Jenni Lehtisalo

A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial

BACKGROUND Modifiable vascular and lifestyle-related risk factors have been associated with dementia risk in observational studies. In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), a proof-of-concept randomised controlled trial, we aimed to assess a multidomain approach to prevent cognitive decline in at-risk elderly people from the general population. METHODS In a double-blind randomised controlled trial we enrolled individuals aged 60-77 years recruited from previous national surveys. Inclusion criteria were CAIDE (Cardiovascular Risk Factors, Aging and Dementia) Dementia Risk Score of at least 6 points and cognition at mean level or slightly lower than expected for age. We randomly assigned participants in a 1:1 ratio to a 2 year multidomain intervention (diet, exercise, cognitive training, vascular risk monitoring), or a control group (general health advice). Computer-generated allocation was done in blocks of four (two individuals randomly allocated to each group) at each site. Group allocation was not actively disclosed to participants and outcome assessors were masked to group allocation. The primary outcome was change in cognition as measured through comprehensive neuropsychological test battery (NTB) Z score. Analysis was by modified intention to treat (all participants with at least one post-baseline observation). This trial is registered at ClinicalTrials.gov, number NCT01041989. FINDINGS Between Sept 7, 2009, and Nov 24, 2011, we screened 2654 individuals and randomly assigned 1260 to the intervention group (n=631) or control group (n=629). 591 (94%) participants in the intervention group and 599 (95%) in the control group had at least one post-baseline assessment and were included in the modified intention-to-treat analysis. Estimated mean change in NTB total Z score at 2 years was 0·20 (SE 0·02, SD 0·51) in the intervention group and 0·16 (0·01, 0·51) in the control group. Between-group difference in the change of NTB total score per year was 0·022 (95% CI 0·002-0·042, p=0·030). 153 (12%) individuals dropped out overall. Adverse events occurred in 46 (7%) participants in the intervention group compared with six (1%) participants in the control group; the most common adverse event was musculoskeletal pain (32 [5%] individuals for intervention vs no individuals for control). INTERPRETATION Findings from this large, long-term, randomised controlled trial suggest that a multidomain intervention could improve or maintain cognitive functioning in at-risk elderly people from the general population. FUNDING Academy of Finland, La Carita Foundation, Alzheimer Association, Alzheimers Research and Prevention Foundation, Juho Vainio Foundation, Novo Nordisk Foundation, Finnish Social Insurance Institution, Ministry of Education and Culture, Salama bint Hamdan Al Nahyan Foundation, Axa Research Fund, EVO funding for University Hospitals of Kuopio, Oulu, and Turku and for Seinäjoki Central Hospital and Oulu City Hospital, Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, and af Jochnick Foundation.

The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER): Study design and progress

Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a multi‐center, randomized, controlled trial ongoing in Finland.

Dietary habits and nutrient intake of Finnish adolescents

OBJECTIVE To evaluate food and nutrient intake and especially eating during the school day among Finnish secondary-school pupils. DESIGN Cross-sectional study. Data were collected using a structured questionnaire mailed to home and by 48 h dietary recall interviews performed at schools in 2007. SETTING Twelve schools in three cities in Finland. SUBJECTS The seventh grade pupils (a total of 1469 at the mean age of 13.8 years). Questionnaire data were available from 726 pupils and dietary data from a subgroup of 40 % (n 306). RESULTS According to the questionnaire data, 40 % of the girls and 28 % of the boys reported eating fresh vegetables daily and the respective figures for fruit were 32 % and 23 %. Altogether, 71 % of the adolescents reported having school lunch every day. The average intake of sucrose was higher and the average intakes of fibre, iron, folate and vitamin D were lower than recommended. School lunch provided around 20 % of daily energy intake, while the recommended daily energy intake level is one-third. However, the school lunch as consumed was nutritionally superior to the other daily meals. Snacks provided 41 % of the daily energy. The most common sources of sucrose were sugary drinks. CONCLUSIONS Low consumption of fruit and vegetables and abundant consumption of sucrose-rich drinks and snacks are the main problems in the diet of Finnish adolescents. The nutritional quality of the school lunch is good, but the supply of healthy snacks must be improved in schools. Schools can promote healthy eating habits by making healthy choices easy during the school day.

