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

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

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

OBJECTIVES

To compare background and process variables, as well as follow up status, of the participants in the International Quit and Win '96 contests of China and Finland, and analyse factors contributing to sustained maintenance.

DESIGN

A standardised 12 month follow up was conducted in both countries with random samples of participants. The sample sizes were 3119 in China and 1448 in Finland, with response rates of 91.2% and 65.2%, respectively.

INTERVENTIONS

The International Quit and Win '96 contest was the second coordinated, multinational smoking cessation campaign targeted at adult daily smokers. Altogether 25 countries participated, including China with 15 000 and Finland with 6000 smokers registered.

MAIN OUTCOME MEASURES

Conservative (considering all non-respondents relapsed) and non-conservative (based on respondents only) estimates were calculated for one month abstinence, 12 month continuous abstinence, and point abstinence at the time point of follow up.

RESULTS

Great differences were found in the background and process variables, as well as in the outcome measures. At one year follow up, the conservative continuous abstinence rates show that the Chinese participants maintained their abstinence better (38%) compared to the Finnish ones (12%). In China women reached higher abstinence rate (50%) than men (36%), whereas in Finland men achieved a better result (14%) than women (9%).

CONCLUSIONS

The Quit and Win contest is a mass smoking cessation method feasible in countries showing great variance in smoking habits and rates. However, in countries with different stages of anti-smoking development, such as China and Finland, different practical implementation strategies may be needed.

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

OBJECTIVE

To assess the trends in blood pressure (BP) and in body mass index (BMI) in the hypertensive and normotensive population in Finland during 1982-1997.

DESIGN

Four independent cross-sectional standardized population surveys were conducted in 1982, 1987, 1992 and 1997.

SETTING

The provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in southwestern Finland.

PARTICIPANTS

Men and women aged 25-64 years were selected randomly from the national population register. The participants were classified into four groups according to their BP level and treatment status: normotensive, unaware hypertensive, aware but untreated hypertensive and treated hypertensive. The total number of participants was 24,083.

MAIN OUTCOME MEASURES

The means of systolic BP (SBP), diastolic BP (DBP) and BMI, as well as the distribution of BMI among the four study groups were measured.

RESULTS

Mean SBP decreased significantly in all groups. The fall in DBP was significant only in drug-treated hypertensive men and women (P< 0.001). Mean BMI increased significantly in all groups except in aware hypertensive women receiving no antihypertensive drug treatment The proportion of obese subjects (BMI > 30 kg/ m2) increased most in aware hypertensive men and in drug-treated hypertensive women.

CONCLUSIONS

The prevalence of obesity has increased significantly in normotensive and particularly in hypertensive Finns during the past 15 years. There is an urgent need for more effective measures for weight reduction in obese hypertensive patients in primary healthcare, and for the prevention and control of obesity in the whole population.

Cardiovascular diseases and risk factors in Finland

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

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

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

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

OBJECTIVE

To assess the extent to which smoking cessation among cohort members during the follow-up affects the estimated association between smoking and coronary heart disease (CHD) risk in an observational study with a single determination of the smoking status at baseline.

DESIGN

Cross-sectional trend and prospective cohort analyses.

SETTINGS

North Karelia and Kuopio provinces in eastern Finland.

SUBJECTS

Men (n = 13542) aged 30-59 years who participated in risk factor surveys between 1972 and 1992. Of these, 3937 men belonged to the 1972 cohort with the prospective follow-up.

MAIN OUTCOME MEASUREMENTS

Smoking prevalence, CHD mortality, non-CHD mortality, and total mortality.

RESULTS

Smoking prevalence in the population decreased from 53% to 37% between 1972 and 1992. In the follow-up of the 1972 study cohort, the association between baseline smoking status and CHD weakened markedly when the follow-up time from the baseline measurement was extended. The risk ratio of cumulative CHD mortality associated with smoking was 6.96 in the first 2-year follow-up and it decreased gradually to 2.06 at the 20-year follow-up. A similar decrease in the risk ratio was observed when the analysis was performed during periods of the follow-up. The association between smoking and non-CHD mortality weakened only slightly when the follow-up time became longer.

