Browsing by Subject "weight loss"

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  • EFSA Panel Dietetic Prod Nutr; Heinonen, Marina (2017)
    Following an application from Marks and Spencer PLC, submitted for authorisation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006 via the Competent Authority of the United Kingdom, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to a CHO:P ratio = 3.0 on overweight and obese adults in the context of energy restriction. Four out of seven studies lasting <12 weeks reported an effect of a CHO: P ratio
  • Koskinen, Milja (Helsingfors universitet, 2011)
    Tämä lisensiaatin tutkielma koostuu kolmesta osasta; kirjallisuuskatsauksesta, kokeellisesta osasta ja liitteistä. Iohexol on ionisoitumaton, trijodattu ja vesiliukoinen röntgenvarjoaine. Iohexolia on hyödynnetty lääketieteessä useita vuosia. Iohexolia on käytetty muun muassa angio- ja myelografiassa, lisäksi iohexolia on hyödynnetty arvioitaessa munuaiskerästen suodattumisnopeutta sekä suoliston läpäisevyyden muutoksia. Hevosen tulehduksellisessa suolistosairaudessa (Inflammatory bowel disease, IBD) suoliston rakenne ja sen läpäisevyys muuttuu; tyypillistä on tulehdussolujen kertyminen suoliston seinämään ja myös sidekudosmuodostusta saattaa esiintyä. Suolisto muutoksia saatetaan havaita sekä ohut- että paksusuolessa. IBD aiheuttaa hevoselle laihtumista, johtuen ravintoaineiden puutteellisesta imeytymisestä ja proteiinien menetyksestä suoleen suoliston häiriötilan yhteydessä. Tällä hetkellä IBD:n diagnostiikka perustuu tyypillisiin oireisiin, kliiniseen tutkimukseen, verinäytteisiin, glukoosin imeytymistestiin ja peräsuolesta otettuun koepalaan. IBD:n diagnostiikka on kuitenkin erittäin haastavaa ja tutkimusmenetelmiin liittyy lukuisia ongelmia, jotka vähentävät niiden luotettavuutta IBD:n diagnostiikassa. Tutkimuksemme tarkoituksena on kehittää hevosen IBD:n diagnostiikkaa entistä helpompaan, luotettavampaan ja turvallisempaan suuntaan. Tämän alustavan tutkimuksen tavoitteet olivat: (1) tutkia voidaanko iohexol havaita hevosen seerumissa oraalisen annostelun jälkeen ja (2) muodostaa iohexolin pitoisuuskuvaaja ajan funktiona terveillä hevosilla. Materiaalimme koostui kymmenestä terveestä hevosesta, joilla ei ollut havaittu laihtumista tai ripulia. Ennen iohexolin annostelua hevosille suoritettiin kliininen tutkimus ja verinäytteet otettiin maha-suolikanavan sairauden poissulkemiseksi. Hevosille suoritettiin myös mahalaukun tähystys. 16 tunnin paaston jälkeen 1 ml/kg Iohexolia annosteltiin 10 % -liuoksena nenämahaletkulla suoraan mahaan ja verinäytteet otettiin 0, 30, 60, 120, 180, 240, 300 ja 360 minuuttia annostelun jälkeen. Iohexolin pitoisuus määritettiin käyttämällä korkean erotuskyvyn nestekromatografiaa. Iohexolin pitoisuuksista tietyillä ajanhetkillä muodostettiin kuvaaja. Hevosilla ei havaittu maha-suolikanavan sairauksia. Kaikki hevoset olivat hyvässä kuntoluokassa ja mahalaukun tähystyksessä ei havaittu merkittäviä muutoksia. Verinäytteiden tulokset olivat viiterajoissa. Kaikki hevoset sietivät iohexolia hyvin ja haittavaikutuksia ei havaittu. Iohexol oli havaittavissa seerumissa 60 minuutin kuluttua annostelusta. Kuvaajassa voitiin havaita kaksi huippua. Statistiset menetelmät tukivat löydöksiä. Iohexol testi oli yksinkertainen suorittaa ja siihen ei liittynyt haittavaikutuksia. Annos 1ml/kg oli havaittavissa seerumissa. Iohexolin pitoisuuskuvaaja muodosti kaksi huippua, ja tämänkaltainen ilmiö on kuvattu kirjallisuudessa aikaisemmin useiden lääkkeiden tapauksessa. Hevosella ilmiö liittyy todennäköisesti maha-suolikanavan rakenteellisiin ja fysiologisiin eroavaisuuksiin ja lisätutkimuksia ilmiön varmistamiseksi tarvitaan. Iohexol näyttää olevan potentiaalinen merkkiaine suoliston läpäisevyyden arviointiin ja lisätutkimuksia IBD:tä sairastavien hevosten seerumin iohexolin pitoisuuksista verrattuna terveiden hevosten seerumin iohexolin pitoisuuksiin on suunnitteilla.
