length of education, physical activity, BMI, waist-to-hip ratio, systolic blood pressure, and serum triglyceride and HDL cholesterol concentrations. The homeostasis model assessment insulin resistance index, the incremental 30-min serum insulin concentration divided by the incremental 30-min glucose concentration, and fasting and 2-h glucose concentrations were the outcome variables. RESULTS—The dietary intake of total as well as water-insoluble and water-soluble fiber was inversely associated with insulin resistance: −0.17 (0.07), P = 0.012; −0.15 (0.07), P = 0.024; and −0.14 (0.07), P = 0.049 [regression coefficients (SE)]. Fiber variables were unrelated to insulin secretion and plasma glucose concentrations. CONCLUSIONS—The results support evidence that a high intake of dietary fiber is associated with enhanced insulin sensitivity and therefore may have a role in the prevention of type 2 diabetes.

High plasma total homocysteine (tHcy) concentration is reported to be a risk factor for vascular diseases. We investigated the extent to which serum folate and plasma tHcy respond to a high intake of natural folate from food. Thirty-seven healthy females volunteered to participate in a crossover dietary intervention. The study included a baseline period and two 5-week diet periods (low- and high-folate diets) with a 3-week washout in between. The low-folate diet contained one serving of both vegetables and frui/, while during the high-folate diet the subjects ate at least seven servings of vegetables, berries, and citrus frui/. Serum and erythrocyte (RBC) folate, serum vitamin B12, and plasma tHcy concentrations were measured at the baseline and at the end of each diet period. The mean concentrations of serum and RBC folate were 11·0 (sd 3·0) nmo/ and 412 (sd 120) nmo/ at the end of the low-folate diet and 78 (95 % CI 62, 94) % and 14 (95 % CI 8, 20) % higher in response to the high-folate diet (P12remained unchanged during the intervention. The mean plasma tHcy concentration was 8·0 μmo/ at the end of the low-folate diet and decreased by 13 (95 % CI 9, 18) % in response to the high-folate diet (P

Objective: To assess the folate status of Finnish adults using plasma folate and homocysteine as biomarkers and to evaluate dietary and supplementary folate intakes. Materials and methods: Plasma folate, vitamin B12 and total homocysteine (tHcy) were determined in a random sample of 643 subjects aged 25–74 y living in the Helsinki area. The methylenetetrahydrofolate reductase (MTHFR)-genotypes were analyzed from a subsample (n=394). Dietary intake data by 24 h recall and use of vitamin supplements were collected. Results: Plasma folate was normal (≥5 nmol/l) in 99% of subjects and optimal (≥8 nmol/l) in terms of a minimum tHcy in 90%. Mean plasma folate of non-supplement users was 13.7 and 12.9 nmol/l and tHcy 11.3 and 9.2 µmol/l for men and women, respectively. Elevated tHcy (>14 µmol/l) was found in 11% of subjects. Homozygote frequency for MTHFR genotype TT was 5.0% and their plasma tHcy was 14.8 µmol/l compared to the mean of the other subjects, 10.5 µmol/l, P

Background: Betaine (trimethylglycine) is found in several tissues in humans. It is involved in homocysteine metabolism as an alternative methyl donor and is used in the treatment of homocystinuria in humans. In pigs, betaine decreases the amount of adipose tissue. Objective: The aim of the study was to examine the effect of betaine supplementation on body weight, body composition, plasma homocysteine concentrations, blood pressure, and serum total and lipoprotein lipids. Design: Forty-two obese, white subjects (14 men, 28 women) treated with a hypoenergetic diet were randomly assigned to a betaine-supplemented group (6 g/d) or a control group given placebo for 12 wk. The intervention period was preceded by a 4-wk run-in period with a euenergetic diet. Results: Body weight, resting energy expenditure, and fat mass decreased significantly in both groups with no significant difference between the groups. Plasma homocysteine concentrations decreased in the betaine group (x ± SD: 8.76 ± 1.63 � mol/L at 4 wk, 7.93 ± 1.52 � mol/L at 16 wk; P = 0.030 for the interaction of time and treatment). Diastolic blood pressure decreased without a significant difference between the groups. Serum total and LDL-cholesterol concentrations were higher in the betaine group than in the control group (P < 0.05). Conclusion: A hypoenergetic diet with betaine supplementation (6 g daily for 12 wk) decreased the plasma homocysteine concentration but did not affect body composition more than a hypoenergetic diet without betaine supplementation did. Am J Clin Nutr 2002;76:961‐7.

