Poor health status before the COVID-19 pandemic is associated with unfavourable changes in health-related lifestyle

AIMS

The effects of COVID-19 containment measures on health-related lifestyle have been both favourable and unfavourable for health. Factors predisposing to unfavourable changes are still poorly known. In this short communication, we aimed to examine which socioeconomic and health-related factors predicted unfavourable lifestyle changes based on data from the same individuals before (2017) the pandemic and during the second wave (2020) of the pandemic in Finland.

METHODS

This individual-level follow-up study was based on a nationally representative, two-stage stratified cluster sample of Finnish adults from the FinHealth 2017 Study, conducted in Spring 2017, and its follow-up survey, conducted in Autumn 2020. A total of 3834 men and women aged 25-69 years at baseline had information of selected lifestyle factors (vegetable consumption, leisure-time physical activity, sleeping problems and nightmares) available at both time points. Odds ratios and 95% confidence intervals for unfavourable lifestyle changes (yes/no) according to socioeconomic and health-related factors were calculated using logistic regression models taking into account the sampling design and non-response.

RESULTS

We found that those having poor health (i.e. psychological distress, poor self-rated health or chronic diseases) or disadvantaged socioeconomic background before the pandemic were prone to unfavourable lifestyle changes during the follow-up.

CONCLUSIONS

Observed unfavourable lifestyle changes in vulnerable population groups may accelerate health inequalities. Targeted health promotion actions are needed to prevent this unfavourable development.

Probable Sarcopenia, Obesity, and Risk of All-Cause Mortality: A Pooled Analysis of 4,612 Participants

INTRODUCTION

Conflicting evidence exists concerning whether having sarcopenic obesity has additive mortality risk over having only sarcopenia or obesity. We examined the independent and combined associations of obesity and probable sarcopenia with all-cause mortality.

METHODS

The pooled analysis included three large, harmonized datasets (Health 2000 Survey; Health, Aging and Body Composition Study; Longitudinal Aging Study Amsterdam) with mortality follow-up data on individuals aged 70 years and over at baseline (n = 4,612). Obesity indicators included body mass index and waist circumference, and probable sarcopenia was defined based on grip strength. The mixed effects Cox model was used for statistical analyses, adjusting for age, sex, marital status, education, race, physical activity, alcohol consumption, smoking, and baseline diseases.

RESULTS

Risk of death increased for those having probable sarcopenia only (hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.39-1.85) or probable sarcopenia with obesity (HR: 1.36, 95% CI: 1.13-1.64) but not for the obese-only group (HR: 0.92, 95% CI: 0.85-1.01), when compared to non-obese non-sarcopenic individuals. The results were similar regardless of adjustments for covariates or different obesity criteria applied.

CONCLUSION

Probable sarcopenia, whether combined with obesity or not, is associated with increased mortality. Obesity did not increase mortality among older adults. Maintaining muscle strength and identifying older adults at risk of sarcopenia is important for the prevention of premature mortality.

Associations of Metabolic Syndrome and Its Components with the Risk of Incident Knee Osteoarthritis Leading to Hospitalization: A 32-Year Follow-up Study

OBJECTIVES

To examine whether metabolic syndrome or its individual components predict the risk of incident knee osteoarthritis (OA) in a prospective cohort study during a 32-year follow-up period.

DESIGN

The cohort consisted of 6274 participants of the Mini-Finland Health Survey, who were free from knee OA and insulin-treated diabetes at baseline. Information on the baseline characteristics, including metabolic syndrome components, hypertension, elevated fasting glucose, elevated triglycerides, reduced high-density lipoprotein, and central obesity were collected during a health examination. We drew information on the incidence of clinical knee OA from the national Care Register for Health Care. Of the participants, 459 developed incident knee OA. In our full model, age, gender, body mass index, history of physical workload, smoking history, knee complaint, and previous injury of the knee were entered as potential confounding factors.

RESULTS

Having metabolic syndrome at baseline was not associated with an increased risk of incident knee OA. In the full model, the hazard ratio for incident knee OA for those with metabolic syndrome was 0.76 (95% confidence interval [0.56, 1.01]). The number of metabolic syndrome components or any individual component did not predict an increased risk of knee OA. Of the components, elevated plasma fasting glucose was associated with a reduced risk of incident knee OA (hazard ratio 0.71, 95% confidence interval [0.55, 0.91]).