  • van der Kolk, Birgitta W.; Muniandy, Maheswary; Kaminska, Dorota; Alvarez, Marcus; Ko, Arthur; Miao, Zong; Valsesia, Armand; Langin, Dominique; Vaittinen, Maija; Paakkonen, Mirva; Jokinen, Riikka; Kaye, Sanna; Heinonen, Sini; Virtanen, Kirsi A.; Andersson, Daniel P.; Männistö, Ville; Saris, Wim H.; Astrup, Arne; Ryden, Mikael; Blaak, Ellen E.; Pajukanta, Paivi; Pihlajamaki, Jussi; Pietiläinen, Kirsi H. (2021)
    Context: Mitochondria are essential for cellular energy homeostasis, yet their role in subcutaneous adipose tissue (SAT) during different types of weight-loss interventions remains unknown. Objective: To investigate how SAT mitochondria change following diet-induced and bariatric surgery-induced weight-loss interventions in 4 independent weight-loss studies. Methods: The DiOGenes study is a European multicenter dietary intervention with an 8-week low caloric diet (LCD; 800 kcal/d; n = 261) and 6-month weight-maintenance (n = 121) period. The Kuopio Obesity Surgery study (KOBS) is a Roux-en-Y gastric bypass (RYGB) surgery study (n = 172) with a 1-year follow-up. We associated weight-loss percentage with global and 2210 mitochondria-related RNA transcripts in linear regression analysis adjusted for age and sex. We repeated these analyses in 2 studies. The Finnish CRYO study has a 6-week LCD (800-1000 kcal/d; n = 19) and a 10.5-month follow-up. The Swedish DEOSH study is a RYGB surgery study with a 2-year (n = 49) and 5-year (n = 37) follow-up. Results: Diet-induced weight loss led to a significant transcriptional downregulation of oxidative phosphorylation (DiOGenes; ingenuity pathway analysis [IPA] z-scores: -8.7 following LCD, -4.4 following weight maintenance; CRYO: IPA z-score: -5.6, all P < 0.001), while upregulation followed surgery-induced weight loss (KOBS: IPA z-score: 1.8, P < 0.001; in DEOSH: IPA z-scores: 4.0 following 2 years, 0.0 following 5 years). We confirmed an upregulated oxidative phosphorylation at the proteomics level following surgery (IPA z-score: 3.2, P < 0.001). Conclusions: Differentially regulated SAT mitochondria-related gene expressions suggest qualitative alterations between weight-loss interventions, providing insights into the potential molecular mechanistic targets for weight-loss success.
  • Drummen, Mathijs; Tischmann, Lea; Gatta-Cherifi, Blandine; Fogelholm, Mikael; Raben, Anne; Adam, Tanja C.; Westerterp-Plantenga, Margriet S. (2020)
    Background: Weight loss has been associated with adaptations in energy expenditure. Identifying factors that counteract these adaptations are important for long-term weight loss and weight maintenance. Objective: The aim of this study was to investigate whether increased protein/carbohydrate ratio would reduce adaptive thermogenesis (AT) and the expected positive energy balance (EB) during weight maintenance after weight loss in participants with prediabetes in the postobese state. Methods: In 38 participants, the effects of 2 diets differing in protein/carbohydrate ratio on energy expenditure and respiratory quotient (RQ) were assessed during 48-h respiration chamber measurements similar to 34 mo after weight loss. Participants consumed a high-protein (HP) diet In = 20; 13 women/7 men; age: 64.0 +/- 6.2 y; BMI: 28.9 +/- 4.0 kg/m(2)) with 25:45:30% or a moderate-protein (MP) diet (n = 18; 9 women/9 men; age: 65.1 +/- 5.8 y; BMI: 29.0 +/- 3.8 kg/m(2)) with 15:55:30% of energy from protein:carbohydrate:fat. Predicted resting energy expenditure (REEp) was calculated based on fat-free mass and fat mass. AT was assessed by subtracting measured resting energy expenditure (REE) from REEp. The main outcomes included differences in components of energy expenditure, substrate oxidation, and AT between groups. Results: EB (MP = 0.2 +/- 0.9 MJ/d; HP = -0.5 +/- 0.9 MJ/d) and RO (MP = 0.84 +/- 0.02; HP = 0.82 +/- 0.02) were reduced and REE (MP: 73 +/- 0.2 MJ/d compared with HP: 78 +/- 0.2 MJ/d) was increased in the HP group compared with the MP group (P <0.05). REE was not different from REEp in the HP group, whereas REE was lower than REEp in the MP group (P <0.05). Furthermore, EB was positively related to AT (r(s) = 0.74; P <0.001) and RQ (r(s) = 0.47; P <0.01) in the whole group of participants. Conclusions: In conclusion, an HP diet compared with an MP diet led to a negative EB and counteracted AT similar to 34 mo after weight loss, in participants with prediabetes in the postobese state. These results indicate the relevance of compliance to an increased protein/carbohydrate ratio for long-term weight maintenance after weight loss.
