Merja K. Laine

Former male elite athletes have better metabolic health in late life than their controls.

Elite‐class athletes have longer life expectancy and lower risk for chronic noncommunicable diseases possibly because of physically active and healthier lifestyle. In this study, we assessed former male Finnish elite‐class athletes’ (n = 392) and their matched controls’ (n = 207) body composition, and risk for the metabolic syndrome (MS) and nonalcoholic fatty liver disease (NAFLD) in later life. Compared with the controls, the former athletes had lower body fat percentage (24.8% vs 26.0%, P = 0.021), lower risk for MS [odds ratio (OR) 0.57, 95% confidence interval (CI) 0.40–0.81], and NAFLD (OR 0.61, 95% CI 0.42–0.88). High volume of current leisure‐time physical activity (LTPA) was associated with lower body fat percentage (P for trend < 0.001). When current volume of LTPA increased 1 MET h/week, the risk of MS and NAFLD decreased (OR 0.99, 95% CI 0.98–0.99 and OR 0.97, 95% CI 0.96–0.98, respectively). Although a career as an elite‐class athlete during young adulthood may help to protect from developing metabolic syndrome, present exercise levels and volume of LTPA seem equally important as well.

Former male elite athletes have better metabolic health in late life than their controls

Elite‐class athletes have longer life expectancy and lower risk for chronic noncommunicable diseases possibly because of physically active and healthier lifestyle. In this study, we assessed former male Finnish elite‐class athletes’ (n = 392) and their matched controls’ (n = 207) body composition, and risk for the metabolic syndrome (MS) and nonalcoholic fatty liver disease (NAFLD) in later life. Compared with the controls, the former athletes had lower body fat percentage (24.8% vs 26.0%, P = 0.021), lower risk for MS [odds ratio (OR) 0.57, 95% confidence interval (CI) 0.40–0.81], and NAFLD (OR 0.61, 95% CI 0.42–0.88). High volume of current leisure‐time physical activity (LTPA) was associated with lower body fat percentage (P for trend < 0.001). When current volume of LTPA increased 1 MET h/week, the risk of MS and NAFLD decreased (OR 0.99, 95% CI 0.98–0.99 and OR 0.97, 95% CI 0.96–0.98, respectively). Although a career as an elite‐class athlete during young adulthood may help to protect from developing metabolic syndrome, present exercise levels and volume of LTPA seem equally important as well.

Branched-Chain Amino Acid Levels Are Related with Surrogates of Disturbed Lipid Metabolism among Older Men

Aims/hypothesis Existing studies suggest that decreased branched-chain amino acid (BCAA) catabolism and thus elevated levels in blood are associated with metabolic disturbances. Based on such information, we have developed a hypothesis how BCAA degradation mechanistically connects to tricarboxylic acid cycle, intramyocellular lipid storage, and oxidation, thus allowing more efficient mitochondrial energy production from lipids as well as providing better metabolic health. We analyzed whether data from aged Finnish men are in line with our mechanistic hypothesis linking BCAA catabolism and metabolic disturbances. Methods Older Finnish men enriched with individuals having been athletes in young adulthood (n = 593; mean age 72.6 ± 5.9 years) responded to questionnaires, participated in a clinical examination including assessment of body composition with bioimpedance and gave fasting blood samples for various analytes as well as participated in a 2-h 75 g oral glucose tolerance test. Metabolomics measurements from serum included BCAAs (isoleucine, leucine, and valine). Results Out of the 593 participants, 59 had previously known type 2 diabetes, further 67 had screen-detected type 2 diabetes, 127 impaired glucose tolerance, and 125 impaired fasting glucose, while 214 had normal glucose regulation and one had missing glucose tolerance information. There were group differences in all of the BCAA concentrations (p ≤ 0.005 for all BCAAs), such that those with normal glucose tolerance had the lowest and those with diabetes mellitus had the highest BCAA concentrations. All BCAA levels correlated positively with body fat percentage (r = 0.29–0.34, p < 0.0001 for all). Expected associations with high BCAA concentrations and unfavorable metabolic profile indicators from metabolomics analysis were found. Except for glucose concentrations, the associations were stronger with isoleucine and leucine than with valine. Conclusion/interpretation The findings provided further support for our hypothesis by strengthening the idea that the efficiency of BCAA catabolism may be mechanistically involved in the regulation of fat oxidation, thus affecting the levels of metabolic disease risk factors.