CONCLUSIONS

Our findings do not support the hypothesis that metabolic syndrome or its components increase the risk of incident knee OA. In fact, elevated fasting glucose levels seemed to predict a reduced risk.

Individual level changes in body weight among Finnish adult population during the COVID-19 pandemic

Background

The indirect effects of COVID-19 pandemic are yet undefined, but behavioral and lifestyle consequences of the containment measures may cause weight changes, with different concerns across demographic groups. Our aim was to determine weight changes based on the data collected from same individuals before (2017) and during (2020) the COVID-19 pandemic.

Methods

Participants aged 25+ years, from the nationally representative FinHealth 2017 Study and its follow-up survey in autumn 2020, with information on self-reported weight in both years were included (n = 4770). Weight maintenance was defined as < ± 5% change in body weight for each individual (i.e. weight loss = ≥5% loss; weight gain = ≥5% gain). Prevalence was estimated using inverse probability weights, acknowledging sampling design and non-response.

Results

Overall, two thirds of the population maintained weight during follow-up, but prevalence rates for weight change differed by age and sex. Prevalence of weight loss was highest among 70+ year olds (22% in men, 95% confidence interval (CI) 17-27; 26% in women, 95% CI 22-30), while they rarely experienced weight gain. Among 50-69 year olds weight gain was as common as loss, being around 15% for both indicators and sexes. Prevalence of weight gain was highest among 25-49 year olds (20% in men, 95% CI 18-23; 36% in women, 95% CI 33-40). Men with lowest education had gained weight more often (24%, 95% CI 19-30) than those with middle (16%, 95% CI 14-19) or high (14%, 95% CI 12-16) education, while for women no differences emerged, the prevalence ranging between 20-24% by education.

Conclusions

The weight loss among 70+ year olds seems worrying, but might be age related. Moreover, younger women and men with low education gained weight, groups known to be vulnerable for weight gain. Further analyses are required to evaluate whether containment measures related to COVID-19 pandemic have caused additional change compared to ageing and time related change.

Key messages

Few weight changes were observed in the Finnish adult population. As weight gain/loss may take longer time to develop, further studies are needed to address the long term effects of COVID-19 pandemic.

To avoid increasing health inequity after pandemic, public health promotion should stress obesity prevention among young women plus men with low education. Weight loss is a concern among the elderly.

Individual level lifestyle changes during the COVID-19 pandemic – A Finnish population-based study

Background

The COVID-19 pandemic containment measures may affect lifestyle. We aimed to examine the changes in key lifestyle factors based on the data from same individuals before (2017) and during (2020) the COVID-19 pandemic.

Methods

The study is based on the FinHealth 2017 Study representing the Finnish adult population, and its follow-up questionnaire conducted in autumn 2020. A total of 4814 individuals aged 25 and older at baseline answered the same questions on lifestyle in both years. Regular leisure-time physical activity (LPA), daily use of vegetables and/or fruits, experience of adequate sleep, daily use of nicotine products and high-risk use of alcohol, were dichotomized (yes/no) for the analysis. Weighted prevalence (no/favorable/unfavorable change) for three age groups (25-49, 50-69, 70+ years) was analyzed using multinomial logistic regression, sampling design and non-response acknowledged.

Results

In general, the prevalence of total changes observed varied 6 − 27% between lifestyle factors. The changes were both unfavorable and favorable for health. About 14% (95% CI 11,17) and 12% (95% CI 9,16) of older women and men, respectively, had LPA in 2017 but not in 2020. Corresponding prevalence for favorable change in LPA were smaller, 6% (95% CI 4,8) in older women and 7% (95% CI 4,9) in men. In older women, the results concerning daily use of vegetables and fruits were parallel. In contrast, in older women the changes observed in the experience of adequate sleep were mainly favorable. In all age groups, high-risk use of alcohol slightly decreased especially in men but the changes in use of nicotine products were minor.

Conclusions

The results highlight unfavorable changes in LPA and vegetable consumption especially in older women during the COVID-19 pandemic. Part of the unfavorable changes may be explained by aging, but the pandemic containment measures may have accelerated them indicating the need for health promotion actions among the elderly.

Key messages

The lifestyle changes observed during COVID-19 pandemic were complex, varying by sex and age groups and being both favorable and unfavorable for health.

Special attention should be given to promotion of physical activity in the elderly during and after the pandemic.