  • Heikelä, Hanna; Ruohonen, Suvi T.; Adam, Marion; Viitanen, Riikka; Liljenback, Heidi; Eskola, Olli; Gabriel, Michael; Mairinoja, Laura; Pessia, Alberto; Velagapudi, Vidya; Roivainen, Anne; Zhang, Fu-Ping; Strauss, Leena; Poutanen, Matti (2020)
    Hydroxysteroid 17-beta dehydrogenase 12 (HSD17B12) is suggested to be involved in the elongation of very long chain fatty acids. Previously, we have shown a pivotal role for the enzyme during mouse development. In the present study we generated a conditional Hsd17b12 knockout (HSD17B12cKO) mouse model by breeding mice homozygous for a floxed Hsd17b12 allele with mice expressing the tamoxifen-inducible Cre recombinase at the ROSA26 locus. Gene inactivation was induced by administering tamoxifen to adult mice. The gene inactivation led to a 20% loss of body weight within six days, associated with drastic reduction in both white (83% males, 75% females) and brown (65% males, 60% females) fat, likely due to markedly reduced food and water intake. Furthermore, the knockout mice showed sickness behavior and signs of liver toxicity, specifically microvesicular hepatic steatosis and increased serum alanine aminotransferase (4.6-fold in males, 7.7-fold in females). The hepatic changes were more pronounced in females than males. Pro-inflammatory cytokines, such as interleukin 6 (IL-6), IL-17 and granulocyte-colony stimulating factor were increased in the HSD17B12cKO mice indicating inflammatory response. Serum lipidomics study showed an increase in the amount of dihydroceramides, despite the dramatic overall loss of lipids. In line with the proposed role for HSD17B12 in the fatty acid elongation, we observed accumulation of ceramides, dihydroceramides, hexosylceramides and lactosylceramides with shorter than 18-carbon fatty acid side chains in the serum. The results indicate that HSD17B12 is essential for proper lipid homeostasis, and HSD17B12 deficiency rapidly results in fatal systemic inflammation and lipolysis in adult mice.
  • Sares-Jäske, Laura; Knekt, Paul; Eranti, Antti; Kaartinen, Niina E.; Heliövaara, Markku; Männistö, Satu (2020)
    Introduction Observational and intervention studies have verified that weight loss predicts a reduced type 2 diabetes (T2D) risk. At the population level, knowledge on the prediction of self-report intentional weight loss (IWL) on T2D incidence is, however, sparse. We studied the prediction of self-report IWL on T2D incidence during a 15-year follow-up in a general adult population. Research design and methods The study sample from the representative Finnish Health 2000 Survey comprised 4270 individuals, aged 30-69 years. IWL was determined with questions concerning dieting attempts and weight loss during the year prior to baseline. Incident T2D cases during a 15-year follow-up were drawn from national health registers. The strength of the association between IWL and T2D incidence was estimated with the Cox model. Results During the follow-up, 417 incident cases of T2D occurred. IWL predicted an increased risk of T2D incidence (HR 1.44; 95% CI 1.11 to 1.87, p=0.008) in a multivariable model. In interaction analyses comparing individuals with and without IWL, a suggestively elevated risk emerged in men, the younger age group, among less-educated people and in individuals with unfavorable values in several lifestyle factors. Conclusions Self-report IWL may predict an increased risk of T2D in long-term, probably due to self-implemented IWL tending to fail. The initial prevention of weight gain and support for weight maintenance after weight loss deserve greater emphasis in order to prevent T2D.
