Trends and socioeconomic differences in overweight among physically active and inactive Finns in 1978-2002

Prevention of gestational diabetes with a prepregnancy lifestyle intervention - findings from a randomized controlled trial

Purpose

Lifestyle intervention studies performed during pregnancy have shown inconsistent results in relation to prevention of gestational diabetes mellitus (GDM). Therefore, the aim of this study was to assess the effect of an intervention initiated already before pregnancy in prevention of GDM in high-risk women.

Patients and methods

A randomized controlled trial was conducted in four Finnish maternity hospitals between the years 2008 and 2014. Altogether 228 high-risk women planning pregnancy were randomized to an intervention (n=116) or a control group (n=112). The risk factors were body mass index ≥30 kg/m² (n=46), prior GDM (n=120), or both (n=62), without manifest diabetes at study inclusion. Trained study nurses provided individualized lifestyle counseling every 3 months in addition to a group session with a dietician. The control group received standard antenatal care. GDM was defined as one or more pathological glucose values in a 75 g 2-hour oral glucose tolerance test, performed between 12 and 16 weeks of gestation and if normal repeated between 24 and 28 weeks of gestation.

Results

Within 12 months, 67% of the women (n=72) in the intervention group and 63% of the women (n=71) in the control group (p=0.84) became pregnant. The cumulative incidence of GDM among the women available for the final analyses was 60% (n=39/65) in the intervention group and 54% (n=34/63) in the control group (p=0.49). GDM was diagnosed already before 20 weeks of gestation in 60% (n=44/73) of the cases.

Conclusion

The preconceptional lifestyle intervention applied in the present study did not reduce the incidence of GDM.

Perceived health-related self-efficacy associated with BMI in adults in a population-based survey

BACKGROUND

The concept of ability to control personal behaviour in various environmental temptations is called self-efficacy. The high prevalence of obesity and overweight in Finland is the reason for studying the determinants of weight. The aim of the present study was to clarify the associations between body mass index and health-related self-efficacy (HSE), including food patterns, health behaviour and education.

METHODS

A random sample of adults was invited to the cross-sectional FINRISK 2002 Study in six regions in Finland. Participants (n=7784) gave information on education, health behaviour, HSE and food consumption. Height and weight were measured in a health examination. The response rate was 60% for men and 71% for women. Six food patterns were identified by principal component analysis on the basis of food consumption. The scores from seven-item HSE was calculated and categorized into tertiles for the analysis. The associations of BMI with self-efficacy and exploratory variables were tested using general linear modelling in total population and by gender.

RESULTS

A weak HSE was associated with a higher BMI after adjusting for age, education, food patterns and health behaviour. In addition, low education, infrequent PA and non-smoking were associated with the higher BMI, but the association of HSE and BMI remained in multivariate model. The associations of food patterns and BMI were small. The adverse association with BMI was observed for patterns with sweet and butter.

CONCLUSION

The study supports the importance of self-control in weight management, which needs to be considered as an empowerment tool in health education.

Physical activity during work, transport and leisure in Germany--prevalence and socio-demographic correlates

BACKGROUND

This study aimed 1) to provide data estimates concerning overall moderate- and vigorous-intensity physical activity (MVPA) as well as MVPA during work, transport and leisure in Germany and 2) to investigate MVPA and possible associations with socio-demographic correlates.

METHODS

A cross-sectional telephone survey interviewed 2248 representative participants in the age of 18-65 years (1077 men; 42.4 ± 13.4 years; body mass index: 25.3 ± 4.5 kg • m(-2)) regarding their self-reported physical activity across Germany. The Global Physical Activity Questionnaire was applied to investigate MVPA during work, transport and leisure and questions were answered concerning their demographics. MVPA was stratified by gender, age, body mass index, residential setting, educational and income level. To identify socio-demographic correlates of overall MVPA as well as in the domains, we used a series of linear regressions.

RESULTS

52.8% of the sample achieved physical activity recommendations (53.7% men/52.1% women). Overall MVPA was highest in the age group 18-29 years (p < .05), in participants with 10 years of education (p < .05) and in participants with lowest income levels < 1.500 € (p < .05). Regression analyses revealed that age, education and income were negatively associated with overall and work MVPA. Residential setting and education was positively correlated with transport MVPA, whereas income level was negatively associated with transport MVPA. Education was the only correlate for leisure MVPA with a positive association.

