Browsing by Organization "National Institute for Health and Welfare (THL)"

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  • Paalanen, Laura (Helsingin yliopisto, 2013)
    The Republic of Karelia in north-western Russia and North Karelia in eastern Finland are situated right next to each other. Part of the Republic of Karelia, including the district of Pitkäranta, was part of Finland until the Second World War, when it was annexed to the Soviet Union. The aim of this study was to explore trends and educational differences in food habits and related biomarkers in Pitkäranta, Russia, and North Karelia, Finland, over a 15-year period, which encompasses the early transition years from a centrally planned economy towards a market economy after the dissolution of the Soviet Union in 1991. Two population-based repeated cross-sectional datasets from the two areas were used: 1) health behaviour surveys from 1994, 1996, 1998, 2000 and 2004 (total n=3599 in Pitkäranta, total n=3652 in North Karelia) and 2) risk factor surveys from 1992, 1997, 2002 and 2007 (total n=2672 in Pitkäranta, total n=5437 in North Karelia). The data were collected by the National Public Health Institute (KTL) (the current National Institute for Health and Welfare, THL) in Finland. In Pitkäranta, the data were collected by the National Public Health Institute in collaboration with the Central Hospital of Pitkäranta and the Ministry of Health and Social Development in the Republic of Karelia. The trends and overall prevalence in food habits were very different between Pitkäranta and North Karelia. Food habits changed remarkably in Pitkäranta between 1992 and 2007. The proportion of those who used butter in cooking plunged from 50% to less than 10%. The proportion of those who used butter on bread decreased as well, although not consistently. The proportion of persons who consumed fat-containing milk fluctuated. The prevalence of daily consumption of fresh vegetables and fruit increased notably. In North Karelia, the changes were smaller. A small decrease in the proportion of those who used butter or consumed fat-containing milk was observed. The prevalence of daily consumption of fresh vegetables and fruit also decreased slightly in North Karelia. The educational differences in food habits were somewhat more notable in North Karelia than in Pitkäranta. In general, food habits were less favourable in the lowest compared to the highest education group in both areas. For example, the use of butter in cooking and the consumption of fat-containing milk were more common among subjects in the lowest education group, whereas the daily consumption of vegetables and fruit was more common among their more highly educated counterparts. The education gradient in the quality of spread used on bread was the opposite in the two areas. In Pitkäranta, using butter on bread tended to be more common among men in the highest education group, whereas in North Karelia, men with a low education used butter on bread more often. The mean serum total cholesterol did not differ by education in Pitkäranta. In North Karelia, it tended to be higher among subjects in the lowest education group. The mean plasma vitamin C concentration was strikingly low in Pitkäranta throughout the study period. In North Karelia, the overall level of plasma vitamin C was higher. The plasma vitamin C concentration tended to be higher among subjects with a higher education in both areas. The study demonstrated that food habits may change quite rapidly if the local circumstances change. In Pitkäranta, the availability and prices of foods are possible underlying factors that are related to the remarkable changes in food habits. In North Karelia, active health policy and the health consciousness of the population are probably more important in directing food choices.
  • Similä, Minna (Helsingin yliopisto, 2012)
    Type 2 diabetes prevalence is on the rise. The carbohydrates inducing a rapid postprandial elevation in blood glucose have been suggested to increase risk of type 2 diabetes. Glycemic index (GI) classifies foods based on their postprandial blood glucose response compared with the response of reference food (glucose solution or white bread). Glycemic load (GL) is a measure of both quantity and GI of carbohydrates. The aim was to investigate the associations between dietary GI, GL, and intake of high-, medium-, and low-GI carbohydrates and the risk of type 2 diabetes and to evaluate the applicability of GI to epidemiologic studies. In a postprandial study (n=11), variations in glycemic responses and GI values of foods were examined and the effects of methodologic choices on variation compared (capillary and venous sampling, white wheat bread and glucose solution as reference foods, and repeating the reference measurement). Both within-subject and between-subject variation was considerable. The variation was smaller when capillary samples were used and when the reference food was tested at least twice. The GI database was compiled for dietary GI and GL calculation for the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study participants. The GI values were obtained from the GI measurement laboratory of the National Institute for Health and Welfare and from publications meeting the methodologic criteria. The ATBC Study cohort comprised 25 943 male smokers, aged 50-69 years, among whom 1098 diabetes cases were identified from the national drug reimbursement register during a 12-year follow-up. Diet was assessed by a validated food frequency questionnaire. The relative risks (RRs) and confidence intervals (CIs) for diabetes were analyzed using Cox proportional hazard modeling, and multivariate nutrient density models were applied to examine the substitutions of macronutrients. Dietary GI and GL were not associated with diabetes risk: RR (and 95% CI) for the highest versus the lowest quintile in the multivariate model was 0.87 (0.71, 1.07) for GI and 0.88 (0.65, 1.17) for GL. Substitution of low-GI (GI≤55) carbohydrates for an isoenergetic amount of high-GI (GI≥70) carbohydrates or low-GI carbohydrates for medium-GI (56-69) carbohydrates was not associated with diabetes risk. Substitution of medium-GI carbohydrates for high-GI carbohydrates was inversely associated with diabetes risk (RR 0.75 (0.59, 0.96)). Total carbohydrate substitutions for total fat and protein were inversely associated with diabetes risk, the multivariate RRs for 2 E% substitution were 0.96 (0.94, 0.99) and 0.85 (0.80, 0.90), respectively. Carbohydrate substitution for saturated plus trans fatty acids, but not unsaturated fatty acids, was inversely associated with diabetes risk. Carbohydrate substitution for total, meat, or milk protein was associated inversely with diabetes risk, independently from GI. Within-subject and between-subject variations in measured food GI were considerable. In addition, the same total dietary GI and GL result from several different food combinations, thus reflecting different properties of the diet, not only the carbohydrate quality. These factors limit the possibilities of epidemiologic studies to observe reliable associations between glycemic effects of diet and disease risk. In this study population, GI was not associated with diabetes risk. A higher percentage of carbohydrate intake was associated with decreased diabetes risk; the risk was lowered when fat or protein was replaced with carbohydrates.
