Mauno Vanhala

Publications (58)155.06 Total impact

• Article: Associations of Chronotype and Sleep With Cardiovascular Diseases and Type 2 Diabetes.

  Ilona Merikanto, Tuuli Lahti, Hannu Puolijoki, Mauno Vanhala, Markku Peltonen, Tiina Laatikainen, Erkki Vartiainen, Veikko Salomaa, Erkki Kronholm, Timo Partonen
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  ABSTRACT: In this study, the authors analyzed whether chronotypes, sleep duration, and sleep sufficiency are associated with cardiovascular diseases and type 2 diabetes by using the National FINRISK Study 2007 data (N = 6258), being a representative sample of the population aged 25 to 74 living in five areas of Finland. Health status assessments and laboratory measurements from the participants (N = 4589) of the DILGOM substudy were used for the detailed analysis of chronotype. Evening types had a 2.5-fold odds ratio for type 2 diabetes (p < .01) as compared with morning types, the association being independent of sleep duration and sleep sufficiency. Evening types had a 1.3-fold odds ratio for arterial hypertension (p < .05 after controlling for sleep duration or sleep sufficiency), a faster resting heart rate and a lower systolic blood pressure (both p < .01), and lower levels of serum total cholesterol and low-density lipoprotein cholesterol (both p < .0001) than morning types. There were significant 1.2- to 1.4-fold odds ratios for arterial hypertension among those with long or short sleep durations or reduced sleep sufficiency. To conclude, the behavioral trait towards eveningness is suggested to predispose individuals to type 2 diabetes in particular, whereas compromised sleep is robustly associated with arterial hypertension. (Author correspondence: ilona.merikanto@helsinki.fi ).
  Chronobiology International 01/2013; · 4.03 Impact Factor
• Article: Perceived Sufficiency of Physical Activity Levels Among Adults at High Risk of Type 2 Diabetes: The FIN-D2D Study.

  Kati Vähäsarja, Sanna Salmela, Jari Villberg, Pauli Rintala, Mauno Vanhala, Timo Saaristo, Markku Peltonen, Sirkka Keinänen-Kiukaanniemi, Eeva Korpi-Hyövälti, Leena Moilanen, Leo Niskanen, Heikki Oksa, Marita E Poskiparta
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  ABSTRACT: BACKGROUND: Any increase from a low level of physical activity reduces the risk of type 2 diabetes. However, lack of awareness of one's physical activity level insufficiency may act as an obstacle to increased physical activity. PURPOSE: This study assessed the determinants of perceived physical activity levels (PALs) among adults at high risk of diabetes and the associations with self-reported physical activity. METHODS: In total, 10,149 adults participated in the FIN-D2D lifestyle intervention at baseline. Opportunistic screening was used in identifying high-risk individuals. Physical activity and perceived PAL sufficiency were assessed and compared. Key risk factors for diabetes and psychosocial and demographic characteristics were analyzed as determinants using logistic regression. RESULTS: PAL sufficiency was rated realistically by 73 % of men and 75 % of women. Perception of sufficient PAL was more likely among individuals with a smaller waist circumference, a higher level of perceived fitness, and no exercise intention. In men, a higher age, and in women, a lower education, and a lower occupational status, also increased the likelihood of perceiving PAL as sufficient. Out of all the participants, 65 % of men and 66 % of women were inactive. Among the inactive participants, 20 (men) and 16 % (women) overestimated their PAL sufficiency. In both genders, such overestimation was predicted by dyslipidemia, a lower waist circumference, a higher level of perceived fitness, and no exercise intention; also (among men) by a higher age and a family history of diabetes, and (among women) by a lower occupational status, and a lower BMI. CONCLUSIONS: In diabetes prevention, it is important to recognize the groups that perceive their PAL as sufficient since they may not see increased PAL as a tool for decreasing their risk of diabetes.
  International Journal of Behavioral Medicine 12/2012; · 2.63 Impact Factor
• Article: Erythropoietin, ferritin, haptoglobin, hemoglobin and transferrin receptor in metabolic syndrome: a case control study.

