Short stature and coronary heart disease: a 35-year follow-up of the Finnish cohorts of The Seven Countries Study

OBJECTIVES

To examine whether short stature is associated with an increased risk of coronary heart disease.

DESIGN

Follow-up study.

SETTING

Two geographically defined areas in eastern and western Finland.

SUBJECTS

A total of 1441 men who were free of coronary heart disease at the start of the follow-up.

MAIN OUTCOME MEASURES

Hazard ratios for fatal and non-fatal coronary heart disease

RESULTS

Height was inversely related to fatal coronary heart disease and incident non-fatal coronary heart disease during the follow-up. These relationships persisted after adjusting for other major cardiovascular risk factors. Comparing the high-risk area in eastern Finland with the low-risk area in south-western Finland, no difference in fatal coronary heart disease and cumulative incidence of non-fatal coronary heart disease was seen in tall men. The increase in risk of coronary heart disease death was 19% for a 10 cm decrease in height (OR = 0.81, 95% CI = 0.68-0.95).

CONCLUSIONS

Our results show that short stature is an independent risk factor for coronary heart disease. Differences in stature partly explain the Finnish east-west difference in the incidence of coronary heart disease.

Muscle sizes and moment arms of rotator cuff muscles determined by magnetic resonance imaging

Biomechanical models which require information on, e.g., joint torque and muscle force are useful in the estimation of when and how mechanical overload of the musculoskeletal system may lead to disorders. The aim was to study the reliability and validity of magnetic resonance imaging (MRI) to quantify muscle sizes and moment arms by MRI and to test selected anthropometric measures as predictors of muscle sizes and moment arms. A total of 20 healthy Scandinavian women (age 22-58 years) participated in an MRI scanning of their dominant shoulder. With a PC-based program the reliability and the validity of the MRI measurements was estimated to be high, and mean anatomical cross-sectional areas (ACSA) and muscle lengths were measured to be 4.0, 9.8 and 12.1 cm(2) and 12.0, 12.6 and 12.8 cm for m. supraspinatus, m. infraspinatus and m. subscapularis, respectively. Volumes were calculated to be 48.8, 125.1 and 153.6 cm(3). Moment arms were measured with the upper arm in a neutral position and in a functional position of 34 degrees abduction for m. supraspinatus only, and were 2.4 and 2.6 cm. Physiological cross-sectional area (PCSA) and its fiber force component were estimated from dissected fiber length and pennation angle. MRI volume and PCSA were 1.4-1.7 times higher than dissection data, primarily because of age differences. No external anthropometric measures were found to be predictors of volumes or moment arms.

Baltic soil survey: total concentrations of major and selected trace elements in arable soils from 10 countries around the Baltic Sea

Agricultural soils were collected from 10 European countries over a 1,800,000 km2 area surrounding the Baltic Sea. The sampling density was 1 site/2500 km2. Two samples were taken at each site: topsoil 0-25 cm (ploughing layer, Ap-horizon) and subsoil (bottom samples, usually B- or C-horizon) at an approximate depth of 50-75 cm, well below the ploughed layer. The samples were analysed for total element concentrations of 41 elements by WD-XRF. Analytical results for both layers are quite comparable. Large differences between element concentrations and variations can be observed for most elements when the different countries are compared. The Nordic countries show considerably higher concentrations and variations for quite a number of elements [Al, Fe, (Mg, P), Ti, Ba, Sc, Sr, V] in their agricultural soils. This is an expression of geology, the relatively younger age of the soils here and of the climatic conditions (reduced weathering rates). Regional geochemical maps demonstrate that geology overwhelmingly dominates the total concentration of chemical elements as observed in the agricultural soils. The three (four) large tectonic units (Caledonian mountain chain, Fennoscandian Shield and the northern and southern eastern European Platform) composing this area are all reflected in the regional maps.