Paraoxonase-1 (PON1), a HDL-associated enzyme, may protect against the development of atherosclerosis. Serum PON1 activity and PON1-mediated capacity of HDL to prevent lipoprotein oxidation are modulated by two common polymorphisms at positions 192 (Gln-->Arg) and 55 (Leu-->Met) of the PON1 gene. We studied the effect of dietary modifications on PON1 activity and the role of PON1 gene polymorphisms in the response. A controlled, crossover dietary intervention of two 5-wk periods was conducted in 37 healthy, nonsmoking women. The two study diets were either low or high in vegetables, and thus in natural antioxidants, with some differences in fatty acid contents. The mean plasma total (-8%, P < 0.001), LDL (-7%, P < 0.01) and HDL (-7%, P < 0.001%) cholesterol, and apolipoprotein A-I (-8%, P < 0.001) concentrations were lower after the high vegetable diet period than after the low vegetable diet period. Also, the serum PON1 activity was lower (P < 0.05) after the high vegetable compared with the low vegetable diet period. The reduction of PON1 activity correlated with the reduction in HDL cholesterol (r = 0.35, P < 0.05). High baseline PON1 activity was related to the presence of the PON1(192Arg) allele (P < 0.001) and PON1(55Leu/Leu) genotype (P < 0.001). The reduction of PON1 activity due to the high vegetable diet was greatest among the women with the PON1(192Arg) allele (P < 0.05) and PON1(55Leu/Leu) genotype (P < 0.05). In conclusion, a diet high in vegetables, berries and fruit reduces PON1 activity, and the response is modulated by the genetic variance of PON1.

Background: It has been suggested that mercury, a highly reactive heavy metal with no known physiologic activity, increases the risk of cardiovascular disease. Because fish intake is a major source of exposure to mercury, the mercury content of fish may counteract the beneficial effects of its n-3 fatty acids. Methods: In a case-control study conducted in eight European countries and Israel, we evaluated the joint. association of mercury levels in toenail clippings and docosahexaenoic acid (C22:6n-3, or DHA) levels in adipose tissue with the risk of a first myocardial infarction among men. The patients were 684 men with a first diagnosis of myocardial infarction. The controls were 724 men selected to be representative of the same populations. Results: The average toenail mercury level in controls was 0.25 μg per gram. After adjustment for the DHA level and coronary risk factors, the mercury levels in the patients were 15 percent higher than those in controls (95 percent confidence interval, 5 to 25 percent). The risk-factor-adjusted odds ratio for myocardial infarction associated with the highest as compared with the lowest quintile of mercury was 2.16 (95 percent confidence interval, 1.09 to 4.29; P for trend = 0.006). After adjustment for the mercury level, the DHA level was inversely associated with the risk of myocardial infarction (odds ratio for the highest vs. the lowest quintile, 0.59; 95 percent confidence interval, 0.30 to 1.19; P for trend = 0.02). Conclusions: The toenail mercury level was directly associated with the risk of myocardial infarction, and the adipose-tissue DHA level was inversely associated with the risk. High mercury content may diminish the cardioprotective effect of fish intake.