  Päivi Hämäläinen, Juha Saltevo, Hannu Kautiainen, Pekka Mäntyselkä, Mauno Vanhala
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  ABSTRACT: Increased ferritin concentrations are associated with metabolic syndrome (MetS). The association between ferritin as well as hemoglobin level and individual MetS components is unclear. Erythropoietin levels in subjects with MetS have not been determined previously. The aim of this study was to compare serum erythropoietin, ferritin, haptoglobin, hemoglobin, and transferrin receptor (sTFR) levels between subjects with and without MetS and subjects with individual MetS components. A population based cross-sectional study of 766 Caucasian, middle-aged subjects (341 men and 425 women) from five age groups born in Pieksämäki, Finland who were invited to a health check-up in 2004 with no exclusion criteria. Laboratory analyzes of blood samples collected in 2004 were done during year 2010. MetS was defined by National Cholesterol Education Program criteria. 159 (53%) men and 170 (40%) women of study population met MetS criteria. Hemoglobin and ferritin levels as well as erythropoietin and haptoglobin levels were higher in subjects with MetS (p < 0.001, p = 0.018). sTFR level did not differ significantly between subjects with or without MetS. Hemoglobin level was significantly higher in subjects with any of the MetS components (p < 0.001, p = 0.002). Ferritin level was significantly higher in subjects with abdominal obesity or high TG or elevated glucose or low high density cholesterol component (p < 0.001, p = 0.002, p = 0.02). Erythropoietin level was significantly higher in subjects with abdominal obesity component (p = 0.015) but did not differ significantly between subjects with or without other MetS components. Haptoglobin level was significantly higher in subjects with blood pressure or elevated glucose component o MetS (p = 0.028, p = 0.025). Subjects with MetS have elevated hemoglobin, ferritin, erythropoietin and haptoglobin concentrations. Higher hemoglobin levels are related to all components of MetS. Higher ferritin levels associate with TG, abdominal obesity, elevated glucose or low high density cholesterol. Haptoglobin levels associate with blood pressure or elevated glucose. However, erythropoietin levels are related only with abdominal obesity. Higher serum erythropoietin concentrations may suggest underlying adipose tissue hypoxemia in MetS.
  Cardiovascular Diabetology 09/2012; 11:116. · 3.35 Impact Factor
• Article: Serum omega-6 polyunsaturated fatty acids and the metabolic syndrome: a longitudinal population-based cohort study.

  Mauno Vanhala, Juha Saltevo, Pasi Soininen, Hannu Kautiainen, Antti J Kangas, Mika Ala-Korpela, Pekka Mäntyselkä
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  ABSTRACT: The serum fatty acid composition reflects the dietary fatty acid composition from the past few days to several weeks. However, the role of serum omega-3 (from fish and fish oils) and omega-6 (from vegetable oils) polyunsaturated fatty acids (PUFAs) in the course of metabolic syndrome is poorly understood. At the Primary Health Care Unit in Pieksämäki, Finland, all subjects born in 1942, 1947, 1952, 1957, and 1962 (n = 1,294) were invited for health checkups in 1997-1998 and 2003-2004. Metabolic syndrome was defined by using the new, harmonized criteria. The serum omega-3 PUFAs, omega-6 PUFAs, and total fatty acids were analyzed by proton nuclear magnetic resonance spectroscopy. Altogether, data from both checkups were available for 665 subjects. After adjustment for age, sex, and baseline body mass index, the incidence of metabolic syndrome between the 2 checkups with a 6.4-year follow-up was inversely associated (P < 0.001) with the increased relative proportion of omega-6 PUFAs in serum lipids. Further adjustment for body mass index change, lipid medication, smoking, alcohol intake, and physical activity conveyed similar results. The authors did not find any significant associations between omega-3 PUFAs and the incidence of metabolic syndrome. Therefore, their results suggest that the change in the relative proportion of omega-6 PUFAs in serum lipids is inversely related to the incidence of metabolic syndrome.
  American journal of epidemiology 07/2012; 176(3):253-60. · 5.59 Impact Factor
• Article: Relationships between depressive symptoms and self-reported unintentional injuries: the cross-sectional population-based FIN-D2D survey.

  Katariina Korniloff, Arja Häkkinen, Hannu Koponen, Hannu Kautiainen, Salme Järvenpää, Markku Peltonen, Pekka Mäntyselkä, Olli Kampman, Heikki Oksa, Mauno Vanhala
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  ABSTRACT: BACKGROUND: There is a lack of knowledge on the influence of different levels of physical activity (PA) on unintentional injuries among those with depressive symptoms (DS). The aim of this study was to evaluate the relationship between PA categories and unintentional injuries among participants with and without DS based on a cross-sectional population-based FIN-D2D survey conducted in 2007. METHODS: Out of 4500, 2682 participants (60 %) aged 45-74 years attended in this study. The unintentional injuries over the past year were captured in a questionnaire. DS were determined with the Beck Depression Inventory (equal or higher than 10 points) and PA with the International Physical Activity Questionnaire. The statistical significance between DS and unintentional injury categories was evaluated by using t-test, chi-square test, or permutation test, analysis of covariance, or regression models. The factors related to unintentional injuries were estimated by univariate and multivariate logistic regression models. RESULTS: The proportion of subjects with unintentional injuries was higher among those with DS (17%) compared to those without DS (10%) (age- and gender-adjusted p=0.023). The median (range) number of activity-loss days after injury was 22 (0-365) in participants with DS and 7 (0-120) in participants without DS (p=0.009). The percentage of subjects with unintentional injuries was not significantly different between PA categories in participants with DS and without DS A stepwise multivariate logistic regression analysis showed that DS, functional ability, and musculoskeletal diseases were related to unintentional injuries. CONCLUSIONS: PA level was not related to unintentional injuries, whereas those with DS had a higher prevalence of unintentional injuries and prolonged activity-loss after injury. These results underline the importance of injury prevention, especially among those who have DS and additional risk factors.
  BMC Public Health 07/2012; 12(1):516. · 2.00 Impact Factor
• Article: Perceived need to increase physical activity levels among adults at high risk of type 2 diabetes. A cross-sectional analysis within a community-based diabetes prevention project FIN-D2D.