Associations between hair and salivary cortisol, salivary alpha-amylase, and temperament dimensions among 3-6-year-olds

Associations between hair cortisol concentration (HCC), diurnal salivary cortisol (sCort) and alpha-amylase (sAA), and temperament dimensions were examined among 3-6-year-old Finnish children (n = 833). Children's hair samples were collected at preschool, while parents collected five saliva samples from children during one weekend day and completed a questionnaire assessing child's temperament dimensions i.e. surgency, negative affectivity, and effortful control (HCC, n = 677; AUCg of sAA, n = 380; AUCg of sCort, n = 302; temperament dimensions, n = 751). In linear regression analysis, diurnal sCort associated positively with HCC, the association persisting after adjustments (β 0.31, 95% CI 0.20-0.42). In logistic regression analysis, increasing scores in effortful control associated with higher likelihood of having high HCC (OR 1.47, 95% CI 1.07-2.03), the association slightly attenuating to non-significant after adjustments. Otherwise, no clear indication for associations between temperament and stress-related biomarkers were found.

Temperament, physical activity and sedentary time in preschoolers - the DAGIS study

Background

Identifying individual characteristics linked with physical activity (PA) and sedentary time (SED) can assist in designing health-enhancing interventions for children. We examined cross-sectional associations of temperament characteristics with 1) PA and SED and 2) meeting the PA recommendation in Finnish children.

Methods

Altogether, 697 children (age: 4.7 ± 0.9 years, 51.6% boys) within the Increased Health and Wellbeing in Preschools (DAGIS) study were included. Parents responded to the Very Short Form of the Children’s Behavior Questionnaire consisting of three temperament dimensions: surgency, negative affectivity, and effortful control. PA and SED were assessed for 7 days (24 h per day) using a hip-worn ActiGraph accelerometer, and the daily minutes spent in light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and SED were calculated. The PA recommendation was defined as having PA at least 180 min/day, of which at least 60 min/day was in moderate-to-vigorous PA. Adjusted linear and logistic regression analyses were applied.

Results

Surgency was associated with LPA (B = 3.80, p = 0.004), MPA (B = 4.87, p < 0.001), VPA (B = 2.91, p < 0.001), SED (B = − 11.45, p < 0.001), and higher odds of meeting the PA recommendation (OR = 1.56, p < 0.001). Effortful control was associated with MPA (B = − 3.63, p < 0.001), VPA (B = − 2.50, p < 0.001), SED (B = 8.66, p < 0.001), and lower odds of meeting the PA recommendation (OR = 0.61, p = 0.004). Negative affectivity was not associated with PA, SED, or meeting the PA recommendation.

Conclusion

Children’s temperament should be considered when promoting PA in preschoolers. Special attention should be paid to children scoring high in the temperament dimension effortful control.

Does temperament make children differently susceptible to their home physical food environment? A cross-sectional DAGIS study on 3-6 year old Finnish children's food consumption

Consistently linked with children's food consumption are food availability and accessibility. However, less is known about potential individual differences among young children in their susceptibility to home food environments. The purpose of the study was to examine whether the association between home food availability and accessibility of sugar-rich foods and drinks (SFD) or fruits and vegetables (FV) and children's consumption of these foods differ according to their temperament. The study used two cross-sectional datasets collected as part of the Increased Health and Wellbeing in Preschools (DAGIS) study: 1) a cross-sectional data of 864 children aged 3-6 years old collected between fall 2015 and spring 2016, and 2) an intervention baseline data of 802 children aged 3-6 collected in fall 2017. Parents reported their children's temperament, consumption of FV and SFD, and home availability and accessibility of SFD and FV. Examination of whether associations between home availability and accessibility of FV and their consumption differ according to children's temperament involved using linear regression models. Similar models were used to examine association between home availability and accessibility of SFD and their consumption, and the moderating role of temperament. The association between home accessibility of SFD and their consumption frequency was dependent on the level of children's negative affectivity. More frequent consumption of SFD was observed with higher home accessibility of SFD. The association was stronger in children with higher scores in negative affectivity. No other interactions were found. Children with higher negative affectivity are possibly more vulnerable to food cues in the home environment than children with lower negative affectivity. Consideration of children's individual characteristics is necessary in supporting their healthy eating.

