Hanna Konttinen

Emotional eating, depressive symptoms and self-reported food consumption. A population-based study.

We examined the associations of emotional eating and depressive symptoms with the consumption of sweet and non-sweet energy-dense foods and vegetables/fruit, also focusing on the possible interplay between emotional eating and depressive symptoms. The participants were 25-64-year-old Finnish men (n=1679) and women (n=2035) from the FINRISK 2007 Study (DILGOM substudy). The Three-Factor Eating Questionnaire-R18, Center for Epidemiological Studies Depression Scale, and a 132-item Food Frequency Questionnaire were used. Emotional eating and depressive symptoms correlated positively (r=0.31 among men and women), and both were related to a higher body mass. Emotional eating was related to a higher consumption of sweet foods in both genders and non-sweet foods in men independently of depressive symptoms and restrained eating. The positive associations of depressive symptoms with sweet foods became non-significant after adjustment for emotional eating, but this was not the case for non-sweet foods. Depressive symptoms, but not emotional eating, were related to a lower consumption of vegetables/fruit. These findings suggest that emotional eating and depressive symptoms both affect unhealthy food choices. Emotional eating could be one factor explaining the association between depressive symptoms and consumption of sweet foods, while other factors may be more important with respect to non-sweet foods and vegetables/fruit.

Tendency Toward Eveningness Is Associated With Unhealthy Dietary Habits

Subjects with higher preference for evening hours in daily activities (eveningness) have been repeatedly shown to practice adverse health behaviors as compared to those preferring morning hours (morningness). However, associations between chronotype and dietary intake have not been explored intensively. The authors explored whether the human chronotype is associated with food and nutrient intakes in a random sample of the population aged 25 to 74 yrs. The cross-sectional study included 4493 subjects from the National FINRISK 2007 Study. Chronotype was assessed using a shortened version of Horne and Östbergs Morningness-Eveningness Questionnaire. Diet was assessed using a validated food frequency questionnaire. Associations between morningness-eveningness (ME) score and dietary intakes were analyzed by linear regression and difference between lowest (eveningness) and highest (morningness) ME score quintiles by Tukeys test. In the multivariable model, intakes of whole grain, rye, potatoes, and vegetables and roots decreased, whereas those of wine and chocolate increased with lower ME scores. Participants in the lowest ME score quintile consumed less fish (p < .001) and fruits (p = .025) and more chocolate (p = .001) and soft drinks (p = .015) compared to the highest quintile. No linear association was found between ME score and total energy intake. In regression analyses, intake of alcohol (as a percentage of total energy intake; E%) and sucrose (E%) increased, whereas intake of carbohydrates (E%), protein (E%), fiber, folic acid, and sodium decreased with lower ME scores. Furthermore, participants in the lowest ME score quintile ingested more fat (E%) (p < .001) and less vitamin D (p < .001) compared to the highest quintile, even though no linear trend between ME score and these nutrients emerged. In conclusion, these results support existing evidence that individuals with circadian preference toward eveningness have less healthy lifestyles, such as unfavorable dietary habits, than those with tendency toward morningness, which could put them at higher risk of several chronic diseases. (Author correspondence: noora.kanerva@thl.fi)

Eating styles, self-control and obesity indicators. The moderating role of obesity status and dieting history on restrained eating.

We examined whether obesity status and dieting history affected the associations of eating styles with measured obesity indicators and self-control among Finnish men (n = 2325) and women (n = 2699) aged 25-75 years. Uncontrolled and emotional eating were positively associated with obesity and reversely with self-control. Among obese subjects and current/past dieters, higher restrained eating was related to lower adiposity, uncontrolled and emotional eating, and higher self-control while these associations were opposite among normal weight subjects and never dieters. These results suggest that restrained eating may be related to better weight control among those who need and/or are motivated to lose weight while among others it may indicate problems with eating.

Comparing sense of coherence, depressive symptoms and anxiety, and their relationships with health in a population-based study.

The strong negative correlations observed between the sense of coherence (SOC) scale and measures of depression and anxiety raise the question of whether the SOC scale inversely measures the other constructs. The main aim of the present study was to examine the discriminant validity of the three measures by comparing their associations with health indicators and behaviours. The participants were 25 to 74-year-old Finnish men (n=2351) and women (n=2291) from the National Cardiovascular Risk Factor Survey conducted in 1997. The SOC scale had high inverse correlations with both depression (r=-0.62 among both men and women) and anxiety measures (r=-0.57 among the men and r=-0.54 among the women). Although confirmatory factor analyses suggested that it was possible to differentiate between SOC, cognitive depressive symptoms and anxiety, the estimated correlations were even higher than those mentioned above. Education was related only to SOC, but the associations of SOC, cognitive depressive symptoms and anxiety with self-reported and clinically measured health indicators (body mass index, blood pressure, cholesterol) and health behaviours were almost identical. The variation in the lowest SOC tertile was more strongly associated with health variables than in the highest tertile. To conclude, the size of the overlap between the SOC and depression scales was the same as between depression and anxiety measures. This indicates that future studies should examine the discriminant validity of different psychosocial scales more closely, and should compare them in health research in order to bring parallel concepts into the same scientific discussion.

