Tuija Jääskeläinen

The positive impact of general vitamin D food fortification policy on vitamin D status in a representative adult Finnish population: evidence from an 11-y follow-up based on standardized 25-hydroxyvitamin D data

Background: A systematic vitamin D fortification of fluid milk products and fat spreads was started in 2003 in Finland to improve vitamin D status. Objective: We investigated the effects of the vitamin D fortification policy on vitamin D status in Finland between 2000 and 2011.Design: Serum 25-hydroxyvitamin D [S-25(OH)D] concentrations of a nationally representative sample comprising 6134 and 4051 adults aged ≥30 y from the Health 2000 and Health 2011 surveys, respectively, were standardized according to the Vitamin D Standardization Program with the use of liquid chromatography-tandem mass spectrometry. Linear and logistic regression models were used to assess the change in S-25(OH)D concentrations.Results: Between 2000 and 2011, the mean S-25(OH)D increased from 48 nmol/L (95% CI: 47, 48 nmol/L) to 65 nmol/L (95% CI: 65, 66 nmol/L) (P < 0.001). The prevalence of vitamin D supplement users increased from 11% to 41% (P < 0.001). When analyzing the effect of fortification of fluid milk products, we focused on supplement nonusers. The mean increase in S-25(OH)D in daily fluid milk consumers (n = 1017) among supplement nonusers was 20 nmol/L (95% CI: 19, 21 nmol/L), which was 6 nmol/L higher than nonconsumers (n = 229) (14 nmol/L; 95% CI: 12, 16 nmol/L) (P < 0.001). In total, 91% of nonusers who consumed fluid milk products, fat spreads, and fish based on Finnish nutrition recommendations reached S-25(OH)D concentrations >50 nmol/L in 2011.Conclusions: The vitamin D status of the Finnish adult population has improved considerably during the time period studied. The increase is mainly explained by food fortification, especially of fluid milk products, and augmented vitamin D supplement use. Other factors, such as the difference in the ultraviolet radiation index between 2000 and 2011, may partly explain the results. When consuming vitamin D sources based on the nutritional recommendations, vitamin D status is sufficient [S-25(OH)D ≥50 nmol/L], and supplementation is generally not needed.

Higher serum 25-hydroxyvitamin D concentrations are related to a reduced risk of depression.

Vitamin D has been suggested to protect against depression, but epidemiological evidence is scarce. The present study investigated the relationship of serum 25-hydroxyvitamin D (25(OH)D) with the prevalence of depressive and anxiety disorders. The study population consisted of a representative sample of Finnish men and women aged 30-79 years from the Health 2000 Survey. The sample included 5371 individuals, of which 354 were diagnosed with depressive disorder and 222 with anxiety disorder. Serum 25(OH)D concentration was determined from frozen samples. In a cross-sectional study, a total of four indicators of depression and one indicator of anxiety were used as dependent variables. Serum 25(OH)D was the risk factor of interest, and logistic models used further included sociodemographic and lifestyle variables as well as indicators of metabolic health as confounding and/or effect-modifying factors. The population attributable fraction (PAF) was estimated. Individuals with higher serum 25(OH)D concentrations showed a reduced risk of depression. The relative odds between the highest and lowest quartiles was 0.65 (95% CI 0.46, 0.93; P for trend = 0.006) after adjustment for sociodemographic, lifestyle and metabolic factors. Higher serum 25(OH)D concentrations were associated with a lower prevalence of depressive disorder especially among men, younger, divorced and those who had an unhealthy lifestyle or suffered from the metabolic syndrome. The PAF was estimated to be 19% for depression when serum 25(OH)D concentration was at least 50 nmol/l. These results support the hypothesis that higher serum 25(OH)D concentrations protect against depression even after adjustment for a large number of sociodemographic, lifestyle and metabolic factors. Large-scale prospective studies are needed to confirm this finding.