  Kati Vähäsarja, Sanna Salmela, Jari Villberg, Pauli Rintala, Mauno Vanhala, Timo Saaristo, Markku Peltonen, Sirkka Keinänen-Kiukaanniemi, Eeva Korpi-Hyövälti, Urho M Kujala, Leena Moilanen, Leo Niskanen, Heikki Oksa, Marita E Poskiparta
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  ABSTRACT: BACKGROUND: Increased physical activity is a cornerstone of type 2 diabetes prevention. The perception of a need to change is considered essential in behaviour change processes. However, the existing literature on individuals' perceived need to change health behaviour is limited. In order to improve understanding of diabetes prevention through increased physical activity levels (PAL), we assessed factors associated with perceiving a need to increase PAL among adults at high risk of diabetes. METHODS: Opportunistic screening was used within a primary-care based lifestyle intervention covering 10 149 men and women at high risk of type 2 diabetes. Data were obtained at baseline visits. The explored determinants were demographic, anthropometric/clinical, behavioural and psychosocial characteristics, along with four categories of PAL awareness. Logistic regression was used in the analysis. RESULTS: 74% of men (n=2 577) and 76% of women (n=4 551) perceived a need to increase their PAL. The participants most likely to perceive this need were inactive, had a larger waist circumference, rated their PAL as insufficient, and were at the contemplation stage of change. Smoking, elevated blood pressure, dyslipidaemia, and a family history of diabetes were not associated with this perception. The likelihood was also greater among women with less perceived fitness and less education. Demographic factors other than education did not determine participants' perceived need to increase PAL. PAL overestimators were less likely to perceive the need to increase their PAL than realistic inactive participants. CONCLUSIONS: Subjective rather than objective health factors appear to determine the perception of a need to increase PAL among adults at high risk of diabetes. Client perceptions need to be evaluated in health counselling in order to facilitate a change in PAL. Practical descriptions of the associations between metabolic risk factors, PAL, and diabetes are needed in order to make the risk factors concrete for at-risk individuals.
  BMC Public Health 07/2012; 12(1):514. · 2.00 Impact Factor
• Article: Weight change and lipoprotein particle concentration and particle size: a cohort study with 6.5-year follow-up.

  Pekka Mäntyselkä, Hannu Kautiainen, Juha Saltevo, Peter Würtz, Pasi Soininen, Antti J Kangas, Mika Ala-Korpela, Mauno Vanhala
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  ABSTRACT: Obesity and overweight are related to unfavourable lipoprotein subclass profiles. Here we studied the relation between weight change and lipoprotein particle concentrations and sizes in a general population cohort in a longitudinal setting. The cohort included 683 adults with a 6.5-year follow-up. Lipoprotein particle subclasses and mean particle sizes of VLDL, LDL, and HDL were measured by nuclear magnetic resonance spectroscopy. During the follow-up period, a weight loss of at least 5% was associated with decreased particle concentrations of all apoB-containing subclasses and increased concentrations of large HDL particles. Coherently, weight gain (≥5%) was associated with increases in all apoB-containing subclasses and decreases in total and medium HDL particle concentrations. The relatively largest increase occurred for large HDL particle concentration (24.1%, 95% CI 15.8-32.5) in weight loss and for large VLDL particle concentration (33.0%, 19.6-46.4) in weight gain. Weight change correlated positively with changes in apoB-containing lipoprotein particle concentrations and also with the change in average VLDL particle size. Negative correlations were found between weight change and the change in average LDL (r = -0.10) and HDL (r = -0.32) particle size, but not between weight change and total HDL particle concentration. Moderate weight loss is related to favourable and weight gain to unfavourable changes in lipoprotein subclass profiles. These population level findings underline the importance of weight control as a modifier of cardiovascular risk factors.
  Atherosclerosis 05/2012; 223(1):239-43. · 3.79 Impact Factor
• Article: Circulating metabolite predictors of glycemia in middle-aged men and women.

