11.12.2006

Ceriello, A., Davidson, J., Hanefeld, M., Leiter, L., Monnier, L., Owens, D., Tajima, N. and Tuomilehto, J.

Nutrition Metabolism and Cardiovascular Diseases. 2006; 16(7): 453-456. Editorial Material. IF 1.482

Type 2 diabetes is characterised by a gradual decline in insulin secretion in response to nutrient loads; hence, it is primarily a disorder of postprandial glucose (PPG) regulation. However, physicians continue to rely on fasting plasma glucose (FPG) and glycosylated haemoglobin (HbA1c) levels as indicators for disease management.

There is a linear relationship between the risk of cardiovascular disease (CVD) and the two-hour oral glucose tolerance test (OGTT), while a recent study confirms postprandial hyperglycaemia as an independent risk factor for CVD in type 2 diabetes. At the same time, several intervention studies have shown that treating postprandial hyperglycaemia may reduce the incidence of new cardiovascular events. Evidence supports the hypothesis that postprandial hyperglycaemia may be linked to CVD through the generation of oxidative stress. Furthermore, clinical data suggest that postprandial hyperglycaemia is a common phenomenon, even in patients who may be considered in 'good metabolic control'.

Therefore, in addition to HbA1c and FPG, physicians should consider monitoring and targeting PPG in patients with type 2 diabetes. (C) 2006 Elsevier B.V. All rights reserved.

Relationship between local perfusion and FFA uptake in human skeletal muscle - no effect of increased physical activity and aerobic fitness

Hannukainen, J. C., Nuutila, P., Kaprio, J., Heinonen, O. J., Kujala, U. M., Janatuinen, T., Ronnemaa, T., Kapanen, J., Haaparanta-Solin, M., Viljanen, T., Knuuti, J. and Kalliokoski, K. K.

Journal of Applied Physiology. 2006; 101(5): 1303-1311. Article. IF 3.037

We investigated heredity independent effects of increased physical activity and aerobic fitness on skeletal muscle free fatty acid (FFA) uptake, perfusion, and their heterogeneity at rest and during exercise. Also, the relationship between local skeletal muscle FFA uptake and perfusion was studied.

Nine young adult male monozygotic twin pairs with significant difference in physical activity [229 min (SD 156) average time spent for conditioning exercise per week in more and 98 min (SD 71) in less active twins, P = 0.013] and aerobic fitness [18% (SD 10) difference in maximum O-2 uptake] between brothers were studied using positron emission tomography. Submaximal knee-extension exercise increased perfusion, FFA uptake, and oxygen uptake in quadriceps femoris muscles 6-10 times compared with resting values (P < 0.001). More active twins tended to utilize more oxygen, while no differences were found in muscle perfusion or FFA uptake between groups. Mean perfusion and FFA uptake correlated strongly at a whole muscle level, both at rest (r = 0.97, P = 0.03 in more and r = 0.98, P = 0.02 in less active twins) and during exercise (r = 0.99, P = 0.01 and r = 0.94, P = 0.06), but at the voxel level (87 mm(3)) correlation was only moderate during exercise [r = 0.73 (SD 0.08) vs. r = 0.74 (SD 0.10), P = 0.92] and weak at rest [r = 0.28 (SD 0.13) vs. r = 0.33 (SD 0.21), P = 0.58]. Exercise decreased both perfusion and FFA uptake heterogeneity within the muscles (P < 0.001) similarly in both groups. In conclusion, long-term history of moderately increased physical activity tends to enhance muscle oxidative metabolism, but it does not have any significant influence on the FFA uptake or perfusion rates or their heterogeneity in skeletal muscle. Submaximal knee-extension exercise decreases heterogeneity of muscle FFA uptake and perfusion and improves matching between local muscle perfusion and FFA uptake.

Thus it seems that the genetic influence is more important to determine the heterogeneity of perfusion and FFA uptake in skeletal muscle than exercise training.

Exercise, genetics and prevention of type 2 diabetes

Hu, G., Rico-Sanz, J., Lakka, T. A. and Tuomilehto, J.