  • Raulio, Susanna (Helsingin yliopisto, 2011)
    Work has a central role in the lives of big share of adult Finns and meals they eat during the workday comprise an important factor in their nutrition, health, and well-being. On workdays, lunch is mainly eaten at worksite canteens or, especially among women, as a packed meal in the workplace s break room. No national-level data is available on the nutritional quality of the meals served by canteens, although the Finnish Institute of Occupational Health laid out the first nutrition recommendations for worksite canteens in 1971. The aim of this study was to examine the contribution of various socio-demographic, socioeconomic, and work-related factors to the lunch eating patterns of Finnish employees during the working day and how lunch eating patterns influence dietary intake. Four different population-based cross-sectional datasets were used in this thesis. Three of the datasets were collected by the National Institute for Health and Welfare (Health Behaviour and Health among the Finnish Adult Population survey from 1979 to 2001, n=24746, and 2005 to 2007, n=5585, the National Findiet 2002 Study, n=261), and one of them by the Finnish Institute of Occupational Health (Work and Health in Finland survey from 1997, 2000, and 2003, n=6369). The Health Behaviour and Health among the Finnish Adult Population survey and the Work and Health in Finland survey are nationally representative studies that are conducted repeatedly. Survey information was collected by self-administered questionnaires, dietary recalls, and telephone interviews. The frequency of worksite canteen use has been quite stable for over two decades in Finland. A small decreasing trend can be seen in all socioeconomic groups. During the whole period studied, those with more years of education ate at worksite canteens more often than the others. The size of the workplace was the most important work-related determinant associated with the use of a worksite canteen. At small workplaces, other work-related determinants, like occupation, physical strain at work, and job control, were also associated with canteen use, whereas at bigger workplaces the associations were almost nonexistent. The major social determinants of worksite canteen availability were the education and occupational status of employees and the only work-related determinant was the size of the workplace. A worksite canteen was more commonly available to employees at larger workplaces and to those with the higher education and the higher occupational status. Even when the canteen was equally available to all employees, its use was nevertheless determined by occupational class and the place of residence, especially among female employees. Those with higher occupational status and those living in the Helsinki capital area ate in canteens more frequently than the others. Employees who ate at a worksite canteen consumed more vegetables and vegetable and fish dishes at lunch than did those who ate packed lunches. Also, the daily consumption of vegetables and the proportion of the daily users of vegetables were higher among those male employees who ate at a canteen. In conclusion, life possibilities, i.e. the availability of a canteen, education, occupational status, and work-related factors, played an important role in the choice of where to eat lunch among Finnish employees. The most basic prerequisite for eating in a canteen was availability, but there were also a number of underlying social determinants. Occupational status and the place of residence were the major structural factors behind individuals choices in their lunch eating patterns. To ensure the nutrition, health, and well-being of employees, employers should provide them with the option to have good quality meals during working hours. The availability of worksite canteens should be especially supported in lower socioeconomic groups. In addition, employees should be encouraged to have lunch at a worksite canteen when one is available by removing structural barriers to its use.
  • Toffol, Elena (Helsingin yliopisto, 2013)
    This research aims at studying the relationship between mental health and reproductive features in women. The epidemiology and phenomenology of many psychiatric disorders differ between genders, with depressive and anxiety disorders, as well as attempted suicide, being more common in women, and completed suicide, personality disorders and substance use disorders, in men. It is plausible that (endogenous and exogenous gonadal hormones and reproductive events contribute to this pattern. Data on women who participated in two Finnish opulation-based studies (Health 2000 and FINRISK 1997, 2002 and 2007) were analyzed. Data were collected through face-to-face interviews, self-administered questionnaires and health examinations. Different structured (BDI-21, BDI-13, GHQ-12, CIDI) and non-structured tools were used to assess mental health and psychological well-being. Study I focused on the association between mental health and miscarriage, by history and number; Studies II and III focused on the relationship with use of hormonal contraception (either oral or intrauterine) and its duration; Study IV concentrated on the associations between mental health and hormone therapy in perimenopausal and postmenopausal women. Study I showed that a miscarriage as a pregnancy outcome was related to a high prevalence of depressive disorders, and to more severe depressive or anxiety symptoms compared with other pregnancy outcomes. Moreover, the higher the number of miscarriages was, the worse the current state of mood was and the higher the frequency of a psychiatric diagnosis. Studies II and III revealed that the use of hormonal contraception was not associated with adverse psychological status or depressive symptoms/disorders. Additionally, no effect of different hormonal compounds was detected. The main finding in Study IV was the high prevalence of depressive and anxiety disorders among women in connection with the menopausal transition. Moreover, in this group, an association between current use of hormone therapy and worse psychological well-being or mental health was detected. The results of this study support the hypothesis of an association between psychological well-being and reproductive features in women. The importance of considering reproductive health and events when assessing psychological status and mental health in women is discussed.