Jouni Maatela

Flavonoid intake and coronary mortality in Finland: a cohort study

Abstract Objective: To study the association between dietary intake of flavonoids and subsequent coronary mortality. Design: A cohort study based on data collected at the Finnish mobile clinic health examination survey from 1967-72 and followed up until 1992. Settings: 30 communities from different parts of Finland. Subjects: 5133 Finnish men and women aged 30-69 years and free from heart disease at baseline. Main outcome measure: Dietary intake of flavonoids, total mortality, and coronary mortality. Results: In women a significant inverse gradient was observed between dietary intake of flavonoids and total and coronary mortality. The relative risks between highest and lowest quarters of flavonoid intake adjusted for age, smoking, serum cholesterol concentration, blood pressure, and body mass index were 0.69 (95% confidence interval 0.53 to 0.90) and 0.54 (0.33 to 0.87) for total and coronary mortality, respectively. The corresponding values for men were 0.76 (0.63 to 0.93) and 0.78 (0.56 to 1.08), respectively. Adjustment for intake of antioxidant vitamins and fatty acids weakened the associations for women; the relative risks for coronary heart disease were 0.73 (0.41 to 1.32) and 0.67 (0.44 to 1.00) in women and men, respectively. Intakes of onions and apples, the main dietary sources of flavonoids, presented similar associations. The relative risks for coronary mortality between highest and lowest quarters of apple intake were 0.57 (0.36 to 0.91) and 0.81 (0.61 to 1.09) for women and men, respectively. The corresponding values for onions were 0.50 (0.30 to 0.82) and 0.74 (0.53 to 1.02), respectively. Conclusion: The results suggest that people with very low intakes of flavonoids have higher risks of coronary disease. Key messages Key messages The protective effect of flavonoids was associated with a diet high in intake of apples and onions The effect may be mediated through prevention of oxidation of low density lipoproteins but other mechanisms could be involved Flavonoids offer an explanation for the suggested beneficial effect of fruits and vegetables in coronary heart disease Further studies should concentrate on the effects of various flavonoid compounds and on populations with different intakes

Depression and cardiovascular diseases

We first review the asSociations between depression and cardiovascular diseases (CVDs). Then we examine them in the nationally representative Mini‐Finland Health Survey, which covers 8,000 persons. Chronic somatic diseases and mental disorders were diagnosed using standardized methods. Cross‐sectionally, CVDs and neurotic depression were asSociated both before and after adjustment for covariates. The strongest asSociations were observed in the case of severe CVDs. During a 6.6 year follow‐up, the risk of CVD death and coronary death was elevated in depressed persons both with and without CVDs at entry. Much of the cross‐sectional asSociation is probably due to depression caused by CVDs. The outcome of CVD may be poorer in depressed persons. The hypothesis that depression is a cause of CVDs requires further study.

Risk of disability and mortality due to overweight in a Finnish population.

OBJECTIVE--To investigate the effect of overweight on premature mortality and work disability in young and middle aged Finns. DESIGN--Prospective cohort study based on data collected in the multiphasic health examinations by the Social Insurance Institution of Finland from 1966 to 1972 and follow up until 1982. SETTING--34 Communities throughout Finland. SUBJECTS--12,053 Women and 19,076 men who were employed and aged 25-64 at baseline. MAIN OUTCOME MEASURES--Mortality and work disability pensions from all and specified causes. RESULTS--Body mass index was a weak predictor of death but a strong predictor of early work disability, which increased linearly with body mass index. After adjustment for age, geographical region, occupation, and smoking the relative risks of work disability for women and men with a body mass index greater than or equal to 30 kg/m2 were, respectively, 2.0 (95% confidence interval 1.8 to 2.3) and 1.5 (1.3 to 1.7) when compared with those of subjects with body mass index less than 22.5 kg/m2. The increased risks were due to an excess of cardiovascular and musculoskeletal diseases but not of mental diseases. One fourth of all disability pensions from cardiovascular and musculoskeletal causes in women and half as many in men could be attributed to overweight (body mass index greater than 25 kg/m2) alone. CONCLUSIONS--Though modest overweight has little impact on mortality it predicts severe functional impairment. A considerable proportion of work disability pensions could probably be prevented by efficient weight control.

Musculoskeletal disorders as determinants of disability in Finns aged 30 years or more

The relationship between disability and various musculoskeletal disorders was investigated in 7217 men and women representative of the Finnish population aged 30 years or more. They participated in the Mini-Finland Health Survey and were first screened by interview and questionnaire about limitations in daily activities. The outcome variables were reduced working capacity, an occasional need for assistance in daily activities, and a regular need for assistance in daily activities. In a two-phase medical examination, all cases fulfilling predetermined diagnostic criteria of musculoskeletal, cardiovascular, respiratory and mental disorders and diabetes were recorded independently. In multivariate logistic regression analyses, inflammatory arthritis was the strongest determinant of all forms of disability. Osteoarthritis, especially in the hip, was a strong determinant of both occasional and regular need for assistance, and chronic low back pain was a strong determinant of reduced working capacity and occasional need for assistance among those aged 30-64 years. Other musculoskeletal disorders also determined the prevalence disability, but these relationships were reduced by taking comorbidity into account. A low level of education and a low (less than 20 kg/m2) or very high (at least 35 kg/m2) body mass index represented independent determinants of all forms of disability, and a history of physically strenuous work an independent determinant of reduced working capacity, when disabling illness was adjusted for. The proportion of all forms of disability attributable to musculoskeletal disorders, in models including, age, sex, other disabling illness and significant non-medical determinants of disability, was close to 20%. The disorders with the highest community impact were chronic low back pain among those aged 30-64, osteoarthritis of the hips and knees and inflammatory arthritis.