CONCLUSION

The results from prospective observational studies conducted in populations with a decreasing smoking prevalence may be biased by the misclassification of study subjects during the follow-up as a result of smoking cessation. This results in an underestimation of the risk of CHD caused by smoking. Thus, smoking may be even more harmful for health than the estimates from prospective studies suggest.

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

OBJECTIVE

To evaluate Quit and Win campaigns repeated in North Karelia and rest of Finland.

DESIGN

Repeated comparisons of participation rates, abstinence rates, and other measures between North Karelia and the rest of Finland.

SUBJECTS

Adult daily smokers in Finland participating in the Quit and Win contests in 1986-1997.

INTERVENTIONS

Quit and Win smoking cessation campaigns targeted at adult daily smokers throughout Finland in 1986, 1989, 1994, 1996, and 1997, including more intensive activities in North Karelia.

MAIN OUTCOME MEASURES

Participation rates, self reported six-month abstinence rates, other effectiveness measures (% of smokers who attended, intended, tried, and succeeded in cessation).

RESULTS

North Karelia's participation rates were significantly higher in each campaign compared with the rest of Finland. The abstinence rates in North Karelia were also higher, the difference being significant in 1986 and 1994 (p < 0.05). In the target population in 1996 over 75% of smokers in North Karelia, compared with 40% of smokers surveyed elsewhere, reported awareness of the campaign (p < 0.001). Approximately 9% of the smokers in North Karelia and 6% elsewhere intended to participate (p = NS). Over 2% in North Karelia, compared with less than 1% elsewhere, tried to quit (p < 0.001). Among the targeted group, 0.3% of North Karelian smokers were complete abstainers throughout the 12 months of follow up, compared with an average of 0.1% in other areas (p < 0.001).

CONCLUSIONS

The Quit and Win campaign is a feasible cessation method in long-term community-wide programmes. Intensified community activities are associated with higher success. In repeat campaigns, high participation and abstinence rates can be maintained.

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

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

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

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

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

BACKGROUND

Within the CINDI framework, a European "Quit and Win" contest was organized in 1994. In Finland the number of participants was 5,879 (0.6% of smokers). In the CINDI demonstration area, North Karelia (NK), the participants numbered 618 (2.0% of smokers). This study compared abstinence maintenance among the participants in NK with the rates found elsewhere in Finland and analyzed determinants for successful quitting.

METHODS

A follow-up study was conducted 12 months after the quit date with a sample of 2,114 participants. Response rates of 67-68% were achieved (n = 1,419). The abstinence was assessed at 1, 6, and 12 months. Two estimates are presented: (1) the proportion of abstainers among the respondents and (2) the proportion of abstainers among the sample, considering all nonrespondents smokers. The determinants for maintenance of smoking cessation were analyzed with logistic regression.

RESULTS

Using the first estimate, the rates at 1/6/12 months were 75/36/28% in NK and 70/28/21% elsewhere (P < 0.01). Using the second estimate, the corresponding rates were 50/24/19% in NK and 46/19/14% elsewhere. The most significant determinants for successful quitting were sex, age, marital status, level of withdrawal symptoms, previous quitting attempts, and support received.

CONCLUSIONS

The recruitment of smokers and the maintained cessation were more successful in the demonstration area. The difference between areas was explained by differences in the combined professional and lay support and by the sex and age distributions.

Alcohol intake and subjective health

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

Smoking and oral health: a population survey in Finland

OBJECTIVES

A survey was conducted to study smokers' oral health behaviors and attitudes, and to determine if smokers were advised by their dentists to quit smoking.

METHODS

A random sample of 1,200 adults 15 to 64 years of age living in the province of North Karelia, Finland, was selected in each of two study years (1990 and 1991) and surveyed using a mail questionnaire. The 102-item questionnaire solicited information on smoking status, oral health behaviors, missing teeth, perceptions of tobacco's harmful effects on oral health, smoking status and quitting, and advice on smoking cessation provided by dentists. Variations in behaviors and opinions according to smoking status were analyzed.