  • Kyhälä, Tanja (Helsingin yliopisto, 2019)
    Studies suggest that isolated impaired fasting glucose (iIFG) and isolated impaired glucose tolerance (iIGT) have distinct pathophysiologic phenotype, including differences in whole body insulin sensitivity. The present study was a sub-study of the PREVIEW intervention study, a three-year randomized trial in eight countries. Participants with either iIFG (n = 44) or iIGT (n = 38) who attended all clinical investigation days (0, 2, 6 and 12 months) in Sydney were included. Pre-diabetes as defined by the American Diabetes Association and BMI >25 were inclusion criteria. The aim was to determine if there was a difference in weight change between PREVIEW participants with iIGT or iIFG at any of the measurement points. In addition, we investigated if there were differences in change in fat mass, fat-free mass, HbA1c, blood lipids, insulin and C-peptide between participants with iIGT versus iIFG. A comparison of the mean changes showed that subjects with iIGT lost significantly less fat mass at 6 months than those with iIFG (-7.30, 95% CI [-8.89, -5.71] versus -9.57, 95% CI [-10.79, -8.35] kg, p = 0.027) and the difference remained significant (-6.30, 95% CI [-7.93, -4.67] versus -8.38, 95% CI [-10.99, -5.77] kg, p = 0.038) at 12 months. Furthermore, participants with iIGT regained fat (as fat %) at 12 months unlike participants with iIFG (-3.1, 95% CI [-4.08, -2.12] versus -4.9, 95% CI [-5.88, -3.92] %, p = 0.007). Reduction in HDL cholesterol was less in subjects with iIGT at 2 months than in those with iIFG (-0.08, 95% CI [-0.14, -0.02] versus -0.15, 95% CI [-0.21, -0.09] mmol/L, p = 0.011). Participants with iIGT lost less and regained more weight versus iIFG although the difference was not significant. No other changes were significant. In conclusion, the results support the hypothesis that participants with iIGT find it more difficult to lose fat mass and maintain the loss than those with iIFG. Studies are needed to confirm these findings and to determine the explanation for the difference in fat loss between iIGT and iIFG categories. As weight loss, including fat loss, is the dominant determinant of the reduced risk of T2DM in lifestyle interventions, actions to develop optimal weight loss methods for patients with different pre-diabetic statuses should be taken.
  • Puhkala, Jatta; Kukkonen-Harjula, Katriina; Mansikkamaki, Kirsi; Aittasalo, Minna; Hublin, Christer; Karmeniemi, Paula; Olkkonen, Seppo; Partinen, Markku; Sallinen, Mikael; Tokola, Kari; Fogelholm, Mikael (2015)
    Objectives We conducted a randomized trial among overweight long-distance drivers to study the effects of structured lifestyle counseling on body weight and cardiometabolic risk factors. Methods Men with waist circumference > 100 cm were randomized into a lifestyle counseling (LIFE, N=55) and a reference (REF, N=58) group. The LIFE group participated in monthly counseling on nutrition, physical activity, and sleep for 12 months aiming at 10% weight loss. After 12 months, the REF group participated in 3-month counseling. Assessments took place at 0, 12, and 24 months. Between-group differences in changes were analyzed by generalized linear modeling. Metabolic risk (Z score) was calculated from components of metabolic syndrome. Results The mean body weight change after 12 months was -3.4 kg in LIFE (N=47) and 0.7 kg in REF (N=48) [net difference -4.0 kg, 95% confidence interval (95% CI) -1.9- -6.2]. Six men in LIFE reduced body weight by >= 10%. Changes in waist circumference were -4.7 cm in LIFE and -0.1 cm in REF (net -4.7 cm, 95% CI -6.6- -2.7). Metabolic risk decreased more in the LIFE than REF group (net -1.2 points, 95% CI -0.6- -2.0). After 24 months follow-up, there were no between-group differences in changes in body weight (net -0.5 kg, 95% CI -3.8-2.9) or metabolic risk score (net 0.1 points; 95% CI -0.8-1.0) compared to baseline. Conclusions Weight reduction and decreases in cardiometabolic risk factors were clinically meaningful after 12 months of counseling.