The diet of adolescents can be improved by school intervention

OBJECTIVE To decrease the intake of sucrose, increase the intake of fibre and the consumption of fruit and vegetables among secondary-school pupils. DESIGN Intervention study among eighth grade pupils during one school year. Data were collected by questionnaires and from a subgroup of pupils by 48 h dietary recall at baseline in spring 2007 and after the intervention in 2008. SETTING Twelve secondary schools were randomly allocated to intervention (IS) and control schools (CS) within three cities. Intervention included nutrition education and improvement of the food environment focusing particularly on the quality of snacks at school. SUBJECTS A total of 659 pupils completed the questionnaires and the dietary recall was obtained from 287 pupils both at baseline and follow-up. RESULTS The frequency of consumption of rye bread increased (P = 0.03) and that of sweets decreased (P = 0.006) among girls in the IS. The intake of sucrose fell among IS pupils, from 12.8 % to 10.5 % of the total energy intake (P = 0.01). Intake of fruit (g/MJ) remained the same in IS, whereas it decreased in CS (P = 0.04). CONCLUSIONS Sugar intake can be lowered by improving the quality of snacks, but it is more difficult to increase fibre intake and fruit and vegetable consumption unless the content of school lunches can be modified. It is the responsibility of the adults working in schools to create a healthy environment and to make healthy choices easy for pupils.

Food consumption and nutrient intake in day care and at home in 3-year-old Finnish children.

OBJECTIVE To assess and compare the food consumption and nutrient intake between 3-year-old children cared for at home full-time and those attending day care outside the home. Nutrient intake on weekdays and weekends was also studied. DESIGN Cross-sectional sample of children invited to the nutrition study within the Type 1 Diabetes Prediction and Prevention (DIPP) birth cohort born in 2001. Families returned 3-d food record completed close to the childs third birthday. SUBJECTS A total of 471 pre-school children aged 3 years of whom 285 had only been cared for at home during the recording time and 186 had attended day care outside the home. RESULTS Among the children cared for outside the home, there were more consumers of recommendable foods as fresh vegetables, fruits, berries, rye bread, fish, skimmed milk and vegetable margarines, than among those cared for at home. The day-care group had higher intake of protein, dietary fibre, thiamine, potassium and magnesium, and lower intake of sucrose compared with the group cared for at home. Adjustment for sociodemographic factors did not change the results. In all children, food consumption was more varied on weekdays compared with weekends. On weekdays, children had higher intake of dietary fibre and protein and lower intake of sucrose compared to weekends. CONCLUSIONS The type of day care was associated with food consumption and nutrient intake among pre-school children and hence might have an impact on their nutrition and health. The diet of the children attending day care outside the home was more balanced and closer to the national recommendations.

Sucrose in the diet of 3-year-old Finnish children: sources, determinants and impact on food and nutrient intake

The aim was to identify the important sources of added sucrose and determinants of high intake, and to evaluate what impact a high proportion of energy from added sucrose has on the intake of foods and nutrients. The subjects consisted of children invited to the nutrition study within the Type 1 Diabetes Prediction and Prevention birth cohort and born in 2001 (n 846). Of these, 471 returned 3 d food records at 3 years of age. The average daily intake of added sucrose was 35 (sd 17) g (11.3 % of energy intake) and that of total sucrose was 41 (sd 18) g (13.3 % of energy intake). Sucrose added by manufacturers accounted for 82 %, naturally occurring sucrose for 15 % and sucrose added by consumers for 3 % of the total sucrose. Juice drinks, yoghurt/cultured milks, and chocolate and confectionery were the main contributors to added sucrose intake. Consumption of rye bread, porridge, fresh vegetables, cooked potatoes, skimmed milk, hard cheeses, margarine and fat spread as well as intake of most nutrients decreased across the quartiles of added sucrose (P < 0.05). Being cared for at home, having a father with a vocational school degree, having at least two siblings and a milk-restricted diet increased the risk for a high-sucrose diet. The study implied that a high proportion of added sucrose in the diet had mainly an unfavourable impact on the intake of recommended foods and key nutrients in Finnish children. The rationale for the recommendation to reduce the intake of refined sugars to ensure adequate intakes of nutrients seems reasonable.