Essays Biochem. 2006; 42: 177-92. IF 3.217

Type 2 diabetes is one of the fastest growing public health problems in both developed and developing countries.

Cardiovascular disease is the most prevalent complication of type 2 diabetes. In the past decade, the associations of physical activity, physical fitness and changes in the lifestyle with the risk of type 2 diabetes have been assessed by a number of prospective studies and clinical trials. A few studies have also evaluated the joint associations of physical activity, body mass index and glucose levels with the risk of type~2 diabetes.

The results based on prospective studies and clinical trials have shown that moderate or high levels of physical activity or physical fitness and changes in the lifestyle (dietary modification and increase in physical activity) can prevent type 2 diabetes.

Impact of Postdischarge Surveillance on the Rate of Surgical Site Infection After Orthopedic Surgery

Huotari, K. and Lyytikäinen, O.

Infect Control Hosp Epidemiol. 2006; 27(12): 1324-1329. IF 2.413

Objective. To evaluate the impact of postdischarge surveillance on surgical site infection (SSI) rates after orthopedic surgery.

Setting. Nine hospitals participating in the Finnish Hospital Infection Program.Patients. All patients who underwent hip or knee arthroplasty or open reduction of a femur fracture during 1999-2002.

Results. The date of discharge was available for 11,812 procedures (90%). The median length of hospital stay was 8 days (range per hospital, 6-9 days). The overall SSI rate was 3.3% (range, 0.8%-6.4%). Of 384 SSIs detected, 216 (56%; range, 28%-90%) were detected after discharge: 93 (43%) were detected on readmission to the hospital, 73 (34%) at completion of a postdischarge questionnaire, and 23 (11%) at a follow-up visit. For 27 postdischarge SSIs (13%), the location of detection was unknown. Altogether, 32 (86%) of 37 of organ/space SSIs, 57 (80%) of 71 deep incisional SSIs, and 127 (46%) of 276 superficial incisional SSIs were detected after discharge. Most SSIs (70%) detected on readmission were severe (organ/space or deep incisional), whereas most SSIs (86%) detected at follow-up visits or at completion of a postdischarge questionnaire were superficial. Of all SSIs, 78% (range, 48%-100%) were microbiologically confirmed. Microbiologic confirmation was less common after discharge than during postoperative hospital stay (66% vs 93%; P<.001).

Conclusions. Postdischarge surveillance had a large impact on the rate of SSI detected after orthopedic surgery. However, postdischarge surveillance conducted by means of a questionnaire detected only a minority of deep incisional and organ/space SSIs.

From genes to systems: New global strategies for the characterization of NCL biology

Jalanko, A., Tyynelä, J. and Peltonen, L.

Biochimica Et Biophysica Acta-Molecular Basis of Disease. 2006; 1762(10): 934-944. Article. IF 2.382

Neuronal ceroid lipofuscinoses (NCL) are rare neurological disorders with a uniform phenotype, caused by mutations in seven known genes. NCL provide a unique model to characterize molecular pathways critical for normal neuronal development and pathological neuronal degeneration. Systems biology based approach utilizes the rapidly developing tools of genomics, proteomics, lipidomics and metabolomics and aims at thorough understanding of the functions of cells, tissues and whole organisms by molecular analysis and biocomputing-assisted modeling. The systems level understanding of NCL is now possible by utilizing different model organisms. Initial work has revealed disturbed metabolic pathways in several NCL disorders and most analyses have utilized the infantile (INCL/CLN1) and juvenile (JNCL/CLN3) disease modeling and utilized mainly human and mouse samples. To date, the data obtained from transcript and lipidomic profiling has pinpointed the role of lipid metabolism and synaptic function in the infantile NCL. Changes in glutamate utilization and amino acid metabolism have been a common theme emerging from the transcript and metabolite profiling of the juvenile NCL. Further experimental models are being developed and systematic sample collection as well as data integration projects are needed. The combined analyses of the global information should provide means to expose all the NCL-associated molecular pathways. (c) 2006 Elsevier B.V. All rights reserved.

Fetal origins of stress-related adult disease

Kajantie, E.

