The present study investigated the association between 24-h urinary sodium excretion and heart rate in the determination of blood pressure (BP) levels in a large random population sample from eastern Finland. Three independent risk factor surveys were performed in 1979, 1982 and 1987 using the same methodology. Data from each survey was pooled for subjects aged 25-64 years who reported a complete 24-h urine collection and were not on the current antihypertensive treatment (1640 men and 1686 women). The effect of urinary sodium excretion and heart rate was examined by regressing BP on urinary sodium excretion and pulse rate, together with age and body mass index (BMI). Analyses stratified by quintiles of heart rate were also performed. There was no association between urinary sodium and BP either in men or in women. There was a significant correlation between heart rate and both systolic and diastolic BP in both men and women. A significant interaction between age and BMI with heart rate was also found in both sexes. Interaction between urinary sodium and heart rate was found neither in men nor in women. Among men, after adjustment for age and BMI, there was a curvilinear relation between 24-h urinary excretion of sodium and diastolic BP (P = 0.054) in the lowest quintile of heart rate (
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.
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.
The survey was conducted in three geographical areas of eastern and south western Finland.
2526 men and 2756 women aged 25-64 years took part in the study, corresponding to a survey participation rate of 82%.
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.
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.
The aim of this study was to examine the effects of childhood BMI growth dynamics on the risk of developing young adult-onset type 1 and type 2 diabetes.
Finnish national healthcare registers were used to identify individuals with diabetes diagnosed between 1992 and 1996 at 15-39 years of age. Non-diabetic control participants were chosen from the National Population Registry. Anthropometric measurements were obtained from the original child welfare clinic records. Only the case-control pairs with sufficient growth data recorded were included in the analyses (218/1,388 for type 1 diabetes [16%] and 64/1,121 for type 2 diabetes [6%]). Two developmental stages in BMI growth (the points of infancy maximum BMI and the BMI rebound) were examined, and conditional logistic regression was applied to the variables of interest.
The risk for type 1 diabetes increased 1.19-fold per 1 kg/m(2) rise in the infancy maximum BMI (p = 0.02). In addition, there was a 1.77-fold increase in the risk for type 2 diabetes per 1 kg/m(2) rise in the level of BMI at the BMI rebound (p = 0.04). Higher values of BMI at these points corresponded to a larger BMI gain from birth to that developmental stage. Age at the infancy maximum BMI or age at the BMI rebound did not affect the risk for either type of diabetes.
The BMI gain in infancy among individuals who subsequently developed young adult-onset type 1 diabetes was faster than that of those who remained healthy. The excess BMI gain in individuals who developed young adult-onset type 2 diabetes could already be seen during early childhood.
To compare nationwide incidence of childhood insulin-dependent diabetes mellitus (IDDM) in children aged 0-14 yr between Estonia and Finland during 1980-1988. For Estonia, which has a population genetically and linguistically related to Finland, only limited information was available. Finland has the highest incidence of IDDM in the world.
The registration of all new cases of IDDM in Estonia was conducted by the local district pediatricians who reported every newly diagnosed diabetic patient to the Republic Endocrinology Centre. Registration of all new cases of IDDM in Finland was based on the statistics of the Social Insurance Institution, which approves free-of-charge insulin treatment for diabetes. These data were validated with one or more additional data sources. The case ascertainment rate approached 100% in both countries.
The average yearly incidence of IDDM standardized for age for the years 1980-1988 in Estonia was approximately 33% of that in Finland. Among males it was 11.3 (95% confidence interval [CI] 10.3-12.3) per 100,000 in Estonia and 35.1 (95% CI 33.4-36.9) per 100,000 in Finland, and among females 10.1 (95% CI 9.2-11.1) per 100,000 in Estonia and 30.4 (95% CI 28.8-32.1) per 100,000 in Finland. When the two periods 1980-1982 and 1986-1988 were compared, the age-standardized incidence in Estonia remained unchanged, whereas in Finland it increased approximately 20%.
The data between two populations who are ethnically and linguistically similar and live geographically close but in a different environment, provides further evidence that both genetic and environmental factors are contributing to the risk of IDDM.
We studied the association of glucose intolerance with total and cause-specific mortality during a 5-year follow-up of 637 elderly Finnish men aged 65 to 84 years. Total mortality was 276 per 1000 for men aged 65 to 74 years and 537 per 1000 for men aged 75 to 84 years. Five-year total mortality adjusted for age was 364 per 1000 in diabetic men, 234 per 1000 in men with impaired glucose tolerance and 209 per 1000 in men with normal glucose tolerance. The relative risk of death among diabetic men was 2.10 (95% confidence interval 1.26 to 3.49) and among men with impaired glucose tolerance 1.17 (95% confidence interval 0.71 to 1.94) times higher compared with men with normal glucose tolerance. Cardiovascular disease was the most common cause of death in every glucose tolerance group. The multivariate adjusted relative risk of cardiovascular death was increased (1.55) in diabetic patients, albeit non-significantly (95% confidence interval 0.84 to 2.85). Diabetes resulted in an increased risk of cardiovascular mortality among men aged 65-74 years but not among the 75- 84-year-old men. Relative risk of death from non-cardiovascular causes was slightly increased among diabetic subjects. In conclusion, diabetes mellitus is a significant determinant of mortality among elderly Finnish men.
To investigate the role of diet as a predictor of glucose intolerance and non-insulin-dependent diabetes mellitus (NIDDM).