CONCLUSIONS

The present data underlines the importance of a comprehensive view on physical activity engagement according to the different physical activity domains and discloses a need for future physical activity interventions that consider socio-demographic variables, residential setting as well as the physical activity domain in Germany.

Eleven-year physical activity trends in a Swiss urban area

OBJECTIVE

Regular physical activity is a major health determinant. Little is known about physical activity trends. We evaluated whether adult physical activity levels are changing in a Swiss urban state (Geneva).

METHOD

We analyzed 11-year trends of physical activity indicators, including 3+MET-minutes per week and physical activity outside working hours, in population representative adults (n=9320, aged 35-74years, 50% women), relating declared physical activity to socioeconomic status, lifestyle, and clinical and blood markers.

RESULTS

Combining yearly cohorts from 1999 to 2009, we found a significant trend for increased physical activity levels. Weekly age and sex adjusted 3+MET-minutes per week increased from 3023 to 3752, between 1999 and 2009 (P=0.02). The increase also concerned physical activity outside working hours (+18kcal/day/year). There was a shift from low levels of physical activity levels towards higher activities. Physical activity indicators were associated with socioeconomic status, comorbidities, and biological and anthropometric measures. The trend for increased physical activity was more prominent over the latter 5years.

CONCLUSION

We found that physical activity levels have increased in an urban Swiss state. The increase is significant but small, and further efforts to promote physical activity are therefore warranted.

Educational differences in estimated and measured physical fitness

BACKGROUND

Available information about the association between education and physical fitness (PF) is scarce. The purpose of this study was to examine educational differences in PF in the working age population using different methods to assess PF.

METHODS

The Health 2000 Survey was carried out for adults aged ≥ 30 years (n = 8028) in Finland. For this study, 30-54-year-old men and women with data on PF and physical activity (PA) were selected (n = 3724). PF was assessed by self-estimated overall physical fitness and running ability, a physician's estimation of a participant's working capacity, the trunk extensors' endurance and hand grip strength tests. The highest educational qualification taken by the participant was used as a measure of education. The analyses were adjusted for age, PA, BMI, smoking and chronic diseases.

RESULTS

PF was best in the high-educated men and women. The educational differences were minor in self-estimated overall PF. Adjusting for the covariates, the differences in self-estimated running ability and working capacity decreased. The educational differences in the trunk extensors' endurance test were independent of covariates. PA and other health behaviours contributed most to the differences.

CONCLUSION

People with high education had better PF irrespective of the method used to assess PF. A large amount of the educational differences could be explained by PA and other health behaviours. More research is needed to understand the determinants of educational differences in PF.

Socioeconomic patterning of childhood overweight status in Europe

There is growing evidence of social disparities in overweight among European children. This paper examines whether there is an association between socioeconomic inequality and prevalence of child overweight in European countries, and if socioeconomic disparities in child overweight are increasing. We analyse cross-country comparisons of household inequality and child overweight prevalence in Europe and review within-country variations over time of childhood overweight by social grouping, drawn from a review of the literature. Data from 22 European countries suggest that greater inequality in household income is positively associated with both self-reported and measured child overweight prevalence. Moreover, seven studies from four countries reported on the influence of socioeconomic factors on the distribution of child overweight over time. Four out of seven reported widening social disparities in childhood overweight, a fifth found statistically significant disparities only in a small sub-group, one found non-statistically significant disparities, and a lack of social gradient was reported in the last study. Where there is evidence of a widening social gradient in child overweight, it is likely that the changes in lifestyles and dietary habits involved in the increase in the prevalence of overweight have had a less favourable impact in low socio-economic status groups than in the rest of the population. More profound structural changes, based on population-wide social and environmental interventions are needed to halt the increasing social gradient in child overweight in current and future generations.

The association of education with body mass index and waist circumference in the EPIC-PANACEA study

Background

To examine the association of education with body mass index (BMI) and waist circumference (WC) in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Method

This study included 141,230 male and 336,637 female EPIC-participants, who were recruited between 1992 and 2000. Education, which was assessed by questionnaire, was classified into four categories; BMI and WC, measured by trained personnel in most participating centers, were modeled as continuous dependent variables. Associations were estimated using multilevel mixed effects linear regression models.