Ann N Y Acad Sci. 2006; 1083: 11-27. IF 1.971

During the past decade, a considerable body of evidence has emerged showing that circumstances during the fetal period may have lifelong programming effects on different body functions with a considerable impact on disease susceptibility.

The purpose of this article is to provide a synopsis of these findings and their role in explaining the development of stress-related adult disease. In the context of Per Bjorntorp memorial symposium, stress-related disease will be interpreted broadly, including cardiovascular disease and components of the metabolic syndrome, for which the evidence of fetal origins is most abundant. It has however become evident that early-life programming has a much broader potential effect on an individual's health. For example, perinatal variables, such as low birth weight, have been associated with increased prevalence of depressive symptoms. Mechanistic studies in animals and humans have shown that lifelong programming of the hypothalamic-pituitary-adrenal axis (HPAA) function by fetal life conditions is likely to be a key factor in mediating associations with these disorders, which frequently are characterized by HPAA overactivity. Preliminary observations suggest a similar important role for early-life programming of sympathoadrenal function. Reduced HPAA activity is characteristic of a number of stress-related disorders, including posttraumatic stress disorder; chronic pain; fatigue; and atypical, melancholic depression.

It is therefore highly plausible that susceptibility to these disorders originates in a similar manner during early life, although direct evidence is to a great deal lacking. Important targets for future research include distinction between the effects of different pregnancy conditions, such as maternal malnutrition, preeclampsia, and maternal infection, which may have dissimilar late-life consequences. This will be a crucial step when the associations that are currently emerging will be translated into disease prevention.

Reliability of self-reported eating disorders: Optimizing population screening

Keski-Rahkonen, A., Sihvola, E., Raevuori, A., Kaukoranta, J., Bulik, C. M., Hoek, H. W., Rissanen, A. and Kaprio, J.

International Journal of Eating Disorders. 2006; 39(8): 754-762. Article. IF 1.915

Objective: The objective of this study was to assess whether short self-report eating disorder screening questions are useful population screening methods.

Method: We screened the female participants (N = 2881) from the 1975-1079 birth cohorts of Finnish twins for eating disorders, using several short screening questions and three Eating Disorder Inventory (EDI) subscales. Comparing these measures with clinician-conducted semi-structured diagnostic interviews (N = 549) of Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) anorexia and bulimia, we calculated their sensitivities and specificities and drew receiver operating characteristic curves to further compare these items.

Results: For current and lifetime bulimia, best tradeoffs between sensitivity and specificity were reached by addressing purging behaviors. For current and lifetime anorexia, the questions "Have you ever had anorexia" and "Has anybody ever suspected that you might have an eating disorder?" optimized tradeoffs between sensitivity and specificity. These questions generally outperformed EDI subscales.

Conclusion: Simple screening questions, although less than ideal, are at least as good as other available instruments for community screenings. (c) 2006 by Wiley Periodicals, Inc.

Metabolic syndrome and cognitive function: A population-based follow-up study in elderly women

Komulainen, P., Lakka, T. A., Kivipelto, M., Hassinen, M., Helkala, E. L., Haapala, I., Nissinen, A. and Rauramaa, R.

Dementia and Geriatric Cognitive Disorders. 2007; 23(1): 29-34. Article. IF 2.603

Objective: To test the hypothesis that metabolic syndrome predicts cognitive impairment, and to examine the association of single metabolic risk factors with cognitive functioning.

Methods: We performed a 12-year follow-up study in a population-based sample of 101 women aged 60 - 70 years at baseline. Metabolic syndrome was defined by the National Cholesterol Education Program criteria (>= 3 out of 5 risk factors). Global cognitive function was measured by the Mini-Mental State Examination both at baseline and follow-up. A detailed neuropsychological evaluation for memory and cognitive speed was performed at follow-up.

Results: The prevalence of metabolic syndrome increased from 13% at baseline to 49% at follow-up ( p < 0.001). Women with metabolic syndrome at baseline had a 4.27 (95% confidence interval: 1.02 - 17.90; p = 0.047) times higher risk of poor memory at follow-up after adjustment for age, education and depression. The increasing number of metabolic risk factors was associated with worsening of memory at follow-up ( p = 0.034 for linear trend). Women with low baseline levels of high-density lipoprotein (HDL) cholesterol were more likely to have poor memory at follow-up than those with higher HDL levels ( p = 0.028). The risk of having poor memory increased by 46.5% (95% confidence interval: 15 - 66%; p = 0.008) with 1 SD decrease in HDL cholesterol level.