  • Christensen, Pia; Larsen, Thomas Meinert; Westerterp-Plantenga, Margriet; Macdonald, Ian; Martinez, J. Alfredo; Handjiev, Svetoslav; Poppitt, Sally; Hansen, Sylvia; Ritz, Christian; Astrup, Arne; Pastor-Sanz, Laura; Sando-Pedersen, Finn; Pietiläinen, Kirsi H.; Sundvall, Jouko; Drummen, Mathijs; Taylor, Moira A.; Navas-Carretero, Santiago; Handjieva-Darlenska, Teodora; Brodie, Shannon; Silvestre, Marta P.; Huttunen-Lenz, Maija; Brand-Miller, Jennie; Fogelholm, Mikael; Raben, Anne (2018)
    Aims Materials and methods The PREVIEW lifestyle intervention study ( Identifier: NCT01777893) is, to date, the largest, multinational study concerning prevention of type-2 diabetes. We hypothesized that the initial, fixed low-energy diet (LED) would induce different metabolic outcomes in men vs women. All participants followed a LED (3.4 MJ/810 kcal/daily) for 8 weeks (Cambridge Weight Plan). Participants were recruited from 8 sites in Europe, Australia and New Zealand. Those eligible for inclusion were overweight (BMI >= 25 kg/m(2)) individuals with pre-diabetes according to ADA-criteria. Outcomes of interest included changes in insulin resistance, fat mass (FM), fat-free mass (FFM) and metabolic syndrome Z-score. Results Conclusions In total, 2224 individuals (1504 women, 720 men) attended the baseline visit and 2020 (90.8%) completed the follow-up visit. Following the LED, weight loss was 16% greater in men than in women (11.8% vs 10.3%, respectively) but improvements in insulin resistance were similar. HOMA-IR decreased by 1.50 +/- 0.15 in men and by 1.35 +/- 0.15 in women (ns). After adjusting for differences in weight loss, men had larger reductions in metabolic syndrome Z-score, C-peptide, FM and heart rate, while women had larger reductions in HDL cholesterol, FFM, hip circumference and pulse pressure. Following the LED, 35% of participants of both genders had reverted to normo-glycaemia. An 8-week LED induced different effects in women than in men. These findings are clinically important and suggest gender-specific changes after weight loss. It is important to investigate whether the greater decreases in FFM, hip circumference and HDL cholesterol in women after rapid weight loss compromise weight loss maintenance and future cardiovascular health.
  • Sarin, Heikki V.; Gudelj, Ivan; Honkanen, Jarno; Ihalainen, Johanna K.; Vuorela, Arja; Lee, Joseph H.; Jin, Zhenzhen; Terwilliger, Joseph D.; Isola, Ville; Ahtiainen, Juha P.; Häkkinen, Keijo; Juric, Julija; Lauc, Gordan; Kristiansson, Kati; Hulmi, Juha J.; Perola, Markus (2019)
    Exercise and exercise-induced weight loss have a beneficial effect on overall health, including positive effects on molecular pathways associated with immune function, especially in overweight individuals. The main aim of our study was to assess how energy deprivation (i.e., "semi-starvation") leading to substantial fat mass loss affects the immune system and immunosuppression in previously normal weight individuals. Thus, to address this hypothesis, we applied a high-throughput systems biology approach to better characterize potential key pathways associated with immune system modulation during intensive weight loss and subsequent weight regain. We examined 42 healthy female physique athletes (age 27.5 +/- 4.0 years, body mass index 23.4 +/- 1.7 kg/m(2)) volunteered into either a diet group (n = 25) or a control group (n = 17). For the diet group, the energy intake was reduced and exercise levels were increased to induce loss of fat mass that was subsequently regained during a recovery period. The control group was instructed to maintain their typical lifestyle, exercise levels, and energy intake at a constant level. For quantification of systems biology markers, fasting blood samples were drawn at three time points: baseline (PRE), at the end of the weight loss period (MID 21.1 +/- 3.1 weeks after PRE), and at the end of the weight regain period (POST 18.4 +/- 2.9 weeks after MID). In contrast to the control group, the diet group showed significant (false discovery rate
  • Orell, Helena; Schwab, Ursula; Saarilahti, Kauko; Österlund, Pia; Ravasco, Paula; Mäkitie, Antti (2019)
    Background: Head and neck cancer and its treatment may deteriorate nutrition status. Previous data have shown that intensive nutrition intervention by a dietician reduces radiation-induced adverse events including weight loss. Objective: To determine if on-demand nutrition counselling (ODC) would be as effective as intensive nutrition counselling (INC) in patients undergoing (chemo)radiotherapy. Methods: Fifty-eight patients were randomly assigned to receive INC (n=26) or ODC (n=32). Outcome measures were nutrition status (PG-SGA), weight loss, handgrip strength (HGS), body composition and survival. Results: Weight loss and impaired nutrition parameters during oncological treatment were seen equally in both groups (NS). Leaner patients at baseline maintained their weight, while overweight patients lost both weight and handgrip strength during treatment. Disease- free survival (DFS) (median=43 months) was not affected by weight loss during treatment. Lower baseline HGS and malnutrition were associated with worse DFS (low vs. normal HGS: 15 vs. 42 months; p=0.05 and malnutrition vs. good nutrition status: 17 vs. 42 months; p=0.014, respectively). Survival according to low vs. normal HGS in the INC group was 4 vs. 44 months (p=0.007) and in the ODC group 28 vs. 40 months (p=0.944). According to malnutrition vs. good nutrition status in the INC group, DFS was 21 vs. 43 months (p=0.025) and in the ODC group 15 vs. 41 months (p=0.03). Conclusions: Individualised on-demand nutrition counselling was as efficient as intensive counselling during (chemo)radiotherapy. Overweight patients had more severe weight loss but not poorer survival. Low HGS and malnutrition at baseline were directly associated with poor survival.
