Pirjo Härkönen

Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study.

BACKGROUND Lifestyle interventions can prevent the deterioration of impaired glucose tolerance to manifest type 2 diabetes, at least as long as the intervention continues. In the extended follow-up of the Finnish Diabetes Prevention Study, we assessed the extent to which the originally-achieved lifestyle changes and risk reduction remain after discontinuation of active counselling. METHODS Overweight, middle-aged men (n=172) and women (n=350) with impaired glucose tolerance were randomly assigned to intensive lifestyle intervention or control group. After a median of 4 years of active intervention period, participants who were still free of diabetes were further followed up for a median of 3 years, with median total follow-up of 7 years. Diabetes incidence, bodyweight, physical activity, and dietary intakes of fat, saturated fat, and fibre were measured. FINDINGS During the total follow-up, the incidence of type 2 diabetes was 4.3 and 7.4 per 100 person-years in the intervention and control group, respectively (log-rank test p=0.0001), indicating 43% reduction in relative risk. The risk reduction was related to the success in achieving the intervention goals of weight loss, reduced intake of total and saturated fat and increased intake of dietary fibre, and increased physical activity. Beneficial lifestyle changes achieved by participants in the intervention group were maintained after the discontinuation of the intervention, and the corresponding incidence rates during the post-intervention follow-up were 4.6 and 7.2 (p=0.0401), indicating 36% reduction in relative risk. INTERPRETATION Lifestyle intervention in people at high risk for type 2 diabetes resulted in sustained lifestyle changes and a reduction in diabetes incidence, which remained after the individual lifestyle counselling was stopped.

Postchallenge Glucose, A1C, and Fasting Glucose as Predictors of Type 2 Diabetes and Cardiovascular Disease A 10-year prospective cohort study

OBJECTIVE A1C has been proposed as a new indicator for high risk of type 2 diabetes. The long-term predictive power and comparability of elevated A1C with the currently used high-risk indicators remain unclear. We assessed A1C, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) as predictors of type 2 diabetes and cardiovascular disease (CVD) at 10 years. RESEARCH DESIGN AND METHODS This prospective population-based study of 593 inhabitants from northern Finland, born in 1935, was conducted between 1996 and 2008. An oral glucose tolerance test (OGTT) was conducted at baseline and follow-up, and A1C was determined at baseline. Those with a history of diabetes were excluded from the study. Elevated A1C was defined as 5.7–6.4%. Incident type 2 diabetes was confirmed by two OGTTs. Cardiovascular outcome was measured as incident CVD or CVD mortality. Multivariate log-binomial regression models were used to predict diabetes, CVD, and CVD mortality at 10 years. Receiver operating characteristic curves compared predictive values of A1C, IGT, and IFG. RESULTS Incidence of diabetes during the follow-up was 17.1%. Two of three of the cases of newly diagnosed diabetes were predicted by a raise in ≥1 of the markers. Elevated A1C, IGT, or IFG preceded diabetes in 32.8, 40.6, and 21.9%, respectively. CVD was predicted by an intermediate and diabetic range of 2-h glucose but only by diabetic A1C levels in women. CONCLUSIONS A1C predicted 10-year risk of type 2 diabetes at a range of A1C 5.7–6.4% but CVD only in women at A1C ≥6.5%.

Insulin resistance and depressive symptoms in young adult males: findings from Finnish military conscripts.

Objective: To investigate whether the association between insulin resistance (IR) and depressive symptoms is present already in young adult males. The association between IR and depression has been poorly studied, although the existence of a connection of Type II diabetes with depression is well established. We previously demonstrated at epidemiological level in two groups of men aged 31 years and 61 to 63 years that IR is linked with depressive symptoms. Methods: In a cross-sectional study, involving 1054 healthy Finnish male military conscripts of about 19 years of age, IR was defined through homeostasis model assessment (HOMA-IR). The severity of the depressive symptoms was evaluated through a Finnish modification of the 13-item Beck Depression Inventory (R-BDI). Moderate-to-severe depressive symptoms were said to be present, if the R-BDI score was ≥8, and mild depressive symptoms were present if the R-BDI score was 5 to 7. Results: After adjusting for confounders, moderate-to-severe depressive symptoms increased the risk for IR, as defined by the highest decile of the HOMA-IR, up to 2.8-fold (odds ratio = 2.8; 1.2–6.5). Mild depressive symptoms were not significantly associated with IR. Conclusions: In young adult males, co-occurring strictly defined IR seems to be positively associated with current moderate-to-severe depressive symptoms. cAMP = cyclic adenosine monophosphate; CI = confidence interval; HOMA = homeostasis model assessment; HPA = hypothalamus-pituitary-adrenal; GR = glucocorticoid receptor; IR = insulin resistance; OR = odds ratio; PKA = protein kinase A; R-BDI = Finnish modification of the 13-item Beck Depression Inventory.