Conclusion: In elderly women, metabolic syndrome may be an important contributor to worsening of memory, which is an essential part of mild cognitive impairment. Copyright (C) 2007 S. Karger AG, Basel.

Skin test reactivity to molds in pre-school children with newly diagnosed asthma

Korhonen, K., Mahonen, S., Hyvärinen, A., Nevalainen, A., Husman, T., Pekkanen, J. and Korppi, M.

Pediatrics International. 2006; 48(6): 577-581. Article. IF 0.666

Background: The aim of the present study was to evaluate the prevalence of sensitization to molds and to house dust mites (HDM) in pre-school children with newly-diagnosed asthma.

Methods: From 1996 to 2000, 122 children 1 to 6 years of age with fresh asthma treated in the Kuopio University Hospital, Kuopio, Finland, were recruited in the study; 94% attended. Skin prick tests were performed to common inhalant allergens and to 10 molds. The homes were surveyed for moisture damage.

Results: A majority of the houses had signs of dampness and moisture. One-third of the children reacted to inhalant allergens. There were 11 positive reactions to molds in five children who all reacted to at least one animal dander or seasonal pollen. Aspergillus fumigatus, Botrytis cinerea, and Cladosporium herbarum were the most common mold allergens. There were only two children with positive reactions to HDM, and none of them reacted to molds. No associations were found between the presence or degree of moisture problems at home and mold or HDM allergy.

Conclusions: Sensitization to molds seems to play only a minor role in pre-school children with newly-diagnosed asthma in a northern climate where the incidences of mold and HDM allergies are rather low.

Well water radioactivity and risk of cancers of the urinary organs

Kurttio, P., Salonen, L., Ilus, T., Pekkanen, J., Pukkala, E. and Auvinen, A.

Environmental Research. 2006; 102(3): 333-338. Article. IF 2.324

Water from bedrock frequently contains higher concentrations of natural radionuclides than water; from other sources. Bladder and kidneys receive a radiation dose when radioactive isotopes are excreted into urine.

The subjects for this case-cohort study were selected from all drilled wells users in Finland. The study comprised 61 bladder cancer and 51 kidney cancer cases diagnosed between 1981 and 1995, as well as a random sample of 274 reference persons, stratified by age and sex. The median activity concentrations of radon in drilled wells used by bladder and kidney cancer cases and the reference cohort were 170, 140, and 130Bq/L, respectively. The radium concentration was 0.01 Bq/L for all groups and the uranium concentrations were 0.08, 0.07, and 0.06 Bq/L, respectively. The bladder cancer risks associated with radon, radium, and uranium activity concentrations in drinking water were 1.02 (0:68-1.54) per log(100 Bq of radon/L), 0.73 (0.21-2.50) per log(0.1 Bq of radium/L), and 0.77 (0.32-1.89) per log(l Bq of uranium/L) The corresponding figures for kidney cancer were 0.81 (0.47-1.37), 0.12 (0.01-1.10), and 0.92 (0.36-2.35), respectively.

In conclusion,.; even though ingested radionuclides from drilled wells are a source of radiation exposure, they are not associated with a substantially increased risk of bladder or kidney cancers in concentrations occurring in drilled wells. (c) 2006 Elsevier Inc. All rights reserved.

Functional biology of the neuronal ceroid lipofuscinoses (NCL) proteins

Kyttälä, A., Lahtinen, U., Braulke, T. and Hofmann, S. L.

Biochimica Et Biophysica Acta-Molecular Basis of Disease. 2006; 1762(10): 920-933. Article. IF 2.382

Neuronal ceroid lipofucinoses (NCLs) are a group of severe neurodegenerative disorders characterized by accumulation of autofluorescent ceroid lipopigment in patients' cells.