Do stressed children have a lot on their plates? A cross-sectional study of long-term stress and diet among Finnish preschoolers

We examined the association between hair cortisol concentration (HCC) - an indicator of long-term stress - and diet among preschoolers in a cross-sectional design. The participants were 597 Finnish 3-6-year-olds, and the data were collected in 2015-16. We used 4-cm hair samples to analyze HCC during the past four months. Food consumption was assessed using a food frequency questionnaire, and we used consumption frequencies of selected food groups as well as data-driven dietary pattern scores in the analyses. The parents of the participating children reported their educational level and family income. The researchers measured the children's weight and height. We examined the associations between HCC and diet using multilevel linear mixed models adjusted for age, gender, the highest education in the family, household relative income, and child BMI. Higher HCCs were associated with less frequent consumption of fruit and berries (B estimate -1.17, 95% CI -2.29, -0.05) and lower scores in a health-conscious dietary pattern (B estimate -0.38, 95% CI -0.61, -0,14). Higher HCCs were also associated with more frequent consumption of sugary beverages (B estimate 1.30, 95% CI 0.06, 2.54) in a model adjusted for age, gender and highest education in the family, but the association attenuated after further adjustments. Our results are parallel with previous studies that show a link between stress and unhealthy diet. In the future, longitudinal studies are needed to establish a causal relationship between stress and diet among children.

Multi-ancestry GWAS of the electrocardiographic PR interval identifies 202 loci underlying cardiac conduction

The electrocardiographic PR interval reflects atrioventricular conduction, and is associated with conduction abnormalities, pacemaker implantation, atrial fibrillation (AF), and cardiovascular mortality. Here we report a multi-ancestry (N = 293,051) genome-wide association meta-analysis for the PR interval, discovering 202 loci of which 141 have not previously been reported. Variants at identified loci increase the percentage of heritability explained, from 33.5% to 62.6%. We observe enrichment for cardiac muscle developmental/contractile and cytoskeletal genes, highlighting key regulation processes for atrioventricular conduction. Additionally, 8 loci not previously reported harbor genes underlying inherited arrhythmic syndromes and/or cardiomyopathies suggesting a role for these genes in cardiovascular pathology in the general population. We show that polygenic predisposition to PR interval duration is an endophenotype for cardiovascular disease, including distal conduction disease, AF, and atrioventricular pre-excitation. These findings advance our understanding of the polygenic basis of cardiac conduction, and the genetic relationship between PR interval duration and cardiovascular disease.

Compliance with the 24-h movement guidelines and the relationship with anthropometry in Finnish preschoolers: the DAGIS study

Background

Recent 24-h movement guidelines for the early years established recommendations for physical activity (PA), screen time (ST), and sleep. To date, few studies have focused on compliance with meeting the guidelines and their associations with health outcomes. Thus, we aimed to investigate: 1) compliance with the 24-h movement guidelines, and 2) associations between compliance and anthropometry in Finnish preschoolers.

Methods

We utilized DAGIS survey data that were collected in 2015–2016 (N = 864). PA was assessed 24 h/day over 7 days using a waist-worn ActiGraph wGT3X-BT accelerometer. ST and sleep were reported by the parents during the same 7 days. Anthropometry was assessed using body mass index (BMI, kg/m²) and waist circumference (WC, cm). Children were classified as meeting the guidelines if they averaged ≥180 min/day of PA, which consisted of ≥60 min of moderate-to-vigorous intensity; ≤60 min/day of ST; and 10–13 h/day of sleep. In total, 778 children (51% boys, mean age: 4.7 ± 0.9 years) were included in the study. The compliance with meeting the 24-h movement guidelines was calculated for each behavior separately and in combinations. Adjusted linear regression analyses were applied to examine associations of compliance with BMI and WC.

Results

Children were physically active on average 390 (±46.2) min/day and spent 86 (±25.5) min/day in moderate-to-vigorous PA. They spent 76 (±37.4) min/day on ST and had on average 10:21 (±0:33) h:min/day of sleep. The compliance rate in meeting all three movement guidelines overall was 24%. The highest compliance rate was found for PA (85%), followed by sleep (76%) and ST (35%). Meeting guidelines separately for PA or sleep, or for both, were associated with lower WC (PA: B = -1.37, p < 0.001; Sleep: B = -0.72, p = 0.009; PA + Sleep: B = -1.03, p < 0.001). In addition, meeting guidelines for sleep or for both PA and sleep were associated with lower BMI (Sleep: B = -0.26, p = 0.027; PA + Sleep: B = -0.30, p = 0.007). There were no significant associations found regarding ST.