Despite different geological features the Nordic countries are generally selenium-poor areas. In each country various factors such as food importation and life-style determine the selenium (Se) intake. Due to an extremely low Se intake in the 1970s in Finland, 0.025 mg/day, an official decision was made in 1984 to supplement multinutrient fertilizers with Se in the chemical form of sodium selenate. Almost all fertilizers used in Finland since 1985 have contained Se. Currently all crop fertilizers contain 15 mg Se/kg. Finland is still the only country to take this country-wide measure. In a national monitoring programme, sampling of cereals, basic foodstuffs, feeds, fertilizers, soils, and human tissues has been carried out annually since 1985 by four governmental research organizations. Sampling of foods has been done four times per year and human blood has been obtained annually from the same (n=60) adults. The accuracy of analyses has been verified by annual interlaboratory quality control. During this programme the selenium concentration of spring cereals has increased on average 15-fold compared with the level before the Se fertilization. The mean increase in the Se concentration in beef, pork and milk was 6-, 2- and 3-fold. In terms of Se, organically grown foods of plant origin are generally comparable to products produced before the Se supplementation of fertilizers. Milk from organically fed cows is 50% lower in Se than the usual milk. The average dietary human intake increased from 0.04 mg Se/day/10 MJ in 1985 to a present plateau of 0.08 mg Se/day/10 MJ, which is well above the current nutrition recommendations. Foods of animal origin contribute over 70% of the total daily Se intake. The mean human plasma Se concentration increased from 0.89 μmol/L to a general level of 1.40 μmol/L that can be considered to be an optimal status. The absence of Se deficiency diseases and a reference population have made conclusions on the impact on human health difficult. However, the rates of cardiovascular diseases and cancers have remained similar during the pre- and post-supplementation indicating medical and life-style factors to be much stronger determinants than Se. The nationwide supplementation of fertilizers with sodium selenate is shown to be effective and safe in increasing the Se intake of the whole population. Also, the health of animals has improved.

Background —Left ventricular hypertrophy (LVH) is a common risk factor for cardiovascular mortality. Causes other than hypertension have not previously been investigated longitudinally. The aim of the present study was to determine hemodynamic, metabolic, and psychosocial predictors at 50 years of age for the prevalence of echocardiographic LVH and geometric subtypes at age 70 by use of a large sample of men from the general population followed up for 20 years. Methods and Results —In 1970 to 1973, all men born from 1920 to 1924 and residing in Uppsala County, Sweden, were invited to participate in a health survey aimed at identifying risk factors for cardiovascular disease. At a reinvestigation 20 years later, echocardiographic left ventricular mass index was determined in 475 subjects. A 1-SD increase in body mass index, systolic or diastolic blood pressure, fasting LDL/HDL cholesterol, serum triglycerides, or the serum cholesterol ester proportion of several saturated fatty acids or oleic acid at age 50 significantly increased the odds of having LVH at age 70 by 27% to 41%, whereas an increase in linoleic acid proportion was protective. Almost all metabolic predictors were independent of ischemic heart disease, valvular disease, and use of antihypertensive medication at age 70. Conclusions —Dyslipidemia and indices of a low dietary intake of linoleic acid and high intake of saturated and monounsaturated fats, as well as hypertension and obesity, at age 50 predicted the prevalence of LVH 20 years later in this prospective longitudinal cohort study, thereby suggesting that lipids may be important in the origin of LVH.

The evidence for the putative role of cow's milk in the development of type 1 diabetes is controversial. We studied infant feeding patterns and childhood diet by structured questionnaire (n = 725) and HLA-DQB1 genotype by a polymerase chain reaction-based method (n = 556) in siblings of affected children and followed them for clinical type 1 diabetes. In a nested case-control design in a population who had both dietary and genetic data available, we selected as cases those siblings who progressed to clinical diabetes during the follow-up period (n = 33). For each case, we chose as matched control subjects siblings who fulfilled the following criteria: same sex, age within 1 year, not from the same family, the start of the follow-up within 6 months of that of the respective case, and being at risk for type 1 diabetes at the time the case presented with that disease (n = 254). The median follow-up time was 9.7 years (range 0.2-11.3). Early age at introduction of cow's milk supplements was not significantly associated with progression to clinical type 1 diabetes (relative risk adjusted for matching factors, maternal education, maternal and child's ages, childhood milk consumption, and genetic susceptibility markers was 1.60 [95% CI 0.5-5.1]). The estimated relative risk of childhood milk consumption for progression to type 1 diabetes was 5.37 (1.6-18.4) when adjusted for the matching and aforementioned sociodemographic factors, age at introduction of supplementary milk feeding, as well as for genetic susceptibility markers. In conclusion, our results provide support for the hypothesis that high consumption of cow's milk during childhood can be diabetogenic in siblings of children with type 1 diabetes. However, further studies are needed to assess the possible interaction between genetic disease susceptibility and dietary exposures in the development of this disease.