The different forms of NCL share many similar pathological features but result from mutations in different genes. The genes affected in NCLs encode both soluble and transmembrane proteins and are localized to ER or to the endosomes/lysosomes. Due to selective vulnerability of the central nervous system in the NCL disorders, the corresponding proteins are proposed to have important, tissue specific roles in the brain. The pathological similarities of the different NCLs have led not only to the grouping of these disorders but also to suggestion that the NCL proteins function in the same biological pathway. Despite extensive research, including the development of several model organisms for NCLs and establishment of high-throughput techniques, the precise biological function of many of the NCL proteins has remained elusive.

The aim of this review is to summarize the current knowledge of the functions, or proposed functions, of the different NCL proteins. (c) 2006 Published by Elsevier B.V.

Pneumolysin polymerase chain reaction for diagnosis of pneumococcal pneumonia and empyema in children

Lahti, E., Mertsola, J., Kontiokari, T., Eerola, E., Ruuskanen, O. and Jalava, J.

European Journal of Clinical Microbiology & Infectious Diseases. 2006; 25(12): 783-789. Article. IF 2.061

Streptococcus pneumoniae is the most important cause of childhood pneumonia and empyema, yet the diagnosis of pneumococcal infections by conventional methods is challenging.

In this study, the clinical value of the pneumolysin-targeted real-time polymerase chain reaction (PCR) method for the diagnosis of pneumococcal pneumonia and empyema was evaluated with 33 whole blood samples and 12 pleural fluid samples. The analytical sensitivity of the PCR assay was 4 fg of pneumococcal DNA, corresponding to two genome equivalents of pneumococcal DNA per reaction. The PCR assay correctly detected all clinical isolates of S. pneumoniae tested, whereas all nonpneumococcal bacterial organisms tested were negative by PCR. In a clinical trial, S. pneumoniae was detected by PCR in the pleural fluid of 75% of children with empyema, increasing the detection rate of pneumococcus almost tenfold that of pleural fluid culture. However, in whole blood samples, PCR detected S. pneumoniae in only one child with pneumonia and one child with pneumococcal empyema and failed to detect S. pneumoniae in three children with blood cultures positive for S. pneumoniae. The present data indicate that pneumolysin-targeted real-time PCR of pleural fluid is a valuable method for the etiologic diagnosis of pneumococcal empyema in children.

The ease and rapidity of the LightCycler technology (Roche Diagnostics, Mannheim, Germany) make real-time PCR an applicable tool for routine diagnostics. In the evaluation of blood samples, blood culture remains the superior method for the diagnosis of bacteremic pneumococcal disease.

Fat intake at midlife and risk of dementia and Alzheimer's disease: A population-based study

Laitinen, M. H., Ngandu, T., Rovio, S., Helkala, E. L., Uusitalo, U., Viitanen, M., Nissinen, A., Tuomilehto, J., Soininen, H. and Kivipelto, M.

Dementia and Geriatric Cognitive Disorders. 2006; 22(1): 99-107. Article. IF 2.603

Background: Lifestyle and vascular factors have been linked to dementia and Alzheimer's disease ( AD), but the role of dietary fats in the development of dementia is less clear.

Methods: Participants were derived from random, population-based samples initially studied in midlife ( 1972, 1977, 1982, or 1987). Fat intake from spreads and milk products was assessed using a structured questionnaire and an interview. After an average follow-up of 21 years, a total of 1,449 (73%) individuals aged 65 - 80 years participated in the re-examination in 1998. Altogether 117 persons had dementia.

Results: Moderate intake of polyunsaturated fats at midlife decreased the risk of dementia even after adjustment for demographic variables, other subtypes of fats, vascular risk factors and disorders, and apolipoprotein E ( ApoE) genotype ( OR 0.40, CI 0.17 - 0.94 for the 2nd quartile vs. 1st quartile), whereas saturated fat intake was associated with an increased risk ( OR 2.45, CI 1.10 - 5.47 for the 2nd quartile). The associations were seen only among the ApoE epsilon 4 carriers.