Limited Overlap Between Intermediate Hyperglycemia as Defined by A1C 5.7–6.4%, Impaired Fasting Glucose, and Impaired Glucose Tolerance

OBJECTIVE We compared the prevalences and overlap between intermediate hyperglycemia (IH), defined by a hemoglobin A1c (A1C) 5.7–6.4%, impaired fasting glucose (IFG), and impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS Oral glucose tolerance test results and A1C measurements were evaluated as markers of IH in an unselected cohort of 486 nondiabetic adults from Finland. RESULTS The overall prevalence of IH was 34%. Prevalences of isolated A1C 5.7–6.4%, IGT, and IFG were 8.0, 13.2, and 4.5%, respectively. Overlap between these three markers was uncommon. Isolated A1C 5.7–6.4% was associated with a higher BMI compared with isolated IFG and IGT and with a more adverse lipid profile compared with isolated IFG. CONCLUSIONS Prevalence of isolated IH was high, with limited overlap between the definitions. Differences in cardiovascular disease risk factors were observed among the groups. This study demonstrates that an A1C of 5.7–6.4% detects, in part, different individuals with IH compared with IFG and IGT.

Physical Activity and Body Composition Changes during Military Service

PURPOSE To examine how body composition changes in different body mass index (BMI) categories among young Finnish men during military service, which is associated with marked changes in diet and physical activity. In addition, this study examined how reported previous physical activity affected the body composition changes. METHODS Altogether 1003 men (19 yr) were followed throughout their military service (6-12 months). Height, weight, BMI, waist circumference, and waist-to-hip ratio (WHR) were recorded. Previous physical activity was assessed at the beginning of the service by a questionnaire. Body composition was measured by bioelectrical impedance assessments (BIA) at the beginning and at the end of the service. The measured parameters were fat mass (FM), fat percentage (fat %), fat-free mass (FFM), visceral fat area (VFA), lean body mass (LBM), and skeletal muscle mass (SMM). RESULTS On average, military training decreased weight by 0.7%, FM by 9.7%, fat % by 6.6%, and VFA by 43.4%. FFM increased by 1.3%, LBM by 1.2%, and SMM by 1.7%. The group of underweight and normal-weight men gained weight, FM, and FFM, whereas overweight and obese men lost weight and FM and gained FFM. FM was most reduced in the groups of overweight (20.8%) and obese (24.9%) men. The amount of VFA was reduced in all BMI groups (38%-44%). Among overweight men who reported being inactive previous to the military service, more beneficial changes in body composition were observed compared with those who reported being physically active. CONCLUSIONS The lifestyle changes associated with military service markedly reduce fat tissue and increase the amount of lean tissue. These beneficial changes are prominent among previously inactive subjects with high BMI.

Prevalence of metabolic syndrome components among the elderly using three different definitions: a cohort study in Finland.

Abstract Objective. Limited data are available on the metabolic syndrome (MetS) and its components in elderly people (aged 70 years and over) at population level in Northern Europe. A study was undertaken to investigate the prevalence of MetS and its components in an aging population by using different definitions. Design, setting, and subjects. A cross-sectional study of 539 inhabitants from Northern Finland (mean age 71.9 years) was conducted to investigate the prevalence of MetS, by using the definitions of MetS by the National Cholesterol Education Panel (NCEP), the modified NCEP (NCEPm), and the International Diabetes Federation (IDF). Main outcome measures. Prevalence of MetS by the NCEP, NCEP modified, and IDF criteria. Results. Overall, the prevalence of MetS was 24.7%, 35.2%, and 37.2% in men, by NCEP, modified NCEP, and IDF-definitions, respectively. In women the corresponding figures were 20.9%, 33.1%, and 47.8%. Hypertension was the most common component in both men (91.8%) and women (89.0%) by the IDF criteria. Glucose abnormalities were particularly prevalent in men (53.2% by NCEP and 78.4% by IDF criteria). Conclusions. The most common component was hypertension in both genders. Lower waist-circumference cut-off points of the IDF criteria led to a higher prevalence of MetS particularly in women. Prevalence of MetS varied significantly when measured by different definitions. Nearly half of older women met the IDF definition of MetS, which was more than twofold when compared with NCEP. Clinical practitioners should be aware of the limitations when using set criteria of MetS, in contrast to identifying the individual cardiovascular risk factors and the accumulation of these.