  Peter Würtz, Mika Tiainen, Ville-Petteri Mäkinen, Antti J Kangas, Pasi Soininen, Juha Saltevo, Sirkka Keinänen-Kiukaanniemi, Pekka Mäntyselkä, Terho Lehtimäki, Markku Laakso, Antti Jula, Mika Kähönen, Mauno Vanhala, Mika Ala-Korpela
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  ABSTRACT: Metabolite predictors of deteriorating glucose tolerance may elucidate the pathogenesis of type 2 diabetes. We investigated associations of circulating metabolites from high-throughput profiling with fasting and postload glycemia cross-sectionally and prospectively on the population level. Oral glucose tolerance was assessed in two Finnish, population-based studies consisting of 1,873 individuals (mean age 52 years, 58% women) and reexamined after 6.5 years for 618 individuals in one of the cohorts. Metabolites were quantified by nuclear magnetic resonance spectroscopy from fasting serum samples. Associations were studied by linear regression models adjusted for established risk factors. Nineteen circulating metabolites, including amino acids, gluconeogenic substrates, and fatty acid measures, were cross-sectionally associated with fasting and/or postload glucose (P < 0.001). Among these metabolic intermediates, branched-chain amino acids, phenylalanine, and α1-acid glycoprotein were predictors of both fasting and 2-h glucose at 6.5-year follow-up (P < 0.05), whereas alanine, lactate, pyruvate, and tyrosine were uniquely associated with 6.5-year postload glucose (P = 0.003-0.04). None of the fatty acid measures were prospectively associated with glycemia. Changes in fatty acid concentrations were associated with changes in fasting and postload glycemia during follow-up; however, changes in branched-chain amino acids did not follow glucose dynamics, and gluconeogenic substrates only paralleled changes in fasting glucose. Alterations in branched-chain and aromatic amino acid metabolism precede hyperglycemia in the general population. Further, alanine, lactate, and pyruvate were predictive of postchallenge glucose exclusively. These gluconeogenic precursors are potential markers of long-term impaired insulin sensitivity that may relate to attenuated glucose tolerance later in life.
  Diabetes care 05/2012; 35(8):1749-56. · 8.09 Impact Factor
• Article: Effect of the Pro12Ala polymorphism of the PPARγ2 gene on serum adiponectin changes

  Firoozeh Mousavinasab, Tuula Tähtinen, Jari Jokelainen, Pentti Koskela, Mauno Vanhala, Jorma Oikarinen, Sirkka Keinänen-Kiukaanniemi, Markku Laakso
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  ABSTRACT: The Pro12Ala polymorphism of the peroxisome proliferator-activated receptor gamma 2 (PPARγ2) gene and adiponectin, a protein secreted from adipose tissue, have been associated with insulin sensitivity. The present The Pro12Ala polymorphism of the peroxisome proliferator-activated receptor gamma 2 (PPARγ2) gene and adiponectin, a protein secreted from adipose tissue, have been associated with insulin sensitivity. The present study demonstrates that in Finnish servicemen who were on a high-caloric diet for 6 mo only subjects with the Ala 12 allele study demonstrates that in Finnish servicemen who were on a high-caloric diet for 6 mo only subjects with the Ala 12 allele of PPARγ2 had a significant increase in adiponectin levels with weight loss induced by heavy exercise. This study demonstrates an interaction of PPARγ2 had a significant increase in adiponectin levels with weight loss induced by heavy exercise. This study demonstrates an interaction of genetic and environmental factors in the regulation of serum adiponectin concentrations. of genetic and environmental factors in the regulation of serum adiponectin concentrations.
  Endocrine 04/2012; 27(3):307-309. · 1.42 Impact Factor
• Article: Association between folate intake and melancholic depressive symptoms. A Finnish population-based study.

  Jussi Seppälä, Hannu Koponen, Hannu Kautiainen, Johan G Eriksson, Olli Kampman, Satu Männistö, Pekka Mäntyselkä, Heikki Oksa, Yrjö Ovaskainen, Merja Viikki, Mauno Vanhala
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  ABSTRACT: An association between low blood folate levels and depressive symptoms (DS) has been reported in several epidemiological studies, but no studies have examined folate intake in melancholic or non-melancholic DS in population-based samples. The aim of the study was to evaluate folate intake in DS with or without melancholic characteristics as a part of the Finnish diabetes prevention program (FIN-D2D). Altogether, 4500 randomly selected subjects aged 45-74 years were selected from the National Population Register. The study population (N=2806, participation rate 62%) consisted of 1328 men and 1478 women. The health examinations were carried out in 2007 according to the WHO MONICA project. The assessment of DS was based on the Beck Depression Inventory (BDI, cut-off≥10 points). A summary score of melancholic items in the BDI was used in dividing the participants with DS (N=429) into melancholic (N=138) and non-melancholic DS (N=291) subgroups. Folate intake was assessed using a validated food frequency questionnaire (FFQ). DS associated linearly with gender specific tertiles of folate intake (p for linearity=0.003). The OR for melancholic DS was 0.55 (95%CI 0.34 to 0.90) for the high tertile of folate intake versus the low (p for linearity=0.018), while the ORs for non-melancholic DS were nonsignificant. Assessment of DS was based on a self-rating scale, and the population was in advanced middle-aged. A low folate intake was associated with DS through its effect on melancholic DS.
  Journal of affective disorders 02/2012; 138(3):473-8. · 3.76 Impact Factor
• Article: Sex differences in the association of adiponectin and low-grade inflammation with changes in the body mass index from youth to middle age.