Conclusions

Meeting recommendations for PA and sleep may have an important role in supporting a healthy weight status in young children. However, there is still a need to improve compliance with the 24-h movement guidelines, especially for ST.

Background characteristics of meat consumption exceeding the Finnish Dietary Guidelines in 2000-2017

Background

Abundant consumption of animal-based foods such as red and processed meat pose a threat to sustainability and public health. This study clarifies how the share of the population group with high red and processed meat consumption has changed in the past two decades.

Methods

We used data of four Finnish cross-sectional surveys: Health 2000 (n = 5976), DILGOM 2007 (n = 4874), FINRISK 2012 (n = 4812), and FinHealth 2017 (n = 6010) concerning 25-74 year-old subjects (in year 2000 30-74 year-olds). Habitual food consumption over the past 12 months was assessed with a validated130-item food frequency questionnaire (FFQ) and daily meat consumption was computed. Questionnaires inquired on general background factors. The risk in belonging to the meat consumption quintiles exceeding the Finnish Dietary Guidelines (500 g /week) was examined with logistic regression analyses.

Results

In 2000, consuming more meat than recommended was more probable among men and those with lower or middle educational level. In 2007 and 2012, in addition to gender and education, having middle or higher income level and belonging to the age group of 35-44 years was associated with higher meat consumption. In 2017, meat consumption was higher among men, those with lower educational level and among 45-64 years old, but no income level differences were observed.

Conclusions

Actions aiming to reduce meat consumption should be targeted to those consuming the largest amount of meat: men, middle-aged, and those having lower educational level.

Key messages

The group consuming more meat than recommended has remained stable in the 21th century to include more often men, middle-aged, and people having lower education but income has become non-significant. Identification of population groups with high meat consumption helps to better design and target the interventions and to change the consumption patterns in a healthier and more sustainable direction.

Quality of dietary fat and genetic risk of type 2 diabetes: individual participant data meta-analysis

OBJECTIVE

To investigate whether the genetic burden of type 2 diabetes modifies the association between the quality of dietary fat and the incidence of type 2 diabetes.

DESIGN

Individual participant data meta-analysis.

DATA SOURCES

Eligible prospective cohort studies were systematically sourced from studies published between January 1970 and February 2017 through electronic searches in major medical databases (Medline, Embase, and Scopus) and discussion with investigators.

REVIEW METHODS

Data from cohort studies or multicohort consortia with available genome-wide genetic data and information about the quality of dietary fat and the incidence of type 2 diabetes in participants of European descent was sought. Prospective cohorts that had accrued five or more years of follow-up were included. The type 2 diabetes genetic risk profile was characterized by a 68-variant polygenic risk score weighted by published effect sizes. Diet was recorded by using validated cohort-specific dietary assessment tools. Outcome measures were summary adjusted hazard ratios of incident type 2 diabetes for polygenic risk score, isocaloric replacement of carbohydrate (refined starch and sugars) with types of fat, and the interaction of types of fat with polygenic risk score.

RESULTS

Of 102 305 participants from 15 prospective cohort studies, 20 015 type 2 diabetes cases were documented after a median follow-up of 12 years (interquartile range 9.4-14.2). The hazard ratio of type 2 diabetes per increment of 10 risk alleles in the polygenic risk score was 1.64 (95% confidence interval 1.54 to 1.75, I²=7.1%, τ²=0.003). The increase of polyunsaturated fat and total omega 6 polyunsaturated fat intake in place of carbohydrate was associated with a lower risk of type 2 diabetes, with hazard ratios of 0.90 (0.82 to 0.98, I²=18.0%, τ²=0.006; per 5% of energy) and 0.99 (0.97 to 1.00, I²=58.8%, τ²=0.001; per increment of 1 g/d), respectively. Increasing monounsaturated fat in place of carbohydrate was associated with a higher risk of type 2 diabetes (hazard ratio 1.10, 95% confidence interval 1.01 to 1.19, I²=25.9%, τ²=0.006; per 5% of energy). Evidence of small study effects was detected for the overall association of polyunsaturated fat with the risk of type 2 diabetes, but not for the omega 6 polyunsaturated fat and monounsaturated fat associations. Significant interactions between dietary fat and polygenic risk score on the risk of type 2 diabetes (P>0.05 for interaction) were not observed.