Socio-economic disparities in the consumption of vegetables, fruit and energy-dense foods: the role of motive priorities

OBJECTIVE A low socio-economic status (SES) is related to less healthy dietary habits, but the reasons for this remain unclear. We examined whether the absolute or relative importance of various food choice motives contributed to SES disparities in vegetable/fruit and energy-dense food intake. DESIGN We analysed cross-sectional data from the FINRISK Study 2007 by means of structural equation modelling and used a shortened version of the Food Choice Questionnaire to assess the absolute importance of health, pleasure, convenience, price, familiarity and ethicality motives. We calculated the relative importance of each motive by dividing the participants rating of it by his/her mean score on all motives. Dietary intake was measured with an FFQ. SETTING A population-based survey in Finland. SUBJECTS Men (n 1691) and women (n 2059) aged 25-64 years. RESULTS Higher education and income were related to a greater vegetable/fruit intake (β = 0·12, P < 0·001), while education was associated negatively with the consumption of energy-dense foods (β = -0·09, P < 0·001). Socio-economically disadvantaged individuals considered price and/or familiarity more important in their food choices in both absolute and relative terms. A higher income was related to a greater relative importance of health considerations. Relative motives were more strongly associated with vegetable/fruit and energy-dense food consumption than absolute motives and the relative importance of price, familiarity and health partly mediated the effects of the SES indicators on the consumption of these food items. CONCLUSIONS Individual priorities in food choice motives, rather than the absolute importance of single motives, play a role in producing SES disparities in diet.

Hostility, Anger Control, and Anger Expression as Predictors of Cardiovascular Disease

Objective: To examine in a prospective setting whether different hostility measures, including Cynical Distrust, Trait Anger, Anger Out, Anger In, and Anger Control, are related to cardiovascular disease (CVD) and ischemic heart disease (IHD). Methods: Participants comprised 25- to 74-year-old men (n = 3850) and women (n = 4083), followed up for 10 to 15 years. Trait Anger, Anger Out, Anger In, and Anger Control were assessed with the Spielberger State-Trait Anger Expression Inventory and Cynical Hostility with the Cynical Distrust Scale. Incident CVD and IHD were derived from hospital records/death certificates. Subjects with a history of CVD or IHD at baseline were excluded. Results: Subjects in the lowest Anger Control tertile had a higher risk of first nonfatal and fatal CVD incidence (relative risk [RR], 1.35; 95% confidence interval [CI], 1.06-1.73) than subjects in the highest tertile after adjustment for age, gender, education, marital status, smoking, body mass index, blood pressure, cholesterol, alcohol consumption, and depressive symptoms. Higher Cynical Distrust scores predicted nonfatal and fatal CVD (RR, 1.31; 95% CI, 1.09-1.56) and IHD (RR, 1.37; 95% CI, 1.08-1.74) events after adjustment for age, but these associations disappeared after further adjustment for gender, education, and marital status. Other hostility measures, i.e., Trait Anger, Anger Out, or Anger In, were not related to CVD or IHD outcomes. Conclusions: This is the first study to show that compared with four other hostility dimensions, low Anger Control predicts CVD events. Further studies should examine whether Anger Control is specific to anger or reflects more general psychosocial factors. BDI = Beck Depression Inventory; BMI = body mass index; CAD = coronary artery disease; CHD = coronary heart disease; CI = confidence interval; CVD = cardiovascular disease; ICD = International Classification of Diseases and Related Health Problems; IHD = ischemic heart disease; IMT = intima medial thickness; MI = myocardial infarction; RR = relative risk.

Morningness–eveningness, depressive symptoms, and emotional eating: A population-based study

The aim of this study was to increase understanding of the associations between different dimensions of morningness–eveningness, depressive symptoms, and emotional eating in the general population. The participants were 25-to-74-year-old Finnish men (n = 2325) and women (n = 2699) from the National FINRISK Study conducted in 2007. The Center for Epidemiological Studies – Depression Scale and the Three-Factor Eating Questionnaire-R18 were used to measure depressive symptoms and emotional eating. Chronotype was assessed with a shortened version of Horne and Östberg’s Morningness–Eveningness Questionnaire (MEQ). Structural equation modeling was used as an analytical approach. Confirmatory factor analysis indicated a two-factor structure for the six-item MEQ with separate factors for morning alertness and circadian preference for daily activities (r = 0.65). Higher alertness in the morning and preference for morning hours were both related to lower depressive symptoms (βtotal effect = −0.36 and −0.11, respectively) and emotional eating (βtotal effect = −0.20 and −0.09; βindirect effect through depressive symptoms = −0.12 and −0.04, respectively), even though the relationships with morning alertness were stronger. However, the associations of circadian preference with depressive symptoms and emotional eating were reversed after adjustment for morning alertness. Finally, among participants who rarely or never experienced sleeping sufficiently, those in the lowest (i.e. eveningness) and higher (i.e. morningness) circadian preference/morning alertness quartiles had the highest depressive symptom scores. In conclusion, the findings emphasize the importance of separating between different dimensions of chronotype when examining its relationships with psychological factors such as depressive symptoms and overeating tendencies.