  Tiina Ahonen, Mauno Vanhala, Hannu Kautiainen, Esko Kumpusalo, Juha Saltevo
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  ABSTRACT: There are sex differences in low-grade inflammation markers in obesity-related disorders. Little is known, however, about a possible sex-specific association of relative weight change from youth to adulthood with actual low-grade inflammation. The aim of this study was to identify possible sex differences in adiponectin, interleukin-1β (IL-1β), interleukin-1Ra (IL-1Ra), and high-sensitivity C-reactive protein (hs-CRP) levels with respect to the relative change in body mass index (BMI) from youth to middle age. The study population consisted of 403 men and 500 women from 1 Finnish town. Weight, height, and adiponectin, IL-1β, IL-1Ra, and hs-CRP levels were measured in 2003 at a mean age of 46 years. Self-reported weight at the age of 20 years was recorded. In women, even after adjustment for BMI in adulthood, a statistically significantly negative linear association was observed between the quartiles of relative change in BMI and adiponectin levels (P < 0.001 for linearity). Significantly positive linear associations were also observed between the change in BMI and IL-1Ra (P = 0.032 for linearity) and hs-CRP (P = 0.029 for linearity) levels. In men, there was no statistically significant association among the quartiles of relative change in BMI and measured inflammatory markers after adjustment for BMI in adulthood. A relative increase in weight may be more harmful in women than in men with respect to adiponectin and inflammatory markers.
  Gender Medicine 02/2012; 9(1):1-8. · 2.10 Impact Factor
• Article: Financial satisfaction and its relationship to depressive symptoms in middle-aged and older adults: Results from the FIN-D2D survey.

  Nina Rautio, Hannu Kautiainen, Hannu Koponen, Pekka Mäntyselkä, Markku Timonen, Leo Niskanen, Timo Saaristo, Heikki Oksa, Markku Peltonen, Hannu Puolijoki, Mauno Vanhala, Sirkka Keinänen-Kiukaanniemi
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  ABSTRACT: BACKGROUND: Studies using traditional measures of socio-economic position, such as education, income and occupation, have found inequalities in depressive symptoms, but less is known about the association between financial satisfaction and depressive symptoms. AIMS: To examine the association of depressive symptoms with financial satisfaction in Finnish adults in a population-based cross-sectional FIN-D2D survey. METHODS: Four thousand, five hundred randomly selected individuals aged 45-74 years were invited to the study. Participation rate for health examinations was 64%. Complete information on depressive symptoms and financial satisfaction was available for 2,819 individuals. Financial satisfaction was asked using a questionnaire. Depressive symptoms were measured by Beck Depression Inventory (≥ 10) and/or use of antidepressants. RESULTS: Altogether 11.6% of individuals who were satisfied with their financial situation had depressive symptoms. Corresponding figures for individuals who were somewhat satisfied or dissatisfied were 20.6% and 42.6%, respectively. Individuals who were less satisfied with their financial situation were more likely to suffer from depressive symptoms even after adjusting for gender, age, marital status, number of chronic diseases, smoking, binge drinking, physical activity, education and household income. CONCLUSIONS: Instead of more traditional measures of socio-economic position, financial dissatisfaction seems to be associated with depressive symptoms in Finnish adults.
  International Journal of Social Psychiatry 01/2012; · 1.15 Impact Factor
• Article: [Referrals of knee osteoarthritis patients to orthopedic surgery].

