Liisa M. Valsta

Thirty-five-year trends in cardiovascular risk factors in Finland

BACKGROUND In the late 1960s, coronary heart disease (CHD) mortality among Finnish men was the highest in the world. From 1972 to 2007, risk factor surveys have been carried out to monitor risk factor trends and assess their contribution to declining mortality in Finland. METHODS The first risk factor survey was carried out in the North Karelia and Kuopio provinces in 1972 as the basis for the evaluation of the North Karelia Project. Since then, up to five geographical areas have been included in the surveys. The target population has been persons aged 25-74 years, except in the first two surveys where the sample was drawn from a population aged 30-59 years. Risk factor contribution on mortality change was assessed by a logistic regression model. RESULTS A remarkable decline in serum cholesterol levels was observed between 1972 and 2007. Blood pressure declined among both men and women until 2002 but levelled off during the last 5 years. Prevalence of smoking decreased among men. Among women, smoking increased throughout the survey years until 2002 but did not increase between 2002 and 2007. Body mass index (BMI) has continuously increased among men. Among women, BMI decreased until 1982, but since then an increasing trend has been observed. Risk factor changes explained a 60% reduction in coronary mortality in middle-aged men while the observed reduction was 80%. CONCLUSIONS The 80% decline in coronary mortality in Finland mainly reflects a great reduction of the risk factor levels; these in turn have been associated with long-term comprehensive chronic disease prevention and health promotion interventions.

Sodium in the Finnish diet: 20-year trends in urinary sodium excretion among the adult population

Objective:High sodium intake increases the risk of cardiovascular diseases and may also be associated with higher rates of stomach cancer, asthma disorders and infections. In Finland, cross-sectional population surveys to monitor cardiovascular risk factors have been carried out since the 1970s. The main aim of this paper is to present trends in urinary sodium and potassium excretion from 1979 to 2002.Design:Cross-sectional population surveys on cardiovascular risk factors.Setting:Surveys were carried out in Finland in 1979, 1982, 1987 and 2002 in four geographical areas: North Karelia, the Kuopio area, Southwestern Finland and the Helsinki area.Subjects:For each survey a random sample stratified by age and sex was drawn from the population register. In this analysis, participants of urine collection subsamples aged 25–64 years (n=4648) were included.Interventions:A 24-h urinary collection was carried out in subsamples (n=2218–2487) in connection with population risk factor surveys. Urinary sodium and potassium concentrations were analyzed in the same laboratory throughout, using a flame photometer in 1979, 1982 and 1987 and an ion-selective electrode in 2002.Results:Between 1979 and 2002 urinary sodium excretion in Finland decreased from over 220 to less than 170 mmol/day among men and from nearly 180 to less than 130 mmol/day among women. Although potassium excretion decreased somewhat as well, the decrease in sodium–potassium molar ratio was also significant.Conclusions:The 24-h urinary sodium excretion in Finland has decreased significantly during the last 20 years. However, excretion levels are still considerably higher than recommendations. A further decrease in sodium intake remains a goal for the Finnish food industry and consumers.Sponsorship:All surveys were funded by the National Public Health Institute in Finland.

Phyto-oestrogen database of foods and average intake in Finland

Information on phyto-oestrogen intake in various populations has been scanty until now, primarily because data on the content of these compounds in foods were lacking. We report here on expansion of the Finnish National Food Composition Database (Fineli) with values for the plant lignans matairesinol and secoisolariciresinol and the isoflavones daidzein and genistein. The values, expressed as aglycones, were based on food analyses (mainly GC-MS) or imputed from analytical data for 180 foods for lignans and 160 foods for isoflavones; additionally, over 1000 values were derived from the recipe database of Fineli. Average intake of these phyto-oestrogens was calculated using food consumption data of the National Dietary Survey FINDIET 1997, which was carried out in a random sample of the adult population in five areas in Finland. The dietary data were collected by 24 h recall =2862). The mean lignan intake was 434 (standard deviation (SD) 1575) microg/d and the mean isoflavone intake was 788 (SD 673) microg/d. Women had a higher lignan density (microg lignans/MJ) in their diet than men (P<0.05). Men had a higher mean daily isoflavone intake, 902 (SD 368) microg, than women, 668 (SD 963) microg (P<0.05). The sources of lignans were many: seeds, cereals, fruit, berries and vegetables. The main sources of isoflavones appeared to be processed meat products/sausages containing soya as an ingredient, and legumes as such. The average intake of lignans and isoflavones in Finland seems to be low, but intake varies throughout the population.