The authors examined the validity of a self-administered 180-item food frequency questionnaire in 125 Norwegian men aged 20-55 years who filled in the questionnaire and completed 14-day weighed records in fall 1995 to winter 1995/6. Spearman correlation coefficients between the two measurements ranged from 0.42 for percent of energy from fat to 0.66 for sugar intake (median r = 0.51). On average, 39% of the men were classified in the same quartile with the two methods, and 3% in the opposite quartile. Correlation coefficients between intake of fatty acids estimated from the questionnaire and the relative amounts of fatty acids in adipose tissue were: linoleic acid (18:2, n-6), r = 0.38; alpha-linolenic acid (18:3, n-3), r = 0.42; eicosapentaenoic acid (20:5, n-3), r = 0.52; and docosahexaenoic acid (22:6, n-3), r = 0.49. The correlations for these fatty acids between the total serum lipids and the diet were 0.16, 0.28, 0.51 and 0.52, respectively. The data suggest that very-long-chain n-3 fatty acids in adipose tissue and total serum lipids reflect the dietary intake of very-long-chain n-3 fatty acids to the same degree. No associations were observed between intake of alpha-tocopherol and concentration in adipose tissue and serum.

The fatty acid composition of dietary fats and oils from 14 European countries was analyzed with particular emphasis on isomerictransfatty acids. The proportion oftransfatty acids in typical soft margarines and low-fat spreads ranged between 0.1 and 17% of total fatty acids and that ofcis-unsaturated fatty acids between 55 and 81%. Hard household margarines and industrial fats for cooking and baking (shortenings) had slightly higher proportions oftransfatty acids and highest amounts, up to 50%, were found in fats for deep frying. Vegetable oils contained only small amounts oftransfatty acids, usually less than 1%. Isomers of C18:1 comprised up to 94% of thetransfatty acids in hardened vegetable oils and 52-68% in butter, whereas hardened fish oils showed a more even distribution oftransmonoenoic fatty acids between C16:1 and C22:1, and C18:1 isomers contributed by 28-42% to totaltransfatty acids. Fat spreads with very low content (

In the TRANSFAIR study, foods contributing to 95% of total fat intake were collected in 14 European countries. In addition to edible fats, dairy, meat, and bakery products some specific food items with relatively high amounts oftransfatty acids were found. French fried potatoes, both those from fast-food restaurants and those from the supermarkets (including potato chips), contained mostly between 12 and 35%transfatty acid, but some products fried in animal fat or vegetable oil contained lower proportions between 0.5 and 7% total fatty acids. Deep-fried croquettes were also rich intransfatty acids. Microwave popcorn samples contained 27-34%transfatty acids. Ready-made popcorn was low intransfatty acids but generally contained even more saturated fatty acids. Dry soup and sauce mixes and cubes and high-fat, frosted breakfast cereals were other examples of foods that often contained >10%transfatty acids. It is concluded that any deep-fried product such as French fried potatoes may contain high proportions of isomerictransfatty acids. Processed foods with a long shelf life such as dry soup powders and cubes, savory snacks, and popcorn often contained relatively high proportions oftransfatty acids, although the contributions of these products to total fat intake are probably small. The foods and snacks with a high proportion oftransfatty acids usually contained less saturated fatty acids and morecis-unsaturated fatty acids than respective foods prepared with low-transsaturated vegetable fats or animal fats. © 1998 Academic Press.

The fatty acid composition of dairy products and meat from 14 European countries was analyzed with particular emphasis ontransfatty acids. In cow's milk, butter, and cheese the proportions oftransfatty acids ranged between 3.2 and 6.2% of fatty acids. C18:1 isomers comprised about 60% and C16:1 and C18:2 isomers about 15% each of totaltransfatty acids. Goat's and sheep's milk and cheese contained between 2.7 and 7.1%transfatty acids. Summer milk contained up to 57% moretransfatty acids, both C18:1 and C18:2 isomers, morecis-unsaturated and less saturated fatty acids than winter milk. Ice-cream with partially hydrogenated vegetable oils contained between 21 and 31%transfatty acids and low-transmodified-fat ice-cream between 0.2 and 0.9%. The high-transice-cream samples contained morecis-unsaturated and less saturated fatty acids than most dairy-fat and low-transproducts. Beef contained 2.8-9.5% and lamb meat 4.3-9.2%transfatty acids whereas pork (0.2-2.2%) and chicken (0.2-1.7%) and meat from other nonruminants were lower intransfatty acids. With very few exceptions, sausages contained pork and showed lowtransfatty acid levels. In conclusion, ruminant fats contained moderate amounts oftransfatty acids, mainly C18:1 isomers. There were considerable differences both between and within the countries, probably due to seasonal factors and differences in feeding practices and the age of the animals. © 1998 Academic Press.