  Marjo Oikari, Arja Häkkinen, Hannu Kautiainen, Maija Pesola, Jari Ylinen, Mauno Vanhala
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  ABSTRACT: Due to large volume of knee osteoarthritis referrals and increasing waiting times, the contents of referrals and patient's pathways were analyzed in the Jyväskylä Central Hospital. The referral contents of 171 knee osteoarthritis patients referred to the orthopedic outpatient clinic were screened, and the post-referral treatment decisions were pulled from the medical records. Most of the referrals had information about the diagnosis (90%), pain (88%) and symptom duration (80%). The least frequently mentioned were BMI (3%) and the implementation of conservative treatment (7%). During the specialist visit following the referral, 62% of the patients ended up in operative and 38% in conservative treatment. There was no connection between the referral contents and the line of treatment chosen. Conservative treatment of knee osteoarthritis should be optimized prior to referral to specialist care.
  Duodecim; lääketieteellinen aikakauskirja 01/2012; 128(15):1593-9.
• Source

  Available from: Jari Jokelainen

  Article: Do statins interfere with lifestyle intervention in the prevention of diabetes in primary healthcare? One-year follow-up of the FIN-D2D project.

  Nina Rautio, Jari Jokelainen, Heikki Oksa, Timo Saaristo, Markku Peltonen, Mauno Vanhala, Hannu Puolijoki, Leena Moilanen, Jaakko Tuomilehto, Sirkka Keinänen-Kiukaanniemi, Matti Uusitupa
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  ABSTRACT: To examine whether the use of statins is associated with the incidence of type 2 diabetes (T2D) and changes in glucose metabolism among individuals at high risk for T2D participating in 1-year lifestyle intervention in primary healthcare setting. Prospective follow-up study. In all, 400 primary healthcare centres and occupational healthcare clinics in Finland. We screened altogether 10 149 individuals at increased risk for T2D; of these, 2798 non-diabetic individuals verified by a 2 h glucose tolerance test participated in the 1-year follow-up. Lifestyle intervention (individual and/or group-based counselling). Incidence of T2D and fasting and 2 h glucose measured at baseline and follow-up. A total of 484 individuals (17.3%) used statins at the baseline. Of them 31 (7.5%) developed T2D during the follow-up, compared to 126 (6.5%) of statin non-users (OR 1.17, 95% CI 0.78 to 1.76, p=0.442). Interestingly, fasting glucose increased by 0.08 mmol/l in statin users, but remained unchanged in non-users, the difference being 0.074 mmol/l (95% CI 0.014 to 0.134) and remained significant even after adjustment for age, sex, baseline fasting glucose, the presence of cardiovascular disease (CVD), use of antihypertensive and/or coronary artery disease medication, weight and 1-year weight change (adjusted p=0.042). The incidence of T2D did not differ between the statin users and non-users. The finding that fasting glucose slightly increased in statin users in spite of lifestyle interventions suggests the view that the use of statins might have unfavourable effects on glucose metabolism and that statins might hamper beneficial effects of lifestyle intervention in people at high risk of T2D.
  BMJ open. 01/2012; 2(5).
• Article: Prevalence of metabolic syndrome in subjects with melancholic and non-melancholic depressive symptoms. A Finnish population-based study.

  Jussi Seppälä, Mauno Vanhala, Hannu Kautiainen, Johan Eriksson, Olli Kampman, Pekka Mäntyselkä, Heikki Oksa, Yrjö Ovaskainen, Merja Viikki, Hannu Koponen
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  ABSTRACT: We aimed to evaluate the prevalence of the metabolic syndrome (MetS) and its components in subjects with predominantly melancholic or non-melancholic depressive symptoms (DS) in a population-based study evaluating the efficacy of the Finnish diabetes prevention program (FIN-D2D). Altogether, 4500 randomly-selected Finnish men and women aged 45-74 years were initially enrolled from the National Population Register: 2820 (63%) attended a health examination. Diagnosis of MetS was based on the criteria of the National Cholesterol Education Program (NCEP-ATPIII), and DS on the 21-item Beck Depression Inventory (BDI-21, ≥10 points). A summary score of the melancholic items in the BDI was used to divide the subjects with DS (N=432) into melancholic and a non-melancholic sub-groups. The prevalence of MetS was higher among subjects with non-melancholic DS compared to those with melancholic DS (69 % versus 55%, p 0.004). The prevalence of MetS among subjects without DS was 51%. The sex- and age-adjusted odd ratio (OR) for MetS was 2.10 (95%CI 1.62 to 2.73, p<0.001) when comparing the non-melancholic and non-depressed groups, 1.15 (95%CI 0.81 to 1.61, p=0.44) for the melancholic and non-depressed groups, and 1.84 (95%CI 1.20 to 2.80, p=0.005) for the non-melancholic and melancholic groups. DS were based on a self-rating scale, and due to the cross-sectional design of our study, we cannot make inferences of causality. Compared to subjects without DS and those with melancholic DS, persons with non-melancholic DS may more frequently suffer from MetS.
  Journal of affective disorders 11/2011; 136(3):543-9. · 3.76 Impact Factor
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  Available from: Matti I J Uusitupa

  Article: Metabolically healthy and unhealthy obesity phenotypes in the general population: the FIN-D2D Survey.