RESULTS

Nonsmokers reported more frequent healthy oral health behaviors than did daily smokers, with the exception that no difference in toothbrushing frequencies existed among women. Daily smoking was associated with increased use of sugar in tea or coffee, and with more frequent alcohol consumption. Daily smoking was correlated with the number of missing teeth in bivariate analyses, but not in multivariate analyses. Fewer daily smokers than nonsmokers considered smoking to have harmful effects on oral health. The majority of daily smokers, however, wanted to quit. Eight percent of daily smokers reported that they had been advised by their dentist to quit.

CONCLUSIONS

Dentists need to provide patients with counseling on tobacco use because of the desire of many smokers to quit. Counseling of smokers by the oral health team requires special attention and skills, because smokers' health behaviors and attitudes appear to be less favorable to oral health compared to nonsmokers.

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

BACKGROUND

Smoking, a high serum cholesterol level and elevated blood pressure are the most important risk factors for coronary disease. Each of these major risk factors contributes independently to the risk of coronary disease, and clustering of the risk factors may increase the risk more than any of the factors alone.

METHODS

This study is a 12-year prospective follow-up of 7928 men and 8530 women examined in eastern Finland. Risk factor categories were created by combining smoking status and dichotomized values of serum cholesterol level and blood pressure. Endpoints for the follow-up were either coronary death or a first coronary event (fatal or non-fatal). The effect of risk factor clustering was analyzed by assessing relative risks, mortality and incidence, and population-attributable risks in each of the risk-factor categories.

RESULTS

The relative risks for coronary death and first coronary event in men with all three risk factors (smoking, serum cholesterol > or = 6.5 mmol/l and either systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg) were 11.8 and 7.3 respectively, compared with men with none of these factors. The corresponding risk ratios for women were 9.6 and 8.6. The 12-year coronary mortality varied between 10.0 deaths per 10000 person-years in men with none of the risk factors to 98.9 per 10000 person-years in men with all three risk factors. The 12-year incidences in men were 37.4 and 206.3 per 10000 person-years, respectively. The coronary mortality in women varied between 3.4 and 27.9 deaths per 10000 person-years and the incidence between 13.3 and 110.8 per 10000 person-years. Most of the population-attributable risk in men was associated with the combination of smoking with a high serum cholesterol level with elevated blood pressure.

CONCLUSION

The results illustrate the public-health importance of these major risk of cardiovascular diseases.

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

BACKGROUND

The North Karelia Project, a major demonstration programme for coronary heart disease (CHD) prevention, began in the eastern province of North Karelia in Finland in 1972. A number of other national CHD prevention activities have also been undertaken particularly since 1977. In the 1980s, a national strategy was developed for CHD prevention. This paper reports the 20-year changes in risk factors in North Karelia and in the original reference area of the project and the 10-year changes in a third area in southwestern Finland.

METHODS

The results are based on comparable surveys of cross-sectional population samples, aged 30-59 years, every fifth year since 1972.

RESULTS

During the first 5 years total cholesterol and blood pressure fell more in North Karelia than in the reference area, but subsequently changes have been about the same in both areas. The decline levelled off between the 1982 and 1987 surveys. This resulted in new nationwide preventive activities and during the last 5 years major declines in both serum total cholesterol and blood pressure have been observed. Smoking reduced more during the first 10 years in North Karelia than in Kuopio province. During the last 10 years a small decline has been observed in both areas. No change in smoking has occurred in southwestern Finland in the last 10 years.

CONCLUSIONS

A major decline in cardiovascular disease risk factors has been observed in the last 20 years in Finland. This decline was associated with the launch of the national demonstration project in North Karelia in the 1970s and with subsequent major national activities thereafter.

[Changes in the panorama of risk factors in heart and vascular diseases]

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

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

BACKGROUND

The study describes 15-year cardiovascular disease risk factor clustering trends in eastern Finland and assesses the degree to which high levels of the risk factors are clustering in the same individuals.