Expression of sodium channel SNS/PN3 and ankyrin(G) mRNAs in the trigeminal ganglion after inferior alveolar nerve injury in the rat

The inferior alveolar nerve is a sensory branch of the trigeminal nerve that is frequently damaged, and such nerve injuries can give rise to persistent paraesthesia and dysaesthesia. The mechanisms behind neuropathic pain following nerve injury is poorly understood. However, remodeling of voltage-gated sodium channels in the neuronal membrane has been proposed as one possible mechanism behind injury-induced ectopic hyperexcitability. The TTX-resistant sodium channel SNS/PN3 has been implicated in the development of neuropathic pain after spinal nerve injury. We here study the effect of chronic axotomy of the inferior alveolar nerve on the expression of SNS/PN3 mRNA in trigeminal sensory neurons. The organization of sodium channels in the neuronal membrane is maintained by binding to ankyrin, which help link the sodium channel to the membrane skeleton. Ankyrin(G), which colocalizes with sodium channels in the initial segments and nodes of Ranvier, and is necessary for normal neuronal sodium channel function, could be essential in the reorganization of the axonal membrane after nerve injury. For this reason, we here study the expression of ankyrin(G) in the trigeminal ganglion and the localization of ankyrin(G) protein in the inferior alveolar nerve after injury. We show that SNS/PN3 mRNA is down-regulated in small-sized trigeminal ganglion neurons following inferior alveolar nerve injury but that, in contrast to the persistent loss of SNS/PN3 mRNA seen in dorsal root ganglion neurons following sciatic nerve injury, the levels of SNS/PN3 mRNA appear to normalize within a few weeks. We further show that the expression of ankyrin(G) mRNA also is downregulated after nerve lesion and that these changes persist for at least 13 weeks. This decrease in the ankyrin(G) mRNA expression could play a role in the reorganization of sodium channels within the damaged nerve. The changes in the levels of SNS/PN3 mRNA in the trigeminal ganglion, which follow the time course for hyperexcitability of trigeminal ganglion neurons after inferior alveolar nerve injury, may contribute to the inappropriate firing associated with sensory dysfunction in the orofacial region.

The fetal and childhood growth of persons who develop type 2 diabetes

BACKGROUND

Type 2 diabetes is associated with low birthweight followed by obesity in adulthood. Persons who develop the disease may therefore have a particular pattern of growth from birth through childhood.

OBJECTIVE

To examine the relation of type 2 diabetes to size at birth and childhood growth.

DESIGN

Cohort study.

SETTING

Helsinki, Finland.

PARTICIPANTS

Men (n = 3,639) and women (n = 3,447) who were bom at the Helsinki University Central Hospital between 1924 and 1933, who went to school in Helsinki, and who still lived in Finland in 1971. Detailed birth and school health records were available for all 7,086 participants. We identified 471 men and women who developed type 2 diabetes by using the national Social Insurance Institution's register of all persons in Finland who are receiving long-term therapy with medication.

MEASUREMENTS

Incidence of diabetes ascertained from a national register. The main explanatory measurements were size at birth and childhood growth in terms of height, weight, and body mass index.

RESULTS

The cumulative incidence of type 2 diabetes was 7.9% (n = 286) in men and 5.4% (n = 185) in women. The incidence increased with decreasing birthweight, birth length, ponderal index (birthweight/length(3)), and placental weight The odds ratio for type 2 diabetes was 1.38 (95% CI, 1.15 to 1.66; P < 0.001) for each 1-kg decrease in birthweight. The mean weights and heights of the children at 7 years of age who later developed type 2 diabetes were about average. Thereafter, their growth in weight and height was accelerated until 15 years of age. The odds ratio for development of type 2 diabetes was 1.39 (CI, 1.21 to 1.61; P < 0.001) for each standard deviation increase in weight between 7 and 15 years of age. The odds ratio became 1.83 (CI, 1.37 to 2.45; P< 0.001) in an analysis restricted to persons whose birthweights were below 3,000 g. Children of both sexes whose mothers had a high body mass index in pregnancy had more rapid growth during childhood and an increased incidence of type 2 diabetes.

CONCLUSIONS

These findings are consistent with the hypothesis that type 2 diabetes is programmed in utero in association with low rates of fetal growth. The increased risk for type 2 diabetes associated with small size at birth is further increased by high growth rates after 7 years of age.