Social support as a predictor of the outcome of depressive and anxiety disorder in short-term and long-term psychotherapy

Social support is known to be important for well-being of individuals, but it is not clear how it predicts psychotherapy outcome in patients suffering from depressive or anxiety disorders. The aim of the present study was to study the prediction of social support on the outcome of short-term and long-term psychotherapy. In the Helsinki Psychotherapy Study, 326 psychiatric outpatients, aged 20-46 years, and suffering from depressive or anxiety disorders, were randomly assigned to short-term psychotherapy (short-term psychodynamic or solution-focused) or long-term psychodynamic psychotherapy. The level of social support at baseline was assessed using the Brief Inventory of Social Support and Integration (BISSI). Psychiatric symptoms were assessed with the Symptom Check List, Global Severity Index (SCL-90-GSI) at baseline and four times during a 3-year follow-up. Patients with a high level of social support before treatment benefitted more from long-term than short-term therapy at the 3-year follow-up, whereas patients with a low level of social support experienced no such benefit. Pretreatment social support seems to predict differentially short- and long-term psychotherapy and thus needs to be acknowledged when evaluating patients resources and treatment options. More research is needed to verify these findings.

Baseline symptom severity predicts serotonin transporter change during psychotherapy in patients with major depression

The role of the serotonin transporter (SERT) in the pathophysiology of depression is unclear and only a few follow‐up studies exist. Our aim was to measure changes in SERT availability during psychodynamic psychotherapy in patients with major depression over a follow‐up time of 12 or 18 months.

Serum 25-hydroxyvitamin D and the risk of knee and hip osteoarthritis leading to hospitalization: a cohort study of 5274 Finns

OBJECTIVE The aim of this study was to investigate whether low levels of serum 25-hydroxyvitamin D [25(OH)D] predicts the development of knee or hip OA. METHODS The cohort consisted of 5274 participants in a national health examination survey who had no knee or hip OA at baseline. Information about the incidence of OA was drawn from the National Health Care Register. During the follow-up of 10 years (50 134 person-years), 127 subjects developed incident, physician-diagnosed OA in the knee and 45 in the hip joint. The information on covariates, including age, sex, education, BMI, work load, leisure time physical activity, smoking history, knee or hip complaint during the past month and previous injuries, was gathered at baseline. Serum 25(OH)D concentrations were determined from baseline serum samples. RESULTS After adjustment for age and gender, serum 25(OH)D showed statistically significant associations with known risk factors for OA except injuries. In the fully adjusted model, low serum 25(OH)D concentration did not predict increased incidence of knee and hip OA. CONCLUSION The results do not support the hypothesis that low levels of serum 25(OH)D contribute to the development of knee or hip OA.

Effects of Scheduled Waiting for Psychotherapy in Patients With Major Depression

Abstract The role of nonspecific factors in the outcome of psychotherapy is poorly understood. To study the effects of pretreatment expectancy of scheduled psychotherapy, we examined the effects of an agreed waiting time on the outcome of psychodynamic psychotherapy. Thirty-three treatment-naive outpatients with major depressive disorder were randomly selected to start psychotherapy either directly (DG; n = 17) or after waiting for 6 months (WG; n = 16). In WG, 18% to 60% of the total decline in symptoms took place during the waiting time. After 1 year of active psychotherapy, the anxiety score declined significantly only in WG, and the total length of treatment needed was shorter in WG. No other outcome differences between WG and DG were found. We conclude that scheduled waiting associates with a significant decline in depressive symptoms. Scheduled waiting should be regarded as a preparatory treatment and not as an inert nontreatment control.

Dietary carbohydrate quantity and quality in relation to obesity: A pooled analysis of three Finnish population-based studies.

Background: The relationship between carbohydrate intake, dietary glycaemic index (GI) and load (GL), and obesity remains unsolved. Sugar intake and obesity represent a timely topic, but studies on sugar subcategories are scarce. We aimed to study whether total carbohydrate, sucrose, lactose, fibre, dietary GI, and GL are associated with obesity in 25–79-year-old Finns. Methods: Our pooled analysis included three cross-sectional population-based studies: the DILGOM Study (n = 4842), the Helsinki Birth Cohort Study (n =1979), and the Health 2000 Survey (n = 5521). Diet was assessed by a validated food-frequency questionnaire, and anthropometric measurements were collected by standardised protocols. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression analysis. Results: In the model, which included sex, age, education, smoking, physical activity, and energy intake, the likelihood of being obese (body mass index ⩾ 30 kg/m2) appeared lower in the highest quartiles of total carbohydrate (OR 0.65; 95% CI 0.57–0.74; P for trend < 0.0001), sucrose (OR 0.53; 95% CI 0.47–0.61; P < 0.0001), and dietary GL (OR 0.64; 95% CI 0.56–0.73; P < 0.0001) compared to the lowest quartiles. In contrast, dietary GI did not associate with obesity. Fibre intake associated inversely with abdominal obesity (OR 0.80; 95% CI 0.71–0.90; P < 0.001). The inverse sucrose–obesity relationship appeared stronger in high fruit consumers compared to low fruit consumers (P for interaction 0.02). Conclusions: Although most of the studied carbohydrate exposures were associated with a diminished likelihood of being obese, prospective studies are needed to assess temporal relations to support causal inference.