METHODS

Four independent cross-sectional surveys in randomly selected population samples (in 1972, 1977, 1982, and 1987) have been carried out in two provinces in eastern Finland (North Karelia and Kuopio) to assess the level of cardiovascular disease risk factors and the impact of a community-based prevention program. Each survey included a self-administered questionnaire, blood pressure measurements, and determination of serum cholesterol. Blood pressure and serum cholesterol values were dichotomized. All subjects were classified as either current smokers or nonsmokers. The total sample size was 30,118 and the participation rate varied between 77 and 94%. The common age range in all four surveys was 30 to 59 years.

RESULTS

The proportion of individuals with a combination of two or three risk factors decreased markedly during the survey period. However, smoking tended to cluster increasingly with the other risk factors in 1987 compared with that seen in 1972. Among men, the proportion of smokers having either high blood pressure or high serum cholesterol levels, or both, is still high.

CONCLUSIONS

The observed clustering of cardiovascular disease risk factors, particularly among men, underlines the importance of assessing other risk factors in persons with a high level of one risk factor and the need for a multifactorial approach in primary prevention. It is possible that high-risk behaviors, like smoking and high consumption of saturated fat and salt, were normal in 1972, but in 1987 they were declining, though they remained clustered among a particular segment of the population.

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

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

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

OBJECTIVE

To determine the prevalence of hypertriglyceridemia and the mean serum triglyceride concentrations in different degrees of glucose tolerance--non-insulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), and normal glucose tolerance (NGT). In addition, we analyzed the correlates of serum triglyceride concentration to explain why it is more prevalent in diabetic subjects.

RESEARCH DESIGN AND METHODS

This study was a cross-sectional survey of 4000 people aged 45-64 yr randomly drawn from the population register of the Finnish population of the provinces of North Karelia and Kuopio in eastern Finland and Turku/Loimaa area in southwestern Finland and stratified by four 10-yr age- and sex groups. The final material comprised 96 subjects with NIDDM, 102 subjects with IGT, and 323 subjects with normal glucose tolerance classified on the basis of two 2-h oral glucose tolerance tests. The prevalence of hypertriglyceridemia by the glucose tolerance status and the variation in serum triglycerides associated with selected life-style and biochemical factors were executed as the main outcome measures.

RESULTS

The prevalence of hypertriglyceridemia (greater than or equal to 2.3 mM) was 47.6% (95% confidence interval [CI] 32.5-62.7%) in NIDDM men, 21.9% (95% CI 7.6-36.2%) in IGT men, and 15.4% (95% CI 9.3-21.5%) in NGT. In women, hypertriglyceridemia was found in 51.9% (95% CI 38.6-65.2%) among those with NIDDM, 25.7% (95% CI 15.5-35.9%) among those with IGT, and 10.7% (95% CI 6.3-15.1%) in women with NGT. After adjusting for body mass index (BMI) and age, the difference in the prevalence of hypertriglyceridemia between the glucose tolerance groups remained significant in both men (P = 0.008) and women (P = 0.0001). High serum total cholesterol, high BMI, high waist-hip ratio, and low high-density lipoprotein (HDL) cholesterol were significantly associated with high serum triglycerides in all glucose tolerance groups. No synergistic effect between these parameters and glucose tolerance status was found. In multiple linear regression analyses, fasting plasma insulin, diabetes status, and serum uric acid were significant predictors of serum triglyceride concentration after taking into account age, BMI, and HDL and total cholesterol. The association between BMI and serum triglycerides in the regression analysis was significant only when plasma insulin was not included in the model.

CONCLUSIONS

Hypertriglyceridemia is common in subjects with NIDDM and IGT and is often associated with low HDL cholesterol, high total cholesterol, hyperinsulinemia, and elevated serum uric acid concentration.

National TV smoking cessation program and contest in Finland

BACKGROUND

In the fall of 1986 the North Karelia Project in cooperation with Finnish TV 2 arranged an eight-part nationwide smoking cessation TV program. The Project, also arranged a smoking cessation contest coinciding with the TV program in cooperation with four major voluntary public health organizations and the national health service. The TV program featured two studio groups of local volunteers: one from Turku (southwestern Finland) and the other from North Karelia, where there was more intensive community support for the activity.