  • Liu, Huikun; Wang, Leishen; Zhang, Shuang; Leng, Junhong; Li, Nan; Li, Weiqin; Wang, Jing; Tian, Huiguang; Qi, Lu; Yang, Xilin; Yu, Zhijie; Tuomilehto, Jaakko; Hu, Gang (2018)
    Aims: To report the weight loss findings after the first year of a lifestyle intervention trial among women with gestational diabetes mellitus (GDM). Methods: A total of 1180 women with GDM were randomly assigned (1: 1) to receive a 4-year lifestyle intervention (intervention group, n = 586) or standard care (control group, n = 594) between August 2009 and July 2011. Major elements of the intervention included 6 face-to-face sessions with study dieticians and two telephone calls in the first year, and two individual sessions and two telephone calls in each subsequent year. Results: Among 79% of participants who completed the year 1 trial, mean weight loss was 0.82 kg (1.12% of initial weight) in the intervention group and 0.09 kg (0.03% of initial weight) in the control group (P=.001). In a prespecified subgroup analysis of people who completed the trial, weight loss was more pronounced in women who were overweight (body mass index = 24 kg/m(2)) at baseline: mean weight loss 2.01 kg (2.87% of initial weight) in the intervention group and 0.44 kg (0.52% of initial weight) in the control group (P Conclusion: The 1-year lifestyle intervention led to significant weight losses after delivery in women who had GDM, and the effect was more pronounced in women who were overweight at baseline.
  • Orpana, Sini (Helsingin yliopisto, 2018)
    Dropout is a serious problem in lifestyle interventions. Dropout is inadequately analyzed and inconsistently reported in weight loss and lifestyle intervention literature even though it is considered to be one of the most important aspects in assessing trial success. Attrition decreases the statistical power of the study, weakens the reliability and validity of the results, decreases generalizability of the outcomes, and deteriorates the accuracy of given recommendations. In addition, withdrawal leads to poor intervention outcomes and wasted resources. Dropout rates in weight loss intervention range from 7 to 90 percent. The analysis of this study comprised of the first two years of a three-year intervention called PREVIEW. The participants analyzed in this thesis (N = 2088) were overweight or obese prediabetic adults with an age of 52 ± 11.5 years at the start of the trial. Participants came from six European and two Australasian countries. Two thirds of the participants were women and the majority were Caucasian. The final prediction model was computed with multivariate logistic regression. Forty-four percent of the participants dropped out by year two. Dropouts were younger, had a higher baseline BMI, and lost less weight in the weight loss phase than the completers. Compared to Australia, the odds for dropping out were higher in the other countries analyzed. The odds for dropout in an ascending order were: Australia, Finland, New Zealand, the Netherlands, Bulgaria, the United Kingdom, Spain and Denmark. Compared to university education, the odds for dropping out were higher for participants with secondary vocational education, secondary school education, or education indicated as ‘other’. The findings of this thesis may be used in the development of similar trials and in public healthcare. In lifestyle intervention programs, special attention could be directed to individuals who are likely to drop out. In addition, as dropout is dependent of the explanatory variables, the results may also benefit future analysis of data from PREVIEW.