Results

Compared with the lowest education level, BMI and WC were significantly lower for all three higher education categories, which was consistent for all countries. Women with university degree had a 2.1 kg/m² lower BMI compared with women with lowest education level. For men, a statistically significant, but less pronounced difference was observed (1.3 kg/m²). The association between WC and education level was also of greater magnitude for women: compared with the lowest education level, average WC of women was lower by 5.2 cm for women in the highest category. For men the difference was 2.9 cm.

Conclusion

In this European cohort, there is an inverse association between higher BMI as well as higher WC and lower education level. Public Health Programs that aim to reduce overweight and obesity should primarily focus on the lower educated population.

Changes in occupational class differences in leisure-time physical activity: a follow-up study

Background

Physical activity is known to have health benefits across population groups. However, less is known about changes over time in socioeconomic differences in leisure-time physical activity and the reasons for the changes. We hypothesised that class differences in leisure-time physical activity would widen over time due to declining physical activity among the lower occupational classes. We examined whether occupational class differences in leisure-time physical activity change over time in a cohort of Finnish middle-aged women and men. We also examined whether a set of selected covariates could account for the observed changes.

Methods

The data were derived from the Helsinki Health Study cohort mail surveys; the respondents were 40-60-year-old employees of the City of Helsinki at baseline in 2000-2002 (n = 8960, response rate 67%). Follow-up questionnaires were sent to the baseline respondents in 2007 (n = 7332, response rate 83%). The outcome measure was leisure-time physical activity, including commuting, converted to metabolic equivalent tasks (MET). Socioeconomic position was measured by occupational class (professionals, semi-professionals, routine non-manual employees and manual workers). The covariates included baseline age, marital status, limiting long-lasting illness, common mental disorders, job strain, physical and mental health functioning, smoking, body mass index, and employment status at follow-up. Firstly the analyses focused on changes over time in age adjusted prevalence of leisure-time physical activity. Secondly, logistic regression analysis was used to adjust for covariates of changes in occupational class differences in leisure-time physical activity.

Results

At baseline there were no occupational class differences in leisure-time physical activity. Over the follow-up leisure-time physical activity increased among those in the higher classes and decreased among manual workers, suggesting the emergence of occupational class differences at follow-up. Women in routine non-manual and manual classes and men in the manual class tended to be more often physically inactive in their leisure-time (<14 MET hours/week) and to be less often active (>30 MET hours/week) than those in the top two classes. Adjustment for the covariates did not substantially affect the observed occupational class differences in leisure-time physical activity at follow-up.

Conclusions

Occupational class differences in leisure-time physical activity emerged over the follow-up period among both women and men. Leisure-time physical activity needs to be promoted among ageing employees, especially among manual workers.

Leisure-time physical activity and metabolic syndrome plus depressive symptoms in the FIN-D2D survey

OBJECTIVE

To examine the association between leisure-time physical activity (LTPA) and simultaneous presence of metabolic syndrome (MetS) and depressive symptoms (DS) based on a population-based FIN-D2D cross-sectional survey conducted in 2007.

METHODS

4500 randomly selected Finnish men and women aged 45-74 years were initially enrolled; 2868 (64%) attended a health examination. Participants with complete information (n=2778) were grouped into three LTPA categories: low, moderate and high. MetS was based on the National Cholesterol Education Program criteria and DS on the Beck Depression Inventory (≥10 points).

RESULTS

The prevalence of MetS and DS were 53% and 15%, respectively; the prevalence of simultaneous MetS and DS was 10%. The proportion of subjects with MetS, DS and simultaneous presence of MetS and DS increased with decreasing LTPA (p<0.001). On multivariate ordered analysis, LTPA was related to education years, household income, smoking, and the presence of MetS only, DS only and simultaneous MetS and DS.

CONCLUSION

The prevalence of simultaneous MetS and DS was higher in participants with low LTPA compared with participants with high LTPA. Furthermore, LTPA level was associated with socioeconomic status and other health related outcomes, outlining the importance of LTPA as part of the general health promotion.