Development of the hypochord and dorsal aorta in the zebrafish embryo (Danio rerio)

The hypochord of the zebrafish embryo (Danio rerio) emerges at the 9-somite stage as a single row of cells in the dorsomedial endoderm immediately ventral to the notochord. It is recognizable from the 2(nd) or 3(rd) somite and extends along the trunk to the same extent as the somites. A basal lamina surrounds the hypochord and its cells are slightly larger than the nearby endoderm cells. TEM studies have shown that the hypochord cells contain, in addition to mitochondria, well-developed rough endoplasmic reticula and Golgi networks, indicating synthetic activity. Once formed, the hypochord will stay in close association with the notochord, and this axial complex gradually moves dorsally, separating the hypochord from the endoderm as a one-cell-wide, rod-like structure that is bean-shaped in transverse section. This is the situation in the 15-somite embryo, at the level of the 4-5(th) somites. In the gap between the hypochord and the endoderm, angioblast cells aggregate and start to form the dorsal aorta, which becomes intimately associated with the hypochord. In the 17-somite embryo the aortic rudiment is established just ventral to the hypochord as a tube with a lumen. As development proceeds, the size of the hypochord decreases. In the pec fin embryo the hypochord is still recognizable in the posterior trunk, but has apparently vanished in anterior regions. The temporal correlation between the appearance of the hypochord and the formation of the dorsal aorta, coupled with the intimate relationship between these structures, suggest that the hypochord may play a role in the positioning of the dorsal aorta.

Relation of adult height to cause-specific and total mortality: a prospective follow-up study of 31,199 middle-aged men and women in Finland

The purpose of this study was to analyze the association of adult height with cause-specific and total mortality. The study included 31,199 men and women aged 25-64 years who participated in a risk factor survey in 1972, 1977, 1982, or 1987 in eastern Finland. The cohorts were followed until the end of 1994. The relation between height and mortality was assessed by using Cox proportional hazard models. The authors found that height was associated inversely with most of the measured risk factors and directly with socioeconomic status. For both genders, height was inversely associated with cardiovascular and total mortality; the age- and birth-cohort-adjusted risk ratios per 5 cm increase in height were 0.89 and 0.91 for men and 0.86 and 0.90 for women, respectively. The inverse association also remained after adjustment for the other known risk factors. For men, an independent inverse association also was found between height and mortality from chronic obstructive pulmonary disease and from violence and accidents. Cancer mortality was not associated with height. Thus, genetic factors, and environmental factors during the fetal period, childhood, and adolescence, which determine adult height, appear to be related to a person's health later in life.

Deletion mutagenesis of the 5' psbA2 region in Synechocystis 6803: identification of a putative cis element involved in photoregulation

Three Synechocystis 6803 mutants, with deletions in the upstream region of the light-regulated psbA2 gene, were constructed. All three mutants grew photoautotrophically but they were affected in psbA2 expression. In one of the mutants, DeltaU80, psbA2 transcription levels were not suppressed under low light conditions and production of psbA2 transcripts occurred also in darkness, in contrast to the situation in the control strain. Comparative sequence analyses of the mutants identified a hexanucleotide repeat as possible cis element in psbA2 light regulation. Electrophoresis mobility shift assays showed that protein binding to the hexanucleotide repeat decreased with light intensity, consistent with a hypothesis that the repeat harbors a binding site for a repressor protein. Repeats similar to that in psbA2 were found also in the upstream region of other light-regulated genes in Synechocystsis 6803. We refer to these hexanucleotide repeats as High Light Regulatory 1 (HLR1) sequences.

Ketoacidosis in young adults is not related to the islet antibodies at the diagnosis of Type 1 diabetes mellitus--a nationwide study

AIMS

To test the hypothesis that there is lower prevalence of islet antibodies in subjects with newly diagnosed Type 1 diabetes mellitus in young adulthood than in children is associated with less severe diabetes at time of diagnosis.

METHODS

This investigation was based on a nationwide study (Diabetes Incidence Study in Sweden) of 15-34-year-old newly diagnosed diabetic subjects. During 1992-1993, all diabetic subjects (excluding secondary and gestational diabetes) were reported on standardized forms, with information about clinical characteristics at diagnosis. The study examined islet cell antibodies (ICA) by indirect immunofluorescence, and autoantibodies to glutamic acid decarboxylase (GADA), tyrosine phosphatase-like antigen (IA-2A) and insulin (IAA) as well as C-peptide by radioimmunoassay.