Former male elite athletes and risk of hypertension in later life

Objective: The aim of this study was to assess whether a former career as an elite athlete protects from hypertension in later life. We hypothesized that vigorous physical activity during young adulthood protects against hypertension later in life. Methods: The study population (n = 3440) consists of 2037 former male elite athletes and 1403 matched controls. Of those, 599 (392 former athletes, 207 controls) participated in a clinical study in 2008. The athletes were divided into three groups: endurance, mixed and power sports. Assessment of hypertension was based on athletes’ entitlement to reimbursable antihypertensive medication from the Finnish Social Insurance Institution; among the clinical study participants, this was also based on self-reported current use of antihypertensive drugs or measured hypertension. The current volume of leisure-time physical activity (LTPA) was determined by questionnaires. Results: Among the participants, the former athletes had lower age-adjusted prevalence of hypertension than the controls [odds ratio (OR) 0.69, 95% confidence interval (CI) 0.49–0.98] and the endurance athletes had the lowest OR (OR 0.43, 95% CI 0.23–0.80). OR for the prevalence of hypertension decreased (OR 0.90, 95% CI 0.84–0.96 per 10 metabolic equivalent hours/week) when there was an increase in the volume of LTPA. The former athletes without blood pressure-lowering medication had significantly lower SBP than the controls [139.2 mmHg (SD 18.7) vs. 144.2 mmHg (SD 19.5)] (P = 0.027). Conclusion: A former career as an elite athlete seems to be associated with a lower prevalence of hypertension in later life. The volume of current LTPA was inversely related to prevalence of hypertension.

Gestational diabetes in primiparous women–impact of age and adiposity: a register‐based cohort study

Data on risk factors for gestational diabetes mellitus (GDM) in primiparous women is limited. The aim of this study was to assess the prevalence of GDM and simultaneously evaluate the impact of age and adiposity in primiparous women at risk of GDM risk.

Mobility and muscle strength in male former elite endurance and power athletes aged 66−91 years

The aim of this cross‐sectional study was to compare mobility and muscle strength in male former elite endurance and power athletes aged 66−91 years (n = 150; 50 men in both former elite athlete groups and in their control group). Agility, dynamic balance, walking speed, chair stand, self‐rated balance confidence (ABC‐scale), jumping height, and handgrip strength were assessed. Former elite power athletes had better agility performance time than the controls (age‐ and body mass index, BMI‐adjusted mean difference −3.6 s; 95% CI −6.3, −0.8). Adjustment for current leisure time physical activity (LTPA) and prevalence of diseases made this difference non‐significant (P = 0.214). The subjects in the power sports group jumped higher than the men in the control group (age‐ and BMI‐adjusted mean differences for vertical squat jump, VSJ 4.4 cm; 95% CI 2.0, 6.8; for countermovement jump, CMJ 4.0 cm; 95% CI 1.7, 6.4). Taking current LTPA and chronic diseases for adjusting process did not improve explorative power of the model. No significant differences between the groups were found in the performances evaluating dynamic balance, walking speed, chair stand, ABC‐scale, or handgrip strength. In conclusion, power athletes among the aged former elite sportsmen had greater explosive force production in their lower extremities than the men in the control group.

Contacting dropouts from type 2 diabetes care in public primary health care: description of the patient population