Estimation of plant sterol and cholesterol intake in Finland: quality of new values and their effect on intake

The Finnish national food composition database Fineli was updated with recent analytical values for plant sterols (PS) (sitosterol, campesterol, stigmasterol, avenasterol, brassicasterols and stanols) and cholesterol. The quality of the new analytical data was assessed. The aims of the present study were: (1) to compare the effect of old and new database values on PS and cholesterol intakes based on average per capita food consumption data; (2) to estimate the current intake and major sources of these compounds in various population groups according to the national FINDIET 1997 survey data. The intake of total PS was 305 mg/d for men and 237 mg/d for women. The respective intakes for cholesterol were 284 mg/d and 201 mg/d. Women had a higher density of PS in their diets than men, whereas the cholesterol density in the diets did not differ between genders. Cereals, margarine, vegetables and vegetable oils were the main food sources of PS. Meat, meat products and eggs were the main sources of cholesterol. A 9 % greater PS intake estimate was obtained with the new PS database compared with the old PS database, probably due to minor methodological differences between the new and old analyses. Notable changes in analytical methods suggest a lower value (-19 %) for cholesterol intake calculated from the new database compared with the old one. We conclude that researchers can have confidence in the new values for PS and cholesterol, because systematic evaluation of the new analytical values showed them to be of high quality.

Isoflavone intake in four different European countries : The VENUS approach

The aim of this study was to identify the level of isoflavone intake (total isoflavones, daidzein and genistein) in four European countries: Ireland, Italy, The Netherlands and the UK. For this purpose national food composition databases of isoflavone content were created in a comparable way, using the Vegetal Estrogens in Nutrition and the Skeleton (VENUS) analytical database as a common basis, and appropriate food consumption data were selected. The isoflavone intake in Ireland, Italy, The Netherlands and the UK is on average less than 1 mg/d. Small groups of consumers of soya foods could be identified in Ireland, The Netherlands and the UK. The estimated intake levels are low compared with those found in typical Asian diets (approximately 20-100 mg/d) and also low compared with levels where physiological effects are expected (60-100 mg/d). The results (including a subgroup analysis of soya product consumers) showed that such levels are difficult to achieve with the European diets studied here.

Sodium in the Finnish diet: II trends in dietary sodium intake and comparison between intake and 24-h excretion of sodium.

Objective:To estimate cross-sectional and long-term dietary sodium intakes and sources in Finland, and to evaluate the validity of 48-h recall to assess sodium intake.Design:Cross-sectional dietary surveys and food availability data (Food Balance Sheets).Setting:Dietary surveys were carried out in Finland in 1992, 1997 and 2002. Food availability data were collected from 1980 to 1999.Subjects:A stratified random sample was drawn from the population register. The total number of participants in the three dietary surveys was 6730. In the subsample for urine collection, the number of participants was 879.Interventions:Nutrient intakes were estimated on the basis of a 3-day food diary in 1992, a 24-h recall in 1997 and a 48-h recall in 2002. The 24-h urinary excretion of sodium was used to validate sodium intake. In addition, salt intake was estimated based on Food Balance Sheets.Results:Sodium intake has slowly decreased since the early 1980s. Reported daily sodium intake correlated significantly with sodium excretion.Conclusions:Sodium intake has decreased during the last two decades, but is still higher than the recommended daily intake. Sodium intake estimation based on dietary surveys and food availability data is a valid method provided that the food composition database is up to date and of good quality.Sponsorship:All surveys were funded by the National Public Health Institute in Finland and the Ministry of Social Affairs and Health.

Folate intake, plasma folate and homocysteine status in a random Finnish population