RESULTS

Blood samples were available from 78 patients with diabetic ketoacidosis (DKA) and 517 non-acidotic patients. The prevalence of ICA (63% vs. 57%), GADA (63% vs. 66%), IA-2A (35% vs. 44%) and IAA (20% vs. 15%) were very similar in patients with or without DKA. The median levels of the four autoantibodies did not differ between the two groups. High blood glucose (P < 0.001) and low C-peptide levels (P < 0.001) were the only parameters found to be related to DKA.

CONCLUSIONS

The similarities in findings of newly diagnosed diabetic patients with or without DKA regarding ICA, GADA, IA-2A and IAA suggest that there is no relationship between the expression of antigenicity and the severity of beta-cell dysfunction. The lower prevalence of the four autoantibodies in 15-34-year-old diabetic subjects compared with previous findings in children is not explained by misclassification of diabetes type.

A statistical basis for testing the significance of mass spectrometric protein identification results

A method for testing the significance of mass spectrometric (MS) protein identification results is presented. MS proteolytic peptide mapping and genome database searching provide a rapid, sensitive, and potentially accurate means for identifying proteins. Database search algorithms detect the matching between proteolytic peptide masses from an MS peptide map and theoretical proteolytic peptide masses of the proteins in a genome database. The number of masses that matches is used to compute a score, S, for each protein, and the protein that yields the best score is assumed as the identification result. There is a risk of obtaining a false result, because masses determined by MS are not unique; i.e., each mass in a peptide map can match randomly one or several proteins in a genome database. A false result is obtained when the score, S, due to random matching cannot be discerned from the score due to matching with a real protein in the sample. We therefore introduce the frequency function, f(S), for false (random) identification results as a basis for testing at what significance level, alpha, one can reject a null hypothesis, H0: "the result is false". The significance is tested by comparing an experimental score, S(E), with a critical score, S(C), required for a significant result at the level alpha. If S(E) > or = S(C), H0 is rejected. f(S) and S(C) were obtained by simulations utilizing random tryptic peptide maps generated from a genome database. The critical score, S(C), was studied as a function of the number of masses in the peptide map, the mass accuracy, the degree of incomplete enzymatic cleavage, the protein mass range, and the size of the genome. With S(C) known for a variety of experimental constraints, significance testing can be fully automated and integrated with database searching software used for protein identification.

The Finnish Diabetes Prevention Study

The aim of the Finnish Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying type 2 diabetes in individuals with impaired glucose tolerance (IGT) and to evaluate the effect of the programme on the risk factors of atherosclerotic vascular diseases and the incidence of cardiovascular events. In this ongoing study, a total of 523 overweight subjects with IGT based on two oral glucose tolerance tests were randomized to either an intervention group or a control group. The main measure in the intervention group is individual dietary advice aimed at reducing weight and intake of saturated fat and increasing intake of dietary fibre. The intervention subjects are individually guided to increase their level of physical activity. The control group receives general information about the benefits of weight reduction, physical activity and healthy diet in the prevention of diabetes. A pilot study began in 1993, and recruitment ended in 1998. By the end of April 1999 there were 65 new cases of diabetes, 34 drop-outs and one death. The weight reduction was greater (-4.6 kg) at 1 year in the intervention group (n = 152) than in the control group (n = 143, -0.9 kg, P < 0.0001), and this difference was sustained in the second year of follow-up. At 1 year 43.4% and at 2 years 41.8% of the intervention subjects had achieved a weight reduction of at least 5 kg, while the corresponding figures for the control subjects were 14.0 and 12.0% (P < 0.001 between the groups). At 1 year the intervention group showed significantly greater reductions in 2 h glucose, fasting and 2 h insulin, systolic and diastolic blood pressure, and serum triglycerides. Most of the beneficial changes in cardiovascular risk factors were sustained for 2 years. These interim results of the ongoing Finnish Diabetes Prevention Study demonstrate the efficacy and feasibility of the lifestyle intervention programme.