One of the aims of the TRANSFAIR study is to provide reliable and comparable data ontransfatty acid (TFA) content of foods in Europe. We performed a market basket study in 14 European countries. In each country, a maximum of 100 food samples representative of the total fat intake were sampled according to a standardized stepwise approach. Samples were analyzed for fat content and fatty acid composition in one central laboratory. This paper describes the design of the market basket study and the analytical methods. Detailed results of separate food groups are presented in the following four separate papers. The current health concern on TFA seems to have resulted in a number of consumer products like soft margarines that are low in TFA. On the other hand, shortenings, frying fats, and convenience foods are frequently high in TFA. There may not be a health benefit if a reduction in TFA is achieved by a similar increase in saturated fatty acid. Moreover, health implications are dependent on overall consumption patterns and these will be studied in the second part of the TRANSFAIR study. © 1998 Academic Press.

Abstract —The effects of stearic acid (C18:0) and trans- fatty acids ( trans- FAs) on measures of platelet function and prostacyclin (PGI 2 ) production are poorly understood in humans. In this controlled dietary study, platelet function and endothelial PGI 2 production were studied in healthy humans after they consumed diets rich in C18:0 or trans- FAs. For 5 weeks, 80 subjects consumed a baseline diet high in saturated FAs and were then switched to a diet containing 9.3% of energy as stearic acid or a diet containing 8.7 energy% as trans- FAs from hydrogenated vegetable oils for another 5 weeks. All diets contained 32.2 to 33.9 energy% fat, 14.6 to 15.8 energy% saturated plus trans- FAs, 12.2 to 12.5 energy% cis -monounsaturated, and 2.9 to 3.5 energy% polyunsaturated FAs. No significant differences between the C18:0 and trans- FA diets were found in the urinary excretion of 2,3-dinor-thromboxane B 2 or 2,3-dinor-6-keto-prostaglandin F 1α . In vitro production of thromboxane B 2 by platelets as well as urinary excretion of β-thromboglobulin were also similar after both diets. Collagen-induced in vitro aggregation was significantly enhanced after the C18:0 diet compared with the trans- FA diet ( P =.02), whereas no differences between the diets were found with ADP. The results indicate similar effects of C18:0 and trans- FA diets on platelet activation and endothelial PGI 2 production.

Conjugated linoleic acid (CLA), fatty acids with 18 carbon atoms and two conjugated cis/trans double bonds, have shown anticarcinogenic effects in experimental studies. We determined the proportion of CLA (the sum of cis-9, trans-11 and trans-9, cis-11 CLA) of total fatty acids in the diets and serum samples of healthy subjects who consumed for 5 weeks a diet high in saturated fatty acids mainly from dairy fat, followed by 5 weeks on a diet high (8.7% of energy, en%) in trans fatty acids from partially hydrogenated vegetable oil (40 subjects) or a similar diet high in stearic acid (9.3 en%, 40 subjects). All diets contained equal amounts of fat and cis-monounsaturated and cis-polyunsaturated fatty acids. The fatty acid compositions of the pooled diets and fasting serum samples drawn at the end of the diet periods were analyzed by gas chromatography, and CLA was identified by comparison with a standard of C18:2 conjugated dienes. The proportions of CLA in the dairy fat, trans fatty acid, and stearic acid diets were 0.37, 0.04, and 0.10% of total methylated fatty acids, respectively. The corresponding mean (SD) proportions in serum were 0.33 (0.07)% after the dairy fat diet, higher, 0.43 (0.12)%, P < 0.001, after the trans fatty acid diet, and lower, 0.17 (0.06)%, P < 0.001, after the stearic acid diet. The difference between dairy fat and stearic acid diets was explained by different dietary intakes but increased amounts of CLA not present in the diet were incorporated into serum lipids during the trans fatty acid diet. CLA in human tissues is partly derived from the diet but part of it may be formed by conversion from dietary trans fatty acids.