Exercise during military training improves cardiovascular risk factors in young men

OBJECTIVE Physical activity is a key component of lifestyle intervention but its independent contribution to weight loss and prevention of cardiovascular disease (CVD) remains unclear. We conducted a population-level follow-up study among young healthy Finnish men undergoing an intensive exercise intervention to examine the independent contribution of exercise to common CVD risk factors. METHODS A prospective study of 1112 young men with mean age of 19.3 years (range 19-28) undergoing military service with structured exercise training program. Endurance (12-min running test) and muscle fitness performance (MFI), body composition, blood pressure and biochemical measurements were obtained at baseline and follow-up (range 6-12 months). RESULTS Both endurance performance and MFI improved during follow-up (+170 m (SD 269) and 1.5 points (2.3), respectively, p<0.001 for both). Both improvement in endurance and MFI performance correlated with a reduction in weight, body mass index, waist circumference, fat mass and percentage, visceral fat area (VFA) and diastolic blood pressure (p<0.001 for all). Improvement in endurance performance also correlated with reduction in systolic blood pressure (p=0.042), total and LDL cholesterol (p=0.024 and p<0.0001, respectively) and improvement in MFI with a reduction in triglyceride levels (p=0.012). The 12-min running test correlated with changes in CVD risk factors better than did MFI. Associations between improved exercise performance and reduction in blood pressure, and changes in lipid levels were attributable to reduced weight and VFA. CONCLUSION We observed that an isolated, intensive exercise intervention, especially endurance training, significantly improved CVD risk factor levels, attributable to weight loss and reduced visceral fat area.

Health-related quality of life and physical well-being among a 63-year-old cohort of women with androgenetic alopecia; a Finnish population-based study

BackgroundThe aim of this study was to assess the possible associations between female androgenetic alopecia (AGA), insulin resistance and health-related quality of life (HRQOL)-linked factors in women. We hypothesized that not only the mental aspects but also certain physical aspect of womens health, such as insulin resistance, have an important role in the determination of HRQOL among women with hair loss.MethodsA population-based cohort of 330 healthy women aged 63 years, who participated in this study in the City of Oulu in Northern Finland, underwent a medical check-up including assessment of hair status on Ludwigs scale. Background data were collected with a standard questionnaire including a validated RAND 36-Item Health Survey (RAND-36) questionnaire.Results105 (31%) women with AGA and 225 (69%) controls completed the RAND-36 questionnaire. The women with AGA were more insulin-resistant than the women with normal hair (QUICKI 0.337 vs. 0.346, p = 0.012). Impaired glucose regulation (IGR) was more prevalent among the former than the latter group (39% vs. 25%). The mean RAND-36 scores were significantly lower on the dimensions of physical functioning, role limitation due to physical health and general health, but not on the mental or social dimensions, among the women with AGA compared with the controls. In multivariate logistic regression analyses with the lowest quintiles of the HRQOL dimensions as the dependent variables and AGA, depression, marital status, education and IGR or QUICKI as independent variables, AGA was independently associated with role limitations due to physical health (2.2, 95% CI 1.20–4.05, 2.45 95% CI 1.32–4.55, respectively).ConclusionIn women aged 63 years, AGA was associated with role limitations due to physical health. Furthermore, the prevalence rates of IGR and insulin resistance measured by QUICKI were higher among the women with hair loss than those with normal hair.

Aerobic performance and body composition changes during military service

Abstract Objective. To examine the association between aerobic performance and body composition changes by body mass index (BMI). Design. 6–12 months’ follow-up during military service. Setting. Conscripts entering military service in 2005 in Sodankylä Jaeger Brigade (Finland). Subjects. 945 men (19 years, SD 1 years). Main outcome measures. Height, weight, waist circumference, BMI, and aerobic performance (Cooper test) were recorded. Body composition was measured by bioelectrical impedance analysis (BIA). The measured parameters were fat mass (FM), fat free mass (FFM), and visceral fat area (VFA). All the measurements were performed at the beginning and end of service. Results. On average, the military training period improved the running distance by 6.8% (169 m, p < 0.001) and the improvements were more pronounced in overweight (223.9 m/9.5%, p < 0.001) and obese (273.3 m/13.6 %, p < 0.001) conscripts. A strong inverse correlation between aerobic performance and body composition changes was observed, especially for weight (r = –0.305, p < 0.001) and VFA (r = –0.465, p < 0.001). A significant association between aerobic performance and changes in weight (p < 0.001), waist circumference (p < 0.001), FM (p < 0.001), and VFA (p < 0.001) by BMI was detected. The associated decrease in weight, waist circumference, FM, and VFA with improved aerobic performance was more substantial between overweight and obese compared with normal-weight subjects. Conclusions. Favourable changes in body composition are associated with improved aerobic performance during a physical training period such as military service. These findings are pronounced among overweight and obese men and can be applied at the population level in reducing obesity and co-morbidities.

Associations of Total Testosterone and Sex Hormone–Binding Globulin Levels With Insulin Sensitivity in Middle-Aged Finnish Men

While sex hormone–binding globulin (SHBG) production in the liver is mainly regulated by sex steroids and thyroxine, insulin is suggested to be another important regulator, and a low SHBG level is a marker of insulin resistance (1) and, consequently, a predictor of type 2 diabetes (2). The role of testosterone, another risk marker of type 2 diabetes, has been insufficiently clarified (2). Further, only one earlier study (3) has found evidence suggesting that, compared with total testosterone, high SHBG may be a more powerful correlate of insulin sensitivity, mediating the link between total testosterone and insulin sensitivity. We investigated the contribution of SHBG to the association between total …