CONCLUSIONS

These data indicate that genetic burden and the quality of dietary fat are each associated with the incidence of type 2 diabetes. The findings do not support tailoring recommendations on the quality of dietary fat to individual type 2 diabetes genetic risk profiles for the primary prevention of type 2 diabetes, and suggest that dietary fat is associated with the risk of type 2 diabetes across the spectrum of type 2 diabetes genetic risk.

Predictors of New Airway Obstruction - An 11 Year's Population-Based Follow-Up Study

In the present study we aimed to investigate the incidence and predictors of spirometry based airway obstruction in a representative population-based sample. Altogether 3,863 subjects, 1,651 males and 2,212 females aged ≥30 years had normal spirometry in year 2000. Fifty-three percent of them were never and 23% current smokers. A re-spirometry was performed 11 years later. Several characteristics, such as level of education, use of alcohol, physical activity, diet using Alternate healthy eating (AHEI) index, body mass index, circumwaist, sensitive C reactive protein (CRP) and cotinine of the laboratory values and co-morbidities including asthma, allergic rhinitis, sleep apnoea and chronic bronchitis, as potential risk factors for airway obstruction were evaluated. Using forced expiratory volume in one second/ forced vital capacity below the lower limit of normal, we observed 124 new cases of airway obstruction showing a cumulative 11-year incidence of 3.2% and corresponding to an incidence rate of 5.6/1,000 per year (PY). The incidence rate was higher in men than in women (6.3/1,000 PY vs. 5.0/1,000 PY, respectively). The strongest risk factors were current smoking (Odds ratio [OR] 2.5) and previously diagnosed asthma (OR 2.1). Sensitive CRP associated with the increased risk and high AHEI index with the decreased risk of airway obstruction. Using the similar study approach our findings on the incidence of airway obstruction are in line with the previously published figures in Europe. We were able to confirm the recent findings on the protective effect of healthy diet.

Association of branched-chain amino acids and other circulating metabolites with risk of incident dementia and Alzheimer's disease: A prospective study in eight cohorts

Introduction

Metabolite, lipid, and lipoprotein lipid profiling can provide novel insights into mechanisms underlying incident dementia and Alzheimer’s disease.

Methods

We studied eight prospective cohorts with 22,623 participants profiled by nuclear magnetic resonance or mass spectrometry metabolomics. Four cohorts were used for discovery with replication undertaken in the other four to avoid false positives. For metabolites that survived replication, combined association results are presented.

Results

Over 246,698 person-years, 995 and 745 cases of incident dementia and Alzheimer’s disease were detected, respectively. Three branched-chain amino acids (isoleucine, leucine, and valine), creatinine and two very low density lipoprotein (VLDL)-specific lipoprotein lipid subclasses were associated with lower dementia risk. One high density lipoprotein (HDL; the concentration of cholesterol esters relative to total lipids in large HDL) and one VLDL (total cholesterol to total lipids ratio in very large VLDL) lipoprotein lipid subclass was associated with increased dementia risk. Branched-chain amino acids were also associated with decreased Alzheimer’s disease risk and the concentration of cholesterol esters relative to total lipids in large HDL with increased Alzheimer’s disease risk.

Discussion

Further studies can clarify whether these molecules play a causal role in dementia pathogenesis or are merely markers of early pathology.

Sociodemographic and socioeconomic differences in sleep duration and insomnia-related symptoms in Finnish adults

Background

Poor sleep tends to be patterned by sociodemographic and socioeconomic factors. The aim of this study was to examine the associations of sociodemographic and socioeconomic factors with sleep duration and insomnia-related symptoms across life course.

Methods

We used cross-sectional Health 2000 Survey (2000–2001) among a total of 5,578 adult Finns, aged 30–79 years, representative of adult Finnish population. Data about sociodemographic and socioeconomic circumstances, insomnia-related symptoms over the previous month as well as average sleep duration were collected by questionnaires. Multinomial logistic regression models were adjusted first for gender and age, second for sociodemographic factors, third additionally for socioeconomic factors, and fourth for all covariates and self-perceived health simultaneously.