RESULTS

Based on a national survey of a representative population sample, the reported viewing rates (at least one part) of the working-age population (15-64 years, smokers and nonsmokers) were 64% in North Karelia, 45% in Turku, and 46% nationally (P less than 0.001). Among smokers who had watched at least one session of the TV program, 7.7% reported to have tried to quit smoking in North Karelia, 4.1% in Turku, and 7.5% nationally. Altogether, 16,089 smokers participated in the contest; again the highest participation rate was in North Karelia. The 6-month success rate among the smokers who participated in the contest was 22% in North Karelia, 18% in Turku, and 17% nationally (P less than 0.05). Men were more likely to succeed in quitting: among men the 6-month success rate was 22% and among women 15% (P less than 0.001).

CONCLUSIONS

The results and experiences indicate high viewing and participation and a beneficial cost-effect ratio. They also stress the importance of community support activities in enhancing the effects of a media-based health promotion program.

Prevalence of diabetes mellitus and impaired glucose tolerance in the middle-aged population of three areas in Finland

The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) was determined in a random sample of the population aged 45-64 years in three areas of Finland. The two-hour oral glucose tolerance test was repeated in subjects whose first test suggested abnormal glucose tolerance. In the final classification, based on the results of the two tests, the age-standardized prevalence of diabetes, according to the WHO criteria was 5.7% (95% confidence interval (CI): 4.3-7.1) in men and 4.6% (95% CI: 3.6-5.0) in women. The prevalence of IGT was 3.1% (95% CI: 2.1-4.1) in men and 5.1% (95% CI: 3.9-6.3) in women. Among those aged 55-64 years the prevalence was 6.9% in men and 7.5% in women. The prevalence of diabetes and IGT were not different between the three areas. The age-specific mean values of fasting and two-hour blood concentrations and the 90th percentiles of the blood glucose distributions were also not different between the areas. The prevalence of IGT and diabetes increased with age more steeply among women than men. The median of fasting blood glucose did not change, but the 90th percentile increased with increasing age. The entire distribution of two-hour blood glucose shifted towards higher values with ageing, but the major increase was seen for the 95th percentile. The majority of the diabetic subjects were aware of their condition. The awareness was better among men than women.

Fifteen-year trends in coronary risk factors in Finland, with special reference to North Karelia

The North Karelia Project, a major demonstration programme for coronary heart disease (CHD) prevention, was begun in an eastern province of Finland in 1972. A number of national CHD prevention activities have been undertaken, quite a few of them since 1977. This paper reports the 15-year changes in CHD risk factors (serum cholesterol, blood pressure, and smoking) in North Karelia and in the original reference area of the project, and more recent changes in a third area in southwestern Finland. The results are based on well-standardized, comparable surveys of cross-sectional populations, aged 30 to 59 years. The results indicate that risk factors reduced markedly in North Karelia from 1972-1977, to a lesser extent from 1977-1982, and only a little from 1982-1987. There was also a decline in the reference area during the first ten years (1972-1982) but the changes did not exceed those in North Karelia and during the second phase, from 1982-1987, risk factor changes were minor. Risk factor levels in the third area in southwestern Finland changed little from 1982-1987. Present serum cholesterol and blood pressure levels in North Karelia are still higher than in southwestern Finland, but smoking is less common among North Karelian men. These findings are discussed in the light of the recent information on Finnish dietary changes and CHD mortality; their bearing on the need for new cardiovascular disease prevention activities in Finland is also discussed.

Prevalence and medical care of hypertension in four ethnic groups in the newly-industrialized nation of Mauritius

Prevalence of hypertension was investigated in Mauritius in 2362 men and 2712 women among Hindu and Muslim Indian, Creole and Chinese ethnic groups aged 25-74 years. The age-standardized prevalence of hypertension varied from 9.4% to 17.3% in men and from 9.5% to 16.9% in women among the four ethnic groups and increased with age. The population mean values of systolic/diastolic blood pressure were 126/79 mmHg in men and 124/75 mmHg in women. The proportion of hypertensive persons aware of their condition was 50.5% in men and 66.6% in women. The proportion of treated and adequately controlled hypertensive patients was only 21.7% in men and 29.3% in women. Creoles had the highest mean value of systolic and diastolic blood pressure and the highest prevalence of hypertension whilst Muslim Asian Indians had the lowest values both in men and women. Further studies are needed to define the determinants of hypertension in the multi-ethnic Mauritian population. Diagnosis and treatment of hypertension need to be improved, especially in men and the Creole ethnic group.