  Pia Pajunen, Anna Kotronen, Eeva Korpi-Hyövälti, Sirkka Keinänen-Kiukaanniemi, Heikki Oksa, Leo Niskanen, Timo Saaristo, Juha T Saltevo, Jouko Sundvall, Mauno Vanhala, Matti Uusitupa, Markku Peltonen
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  ABSTRACT: The aim of this work was to examine the prevalence of different metabolical phenotypes of obesity, and to analyze, by using different risk scores, how the metabolic syndrome (MetS) definition discriminates between unhealthy and healthy metabolic phenotypes in different obesity classes. The Finnish type 2 diabetes (FIN-D2D) survey, a part of the larger implementation study, was carried out in 2007. The present cross-sectional analysis comprises 2,849 individuals aged 45-74 years. The MetS was defined with the new Harmonization definition. Cardiovascular risk was estimated with the Framingham and SCORE risk scores. Diabetes risk was assessed with the FINDRISK score. Non-alcoholic fatty liver disease (NAFLD) was estimated with the NAFLD score. Participants with and without MetS were classified in different weight categories and analysis of regression models were used to test the linear trend between body mass index (BMI) and various characteristics in individuals with and without MetS; and interaction between BMI and MetS. A metabolically healthy but obese phenotype was observed in 9.2% of obese men and in 16.4% of obese women. The MetS-BMI interaction was significant for fasting glucose, 2-hour plasma glucose, fasting plasma insulin and insulin resistance (HOMA-IR)(p < 0.001 for all). The prevalence of total diabetes (detected prior to or during survey) was 37.0% in obese individuals with MetS and 4.3% in obese individuals without MetS (p < 0.001). MetS-BMI interaction was significant (p < 0.001) also for the Framingham 10 year CVD risk score, NAFLD score and estimated liver fat %, indicating greater effect of increasing BMI in participants with MetS compared to participants without MetS. The metabolically healthy but obese individuals had lower 2-hour postload glucose levels (p = 0.0030), lower NAFLD scores (p < 0.001) and lower CVD risk scores (Framingham, p < 0.001; SCORE, p = 0.002) than normal weight individuals with MetS. Undetected Type 2 diabetes was more prevalent among those with MetS irrespective of the BMI class and increasing BMI had a significantly greater effect on estimates of liver fat and future CVD risk among those with MetS compared with participants without MetS. A healthy obese phenotype was associated with a better metabolic profile than observed in normal weight individuals with MetS.
  BMC Public Health 10/2011; 11:754. · 2.00 Impact Factor
• Article: Behaviour-change interventions in primary care: influence on nutrition and on the metabolic syndrome definers.

  Hanna Kuninkaanniemi, Jari Villberg, Mauno Vanhala, Marita Poskiparta
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  ABSTRACT: The purpose of this paper was to examine whether interventions influenced patients' (i) consumption of fish; whole grain products; fruits and vegetables; (ii) overall nutrition, that is, the three former as an index; and (iii) clinical outcomes in terms of metabolic syndrome definers. A questionnaire was delivered to adult patients entering the nine health centres on November 2006 (n = 1211). During the year the ward personnel conducted intervention on patients with unhealthy habits. The 12-month follow up was conducted by mailings. Also clinical data of pre- and post-intervention values of metabolic syndrome definers were collected. For the analyses, intervention was divided into brief (≤ 15 min, at most three visits) and extended (> 15 min, more than three visits) intervention. Logistic Regression and manova were used to measure changes in the outcomes. Nutrition-related intervention was conducted on 218 patients (brief intervention n = 179, extended intervention n = 39). In the extended intervention group it was three times more likely to have a positive change in the nutrition index than in the brief intervention group (P = 0.017, confidence interval 1.223-7.773). In conclusion, brief interventions were commonly used in the primary care. However, they were not enough to produce changes in the patients' nutrition or in the clinical outcomes.
  International Journal of Nursing Practice 10/2011; 17(5):470-7. · 0.72 Impact Factor
• Article: The reporting of previous lifestyle counseling by persons at high risk of Type 2 diabetes.

