Laura Paalanen

Socio-economic differences in the consumption of vegetables, fruit and berries in Russian and Finnish Karelia: 1992-2007

BACKGROUND Food habits and their socio-economic differences in Russia have rarely been compared to those in western countries. Our aim was to determine socio-economic differences and their changes in the consumption of vegetables, fruit and berries in two neighbouring areas: the district of Pitkäranta in the Republic of Karelia, Russia, and North Karelia, Finland. METHODS Cross-sectional risk factor surveys in Pitkäranta, in 1992, 1997, 2002 and 2007 (1144 men, 1528 women) and in North Karelia, in 1992, 1997 and 2002 (2049 men, 2316 women), were carried out. Data collected with a self-administered questionnaire were analysed with logistic regression. RESULTS The consumption of fruit and vegetables was more common in North Karelia than in Pitkäranta, but increased markedly in Pitkäranta from 1992 to 2007. In Pitkäranta, women, and in North Karelia both men and women with higher education ate fresh vegetables more often than those with a lower education. In both areas, daily consumption of fruit tended to be more common among subjects with a higher education. In Pitkäranta, there were virtually no differences by employment status. In North Karelia, vegetable consumption was less common among the unemployed than the employed subjects. Only minor socio-economic differences in berry consumption were observed. The educational differences in vegetable consumption seemed to widen in Pitkäranta and narrow in North Karelia. CONCLUSION A converging trend was observed, with the Russian consumption levels and socio-economic differences starting to approach those observed in Finland. This may be partly explained by the improvements in availability and affordability of fruit and vegetables in Pitkäranta.

Educational variations in the consumption of foods containing fat in Finland and the Baltic countries

OBJECTIVE To examine educational differences among people who consume foods containing fat in Finland and the Baltic countries. DESIGN Data were collected from cross-sectional postal Finbalt Health Monitor surveys that were carried out in 1998, 2000 and 2002. SETTING Estonia, Finland, Latvia and Lithuania. SUBJECTS For each survey, nationally representative random samples of adults aged 20-64 years were drawn from population registers (Estonia, n = 3656; Finland, n = 9354, Latvia, n = 6015; Lithuania, n = 5944). RESULTS Differences were revealed between the countries in the consumption of foods that contain fat. Finnish people consumed butter on bread, high-fat milk, meat and meat products, and vegetable oil for cooking less frequently than people in the Baltic countries. Cheese was most popular in Finland. Educational differences in fat-related food habits were examined by applying logistic regression analysis. A positive association was found between level of education and consumption of vegetable oil used in food preparation. Drinking high-fat milk was associated with low education in all countries. People with higher education tended to consume cheese more often. Educational patterns in the consumption of butter on bread and in the consumption of meat and meat products differed between countries. CONCLUSIONS The consumption of foods containing fat was related to educational levels in all four countries. The diet of better-educated people was closer to recommendations for the consumption of saturated and unsaturated fats than the diet of people with lower level of education. The educational gradient was more consistent in Finland than in the Baltic countries. These existing educational differences in sources of fat consumed should be taken into account in the development of national cardiovascular disease prevention programmes.

Significant disparities in allergy prevalence and microbiota between the young people in Finnish and Russian Karelia

Atopic allergy has been more common among schoolchildren in Finland, as compared to Russian Karelia. These adjacent regions show one of the most contrasting socio‐economical differences in the world.

Patterns in the skin microbiota differ in children and teenagers between rural and urban environments

The composition of human microbiota is affected by a multitude of factors. Understanding the dynamics of our microbial communities is important for promoting human health because microbiota has a crucial role in the development of inflammatory diseases, such as allergies. We have studied the skin microbiota of both arms in 275 Finnish children of few months old to teenagers living in contrasting environments. We show that while age is a major factor affecting skin microbial composition, the living environment also discriminates the skin microbiota of rural and urban children. The effect of environment is age-specific; it is most prominent in toddlers but weaker for newborns and non-existent for teenagers. Within-individual variation is also related to age and environment. Surprisingly, variation between arms is smaller in rural subjects in all age groups, except in teenagers. We also collected serum samples from children for characterization of allergic sensitization and found a weak, but significant association between allergic sensitization and microbial composition. We suggest that physiological and behavioral changes, related to age and the amount of contact with environmental microbiota, jointly influence the dynamics of the skin microbiota, and explain why the association between the living environment skin microbiota is lost in teenager.

Vegetable and fruit consumption, education and plasma vitamin C concentration in Russian and Finnish Karelia, 1992-2002.

OBJECTIVE To examine (i) whether the consumption of fresh vegetables, fruit and berries is associated with plasma vitamin C concentration and (ii) educational differences in plasma vitamin C concentration in two neighbouring areas in Russia and Finland. DESIGN Cross-sectional risk factor surveys in 1992, 1997 and 2002. Logistic regression analysis was applied to examine the associations of consumption of selected foods and education with plasma vitamin C concentration. SETTING District of Pitkäranta in the Republic of Karelia, Russia and North Karelia, Finland. SUBJECTS Adults aged 25-64 years: 579 men and 612 women in Pitkäranta; 974 men and 642 women in North Karelia. RESULTS The plasma vitamin C concentration was strikingly low in Pitkäranta, Russia across the study years. During the 10 years of monitoring, the mean plasma vitamin C concentration among men ranged from 2·5 to 8·0 μmol/l in Pitkäranta, Russia and from 27·1 to 53·9 μmol/l in North Karelia, Finland. In both areas, daily consumption of fruit was most strongly associated with plasma vitamin C, while the association of fresh vegetable consumption with plasma vitamin C was less consistent. Consumption of berries was less important in explaining plasma vitamin C. In Pitkäranta, the plasma vitamin C concentration was lower among respondents in the lowest education group. CONCLUSIONS Differences in the consumption of fresh vegetables and fruit resulted in notable differences in vitamin C status between Pitkäranta and North Karelia in spring. In comparative settings, knowledge of local food culture and validation pilots are important before conducting large population surveys.