Body fat distribution in the Finnish population: environmental determinants and predictive power for cardiovascular risk factor levels

STUDY OBJECTIVE

The aim was to examine (1) whether health habits are associated with body fat distribution, as measured by the waist/hip girth ratio, and (2) to what extent environmental factors, including anthropometric characteristics, explain the variability in levels of cardiovascular risk factors.

DESIGN

The study was a population based cross sectional survey, conducted in the spring of 1987 as a part of an international research project on cardiovascular epidemiology.

SETTING

The survey was conducted in three geographical areas of eastern and south western Finland.

SUBJECTS

2526 men and 2756 women aged 25-64 years took part in the study, corresponding to a survey participation rate of 82%.

MEASUREMENTS AND MAIN RESULTS

In men, waist/hip ratio showed stronger associations with exercise (Pearson's r = -0.24), resting heart rate (r = 0.10), alcohol consumption (r = 0.07), smoking (r = 0.05), and education (r = -0.23) than did body mass index. Jointly, exercise, resting heart rate, alcohol consumption, education, and age explained 18% of variance in male waist/hip ratio, but only 9% of variance in male body mass index. In women, environmental factors were more predictive for body mass index than for waist/hip ratio, with age and education being the strongest determinants. Waist/hip ratio and body mass index were approximately equally strong predictors of cardiovascular risk factor levels. The additional predictive power of waist/hip ratio over and above body mass index was tested in a hierarchical, stepwise regression. In this conservative type of analysis the increase in explained variance uniquely attributable to waist/hip ratio was 2-3% for female and 1-2% for male lipoprotein levels, and less than 0.5% for female and 0-2% for male blood pressure values.

CONCLUSIONS

The distribution of abdominal obesity in Finland is significantly influenced by health habits and sociodemographic factors in both men and women. This in turn is obviously one reason for the relatively small "independent" effect of body fat distribution on cardiovascular risk factor levels.

Five-year trend in serum HDL-lipoprotein cholesterol in the Finnish population aged 25-64 years. A suggestion of an increase

High density lipoprotein cholesterol (HDLC) was measured in the population surveys carried out in Finland in 1982 and 1987. The mean (+/- SD) of HDLC for men aged 25-64 years was 1.23 +/- 0.32 mmol/l in 1982 and 1.30 +/- 0.33 mmol/l in 1987, the increase being 5.7%. Respective values in women were 1.46 +/- 0.33 mmol/l and 1.58 +/- 0.35 mmol/l, an increase of 8.2%. The increase was significantly greater in women than in men (P less than 0.001). The prevalence of low HDLC (less than or equal to 0.9 mmol/l) fell from 13.5 to 9.6% in men and from 3.2 to 1.4% in women. Factors associated with low HDLC were the history of ischemic heart disease (IHD), diabetes and hypertension in both sexes and the positive family history of IHD in women. Subjects with low HDLC also had higher body mass index (BMI), waist-hip ratio and serum total cholesterol (TC) concentration than subjects with normal HDLC. Changes in BMI, waist-hip ratio, alcohol intake, leisure time physical activity, prevalence of smoking or in the dietary variables recorded, did not explain the increase in HDLC.

Fatty acid composition of serum cholesterol esters in different degrees of glucose intolerance: a population-based study