Adults born at very low birth weight exercise less than their peers born at term

OBJECTIVE

To study the effects of very low birth weight (VLBW, <1500 g) birth on physical activity, an important protective and modifiable factor.

STUDY DESIGN

VLBW participants (n=163) with no major disability and 188 individuals born at term (mean age, 22.3 years; range, 18.5-27.1) completed a standardized questionnaire of physical activity.

RESULTS

VLBW participants reported less leisure-time conditioning physical activity. They were 1.61-fold more likely to "not exercise much," 1.61-fold more likely to exercise infrequently (once a week or less), 2.75-fold more likely to exercise with low intensity (walking), and 3.11-fold more likely to have short exercise sessions (<30 minutes). The differences were present even in subjects with no history of bronchopulmonary dysplasia or asthma and were only slightly attenuated when adjusted for height, parental education, lean body mass, and percent body fat.

CONCLUSIONS

Unimpaired adults who were VLBW exercise less during their leisure time than adults born at term. Promoting physical activity may be particularly important in the VLBW population to counteract the risks of chronic disease in adult life.

Fat free mass and obesity in relation to educational level

BACKGROUND

The aim of the study was to describe the body composition of Finnish adults, especially by education, and to investigate whether fat-free mass (FFM) can explain educational gradients relating to body mass index (BMI) and waist-to-hip ratio (WHR).

METHODS

Data for this cross-sectional study were based on data collected in 2000-2001 for the Health 2000 Survey. Of the nationally representative sample of 8,028 Finnish men and women aged 30 years and older, 6,300 (78.5%) were included in the study. Body composition measurements were carried out in the health examination, where FFM was assessed with eight-polar bioelectrical impedance analysis. Questions on education were included in the health interview.

RESULTS

The mean FFM varied by education in older (>or= 65 y.) men only. In the middle-aged group (30-64 y.), highly educated men were less likely to belong to the lowest quintile of FFM (OR 0.67, 95%CI 0.48-0.93) compared with the least educated subjects. The level of education was inversely associated with the prevalence of high BMI and WHR in middle-aged men. In women, the respective associations were found both in middle-aged women and their older counterparts. Adjustment for FFM slightly strengthened the associations of education with BMI and WHR.

CONCLUSIONS

The association between education and FFM is weak. Educational gradients of high BMI and high WHR cannot be explained by FFM.

Maternal high-fat diet promotes body length increases and insulin insensitivity in second-generation mice

Maternal obesity and diet consumption during pregnancy have been linked to offspring adiposity, cardiovascular disease, and impaired glucose metabolism. Furthermore, nutrition during development is clearly linked to somatic growth. However, few studies have examined whether phenotypes derived from maternal high-fat diet exposure can be passed to subsequent generations and by what mechanisms this may occur. Here we report the novel finding of a significant body length increase that persisted across at least two generations of offspring in response to maternal high-fat diet exposure. This phenotype is not attributable to altered intrauterine conditions or maternal feeding behavior because maternal and paternal lineages were able to transmit the effect, supporting a true epigenetic manner of inheritance. We also detected a heritable feature of reduced insulin sensitivity across two generations. Alterations in the GH secretagogue receptor (GHSR), the GHSR transcriptional repressor AF5q31, plasma IGF-I concentrations, and IGF-binding protein-3 (IGFBP3) suggest a contribution of the GH axis. These studies provide evidence that the heritability of body length and glucose homeostasis are modulated by maternal diet across multiple generations, providing a mechanism where length can increase rapidly in concert with caloric availability.

International perspectives on the physical inactivity crisis--structural solutions over evidence generation?

Many programs to increase physical activity have been evaluated in developed countries, where 'leisure time physical activity' is the most frequent domain for interventions. In developing countries, and also with reference to global obesity prevention, different kinds of interventions targeting 'total physical activity' are needed. This requires efforts across agencies and sectors, and in the domains of work, active transport, reduced sitting time, as well as leisure time physical activity promotion. In considering possible solutions, this commentary examined the use of complex systems, where integrated efforts across sectors and agencies might, in combination, contribute to increasing total physical activity. The key sets of actions required globally to increase physical activity were, in our opinion, [i] efforts to disseminate individual-level behavior change programs to reach much larger populations rather than volunteers, [ii] social marketing and mass communication campaigns to change social norms in the community and among professionals and policymakers, [iii] efforts to influence the social and physical environment to make them more conducive to physical activity, and [iv] the development and implementation of national physical activity plans and strategies, with sufficient timelines and resources to achieve measurable change.