Contribution of education level and dairy fat sources to serum cholesterol in Russian and Finnish Karelia: results from four cross-sectional risk factor surveys in 1992-2007

BackgroundFood habits vary by socio-economic group and geographic area. Data on socio-economic differences in food habits and in serum total cholesterol concentration from Russia are scarce. Our aim was to examine changes and educational differences in serum total cholesterol and in the consumption of major sources of saturated fat in two geographically neighbouring areas, Russian and Finnish Karelia, and to examine whether the foods associated with serum total cholesterol are different in the two areas.MethodsData from cross-sectional risk factor surveys from years 1992, 1997, 2002 and 2007 in the district of Pitkäranta, the Republic of Karelia, Russia (n = 2672), and North Karelia, Finland (n = 5437), were used. The analyses included two phases. 1) To examine the differences in cholesterol by education, the means and 95% confidence intervals for education groups were calculated for each study year. 2) Multivariate linear regression analysis was employed to examine the role of butter in cooking, butter on bread, fat-containing milk and cheese in explaining serum total cholesterol. In these analyses, the data for all four study years were combined.ResultsIn Pitkäranta, serum total cholesterol fluctuated during the study period (1992–2007), whereas in North Karelia cholesterol levels declined consistently. No apparent differences in cholesterol levels by education were observed in Pitkäranta. In North Karelia, cholesterol was lower among subjects in the highest education tertile compared to the lowest education tertile in 1992 and 2002. In Pitkäranta, consumption of fat-containing milk was most strongly associated with cholesterol (β=0.19, 95% CI 0.10, 0.28) adjusted for sex, age, education and study year. In North Karelia, using butter in cooking (β=0.09, 95% CI 0.04, 0.15) and using butter on bread (β=0.09, 95% CI 0.02, 0.15) had a significant positive association with cholesterol.ConclusionsIn the two geographically neighbouring areas, the key foods influencing serum cholesterol levels varied considerably. Assessment and regular monitoring of food habits are essential to plan nutrition education messages that are individually tailored for the target area and time.

From margarine to butter: predictors of changing bread spread in an 11-year population follow-up

OBJECTIVE Finland is known for a sharp decrease in the intake of saturated fat and cardiovascular mortality. Since 2000, however, the consumption of butter-containing spreads - an important source of saturated fats - has increased. We examined social and health-related predictors of the increase among Finnish men and women. DESIGN An 11-year population follow-up. SETTING A representative random sample of adult Finns, invited to a health survey in 2000. SUBJECTS Altogether 5414 persons aged 30-64 years at baseline in 2000 were re-invited in 2011. Of men 1529 (59 %) and of women 1853 (66 %) answered the questions on bread spreads at both time points. Respondents reported the use of bread spreads by choosing one of the following alternatives: no fat, soft margarine, butter-vegetable oil mixture and butter, which were later categorized into margarine/no spread and butter/butter-vegetable oil mixture (= butter). The predictors included gender, age, marital status, education, employment status, place of residence, health behaviours, BMI and health. Multinomial regression models were fitted. RESULTS Of the 2582 baseline margarine/no spread users, 24.6% shifted to butter. Only a few of the baseline sociodemographic or health-related determinants predicted the change. Finnish women were more likely to change to butter than men. Living with a spouse predicted the change among men. CONCLUSIONS The change from margarine to butter between 2000 and 2011 seemed not to be a matter of compliance with official nutrition recommendations. Further longitudinal studies on social, behavioural and motivational predictors of dietary changes are needed.

European health examination surveys – a tool for collecting objective information about the health of the population

BackgroundRepresentative and reliable data on health and health determinants of the population and population sub-groups are needed for evidence-informed policy making; planning and evaluation of prevention programmes; and research. Health examination surveys (HESs) including questionnaires, objective health measurements and analysis of biological samples, provide information on many health indicators that are available not at all or less reliably or completely through administrative registers or health interview surveys.MethodsStandardized cross-sectional HESs were already conducted in the 1980’s and 1990’s, in the framework of the WHO MONICA Project. The methodology was developed and finally, in 2010–2012, a European Health Examination Survey (EHES) Pilot Project was conducted. During this pilot phase, an EHES Coordinating Centre (EHES CC, formerly EHES Reference Centre) was established. Standardized protocols, guidelines and quality control procedures were prepared and tested in 12 countries which conducted pilot surveys, demonstrating the feasibility of standardized HES data collection in the European Union (EU).Currently, the EHES CC operates at the National Institute for Health and Welfare (THL), Finland. Its activities include maintaining and developing the standardized protocols, guidelines and training programme; maintaining the EHES network; providing professional support for countries planning and organizing their national HESs; external quality assessment for surveys organized in the EU Member States; and development of a centralized database and joint reporting system for HES data.ResultsAn increasing number of EU Member States are conducting national HESs, demonstrating a strong need for such surveys as part of the national health monitoring systems. Standardization of the data collection is essential to ensure that HES data are comparable across countries and over time. The work of the EHES CC helps to ensure the quality and comparability of HES data across the EU.ConclusionsHES data have been used for health monitoring and identifying public health problems; to develop health and prevention programmes; to support health policies and preparation of health-related legislation and regulations; and to develop clinical treatment guidelines and population reference values. HESs have also been utilized to prepare health measurement tools and diagnostic methods; in training and research and to increase health awareness among population.