The fatty acid composition of serum cholesterol esters was investigated in 325 subjects with normal glucose tolerance, 97 subjects with impaired glucose tolerance (IGT), and 98 subjects with non-insulin-dependent diabetes mellitus (NIDDM) identified by population-based screening. The proportions of palmitic acid (16:0) and palmitoleic acid (16:1) in serum cholesterol esters increased from the normal glucose tolerance group to the IGT and diabetic groups. On the other hand, the proportion of linoleic acid (18:2) was lower in diabetic subjects than in the subjects with IGT or normal glucose tolerance. The proportions of gamma-linolenic (18:3), dihomo-gamma-linoleic (20:3), and arachidonic (20:4) acids were highest in diabetic subjects and lowest in subjects with normal glucose tolerance. Our findings suggest that subjects with NIDDM or IGT have had higher dietary intake of saturated fatty acids. Both serum insulin and blood glucose concentrations probably have an effect on the elongation and desaturation of fatty acids, but the metabolism of linoleic acid to prostaglandin precursors seems to be different in different types of diabetes, NIDDM patients showing no abnormalities. The possibility that the fatty acid composition of plasma and membrane lipids has a role in insulin resistance and blood glucose regulation deserves further investigation.

Serum cholesterol distribution, measurement frequency and cholesterol awareness in three geographical areas of Finland

The serum cholesterol distribution in three geographical areas of Finland was examined during the first and the second FINMONICA surveys in 1982 and 1987. The mean serum cholesterol concentration changed very little during this observation period. In 1987 the population mean (+/- SD) was 6.12 +/- 1.26 mmoll-1 in men aged 25-64 years and 5.96 +/- 1.28 mmoll-1 in women. Only approximately 20% of the Finns had their serum cholesterol at the level which is regarded as desirable by recent international recommendations. The frequency of cholesterol measurements increased in Finland, especially in North Karelia, from 1972 to 1977 but since then no further increase has taken place. From 1982 to 1987 the proportion of subjects whose cholesterol level was over 6.5 mmoll-1 and who reported knowing that their cholesterol was high increased from 27% to 31% in men and from 24% to 34% in women, respectively. It is concluded that approximately 45% of the adult Finnish population is at moderately increased risk and further 33% at considerably increased risk of coronary heart disease because of the elevated serum cholesterol.

The development of hypertension care in Finland from 1982 to 1987

The development of hypertension care in Finland was evaluated using the data from two independent population samples of the FINMONICA Project comprising 9350 and 6250 persons examined in 1982 and 1987, respectively. The sampling frame was the population aged 25 to 64 years in the provinces of North Karelia and Kuopio in eastern Finland and in the Turku-Loimaa region in south-western Finland. During the 5-year period, the mean systolic blood pressure levels decreased in all of the groups except the North Karelian men. Mean diastolic blood pressure did not change significantly. The proportion of hypertensive men with adequately controlled blood pressure increased from 22.6 to 29.4% [difference 6.8%, 95% confidence interval (Cl) for the difference 2.4-11.2] during 1982-1987. At the same time, the proportion of hypertensive men unaware of their condition fell from 30 to 20.9% (difference -9.1%, 95% Cl for the difference -13.4- -4.8). There was corresponding falls for women from 39.2 to 41.3% (difference 2.1%, 95% Cl for the difference -3.1-7.3) and from 15.4 to 13.1% (difference -2.3%, 95% Cl for the difference 1.4- -6.0), respectively. Thus, obvious progress had taken place, although the situation remained far from satisfactory. The possibility of overly aggressive treatment of hypertension was also investigated. It was found that only less than 10% of the middle-aged hypertensive men treated with drugs had diastolic pressures less than or equal to 85 mmHg, suggesting that this might not be an issue of concern at community level.

The North Karelia project: 15 years of community-based prevention of coronary heart disease

The North Karelia Project - a community-wide health intervention programme - was launched in 1972 as response to the local petition to reduce the heavy toll of heart disease in North Karelia. The strategy of community-based prevention was based on the previous pioneering international work on epidemiology of cardiovascular diseases and prevention in which Finland had in many ways participated. Comprehensive scientific evaluation of the programme was carefully designed. The effects of the programme on risk factor reduction and on prevention of cardiovascular diseases are assessed by large population surveys every five years and by data on incidence of cardiovascular diseases and mortality rates. The authors present the 15 years' results and some of the most recent findings of the North Karelia Project, and discuss the overall experience and its national an international implications.