SummaryThe effects of stearic acid (Cl8:0) and trans fatty acids on variables related to coagulation and fibrinolysis were studied in 80 healthy humans average age 29 ± 9 years. All subjects consumed a baseline diet high in saturated fatty acids, mainly from dairy fat for 5 weeks. After this baseline diet they were allocated either to a diet high (8.7% of energy, En%) in trans fatty acids from partially hydrogenated vegetable oil (40 subjects) or a diet high (9.3 En%) in stearic acid (40 subjects) for 5 weeks. All diets contained 32.2-33.9 En% fat, 14.6-15.8 En% saturated plus trans fatty acids, 12.2-12.5 En% cis-monounsaturated and 2.9-3.5 En% polyunsaturated fatty acids and 216-250 mg/10 MJ cholesterol. The fats were mixed into solid foods and almost all daily food was provided.In comparison with the baseline dairy fat diet no change was observed in the concentrations of plasma fibrin degradation products and D-dimers. Also the factor VII coagulant activity (F VII :C), tissue type plasminogen activity (tPA) and plasminogen activator inhibitor activity (PAI-1) were not affected by the experimental diets. Small increase in plasma fibrinogen concentration during the stearic acid diet was statistically significant (from 3.49 to 3.63 g/1; p = 0.041), but probably without any biological significance. Both diets increased plasma level of lipoprotein Lp(a). It can be concluded that as far as coagulation and fibrinolysis are concerned there is no need to differentiate between stearic acid or trans monoenoic fatty acids.

A low serum tocopherol concentration and a low proportion of linoleic acid in plasma cholesterol esters have been reported to be associated with coronary heart disease. This study was undertaken to evaluate the predictive importance of the serum cholesterol ester fatty acid composition and serum tocopherol concentration in addition to established risk factors for myocardial infarction. The study comprised 2322 fifty-year-old men who participated in a health survey in 1970–1973 regarding risk factors for coronary heart disease. The proportions of myristic, palmitic, palmitoleic, and dihomogammalinolenic acid were significantly higher in 1970–1973 in subjects who suffered myocardial infarction during the following 19 years, while the proportion of linoleic acid was lower, than in those who remained healthy. Serum tocopherol did not differ significantly between the groups. LDL HDL ratio, systolic blood pressure, and arachidonic acid/dihomogammalinolenic acid ratio were significant independent discriminators between cases and controls in a stepwise logistic regression analysis. This study suggests that middle-aged men who later develop a myocardial infarction are characterized not only by conventional risk factors but also by an altered fatty acid composition of serum cholesterol esters, with a low arachidonic to dihomogammalinolenic acid ratio, indicating reduced Δ 5 desaturase activity. This may imply that changes in the quality of dietary fat intake, or an altered capacity to metabolize fatty acids in the body, could precede the development of coronary heart disease.

The aim of this study was to examine how the diagnosis of insulin-dependent diabetes mellitus (IDDM) in one child affects the consumption patterns of milk and fat among nondiabetic siblings. Food habits of 478 Finnish nondiabetic siblings (3–19 years) of children with IDDM ( 12 years). As compared with population-based control subjects, the use of high-and low-fat milk, butter on bread, and butter and margarines in food preparation was less common and the use of skim milk, margarines on bread, and oils in food preparation more common among the nondiabetic siblings 2 years after the diagnosis of IDDM in the proband. The diagnosis of IDDM in a child has significant and beneficial effects on the choice of the type of milk and dietary fat of his/her siblings. Farmers and families in lower socioeconomic groups need more attention to modify the diet after the diagnosis of IDDM in a child.