  Sanna M Salmela, Kati Vähäsarja, Jari Villberg, Mauno Vanhala, Timo Saaristo, Jaana Lindström, Heikki Oksa, Eeva Korpi-Hyövälti, Leo Niskanen, Sirkka Keinänen-Kiukaanniemi, Marita Poskiparta
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  ABSTRACT: To assess (i) whether the reporting of counseling previously received is associated with high-risk individuals' agreement to participate in lifestyle intervention, (ii) whether the reporting of previous counseling differed within such a high-risk group, and (iii) the associations between lifestyles and previous lifestyle counseling. Cross-sectional data were drawn from 10149 adults at high risk of Type 2 diabetes, who were participating in a Finnish national diabetes prevention project (FIN-D2D). Bivariate analysis and multivariate logistic regression were used. In relation to the reporting of previous counseling, no difference was found between persons who had agreed and persons who had not agreed to participate in the lifestyle intervention. Persons who were more educated or who had dyslipidemia or diabetes were more likely than the others to report previous counseling. A generally healthy lifestyle, or certain health behaviors (being a non-smoker or eating large amounts of fruit and vegetables) may make the reporting of previous counseling more likely. The results raise questions about the amount and quality of the previously received lifestyle counseling. There is a need for sustainable lifestyle counseling structures, within vigorously implemented diabetes prevention projects, if long-lasting lifestyle changes are to be achieved.
  Patient Education and Counseling 09/2011; 87(2):178-85. · 2.31 Impact Factor
• Article: Psychological distress measured by the GHQ-12 and mortality: a prospective population-based study.

  Pekka Johannes Puustinen, Hannu Koponen, Hannu Kautiainen, Pekka Mäntyselkä, Mauno Vanhala
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  ABSTRACT: To examine whether persons with psychological distress have a greater risk of all-cause mortality in the Scandinavian population; whether this association is gender-specific; and what is the influence of socioeconomic status, body mass index (BMI) and health behaviour in this association. A total of 923 (414 male and 509 female) people, aged 36 to 56 years, participated in a population-based study from 1997-98 in Pieksämäki, Finland. Psychological distress was measured using the 12-item General Health Questionnaire (GHQ-12). The GHQ-12 points were summed to a global score ranging from 0-12. Mortality data until 31 December 2009 were drawn from the national mortality register. There were 44 death events (27 men, 17 women) during the mean observation time of 11 years. The hazard ratio (HR) increased by 16% for every GHQ-12 point (gender and age adjusted HR 1.16, 95% confidence interval (95% CI): 1.07-1.25, p < 0.001). In the fully adjusted model with gender, age, socioeconomic status, BMI, smoking and physical activity, HR was 1.13 (95% CI: 1.04-1.22, p = 0.003). In men, the 10-year survival for distressed (GHQ-12 score ≥ 4) participants was 84% (95% CI: 73- 91) and for non-distressed (GHQ-12 score 0-3) participants it was 96% (95% CI: 93-97), HR = 3.38 (95% CI: 1.55-7.39, p = 0.002). Among women, no significant association was found. Psychological distress measured by the GHQ-12 is associated with all-cause mortality risk during an 11-year observation time. This is mainly due to excess mortality among distressed men.
  Scandinavian Journal of Public Health 08/2011; 39(6):577-81. · 1.39 Impact Factor
• Article: Psychological distress and C-reactive protein: do health behaviours and pathophysiological factors modify the association?

  Pekka Johannes Puustinen, Hannu Koponen, Hannu Kautiainen, Pekka Mäntyselkä, Mauno Vanhala
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  ABSTRACT: The objective of this study is to examine the association of psychological distress to high-sensitivity C-reactive protein (hsCRP) levels and to examine the potential mediating role of health behaviours and pathophysiological factors. A total of 883 (393 men and 490 women) subjects, aged 36-56 years, participated in a population-based, cross-sectional study from 1997 to 1998 in Pieksämäki, Finland. Various clinical, biochemical and behavioural factors were measured, including hsCRP concentration. Psychological distress was measured using the 12-item General Health Questionnaire (GHQ-12). Subjects with low psychological distress (0 points in GHQ-12) were younger and more physically active, and their mean hsCRP level was lower when compared to subjects with medium (1-3 points) or high (4-12 points) psychological distress (1.26 ± 1.36, 1.53 ± 1.75 and 1.70 ± 1.68 mg/l, respectively, P for linearity = 0.003). Psychological distress was also associated with high relative cardiovascular risk (hsCRP >3.00 mg/l). After adjusting for gender, age, BMI, smoking, use of alcohol and leisure time physical activity, odds ratios for hsCRP >3.00 mg/l in the groups that had medium and high psychological distress were 1.32 (95% CI: 0.81-2.16) and 1.79 (95% CI: 1.05-3.04), respectively, compared with the low distress group (P for linearity 0.032). Psychological distress was associated with elevated hsCRP levels representing high relative cardiovascular risk. This association remained after adjusting for health behaviours and pathophysiological factors, supporting a direct, physiological link between psychological distress and inflammation. CRP could be an important pathophysiological mechanism through which psychological factors are associated with cardiovascular disease.
  Archiv f ur Psychiatrie und Nervenkrankheiten 06/2011; 261(4):277-84. · 2.75 Impact Factor