Airway obstruction, serum vitamin D and mortality in a 33-year follow-up study

Background and objective:Chronic obstructive pulmonary disease and low vitamin D status predict mortality, but their combined effect on mortality remains inconclusive. We aimed to investigate a joint effect of airway obstruction and vitamin D status on mortality in a nationally representative cohort.Methods:We analysed data of 6676 Finnish adults participating between 1978 and 1980 in a national health examination survey, undergoing spirometry and having all necessary data collected. We followed them up in national registers through record linkage until 31 December 2011. We categorised the subjects with obstruction using the lower limit of normal (LLN) and the measured serum 25-hydroxyvitamin-D (s-25(OH)D) into tertiles.Results:Both obstruction and low s-25(OH)D independently predicted mortality in a multivariate model adjusted also for age, sex, smoking, education, leisure physical activity, body mass index, asthma and serum C-reactive protein. However, a statistically significant (p = 0.007) interaction emerged: the adjusted mortality HRs (95% CI’s) for s-25(OH)D in tertiles among the subjects without and with obstruction were 1.00 (lowest), 0.96 (0.87–1.05) and 0.89 (0.81–0.98); and 1.00, 0.96 (0.71–1.31) and 0.57 (0.40–0.80), respectively.Conclusions:In conclusion, obstruction and low s-25(OH)D predict mortality independently of each other. Our findings suggest that low vitamin D status might be particularly detrimental among subjects with obstruction.

Reasons for non-participation and ways to enhance participation in health examination surveys-the Health 2011 Survey

High-participation rates to the health examination surveys are needed to obtain representative information about population health. This study aimed to examine reasons for non-participation and factors that could enhance participation using data from the Health 2011 Survey, conducted in 2011-12 in Finland (N = 8135). The most common reason for non-participation was unsuitable timing or location of the health examinations. Older persons also reported that they were too sick to participate. Flexibility on selection of examination times and places and getting feedback on the measurements were most often mentioned as factors which would increase willingness to participate in the future.

Dietary carbohydrate quantity and quality in relation to obesity: A pooled analysis of three Finnish population-based studies

Background: The relationship between carbohydrate intake, dietary glycaemic index (GI) and load (GL), and obesity remains unsolved. Sugar intake and obesity represent a timely topic, but studies on sugar subcategories are scarce. We aimed to study whether total carbohydrate, sucrose, lactose, fibre, dietary GI, and GL are associated with obesity in 25–79-year-old Finns. Methods: Our pooled analysis included three cross-sectional population-based studies: the DILGOM Study (n = 4842), the Helsinki Birth Cohort Study (n =1979), and the Health 2000 Survey (n = 5521). Diet was assessed by a validated food-frequency questionnaire, and anthropometric measurements were collected by standardised protocols. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression analysis. Results: In the model, which included sex, age, education, smoking, physical activity, and energy intake, the likelihood of being obese (body mass index ⩾ 30 kg/m2) appeared lower in the highest quartiles of total carbohydrate (OR 0.65; 95% CI 0.57–0.74; P for trend < 0.0001), sucrose (OR 0.53; 95% CI 0.47–0.61; P < 0.0001), and dietary GL (OR 0.64; 95% CI 0.56–0.73; P < 0.0001) compared to the lowest quartiles. In contrast, dietary GI did not associate with obesity. Fibre intake associated inversely with abdominal obesity (OR 0.80; 95% CI 0.71–0.90; P < 0.001). The inverse sucrose–obesity relationship appeared stronger in high fruit consumers compared to low fruit consumers (P for interaction 0.02). Conclusions: Although most of the studied carbohydrate exposures were associated with a diminished likelihood of being obese, prospective studies are needed to assess temporal relations to support causal inference.