Background. Coronary heart disease mortality has declined in Finland by 55% among men and 68% among women between 1972 and 1992. About three-quarters of this decline has been explained by changes in the main coronary risk factors, the decrease in serum cholesterol being the most important one. The aim of this study was to analyze to what extent dietary changes could explain the change in serum cholesterol. Methods. Cardiovascular risk factor surveys have been carried out in Finland from 1972 to 1992 at 5-year intervals. Dietary surveys were carried out in connection with these surveys in 1982 and 1992. An earlier, representative dietary survey carried out in 1969–1972 was used as the baseline measure for diet. Results. The total fat content of the Finnish diet changed from 38% of energy to 34%, saturated fat from 21 to 16%, and polyunsaturated fat from 3 to 5% and the intake of cholesterol decreased by 16%. Based on Keys equation these changes could have decreased serum cholesterol level by 0.6 mmol/liter (23 mg/dl) in both genders. A shift from boiled to filtered coffee could have further decreased serum cholesterol by 0.3 mmol/liter (11 mg/dl). Thus, these changes together could explain the total change in serum cholesterol, which has been on average 1.0 mmol/liter (38 mg/dl). Several other changes in the diet have also been favorable. Fruit and vegetable consumption has increased two- to three-fold during this time period. Supplementation of fertilizers with selenium since 1985 has tripled the intake of selenium. Conclusions. Dietary changes seem to explain the decrease in serum cholesterol. Together with a decline in smoking among males as well as better blood pressure control they have contributed to the dramatic decline in coronary heart disease mortality in Finland.

The impacts of Se supplemented fertilization in Finland were studied in relation to concentration, time variation, speciation, distribution, bioaccumulation and sedimentation of selenium (Se) in lake ecosystems. The background level of Se in lake waters ( n = 41) was 58.4 ng l −1 (28.7–115 ng l −1 ) and the seasonal variation was small. The mean water Se concentration of lakes surrounded by fields was significantly higher than that of forest lakes in late summer, but not in spring. The fraction of Se in humic substances constituted 52% of the dissolved Se in lake water, whereas selenite and selenate made up 8–9% each. Particulate Se in lake waters was about 10% of the total water Se concentration. The vertical distribution of Se in lake water was related to the growth of algae. Se accumulated in perch muscle tissue. The Se concentration of lake sediments has increased from the last century to the 1990s mainly because of agricultural activity and atmospheric fallout. The accumulation of Se in perch and the Se concentration in sediments were strongly related to the trophic state of the lakes. No clear evidence was found that Se fertilization has significantly increased Se sedimentation in lakes.

Dietary isomeric trans fatty acids-mainly produced by hydrogenation of oils-are suspected of increasing the risk of coronary heart disease. Dietary trans fatty acid intake is reflected in the fatty acid composition of adipose tissue. In an international multicentre study in eight European countries and Israel (EURAMIC), adipose tissue aspiration samples were obtained from 671 men with acute myocardial infarction (AMI), aged 70 years or less, and 717 men without a history of AMI (controls). The proportion of fatty acids, including isomeric trans monoenoic fatty acids with 18 carbon atoms (C18:1), was determined by gas chromatography. Although there were considerable differences between countries in mean (SD) proportion of adipose tissue C18:1 trans fatty acids, there was no overall difference between cases (1.61 [0.92]%) and the controls (1.57 [0.86]%). The risk of AMI did not differ significantly from 1.0 over quartiles of adipose C18:1 trans fatty acids: the multivariate odds ratio was 0.97 (95% CI 0.56-1.67) for the highest versus lowest quartile. After exclusion of subjects from Spanish centres because they had far lower proportions of adipose trans fatty acids than subjects from other countries, there was a tendency to increased risk of AMI in the upper quartiles of C18:1 trans; however, the trend was not statistically significant. Our results reflect considerable differences between countries in dietary intake of trans fatty acids but do not suggest a major overall effect of C18:1 trans fatty acids on risk of AMI. We cannot exclude the possibility that trans fatty acids have a significant impact on risk of AMI in populations with high intake.

The background level, seasonal variation, speciation, and geographical distribution of selenium (Se) were studied in dug and drilled wells and in natural groundwaters in Finland. The total Se concentration of well water samples (n = 256) ranged from 4.1 to 2720 ng/l, with a median of 68.4 ng/l. The median Se concentration of groundwater from locations in natural surroundings was 51.5 ng/l (n = 41) and 50.5 ng/l (n = 39) in 1989 and 1990, respectively. The season had only a minor effect on both well and groundwater Se concentrations. Selenate was the most abundant species in groundwater. Locally, high concentrations of groundwater Se may originate from bedrock. The proportions of both selenite and Se associated with humic substances were less than 8 and 15%, respectively. The median Se concentration of 37 infiltration water samples was 28.6 ng/l (range 6.1–137 ng/l). The annual net deposition of Se from precipitation into soils was estimated to be 0.49 g/ha in the southern and 0.33 g/ha in the northern parts of Finland. Se from precipitation had no impact on groundwater Se. The effect of agricultural activities including Se supplemented fertilization on the Se concentration of groundwater in cultivated areas could not be demonstrated.