Results

On average 70% of Finnish adults slept 7–8 hours a day. Frequent insomnia-related symptoms were more prevalent among women (14%) than men (10%). Not being married, not having children, having low education, low income, being unemployed, and being a disability retiree were associated with frequent insomnia-related symptoms. Similar factors were associated with short and long sleep duration. However, childhood socioeconomic position was mostly unrelated to sleep in adulthood except parental education had some associations with short sleep duration.

Conclusions

Disadvantaged socioeconomic position in adulthood, in particular income and employment status, is associated with poorer sleep. When promoting optimal sleep duration and better sleep quality, families with low incomes, unemployed people, and disability retirees should be targeted.

Serum vitamin D and the risk of Parkinson disease

OBJECTIVE

To investigate whether serum vitamin D level predicts the risk of Parkinson disease.

DESIGN

Cohort study.

SETTING

The study was based on the Mini-Finland Health Survey, which was conducted from 1978 to 1980, with Parkinson disease occurrence follow-up through the end of 2007. During the 29-year follow-up period, 50 incident Parkinson disease cases occurred. Serum 25-hydroxyvitamin D level was determined from frozen samples stored at baseline. Estimates of the relationship between serum vitamin D concentration and Parkinson disease incidence were calculated using the Cox model.

PARTICIPANTS

Three thousand one hundred seventy-three men and women, aged 50 to 79 years and free of Parkinson disease at baseline. Main Outcome Measure Parkinson disease incidence.

RESULTS

Individuals with higher serum vitamin D concentrations showed a reduced risk of Parkinson disease. The relative risk between the highest and lowest quartiles was 0.33 (95% confidence interval, 0.14-0.80) after adjustment for sex, age, marital status, education, alcohol consumption, leisure-time physical activity, smoking, body mass index, and month of blood draw.

CONCLUSIONS

The results are consistent with the suggestion that high vitamin D status provides protection against Parkinson disease. It cannot, however, be excluded that the finding is due to residual confounding and further studies are thus needed.

Self-administered questionnaire is a reliable measure of coffee consumption

Background

The objective of this study was to assess the agreement and repeatability of 2 methods of measuring habitual coffee consumption, and to examine their homogeneity with respect to socioeconomic and lifestyle factors.

Methods

Data on coffee consumption were collected from 4254 subjects by means of a health questionnaire (HQ) and a 1-year dietary history interview (DHI), the latter of which was used as the reference method during the Finnish Mobile Clinic Health Examination Survey conducted in 1973–1976. Short-term repeatability of the methods was assessed using data from 286 and 93 subjects who repeated the HQ and the DHI, respectively, after an interval of 4 to 8 months. The strength of agreement between the 2 methods and between the repeated measurements was estimated using intraclass correlation coefficients (ICCs).

Results

The ICC was 0.86 for the agreement between the HQ and the DHI, and 0.77 and 0.85 for the repeatability of the HQ and the DHI, respectively. There were no statistically significant systematic differences in mean intake values between the 2 methods or between repeated measurements. In subgroup analysis of background variables, there were only minor differences in agreement and repeatability, with somewhat higher ICC values among subjects with a healthier lifestyle and higher education.

Conclusions

The high reliability and homogeneity of the health questionnaire make it a useful tool for measuring habitual coffee consumption for the purposes of epidemiological research.

Prospective study of coffee consumption and risk of Parkinson's disease

OBJECTIVE

To examine the prediction of coffee consumption on the incidence of Parkinson's disease.

SUBJECTS AND METHODS

The study population comprised 6710 men and women, aged 50-79 years and free from Parkinson's disease at the baseline. At baseline, enquiries were made about coffee consumption in a self-administered questionnaire as the average number of cups per day. During a 22-year follow-up, 101 incident cases of Parkinson's disease occurred. Parkinson's disease cases were identified through a nationwide registry of patients receiving medication reimbursement, which is based on certificates from neurologist.

RESULTS

After adjustments for age, sex, marital status, education, community density, alcohol consumption, leisure-time physical activity, smoking, body mass index, hypertension and serum cholesterol, the relative risk for subjects drinking 10 or more cups of coffee per day compared with non-drinkers was 0.26 (95% confidence interval 0.07-0.99, P-value for trend=0.18). The association was stronger among overweight persons and among persons with lower serum cholesterol level (P-value for interaction=0.04 and 0.03, respectively).

CONCLUSIONS

The results support the hypothesis that coffee consumption reduces the risk of Parkinson's disease, but protective effect of coffee may vary by exposure to other factors.