Design and evaluation of a software prototype for participatory planning of environmental adaptations

A software prototype to support the planning process for adapting home and work environments for people with physical disabilities was designed and later evaluated. The prototype exploits low-cost three-dimensional (3-D) graphics products in the home computer market. The essential features of the prototype are: interactive rendering with optional hardware acceleration, interactive walk-throughs, direct manipulation tools for moving objects and measuring distances, and import of 3-D-objects from a library. A usability study was conducted, consisting of two test sessions (three weeks apart) and a final interview. The prototype was then tested and evaluated by representatives of future users: five occupational therapist students, and four persons with physical disability, with no previous experience of the prototype. Emphasis in the usability study was placed on the prototype's efficiency and learnability. We found that it is possible to realise a planning tool for environmental adaptations, both regarding usability and technical efficiency. The usability evaluation confirms our findings from previous case studies, regarding the relevance and positive attitude towards this kind of planning tool. Although the prototype was found to be satisfactorily efficient for the basic tasks, the paper presents several suggestions for improvement of future prototype versions.

Insulin sensitivity and insulin secretion in monozygotic and dizygotic twins

AIMS/HYPOTHESIS

To estimate the heritability of insulin sensitivity and insulin secretion, both of which are considered to contribute to the development of Type II (non-insulin-dependent) diabetes mellitus.

METHODS

Intraclass correlation coefficients and heritability estimates for insulin sensitivity (euglycaemic clamp) as well as first-phase and late-phase insulin secretion (intravenous glucose tolerance test) were calculated in 21 monozygotic and 20 dizygotic twin pairs of the same sex between 54 and 72 years of age.

RESULTS

Intrapair correlations for all traits were consistently higher in monozygotic than in dizygotic pairs. Insulin secretion correlated significantly only between monozygotic (first-phase r = 0.55; p = 0.003 and late-phase r = 0.66; p < 0.001) twins giving heritability estimates of 0.55 and 0.58, respectively. Insulin-stimulated glucose uptake showed a more modest correlation between monozygotic twins (r = 0.46; p = 0.015). The heritability estimate was 0.37. The heritability estimate for waist-to-hip ratio was 0.76 in female and 0.70 in male twins.

CONCLUSION/INTERPRETATION

Genetic variability seems to contribute to the variance of insulin sensitivity as well as of insulin secretion. In the current study, genetic variance accounted almost 60% for the variance in glucose-stimulated insulin secretion and almost 40% for the variance in insulin-stimulated glucose uptake. Our data is also compatible with findings in monogenic forms of diabetes in which genetic defects in insulin secretion play a predominant part in the pathogenesis of hyperglycaemia.

Cerivastatin gender effect: sub-analyses of results from a multinational, randomised, double-blind study. Cerivastatin Study Group

We previously reported the results of a multicentre, randomised, double-blind, parallel-group study comparing the efficacy and safety of cerivastatin 0.4 mg/day and cerivastatin 0.2 mg/day in patients with primary hypercholesterolaemia. Exploratory analysis in this study suggested a gender difference in the 0.4 mg group: mean low-density lipoprotein cholesterol (LDL-C) decreased by 44.4 +/- 8.9% in women, compared with a mean decrease of 37.0 +/- 0.9% in men (p < 0.046). This paper reports the results of further sub-analyses from this study. Overall in the per-protocol (PP) population, 71.5% (n = 73) of women taking cerivastatin 0.4 mg had an LDL-C decrease of > 40%, compared with 38.0% (n = 76) of men taking the same dose. In the cerivastatin 0.2 mg PP population, 34% (n = 17) of women had an LDL-C decrease of > 40%, compared with 19% (n = 18) of men. Mean LDL-C/HDL-C ratio decreased by 43% from baseline to the end of the study in the cerivastatin 0.4 mg PP group: -41.3% in males vs. -48.3% in females. In the cerivastatin 0.2 mg group, the decrease in LDL-C/HDL-C ratio from baseline to endpoint did not markedly differ between genders: -37.0% for males vs. -37.3% for females. Categorial analysis of the LDL-C/HDL-C ratio found that 90% of PP patients taking cerivastatin 0.4 mg, and 84% of PP patients taking cerivastatin 0.2 mg, had a low CHD risk (defined as a LDL-C/HDL-C ratio < or = 3) after 8 weeks of treatment. The 6th and 95th percentiles of the distribution of LDL-C reduction from baseline revealed that 90% of PP patients taking cerivastatin 0.4 mg had an LDL-C reduction of between 22% and 56%. The mean LDL-C reduction for this 90% subset of patients was 40.1%. The same analysis for PP patients taking cerivastatin 0.2 mg found that 90% had an LDL-C reduction of between 13% and 49%. The mean LDL-C reduction in this 90% subset of patients was 31.5%. Of the patients taking cerivastatin 0.4 mg and valid for treatment according to National Cholesterol Education Program (NCEP) criteria, 71% (149/211) achieved NCEP targets for LDL-C at Week 16.