We carried out a double-blind, placebo-controlled cross-over trial to evaluate changes in nutrient intake during acarbose therapy and short-term changes in metabolic control in Finnish patients with non-insulin dependent diabetes mellitus. The efficacy and tolerability of acarbose was also assessed during this short 8-week treatment period. Patients were treated either with diet only (18 subjects) or with diet and sulphonylurea (9 subjects) prior to entering this trial. The nutrient intake was assessed using food records kept during the last 2-5 days of each treatment period. Treatment with acarbose did not affect body weight or the intake of energy and carbohydrates, but it was associated with a slight decrease in the dietary fat intake. Both fasting and 2-h postprandial blood glucose levels fell continuously during acarbose but the change did not reach statistical significance during the 8-week treatment period. The 2-h serum insulin response was not affected. The results were similar in patients treated with acarbose alone and in those receiving acarbose together with sulphonylurea regimen. The acarbose regimen was relatively well tolerated although mild gastrointestinal side-effects were observed in many patients. In conclusion, treatment with acarbose has no major effects on nutrient intake in diabetic patients. To monitor changes in metabolic control after the introduction of acarbose to the treatment regimen a longer than 8-week period is needed.

Finland is a country covered by thin layers of glacial deposits, mainly till, on top of Precambrian igneous and metamorphic rocks. The environment is characterised by low selenium (Se) concentrations. To improve the Se intake of the population, Se-supplemented fertilisers have been used nationwide since 1985. This raises the possibility of undesirable environmental effects of the operation. The present study, the first one dealing with Se concentration of stream waters and stream sediments in Finland, throws light on the mobilisation of Se in the environment. The median Se concentrations (range) in stream waters and stream sediments were 67.5 ng 1 −1 (32–180 ng 1 −1 ) and 258 μg kg −1 (29–3940 μg kg −1 ), respectively. There was a highly significant correlation between the Se concentration of stream waters and sediments ( r =0.313, P n =204). The rainfall-related seasonal variations of the Se concentrations in stream water exceeded 100%. The stream water Se concentrations decreased from 1991 to 1992, possibly as the result of a reduction in the amount of Se added to fertilisers since 1991. The stream water Se concentrations correlated with those in well water and with cultivated field area per community. About 8.5% of the Se in stream waters was in particulate form. The fractions of the total Se in humic substances (36%) and selenate (35.7%) dominated the Se species of stream waters, while selenite comprised only 9.6% of the total Se. Cultivation and the use of Se-supplemented fertilisers may have temporarily increased the Se concentrations in headwater stream and river waters in Finland.

Quite different nutrition-related environmental factors influence the development of type 1 insulin-dependent diabetes (IDDM) and type 2 non-insulin-dependent diabetes (NIDDM). IDDM is characterized by progressive beta-cell destruction which leads to complete insulin deficiency; at the time of diagnosis 80-90% of beta cells have been destroyed. In children there is epidemiological evidence that high intake of nitrites and N-nitroso compounds, early introduction of cow's milk to the diet and short duration or absence of breastfeeding increase the risk of IDDM. Studies in experimental animals suggest that cow's milk and soy proteins may be diabetogenic. There is current interest in the effects of free radical scavengers, particularly niacin and natural and synthetic antioxidants on the incidence of IDDM. These findings from ecological, animal, and human case-control studies remain to be evaluated in prospective cohort studies covering infancy and childhood and finally in human intervention trials. NIDDM is characterized by insulin resistance which is complicated by impaired insulin secretion at the time of appearance of hyperglycaemia and clinical diabetes. Its preclinical development is insidious and poorly defined, and there is little direct evidence that the same factors which influence metabolic control in clinical diabetes also affect the preclinical development of the disorder. Obesity, particularly of the abdominal type, is common in people who develop NIDDM, and weight control by appropriate diet and physical activity is probably the most important measure for preventing NIDDM. High (saturated) fat intake seems to be associated with insulin resistance, obesity and increased risk of NIDDM, and diets high in carbohydrate seem to protect from glucose intolerance and diabetes, mainly owing to their high fibre content.