  • Huttunen-Lenz, Maija; Hansen, Sylvia; Christensen, Pia; Larsen, Thomas Meinert; Sando-Pedersen, Finn; Drummen, Mathijs; Adam, Tanja C.; Macdonald, Ian A.; Taylor, Moira A.; Alfredo Martinez, J.; Navas-Carretero, Santiago; Handjiev, Svetoslav; Poppitt, Sally D.; Silvestre, Marta P.; Fogelholm, Mikael; Pietilainen, Kirsi H.; Brand-Miller, Jennie; Berendsen, Agnes A. M.; Raben, Anne; Schlicht, Wolfgang (2018)
    Purpose: Onset of type 2 diabetes (T2D) is often gradual and preceded by impaired glucose homeostasis. Lifestyle interventions including weight loss and physical activity may reduce the risk of developing T2D, but adherence to a lifestyle change is challenging. As part of an international T2D prevention trial (PREVIEW), a behavior change intervention supported participants in achieving a healthier diet and physically active lifestyle. Here, our aim was to explore the influence of this behavioral program (PREMIT) on social-cognitive variables during an 8-week weight loss phase. Methods: PREVIEW consisted of an initial weight loss, Phase I, followed by a weight-maintenance, Phase II, for those achieving the 8-week weight loss target of >= 8% from initial bodyweight. Overweight and obese (BMI >= 25 kg/m(2))individuals aged 25 to 70 years with confirmed pre-diabetes were enrolled. Uni- and multivariate statistical methods were deployed to explore differences in intentions, self-efficacy, and outcome expectancies between those who achieved the target weight loss ("achievers") and those who did not ("non-achievers"). Results: At the beginning of Phase I, no significant differences in intentions, self-efficacy and outcome expectancies between "achievers" (1,857) and "non-achievers" (163) were found. "Non-achievers" tended to be younger, live with child/ren, and attended the PREMIT sessions less frequently. At the end of Phase I, "achievers" reported higher intentions (healthy eating chi(2)((1))=2.57; P <0.008, exercising chi(2)((1))=0.66; P <0.008), self-efficacy (F-(2;1970)=10.27, P Conclusion: Although statistically significant, effect sizes observed between the two groups were small. Behavior change, however, is multi-determined. Over a period of time, even small differences may make a cumulative effect. Being successful in behavior change requires that the "new" behavior is implemented time after time until it becomes a habit. Therefore, having even slightly higher self-efficacy, positive outcome expectancies and intentions may over time result in considerably improved chances to achieve long-term lifestyle changes.
  • Udd, Marianne; Lyytinen, Jukka; Eerola-Rautio, Johanna; Kenttämies, Anu; Lindström, Outi; Kylänpää, Leena; Pekkonen, Eero (2017)
    Background: Continuous levodopa-carbidopa intestinal gel (LCIG) diminishes daily off time and dyskinesia in patients with advanced Parkinsons disease (PD). Complications are common with percutaneous endoscopic gastrostomy with a jejunal extension tube (PEG-J). Aim of the Study: To report the clinical outcome of LCIG in patients with advanced PD in the years 2006-2014 at Helsinki University Hospital. Patients and Methods: Levodopa-carbidopa intestinal gel treatment started following PEG-J placement in patients with advanced PD after successful in-hospital LCIG trial with a nasojejunal tube. Demographics, PEG-J procedures, discontinuation of LCIG, complications and mortality were retrospectively analyzed. Results [mean (SD)]: Sixty patients with advanced PD [age 68(7) years; duration of PD: 11(4) years] had LCIG treatment for 26(23) months. The majority of patients with advanced PD were satisfied with the LCIG treatment. For 51 patients (85%), the pump was on for 16hr a day, and for nine patients (15%) it was on for 24hr a day. After 6months, the levodopa-equivalent daily dose (LEDD) had increased by 30% compared to pre-LCIG LEDD. Sixty patients underwent a total of 156 PEG-J procedures, and 48 patients (80%) had a total of 143 complications. Forty-six patients (77%) had 119 PEG-J or peristomal complications, and 22 patients (37%) had a total of 25 other complications. The most common complications were accidental removal of the J-tube in 23 patients (38%) and 5% weight loss in 18 patients (30%). Fifteen patients discontinued the LCIG after 21 (21) months. At the end of the follow-up period of 33(27) months, 38 patients were still on LCIG and nine (15%) had died. Conclusion: Most patients were satisfied with LCIG treatment. A few patients lost weight whereas the majority had complications with PEG-J. When LCIG treatment is carried out, neurological and endoscopic units must be prepared for multiple endoscopic procedures.