Mapping geographical variation in obesity in Finland

BACKGROUND

The prevalence of obesity varies across countries. However, less is known about the geographical, within-country variation. This study investigated and visualized the geographical differences in general obesity defined by body mass index (BMI) and in abdominal obesity defined by waist circumference and waist-to-hip ratio (WHR) in Finland.

SUBJECTS AND METHODS

Data for the study consisted of three large population surveys: Health 2000 Survey with a nationally representative sample together with the National FINRISK Study conducted in five areas in 1997 and six areas in 2002. Altogether, 17 816 men and women aged 30-64 years participated in the surveys. In each survey, subjects' weight, height and circumferences of waist and hip were measured. The geographical pattern of mean anthropometric values and obesity prevalence were studied applying a Bayesian hierarchical approach and Geographical Information Systems.

RESULTS

Both in men and women, the prevalence of obesity (BMI >/= 30 kg m(-2)) varied little across geographical areas, but it was smaller in cities compared with other areas across the country. In men, the prevalence of abdominal obesity defined both by waist circumference and WHR was higher in western Finland compared with southern and northern Finland. Also in women, the prevalence of abdominal obesity was highest in western Finland, especially as defined by waist circumference.

CONCLUSIONS

Geographical variation in BMI was different and less prominent than in waist circumference and WHR. Abdominal obesity was surprisingly high in western Finland, the area seldom investigated. Mapping obesity gives a useful tool for professionals working in the field of health promotion.

The epidemiology of obesity: the size of the problem

The epidemic of obesity took off from about 1980 and in almost all countries has been rising inexorably ever since. Only in 1997 did WHO accept that this was a major public health problem and, even then, there was no accepted method for monitoring the problem in children. It was soon evident, however, that the optimum population body mass index is about 21 and this is particularly true in Asia and Latin America where the populations are very prone to developing abdominal obesity, type 2 diabetes and hypertension. These features are now being increasingly linked to epigenetic programming of gene expression and body composition in utero and early childhood, both in terms of fat/lean tissue ratios and also in terms of organ size and metabolic pathway regulation. New Indian evidence suggests that insulin resistance at birth seems linked to low birth weight and a higher proportion of body fat with selective B12 deficiency and abnormalities of one carbon pool metabolism potentially responsible and affecting 75% of Indians and many populations in the developing world. Biologically there are also adaptive biological mechanisms which limit weight loss after weight gain and thereby in part account for the continuing epidemic despite the widespread desire to slim. Logically, the burden of disease induced by inappropriate diets and widespread physical inactivity can be addressed by increasing physical activity (PA), but simply advocating more leisure time activity is unrealistic. Substantial changes in urban planning and diet are needed to counter the removal of any every day need for PA and the decades of misdirected food policies which with free market forces have induced our current 'toxic environment'. Counteracting this requires unusual policy initiatives.

Leisure-time physical activity alone may not be a sufficient public health approach to prevent obesity--a focus on China

Much small-scale research has identified the role of physical activity in obesity prevention. This is the 'energy expenditure' side of the energy balance equation. Although around half an hour of daily moderate-intensity physical activity is required for cardiovascular health and disease prevention, the quantum of physical activity required for obesity prevention and weight loss is around 60-90 minutes per day. This amount of physical activity is difficult to achieve through leisure time physical activity (LTPA) alone, and additional energy expenditure is needed in the domains of active transport, occupation activity and in domestic settings. Modeling of 24-hour energy expenditures demonstrate the need for 'active living', namely energy expenditure over and above that due to LTPA, for weight loss and obesity prevention. The consequences of this for developing countries such as China are the need to focus on preventing the declines in energy expenditure attributable to urbanization, industrialization, and motor vehicle dependence. These will pose policy challenges in the developing world, if they are to be taken seriously as obesity prevention strategies.