Objective: To assess the folate status of Finnish adults using plasma folate and homocysteine as biomarkers and to evaluate dietary and supplementary folate intakes.Materials and methods: Plasma folate, vitamin B12 and total homocysteine (tHcy) were determined in a random sample of 643 subjects aged 25–74 y living in the Helsinki area. The methylenetetrahydrofolate reductase (MTHFR)-genotypes were analyzed from a subsample (n=394). Dietary intake data by 24 h recall and use of vitamin supplements were collected.Results: Plasma folate was normal (≥5 nmol/l) in 99% of subjects and optimal (≥8 nmol/l) in terms of a minimum tHcy in 90%. Mean plasma folate of non-supplement users was 13.7 and 12.9 nmol/l and tHcy 11.3 and 9.2 µmol/l for men and women, respectively. Elevated tHcy (>14 µmol/l) was found in 11% of subjects. Homozygote frequency for MTHFR genotype TT was 5.0% and their plasma tHcy was 14.8 µmol/l compared to the mean of the other subjects, 10.5 µmol/l, P<0.05. The mean dietary folate intake was 241 µg/day (29 µg/MJ of energy) for men and 205 µg/day (33 µg/MJ) for women, respectively. The main dietary sources of folate were vegetables 12%, wholemeal ryebread 11%, fruits 10%, and potato 10%. Regular supplement users (n=97) received on average 207 µg folic acid per day from supplements.Conclusion: The folate status of Finnish adults seems to be adequate according to energy adjusted folate intake, plasma folate and homocysteine. The MTHFR homozygote frequency was low compared to other countries. Regular use of supplementary folic acid less than 300 µg increased plasma folate, but supplemental folic acid over 300 µg was required to lower tHcy values significantly.

FINDIET 2007 Survey: energy and nutrient intakes.

OBJECTIVE The National FINDIET surveys are carried out every 5 years to monitor dietary habits and nutrient intake of the adult Finnish population. The latest survey was carried out in 2007. DESIGN Cross-sectional population-based study. Dietary assessment was carried out using 48 h recall interviews. A picture book of food portions was used to estimate portion sizes and the national Food Composition Database Fineli(R) to calculate nutrient intakes. SETTING A representative sample taken in five regions in Finland. SUBJECTS A total of 730 men and 846 women aged 24-64 years. RESULTS The percentage contribution of fat to the total energy intake was 33 % in men and 31 % in women. The respective percentages for SFA in men and women were 13 % and 12 %, respectively, and 0.4 % for trans fatty acids in both genders. The average intakes of folate, vitamin D and fibre fell below the recommended levels, whereas the average salt intake was somewhat higher than the recommendations. Womens diet was higher in protein, dietary fibre and sucrose compared to that of men. CONCLUSIONS According to the FINDIET 2007 Survey, the dietary habits of the adult Finnish population have headed in a positive direction overall. However, although the quality of the fats consumed has continued to improve, and the intake of salt has decreased, they still do not meet the recommended levels of intake. Similarly, the average intakes of folate and vitamin D continue to fall below the recommendations. There is also a need to increase fibre intake and to cut down the intake of sucrose.

The compilation of food analysis values as a database for dietary studies—the finnish experience

In dietary studies the food composition data are needed for assessing intake of study subjects. A database for this purpose should include content for foods as consumed, i.e. the database should include brands and dishes described by recipes. The progress made in developing the national Finnish food composition database for dietary studies at the National Public Health Institute is presented. The usefulness of a relational database model in database maintenance is considered and some gaps (e.g. missing foods and retention factors for loss) are discussed. As future challenges, setting priorities in analysis needs, co-operation on food description as well as on nutrient identification are emphasized.

Body Size at Birth Is Associated with Food and Nutrient Intake in Adulthood

Background Small body size at birth is associated with an increased risk of cardiovascular disease and type 2 diabetes. Dietary habits are tightly linked with these disorders, but the association between body size at birth and adult diet has been little studied. We examined the association between body size at birth and intake of foods and macronutrients in adulthood. Methodology/Principal Findings We studied 1797 participants, aged 56 to 70, of the Helsinki Birth Cohort Study, whose birth weight and length were recorded. Preterm births were excluded. During a clinical study, diet was assessed with a validated food-frequency questionnaire. A linear regression model adjusted for potential confounders was used to assess the associations. Intake of fruits and berries was 13.26 g (95% confidence interval [CI]: 0.56, 25.96) higher per 1 kg/m3 increase in ponderal index (PI) at birth, and 83.16 g (95% CI: 17.76, 148.56) higher per 1 kg higher birth weight. One unit higher PI at birth was associated with 0.14% of energy (E%) lower intake of fat (95% CI: -0.26, -0.03) and 0.18 E% higher intake of carbohydrates (95% CI: 0.04, 0.32) as well as 0.08 E% higher sucrose (95% CI: 0.00, 0.15), 0.05 E% higher fructose (95% CI: 0.01, 0.09), and 0.18 g higher fiber (95% CI: 0.02, 0.34) intake in adulthood. Similar associations were observed between birth weight and macronutrient intake. Conclusions Prenatal growth may modify later life food and macronutrient intake. Altered dietary habits could potentially explain an increased risk of chronic disease in individuals born with small body size.