Gender Differences in the Associations Between Depressive Symptoms, Cardiovascular Diseases, and All-Cause Mortality

PURPOSE We examine the relationships between depressive symptoms and all-cause mortality and cardiovascular disease (CVD) in a representative sample of the Finnish population. METHODS Subjects included men (N Z 3,850) and women (N Z 4,083) aged 25-74 years who had participated in risk factor surveys (The FINRISK Study) conducted in Finland in 1992 and 1997. Depressive symptoms were measured with the Beck Depression Inventory (BDI). RESULTS During a 10-15 year follow-up, there were 422 deaths and 305 nonfatal and fatal CVD events among men and 195 deaths and 145 CVD events among women. Subjects in the third BDI quartile and the highest BDI quartile had higher risk for all-cause mortality than subjects in the first quartile (relative risk [RR], 1.39; 95% confidence interval [CI]: 1.03-1.86; RR, 1.64; 95% CI, 1.24-2.17, respectively) after adjustment for age, gender, education, smoking, alcohol consumption, and chronic diseases. Among women without a history of CVD, females in the highest BDI quartile had a relative risk of 1.84 (95% CI, 1.06-3.20) compared with those in the first quartile for nonfatal and fatal CVD events after adjusting for age, education, smoking, body mass index, blood pressure, cholesterol, and alcohol consumption. CONCLUSIONS The relationship between depressive symptoms and CVD varies according to gender and previous history of CVD.

Sense of coherence, depressive symptoms, cardiovascular diseases, and all-cause mortality.

Objective There is increasing interest in whether positive and negative psychological constructs are bipolar opposites of the same phenomenon. We examine whether a positive construct—sense of coherence (SOC)—has independent predictive power over and above depressive symptoms for cardiovascular disease (CVD) and all-cause mortality. Methods Participants included 3850 men and 4083 women aged 25 to 74 years who had participated in risk factor surveys conducted in 1992 or 1997. Antonovsky’s 13-item SOC scale was used to measure SOC, and had a correlation of −0.60 with the Beck Depression Inventory. Results During a mean follow-up time of 14.2 years, there were 670 deaths and 487 nonfatal and fatal CVD events. Higher SOC scores were associated with a lower risk of all-cause mortality (relative risk [RR] = 0.90, 95% confidence interval [CI] = 0.84–0.97 per unit), especially among men, but this association became nonsignificant after adjustment for depressive symptoms (RR = 0.99, 95% CI = 0.90–1.08). Among participants without a history of CVD, higher SOC scores were related to a lower risk for CVD (RR = 0.90, 95% CI = 0.83–0.98), but this association disappeared after adjustment for cardiovascular risk factors. Depressive symptoms remained significant predictors of CVD among women in a model including also SOC (RR = 1.24, 95% CI = 1.06–1.46). Conclusions SOC was related to all-cause mortality among men; the association with CVD events was modest. Measures for SOC and depressive symptoms were significantly correlated, which might result in overlap in their associations with adverse disease and mortality outcomes.

A diet following Finnish nutrition recommendations does not contribute to the current epidemic of obesity

OBJECTIVE Recently, the general public opinion is that nutritional recommendations promote obesity rather than prevent it. We created the Recommended Finnish Diet Score (RFDS) that illustrates the Finnish nutrition recommendations and assessed whether this score is associated with BMI, waist circumference (WC) and body fat percentage (BF%). DESIGN Cross-sectional study included two phases of the National FINRISK 2007 Study. Diet was assessed using a validated FFQ. Height, weight, WC and BF% were measured, and BMI values were calculated. The RFDS was developed based on the national nutrition recommendations. SETTING A large representative sample of the Finnish population. SUBJECTS Men (n 2190) and women (n 2530) aged 25-74 years. RESULTS The RFDS was inversely associated with WC in men (OR = 0·48, 95 % CI 0·28, 0·81, P < 0·05) and BF% in both men (OR = 0·44, 95 % CI 0·24, 0·82, P-trend < 0·05) and women (OR = 0·63, 95 % CI 0·37, 1·08, P-trend < 0·05). The inverse association of RFDS and BF% appeared stronger among older age groups (men: OR = 0·21 CI 0·07, 0·64, P-trend < 0·01; women: OR = 0·56, 95 % CI 0·25, 1·27, P-trend < 0·05) and among women with normal BMI (OR = 0·62, 95 % CI 0·36, 1·09, P-trend < 0·05). The RFDS was not associated with BMI. CONCLUSIONS A diet following nutrition recommendations is likely to help to maintain normal WC and BF%. These findings could be useful for dietary counselling and the prevention of obesity.