Prevalence of mental disorders among adults in Finland: basic results from the Mini Finland Health Survey

The Mini Finland Health Survey was an extensive epidemiological study of the Finnish population aged 30 or over; the prevalence of mental disorders was one aspect studied. Prevalence of symptoms in the General Health Questionnaire as well as the prevalence of self‐perceived and clinically assessed mental disorders was studied. The total prevalence of clinically assessed mental disorders was 17.4%, 14.8% in the men and 19.5% in the women. A definite disorder was observed for 11.7% of the subjects. About half of the subjects suffering from a mental disorder according to clinical assessment also reported a self‐perceived disorder. Of various diagnoses, the most common were phobic and anxiety neurosis (6.2%) and neurotic depression (4.6%). The prevalence of schizophrenia was 1.3%. The highest prevalence was found in the ages 50 to 64 years. The prevalence of psychoses was highest in northern and eastern Finland, and that of neuroses in southern Finland.

The Epidemiology of Hyperostosis of the Spine Together with Its Symptoms and Related Mortality in a General Population

The prevalence rate of hyperostosis, defined as the presence of complete bony bridges linking two vertebrae in at least two separate sites in the dorsal spine, was studied in a sample of some 9 000 persons who were 40 years of age or older and were representative of the general population of Finland. The standardized rates of hyperostosis were 3.8% for men and 2.6% for women. The prevalence rates rose sharply with age, and depending on the age group, the male-female ratio varied between 1.4 and 2.1. The adjusted rate of hyperostosis was higher in East Finland than elsewhere. There was a suggestion of hyperostosis being associated with a higher mortality rate as judged by regional variations and by analysis of matched case-controled pairs. There was no evidence that locomotor symptoms occurred in excess in subjects with hyperostosis; nor was prior traumatic experience more common.

Sero-epidemiologal association between human-papillomavirus infection and risk of prostate cancer

Some epidemiological studies of prostate cancer have suggested the existence of a sexually transmitted risk factor, and some studies have reported the presence of human papillomavirus (HPV) DNA in prostate‐cancer tissue. To perform a sero‐epidemiological evaluation of whether HPV infection is associated with increased risk for prostate cancer, we performed a nested case‐control study within a serum bank containing samples from 20,243 healthy Finnish men. We identified 165 cases of prostate cancer that were diagnosed up to 24 years after donation of the serum sample. Two control subjects per case were selected, matched for gender, age and municipality of residence. Serum samples were analyzed for the presence of IgG antibodies against 4 HPV types and against Chlamydia. The presence of antibodies against HPV type 18 was associated with a 2.6‐fold increased risk of developing prostate cancer during follow‐up (p < 0.005). HPV type 16 tended to be associated with subsequent prostate‐cancer occurrence (relative risk: 2.4, p = 0.06), whereas seropositivity for HPV type 11 or type 33 or for Chlamydia was not associated with risk. The results suggest that infection with oncogenic HPV might be involved in the etiology of a minority of prostate cancers. Int. J. Cancer 75:564–567, 1998.

Need for mental health services of the adult population in Finland: results from the Mini Finland Health Survey

This article presents results on the self‐perceived and clinically assessed met and unmet need for mental health care as indicated by the Mini Finland Health Survey, an extensive epidemiological study of the Finnish population aged 30 years or over. The prevalence of self‐perceived definite or probable need for care was 6.4% in the men and 8.2% in the women. The corresponding clinical assessments were 14.5% in the men and 19.6% in the women. The need for specialist care was 7.5% in the men and 9.6% in the women. The need was greatest in the middle‐aged groups. About 60% of persons in need of care were not receiving any treatment. Half of the treatment received was assessed as inadequate. The treatment situation was much better for psychoses than for neuroses, but it varied little between the different parts of the country.

The physical activity of healthy and chronically ill adults in Finland at work, at leisure and during commuting

The present study was conducted as part of the Mini‐Finland Health Survey, a comprehensive evaluation of the populations health. The sample was representative of the Finnish population aged 30 or over and consisted of 8000 people from 40 localities all over Finland. Both medical and physical activity interviews were used in this study. Total physical activity and physical activity in spare time decreased with age, but physical activity at work was highest in the 45‐ to 54‐year‐old age cohort. Total physical activity as well as physical activity at work and during spare time were higher in men than in women. The majority of people physically active at work were inhabitants of rural areas, whereas the majority of those physically active in their spare time were living in urban areas. Skiing was the most popular exercise among both sexes. People who reported having mental problems were the most passive in their spare time.

POOR APPLICABILITY OF THE FRIEDEWALD FORMULA IN THE ASSESSMENT OF SERUM LDL CHOLESTEROL FOR CLINICAL PURPOSES

OBJECTIVE To determine the accuracy of the estimation of serum low-density lipoprotein (LDL) cholesterol concentration by the Friedewald formula. METHODS Modifications of the calculation formula are presented on the basis of ultracentrifugal separation of serum high-density lipoprotein and LDL cholesterol in the specimens collected (n = 1215) in a nationwide health survey. RESULTS The formulas obtained from different subject groups differed relatively little from each other. The accuracy of the original Friedewald formula was poor; in about 36% of the subjects the error was more than 5% compared with ultracentrifugally obtained results. By applying the currently recommended coronary heart disease (CHD) risk categorizations, high proportions (5%-28%) of the subjects were classified into wrong CHD risk categories when LDL cholesterol was calculated with any of the formulas. At high serum triglyceride levels, misclassifications were especially common. CONCLUSIONS We conclude that even the most accurate LDL cholesterol calculation methods should be used with caution while classifying subjects into categories of CHD risk. In hypertriglyceridemic subjects, the calculation formulas probably should not be used at all.