  • Harjupatana, Sanna (Helsingfors universitet, 2007)
    Tämä syventävien opintojen kirjallinen osa koostuu kolmesta osasta: kirjallisuuskatsauksesta, kokeellisesta osasta sekä tapausselostuksista. Xyloosi on pentoosi sokeri, jota käytetään arvioitaessa hiilihydraattien imeytymistä sekä ohutsuolen tilaa useilla eläinlajeilla. Hevosella ohutsuolen tutkimisen tekee erityisen hankalaksi sen vaikea saavutettavuus ja suuri tilavuus sekä pituus. Xyloosin imeytymistesti on vain yksi monista diagnostisista keinoista, joilla pyritään ymmärtämään paremmin hevosen suoliston toimintaa. Testin etu on sen tunkeutumattomuus elimistöön sekä melko edullinen hinta. Hevosella testi on standardoitu jo yli 30 vuotta sitten. Xyloosin imeytymiseen vaikuttavat useat eri tekijät: ruokavalio, paaston pituus, suolen bakteerilajisto, mahan tyhjenemisnopeus, suolen liike, munuaisten toiminta, suolen sisältö, kudosten aineenvaihdunta sekä verenkierto. Xyloosin imeytymistestin normaaliarvot, joita tutkimuksessakin käytimme ovat: 1,37mmol/l +/- 0,33 mmol/l saavutettuna 60-90 min annostelun jälkeen. Tulehduksellinen suolistosairaus, IBD, on yksi sairauksista, jonka diagnostiikassa xyloosi imeytymistestiä käytetään. Tutkimusmateriaalimme koostui kolestakymmenestäkahdesta 2-20 vuotiaasta hevosesta, jotka olivat kärsineet toistuvista ähkyistä ja/tai laihtumisesta säännöllisestä madotuksesta, hampaiden hoidosta ja riittävästä ruokinnasta huolimatta. Hevosten omistajat vastasivat kattavaan kyselyyn hevosten historiasta. Hevosille suoritettiin Yliopistollisen eläinsairaalan hevosklinikalla perusteellinen tutkimusprotokolla, joka sisälsi seuraavat tutkimukset: kliininen yleistutkimus, kuntoluokitus, ontumatutkimus (tutkimukseen ei otettu hevosia, jotka ontuivat enemmän kuin 2/5 ravissa), keuhkojen ja vatsaontelon röntgenkuvaus, suoliston ultraäänitutkimus, vatsaontelonestenäyte, ulostenäyte, virtsanäyte, perusverenkuva ja seerumista maksa, munuasivarvot, elektrolyytit sekä lihasarvot, mahantähystys, peräsuolikoepala sekä xyloosin imeytysmistesti. Kliininen tulehduksellisen suolistosairauden diagnoosi tehtiin sulkemalla muut mahdolliset vastaavien oireiden aiheuttajat sekä normaalista poikkeavien imeytymistesti tulosten, peräsuolikoepalojen ja muiden mahdollisten löydösten perusteella. Muita löydöksiä olivat tyypillisesti paksuuntunut suoli ultraäänitutkimuksessa, poikkevat valkosolu- ja fibrinogeeniarvot. Hypoteesimme oli seuraava: merkittävällä osalla hevosista, joitka kärsivät toistuvista ähkyistä tai laihtumisesta olisi epänormaali xyloosin imeytyminen. Oletimme myös, että xyloosi imeytymistesti yhdistettynä perusteelliseen suoliston tutkimukseen olisi hyvä tapa diagnostisoida tulehduksellinen suolistosairaus ilman lapratomiaa. Materiaalissamme melko monella hevosella, jotka kärsivät toistuvista ähkyistä ja/tai laihtumisesta oli epänormaali xyloosin imeytyminen (15/31). Yhdeksällä hevosella oli alentunut xyloosin imeytyminen, ja yhdeksällä viivästynyt (kolme hevosta kuului molempiin ryhmiin). Tulehduksellinen suolistosairaus varmistettiin ruumiinavauksessa kolmella hevosella, kliininen diagnoosi tehtiin kahdeksalle. Muutkin sairaudet voivat aiheuttaa epänormaalin xyloosin imeytymisen. Tällaisia ovat esimerkiksi kasvaimet, jollaisia diagnosoitiin tässä tutkimuksessa kahdella hevosella, joilla oli epänormaalin alhainen xyloosin imeytyminen. Tulehduksellinen suolistosairaus-diagnoosi perustuu pitkälti muiden syiden poissulkemiseen. Xyloosi absorptio testi ei siis ole yksinään diagnostinen taudille, mutta sitä voidaan käyttää osana laajempaa tutkimusprotokollaa tulehduksellisen suolistosairauden diagnostiikassa hevosella.