At the 30-year follow-up survey of the Dutch and Finnish cohorts of the Seven Countries Study, in 1989/1990, men were examined according to a standardized protocol including a 2-h oral glucose tolerance test. Information on habitual food consumption was obtained using the cross-check dietary history method. Those 338 men in whom information on habitual diet was also available 20 years earlier were included in this study. Subjects known as having diabetes in 1989/1990 were excluded from the analyses.
Adjusting for age and cohort, the intake of total, saturated, and monounsaturated fatty acids and dietary cholesterol 20 years before diagnosis was higher in men with newly diagnosed diabetes in the survey than in men with normal or impaired glucose tolerance. After adjustment for cohort, age, past body mass index, and past energy intake, the past intake of total fat was positively associated with 2-h postload glucose level (P
Great spatial variation in the incidence of IDDM is found among countries around the Baltic Sea, a relative small area on the global scale. We present recent data on IDDM incidence from countries around the Baltic Sea, monthly variation and time trends in incidence from the early 1980s to the early 1990s. The change in IDDM incidence was calculated from logarithms of incidence using linear regression. The incidence was high in the countries to the north and west from the Baltic Sea, being the highest in Finland (35 per 100,000/year) followed by Sweden (26), Denmark (22) and Norway (21). In the countries on the eastern and southern coast of the Baltic Sea the incidence was markedly lower, in Estonia the incidence (10) was the highest within these countries, though slightly less than one third of that in Finland, while it was in Lithuania 7, Latvia 7 and Poland 6. There was an increasing trend in incidence of IDDM in Finland, Norway and Poland. In Sweden the incidence increased from 1978 to 1984, but since then the trend has been flat. In Estonia, Latvia and Lithuania, no significant change in incidence was seen. The reasons for large differences observed in the incidence of IDDM between countries around the Baltic Sea area are unknown, but a complex interaction between genetic and environmental risk factors that can vary in different ethnic, socio-economic and cultural settings play an important role in this variation.
The aim of this study was to examine the incidence and trends of type 1 and type 2 diabetes in the 15-39 year-old population between 1992 and 1996 in Finland.
Data on the nationwide incidence of diabetes were obtained from four data sources: standardised reports from diabetes nurses, the Finnish National Hospital Discharge Register, the Drug Reimbursement Register and the Drug Prescription Register. The inclusion criterion was consistency in the diagnosis of diabetes across at least two data sources. The sex- and age-specific incidence was calculated for 5-year age groups, both for type 1 and type 2 diabetes. The effects of age, sex and year of diagnosis were assessed by fitting the linear regression model to the incidence data.
Between 1992 and 1996 the age-adjusted incidence of type 1 diabetes among 15-39 year olds was 15.9 per 100,000/year. The incidence was highest among the 15-19 year olds and decreased with age. Conversely, the incidence of type 2 diabetes was very low among 15-19 year olds and increased with age. The total age-adjusted incidence of type 2 diabetes among 15-39 year olds was 11.8 per 100,000/year. The average annual increase in the incidence of type 2 diabetes was 7.9% (95% CI 3.7-12.2%).
The age at which the Finnish population is at risk of type 1 diabetes extends into young adulthood. The rapid increase in the incidence of type 2 diabetes in the young adult population is a current public health problem.
To estimate the relationship between joint heavy use of alcohol, cigarettes and coffee, and the risk of suicide in a general population with high rate of suicide.
Prospective cohort analyses.
Data from 36,689 adult (age range 25-64 years) men and women who participated in the population surveys between 1972 and 1992.
The mortality of the cohort was monitored for a mean of 14.4 years, which yielded 169 suicides. Criteria for heavy use of each psychoactive substance were defined as follows: alcohol (> 120 g/week), cigarettes (> or = 21/day) and coffee (> or = seven cups/day).
About half the men and 80% of the women did not use any of the psychoactive substances heavily. Every third man and every fifth woman used one substance heavily, and the prevalence for those who exceeded criteria for joint heavy use of two substances was 9% for men and 1% for women. Joint heavy use of all three substances was rare. The adjusted relative risk of suicide increased linearly with increasing level of joint heavy use of alcohol, cigarettes and coffee. Among subjects with heavy use of one substance the risk was 1.55 (95% CI = 1.10, 2.18), with joint heavy use of two substances 2.22 (95% CI = 1.37, 3.61), and with joint heavy use of all three substances 3.99 (95% CI = 1.80, 8.84) compared with no heavy use.
Clustering of the heavy use of alcohol, cigarettes and coffee could serve as a new marker for increased risk of suicide.
Coronary risk factors and levels of physical activity at leisure were measured in a random sample of 3975 men 25-64 years of age residing in four areas of Finland. An index of leisure-time physical activity (LTPA) as the product of weekly exercise sessions times their usual intensity (expressed as metabolic equivalents) was computed. It showed a graded, inverse association with mean arterial blood pressure, smoking and serum thiocyanate, coronary heart disease risk estimate (combining blood pressure, total cholesterol and smoking), and a nonlinear favorable association with serum lipoproteins. In multiple regression analysis, LTPA contributed significantly and independently to the variation in mean arterial pressure; the standardized regression coefficients were -0.06 for LTPA, 0.09 for weekly alcohol consumption, 0.25 for body mass index, 0.25 for age. In the regression of coronary risk estimate, the standardized regression coefficients were -0.19 for LTPA, 0.22 for weekly alcohol consumption, 0.09 for body mass index, 0.15 for age. There was no evidence that LTPA above 2000 kcal of weekly energy expenditure was associated with further reduced coronary risk factor levels. These findings thus support the inverse direction of the association between exercise and coronary risk factors but they also point towards an independent, but modest, role of leisure-time physical activity as a determinant of coronary risk estimate and blood pressure.