Prevalence of gastrointestinal symptoms in young and middle-aged diabetic patients

BACKGROUND

Gastrointestinal disorders have been reported in patients with diabetes mellitus. The present investigation was carried out to evaluate the frequency of gastrointestinal symptoms in out-clinic diabetic patients in the county of Umeå, Sweden.

METHODS

Diabetic patients aged 24-59 years residing in Umeå County (population, 136,000) were included in the study (n = 489), as were 200 sex- and age-matched healthy controls. A questionnaire was mailed to the patients and controls, and a reminder was sent 5 months later. The questionnaire contained 28 questions concerning gastrointestinal symptoms, bowel habits, and medication during the preceding year.

RESULTS

Fifty-nine per cent of the patients and 53% of the controls responded. The total number of reported gastrointestinal symptoms was significantly greater in patients (1.25 +/- 0.10; mean +/- standard deviation) than in control subjects (0.50 +/- 0.08). This increase was seen in both type-1 (1.12 +/- 0.11) and type-2 (1.52 +/- 0.25) diabetic patients. Female diabetic patients reported significantly more symptoms than did male patients (1.59 +/- 0.17 and 0.81 +/- 0.12, respectively). Patients with neuropathy had significantly more symptoms than the other patients. Symptom frequency was not correlated with nephropathy or retinopathy or with the duration of diabetes, body mass index, glycosylated haemoglobin, or insulin dose. Heartburn, constipation, and nocturnal urge to defecate were significantly more frequent in patients than in controls. Furthermore, a feeling of incomplete defecation, a need to strain at defecation, and urgency were significantly more common in patients.

CONCLUSION

Diabetic patients had more gastrointestinal symptoms than non-diabetic population. These symptoms did not correlate with duration of the disease, metabolic control, or any other complication except neuropathy. Heartburn and constipation were among the symptoms that occurred more frequently in diabetic patients than in the non-diabetic population.

Leptin concentrations and their relation to body fat distribution and weight loss--a prospective study in individuals with impaired glucose tolerance. DPS-study group

Leptin is proposed to be involved in regulation of body weight. Only little information is available on leptin concentrations in individuals with impaired glucose tolerance (IGT). The aim of the present study was to assess the effect of body fat distribution and weight reduction on serum leptin levels in a prospective setting in IGT subjects. Sixty-nine individuals with impaired glucose tolerance aged 45-64 years participated in this prospective study. Serum leptin levels were about 300% higher among females than among males, despite an only 30% higher fat percentage in females. A close association between degree of obesity and leptin concentrations was observed in both sexes. The correlation coefficient between fat mass and leptin concentration ranged between r = 0.467- 0.817 (p< 0.001 - 0.01). A close correlation between degree of weight loss and decrease in leptin concentrations was observed in both sexes. A 10.1 kg (9.6%) decrease in body weight among females was associated with a 32% decrease in leptin concentrations. The corresponding value among males for an 8.0 kg (8.6%) decrease was 29%. Changes in leptin concentrations were best explained by changes in fat mass among both males and females. Body fat distribution was also of importance, especially among females. Gender associated differences in leptin concentrations appear to be largely influenced by gender differences in body fat distribution.

Prevention of Type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland. Study design and 1-year interim report on the feasibility of the lifestyle intervention programme

AIMS/HYPOTHESIS; The aim of the Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying Type II (non-insulin-dependent) diabetes mellitus in subjects with impaired glucose tolerance, to evaluate the effects of the intervention programme on cardiovascular risk factors and to assess the determinants for the progression to diabetes in persons with impaired glucose tolerance.

METHODS

A total of 523 overweight subjects with impaired glucose tolerance ascertained by two oral glucose tolerance tests were randomised to either a control or intervention group. The control subjects received general information at the start of the trial about the lifestyle changes necessary to prevent diabetes and about annual follow-up visits. The intervention subjects had seven sessions with a nutritionist during the first year and a visit every 3 months thereafter aimed at reducing weight, the intake of saturated fat and increasing the intake of dietary fibre. Intervention subjects were also guided individually to increase their physical activity.