Abstract Objective: To characterize dropouts from type-2 diabetes (T2D) care in communal primary health care. Design: An observational study. Setting: In a Finnish city, patients with T2D who had not contacted the public primary health care system during the past 12 months were identified with a computer based search and contacted by a trained diabetes nurse. Subjects: Dropouts from T2D treatment. Main outcome measures: Demographic factors, laboratory parameters, examinations, medications, and comorbidities. Results: Of the patients with T2D, 10% (n = 356) were dropouts and 60% of them were men. Median HbA1c was 6.5 (QR for 25% and 75%: 6.0, 7.7) %, (45 [42,61] mmol/mol). Of the dropouts, 14% had HbA1c ≥ 9.0% (75 mmol/mol), and these patients were younger than the other dropouts (mean age 54.4 [SD 10.8] years vs. 60.6 [9.4] years, p < 0.001). Median low-density lipoprotein (LDL) cholesterol level was 2.8 (QR 2.1, 3.4) mmol/l. Median systolic blood pressure (BP) was 142 (QR 130, 160) mm Hg. Median diastolic BP was 86 (78, 94) mm Hg. Of the dropouts, 83% had comorbidities and 62% were prescribed metformin as a treatment. Conclusions: Ten percent of T2D patients were dropouts of whom those with a poor glycaemic control were younger than the other dropouts. BP and LDL cholesterol concentrations were non-optimal among the majority of the dropouts. Metformin was prescribed less frequently to the dropouts than is usual for T2D patients. The comorbidities were equally common among the dropouts as among the other T2D patients. KEY POINTS   Which kinds of patients are dropouts from type-2 diabetes care is not known. • One-tenth of the patients with T2D were dropouts and they generally had good glycaemic control. • Blood pressure and LDL cholesterol concentrations were non-optimal among the majority of the dropouts. • Fourteen percent of these dropouts had HbA1c > 9% (75 mmol/mol) and they were more often younger than the other dropouts.

Comparison of use of diabetic medication and clinical guidelines in four Nordic countries

Abstract Background Clinical guidelines form one of the cornerstones for providing high-quality care for patients with diabetes. We compare the national guidelines and the use of glucose lowering medication for type 2 diabetes (T2D) in Denmark, Finland, Norway and Sweden. Methods We compared how guidelines take comprehensive care into consideration, what treatment targets and what antihyperglycemic medication was recommended. The use of glucose-lowering medication was based on the sales of diabetes drugs in these countries. Results All guidelines stress the importance of comprehensive diabetes care. Individualized glycemic targets are emphasized especially in the Danish and Finnish guidelines. In 2013, sulfonylureas were the most common second-line treatment after metformin in Denmark, Norway and Sweden; in Finland, this position was taken by DPP-4 inhibitors. Recommended initial insulin type for patients with T2D differs between the four countries. Danish, Norwegian and Swedish guidelines also take economic aspects into account. Conclusions All guidelines stress regular and comprehensive diabetes care. Danish and Finnish guidelines strongly underline the importance of individualized glycemic targets. All guidelines recommend metformin as the initial oral antihyperglycemic drug. In relation to recommended second line drug therapy and initial insulin type for patients with T2D, the guidelines vary largely between the four countries. Key messages All Nordic guidelines for treating type 2 diabetes stress the importance of comprehensive care. The Danish and Finnish guidelines underline the importance of individualized glycemic targets. The first line and most commonly used oral antihyperglycemic drug is metformin in all four countries. Recommended second line antihyperglycemic treatment differs largely between the four Nordic guidelines. Recommended initial insulin type for patients with T2D differs between the guidelines.

Risk of preterm birth in primiparous women with exposure to antidepressant medication before pregnancy and/or during pregnancy – impact of body mass index

Abstract Introduction: Preterm birth is a major cause of infant mortality. It is unknown whether body mass index (BMI) influences the risk of preterm birth in women, who prenatally use antidepressants. Materials and methods: The study cohort (N = 6920) consists of all primiparous European born women without previously diagnosed diabetes from the city of Vantaa, Finland, who delivered a singleton child between 2009 and 2015. Data on births, pre-pregnancy BMI and purchases of antidepressants from 12 months before conception until delivery were obtained from Finnish National Registers. Results: Of the primiparous women, 9.9% used antidepressants. The overall prevalence of preterm birth was 5.2%. In women with a pre-pregnancy BMI <18.5 kg/m2, the Odds Ratio (OR) for preterm birth among antidepressant users compared with those who were non-users was 1.91 (95% confidence intervals [CI] 0.40 to 9.15, adjusted for age, smoking, education, use of fertility treatments and number of previous pregnancies) while in women with a pre-pregnancy BMI ≥30 kg/m2, the OR was 0.53 (95% CI 0.21–1.36), respectively. Discussion: Primiparous women using antidepressants, who were underweight before conception should be closely monitored and provided tailored care in a maternity clinic to minimize the risk of preterm birth. Key messages In primiparous women, one in ten used antidepressant medications before pregnancy and/or during pregnancy. In primiparous women, the prevalence of preterm birth was 5%. Underweight primiparous women using antidepressants should be closely monitored and provided tailored care in a maternity clinic.