Smoking and leanness: evidence for change in Finland

Many studies have shown smokers to weigh less than non-smokers, which is plausible given the metabolic effects of cigarette smoke. The interrelation between smoking and relative body weight and its change over time were analysed by using data from Finnish population based surveys from 1982 and 1987. Among both men and women the inverse association between smoking and body mass index was clearly weakened between 1982 and 1987. In 1987 among men aged 25-44 smoking was positively related to body mass index. Moreover, the relation between smoking and waist to hip girth ratio was positive in both sexes at all ages. Years of smoking was nevertheless confirmed as a significant inverse predictor of relative weight. A cluster of unfavourable health habits, including high consumption of alcohol and saturated fats, especially emerged among younger smokers. This may have been due to different selection of smokers in Finland, where smoking increasingly seems to be a form of deviant or risk taking behaviour. It is concluded that at a population level the metabolic effects of smoking seem to be increasingly overridden by several other unfavourable health behaviours of smokers.

Ten-year results of hypertension care in the community. Follow-up of the North Karelia hypertension control program

The development of hypertension care over the 10-year period 1972-1982 in North Karelia and a reference area was assessed using three separate random samples of the population aged 30-59 years. The results show a clear improvement in the blood pressure levels of the population and in the hypertension care in North Karelia between 1972 and 1977 when the activities of the hypertension program of the North Karelia Project were gradually implemented. Awareness of elevated blood pressure increased from 39% to 71% among men and from 60% to 87% among women. The proportion of men under antihypertensive drug treatment increased from 4% to 10% and that of women increased from 10% to 15%. After 1977, the hypertension care was maintained but no further improvements were observed in general blood pressure levels. An improvement in hypertension care started in the reference area later than in North Karelia. In spite of favorable changes, the blood pressure level of the population was still high in 1982, the mean casual value among men being 145/87 mmHg and that among women being 141/84 mmHg. It is obvious that further progress in hypertension care is needed.

Acute effects of marathon running on levels of serum lipoproteins and androgenic hormones in healthy males

The acute effects of marathon (42.2 km) running on serum lipid and lipoprotein levels, particularly high-density lipoprotein (HDL) subfractions HDL2 and HDL3, and on levels of serum androgenic hormones, luteinizing hormone (LH), and testosterone were studied in 20 healthy non- champion -class joggers participating in the First North Karelian Heart Marathon. Serum triglyceride and cholesterol levels were unchanged after the marathon, whereas the lipoprotein distribution of both lipids was significantly altered. Very-low-density lipoprotein triglyceride (VLDL-TG) and cholesterol (VLDL-C) levels decreased significantly, whereas low-density lipoprotein triglyceride (LDL-TG) but not cholesterol (LDL-C) levels were increased, suggesting an accumulation of VLDL remnants in the LDL density range. HDL cholesterol (HDL-C) level rose significantly owing to an increase in HDL2-C. HDL3-C level remained the same. Serum levels of apolipoproteins A-I and A-II, the main apolipoprotein constituents of HDL, did not change during the marathon but their distribution between the HDL subfractions differed, indicating a conversion of HDL3 to HDL2. Serum levels of LH, testosterone, and sex-hormone-binding globulin (SHBG) all decreased during the marathon. The changes in levels of serum lipoproteins and androgenic hormones were not interrelated. We concluded that the short-term regulation of HDL levels during acute exhaustive exercise is controlled not by changes in serum androgenic hormones but by enhanced degradation of triglyceride-rich lipoproteins.

Controlled, randomised trial of the effect of dietary fat on blood pressure

57 couples living in two communities of North Karelia, aged 30-50 years, were randomly allocated to three groups. After a 2-week baseline period group I followed a diet low in fat (23% of energy) with a high polyunsaturated/saturated (P/S) ratio (1 . 0), group II reduced daily salt intake from 192 mmol to 77 mmol, and group III (control group) continued the usual diet. After the 6-week intervention period groups I and II reverted to their usual diets. In group I systolic blood pressure declined from 138 . 4 to 129 . 5 mm Hg and diastolic blood pressure from 88 . 9 to 81 . 3 mm Hg during the intervention period; the values rose during switch-back. The fall was greater among hypertensive than among normotensive subjects. In groups II and III the mean blood pressure changed very little during the study.