RESULTS

During the first year, weight loss in the first 212 study subjects was 4.7 +/- 5.5 vs 0.9 +/- 4.1 kg in the intervention and control group, respectively (p < 0.001). The plasma glucose concentrations (fasting: 5.9 +/- 0.7 vs 6.4 +/- 0.8 mmol/l, p < 0.001; and 2-h 7.8 +/- 1.8 vs 8.5 +/- 2.3 mmol/l, p < 0.05) were significantly lower in the intervention group after the first year of intervention. Favourable changes were also found in blood pressure, serum lipids and anthropometric indices in the intervention group.

CONCLUSION/INTERPRETATION

The interim results show the efficacy and feasibility of the lifestyle intervention programme.

Familiality of quantitative metabolic traits in Finnish families with non-insulin-dependent diabetes mellitus. Finland-United States Investigation of NIDDM Genetics (FUSION) Study investigators

Type 2 diabetes mellitus (NIDDM) is a complex disorder encompassing multiple metabolic defects. There exists strong evidence for a genetic component to NIDDM; however, to date there have been few reports of linkage between genetic markers along the genome and NIDDM or NIDDM-related quantitative traits. We sought to determine whether individual quantitative traits which determine glucose tolerance exhibit familiality in Finnish families with at least one NIDDM-affected sibling pair. Tolbutamide-modified frequently sampled intravenous glucose tolerance tests (FSIGT) were performed on unaffected offspring (n = 431) and spouses (n = 154) of affected sibling pairs sampled for the Finland-United States Investigation of NIDDM Genetics (FUSION) study. FSIGT data were analyzed using the Minimal Model to obtain quantitative measures of insulin sensitivity (SI), glucose effectiveness (SG), and insulin secretion assessed as the acute insulin response to glucose (AIR). The disposition index (DI), a measure of insulin resistance-corrected beta-cell function, was also derived as the product of SI and AIR. Variance components analysis was used to determine for each trait, the heritability (h2), the proportion of the total trait variance accounted for by additive genes. After adjustment for age, gender, and body mass index, h2 estimates were: SG: 18 +/- 9%, SI: 28 +/- 8%, AIR: 35 +/- 8%, and DI: 23 +/- 8%. We conclude that there is strong evidence for modest heritability of Minimal-Model-derived NIDDM-related quantitative traits in unaffected spouses and offspring of Finnish affected sibling pairs.

Type 2 diabetes: evidence for linkage on chromosome 20 in 716 Finnish affected sib pairs

We are conducting a genome scan at an average resolution of 10 centimorgans (cM) for type 2 diabetes susceptibility genes in 716 affected sib pairs from 477 Finnish families. To date, our best evidence for linkage is on chromosome 20 with potentially separable peaks located on both the long and short arms. The unweighted multipoint maximum logarithm of odds score (MLS) was 3.08 on 20p (location, chi = 19.5 cM) under an additive model, whereas the weighted MLS was 2.06 on 20q (chi = 57 cM, recurrence risk,lambda(s) = 1. 25, P = 0.009). Weighted logarithm of odds scores of 2.00 (chi = 69.5 cM, P = 0.010) and 1.92 (chi = 18.5 cM, P = 0.013) were also observed. Ordered subset analyses based on sibships with extreme mean values of diabetes-related quantitative traits yielded sets of families who contributed disproportionately to the peaks. Two-hour glucose levels in offspring of diabetic individuals gave a MLS of 2. 12 (P = 0.0018) at 9.5 cM. Evidence from this and other studies suggests at least two diabetes-susceptibility genes on chromosome 20. We have also screened the gene for maturity-onset diabetes of the young 1, hepatic nuclear factor 4-a (HNF-4alpha) in 64 affected sibships with evidence for high chromosomal sharing at its location on chromosome 20q. We found no evidence that sequence changes in this gene accounted for the linkage results we observed.