Recruitment and Baseline Characteristics of Participants in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) : A Randomized Controlled Lifestyle Trial

Our aim is to describe the study recruitment and baseline characteristics of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study population. Potential study participants (age 60–77 years, the dementia risk score ≥6) were identified from previous population-based survey cohorts and invited to the screening visit. To be eligible, cognitive performance measured at the screening visit had to be at the mean level or slightly lower than expected for age. Of those invited (n = 5496), 48% (n = 2654) attended the screening visit, and finally 1260 eligible participants were randomized to the intervention and control groups (1:1). The screening visit non-attendees were slightly older, less educated, and had more vascular risk factors and diseases present. The mean (SD) age of the randomized participants was 69.4 (4.7) years, Mini-Mental State Examination 26.7 (2.0) points, systolic blood pressure 140.1 (16.2) mmHg, total serum cholesterol 5.2 (1.0) mmol/L for, and fasting glucose 6.1 (0.9) mmol/L for, with no difference between intervention and control groups. Several modifiable risk factors were present at baseline indicating an opportunity for the intervention. The FINGER study will provide important information on the effect of lifestyle intervention to prevent cognitive impairment among at risk persons.

Association of long-term dietary fat intake, exercise, and weight with later cognitive function in the Finnish Diabetes Prevention Study

ObjectivesTo investigate associations of long-term nutrient intake, physical activity and obesity with later cognitive function among the participants in the Finnish Diabetes Prevention Study, in which a lifestyle intervention was successful in diabetes prevention.DesignAn active lifestyle intervention phase during middle age (mean duration 4 years) and extended follow-up (additional 9 years) with annual lifestyle measurements, followed by an ancillary cognition assessment.Setting5 research centers in Finland.ParticipantsOf the 522 middle-aged, overweight participants with impaired glucose tolerance recruited to the study, 364 (70%) participated in the cognition assessment (mean age 68 years).MeasurementsA cognitive assessment was executed with the CERAD test battery and the Trail Making Test A on average 13 years after baseline. Lifestyle measurements included annual clinical measurements, food records, and exercise questionnaires during both the intervention and follow-up phase.ResultsLower intake of total fat (p=0.021) and saturated fatty acids (p=0.010), and frequent physical activity (p=0.040) during the whole study period were associated with better cognitive performance. Higher BMI (p=0.012) and waist circumference (p=0.012) were also associated with worse performance, but weight reduction prior to the cognition assessment predicted worse performance as well (decrease vs. increase, p=0.008 for BMI and p=0.002 for waist).ConclusionsLong-term dietary fat intake, BMI, and waist circumference have an inverse association with cognitive function in later life among people with IGT. However, decreases in BMI and waist prior to cognitive assessment are associated with worse cognitive performance, which could be explained by reverse causality.

Cognition in the Finnish Diabetes Prevention Study

We studied cognition in the Finnish Diabetes Prevention Study (DPS), a trial of lifestyle intervention that prevented diabetes in persons with impaired glucose tolerance. Cognition was similar in the randomization arms 9 years after the intervention in 364 participants, suggesting that the intervention did not benefit cognition.

Multidomain lifestyle intervention benefits a large elderly population at risk for cognitive decline and dementia regardless of baseline characteristics: The FINGER trial

The 2‐year Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) multidomain lifestyle intervention trial (NCT01041989) demonstrated beneficial effects on cognition. We investigated whether sociodemographics, socioeconomic status, baseline cognition, or cardiovascular factors influenced intervention effects on cognition.