The W64R variant of the beta3-adrenergic receptor is not associated with type II diabetes or obesity in a large Finnish sample

Recent studies have suggested an association between Type II (non-insulin-dependent) diabetes mellitus-related phenotypes and a cytosine-to-thymidine substitution that results in the replacement of tryptophan by arginine at codon 64 (Trp64Arg or W64R) of the beta3-adrenergic receptor gene. Here, we present the results of possibly the largest association study to date on the variant in a sample of 526 families with a total of 1725 subjects, 1053 of whom had Type II diabetes. Preliminary calculations suggested that we had excellent power to detect the moderate associations which were reported in previous studies. No associations were found between the W64R variant and the following phenotypes in our sample: Type II diabetes, age at diagnosis for Type II diabetes, measures of obesity, fasting glucose, fasting insulin, minimal model variables, and systolic and diastolic blood pressures. In the analysis of plasma lipids, we detected an association between the variant and HDL ratios (HDL cholesterol/total cholesterol) (p = 0.013), which remained significant even after adjusting for sex, affection status and age. Since W64R homozygotes (n = 11) had the highest HDL ratios, however, heterozygotes had the lowest and the wild-type subjects had intermediate values, we conclude that the W64R variant is unlikely to reduce HDL ratios in a dose-dependent, pathogenic manner.

The effect of knee bracing after anterior cruciate ligament reconstruction. A prospective, randomized study with two years' follow-up

The purpose of this prospective, randomized, clinical trial was to evaluate the effect of knee bracing after anterior cruciate ligament reconstruction. Sixty patients were randomized into one of two groups: Patients in the braced group wore rehabilitative braces for 2 weeks, followed by functional braces for 10 weeks, and patients in the nonbraced group did not wear braces. Data were recorded preoperatively, and postoperatively after 6 weeks, 3 and 6 months, and 1 and 2 years. The following outcome measures were used: KT-1000 arthrometry, the Cincinnati knee score, goniometry to record range of motion, computed tomography to determine thigh atrophy, Cybex 6000 isokinetic testing to evaluate muscle strength, three functional knee tests, and a visual analog scale to evaluate pain. At all follow-up times there were no significant differences between the two groups with regard to knee joint laxity, range of motion, muscle strength, functional knee tests, or pain. However, the Cincinnati knee score showed that patients in the braced group had significantly improved knee function compared with patients in the nonbraced group at the 3-month follow-up, even though the braced group showed significantly increased thigh atrophy compared with the nonbraced group at 3 months.

Efficacy and safety of cerivastatin, 0.2 mg and 0.4 mg, in patients with primary hypercholesterolaemia: a multinational, randomised, double-blind study. Cerivastatin Study Group

Elevated serum cholesterol level is a key risk factor for cardiovascular morbidity and mortality. Cerivastatin is a highly effective lipid-lowering agent currently licensed at doses of 0.1, 0.2, 0.3 and 0.4 mg. This was a multicentre, randomised, double-blind, parallel-group study comparing the efficacy and safety of cerivastatin 0.4 mg/day with that of cerivastatin 0.2 mg/day in patients with primary hypercholesterolaemia. There was a six-week placebo run-in phase followed by a 24-week active treatment phase. A total of 494 patients were randomised to receive cerivastatin 0.4 mg (n = 332) or 0.2 mg (n = 162). Per-protocol (PP) analysis revealed that mean low-density lipoprotein cholesterol (LDL-C) level decreased by 38.4 +/- 0.7% from baseline in the 0.4 mg group, compared with a decrease of 31.5 +/- 0.9% in the 0.2 mg group (p < 0.0001). There was a significant gender difference in the 0.4 mg group: LDL-C decreased by 44.4 +/- 8.9% in women, compared with a decrease of 37.0 +/- 0.9% in men (p < 0.046). In the PP group as a whole, total cholesterol decreased by 26.0 +/- 0.5% from baseline in the 0.4 mg group, compared with a decrease of 21.6 +/- 0.7% in the 0.2 mg group (p < 0.0001). Both doses were well tolerated; only eight (2.4%) patients in the 0.4 mg group and five (3.1%) patients in the 0.2 mg group withdrew owing to adverse events. Cerivastatin 0.2 mg/day and 0.4 mg/day was found to lower low-density lipoprotein cholesterol and total cholesterol levels in a dose-dependent manner, with both doses exhibiting a good safety profile.