Conclusions: Moderate intake of unsaturated fats at midlife is protective, whereas a moderate intake of saturated fats may increase the risk of dementia and AD, especially among ApoE epsilon 4 carriers. Thus, dietary interventions may potentially modify the risk of dementia, particularly among genetically susceptible individuals. Copyright (C) 2006 S. Karger AG, Basel.

Special issue: Molecular basis of NCL

Mole, S. E., Dawson, G. and Jalanko, A.

Biochimica Et Biophysica Acta-Molecular Basis of Disease. 2006; 1762(10): 849-849. Editorial Material. IF 2.382

Identification of alpha-1 acid glycoprotein as a lysophospholipid binding protein: A complementary role to albumin in the scavenging of lysophosphatidylcholine

Ojala, P. J., Hermansson, M., Tolvanen, M., Polvinen, K., Hirvonen, T., Impola, U., Jauhiainen, M., Somerharju, P. and Parkkinen, J.

Biochemistry. 2006; 45(47): 14021-14031. Article. IF 3.848

Alpha-1 acid glycoprotein (AGP, orosomucoid), a major acute phase protein in plasma, displays potent cytoprotective and anti-inflammatory activities whose molecular mechanisms are largely unknown. Because AGP binds various exogenous drugs, we have searched for endogenous ligands for AGP. We found that AGP binds lysophospholipids in a manner discernible from albumin in several ways. First, mass spectrometric analyses showed that AGP isolated from plasma and serum contained lysophosphatidylcholine (LPC) enriched in mono and polysaturated acyl chains, whereas albumin contained mostly saturated LPC. Second, AGP bound LPC in a 1:1 molar ratio and with a higher affinity than free fatty acids, whereas albumin bound LPC in a 3:1 ratio but with a lower affinity than that of free fatty acids. Consequently, free fatty acids displaced LPC more avidly from albumin than from AGP. Competitive ligand displacement indicated the highest affinity for AGP to LPC20:4, 18:3, 18:1, and 16:0 (150-180 nM), lysophosphatidylserine (K-d 190 nM), and platelet activating factor (PAF) (K-d 235 nM). The high affinity of AGP to LPC in equilibrium was verified by stopped-flow kinetics, which implicated slow dissociation after fast initial binding, being consistent with an induced-fit mechanism. AGP also bound pyrene-labeled phospholipids directly from vesicles and more efficiently than albumin. AGP prevented LPC-induced priming and PAF-induced activation of human granulocytes, thus indicating scavenging of the cellular effects of the lipid ligands.

The results suggest that AGP complements albumin as a lysophospholipid scavenging protein, particularly in inflammatory conditions when the capacity of albumin to sequester LPC becomes impaired.

Comparison of media for enumeration of coliform bacteria and Escherichia coli in non-disinfected water

Pitkänen, T., Paakkari, P., Miettinen, I. T., Heinonen-Tanski, H., Paulin, L. and Hänninen, M. L.

J Microbiol Methods. 2006. IF 2.297

In this work alternative media for detection and enumeration of E. coli and coliform bacteria were compared to the reference method ISO 9308-1 (LTTC) using non-disinfected water samples with background flora.

The alternative media included LES Endo agar medium (LES Endo), Colilert(R)-18 with 51-well Quanti-tray(R) (Colilert), Chromocult(R) Coliform agar (CC), Harlequintrade mark E. coli/Coliform medium (HECM) and Chromogenic Escherichia coli/Coliform medium (CECM). A total of 110 samples of groundwater, bathing water and spiked water was used.

Our results revealed that confirmation of coliform bacteria counts is necessary, not only on lactose-based LTTC and LES Endo media, but also on the chromogenic agar media tested, due to the growth of oxidase positive colonies. LTTC and CC media also allowed the growth of some morphologically typical coliform colonies containing gram-positive bacteria. The recovery of coliform bacteria was lower on LES Endo than on LTTC. In most cases Colilert, CC, HECM and CECM gave higher coliform counts than LTTC. The use of the LTTC medium led to higher E. coli counts than obtained with any of the alternative mediums. There are three explanations for this: (1) high sensitivity of LTTC, (2) false positives on LTTC or (3) false negatives especially with Colilert, but also with chromogenic agar media. Although LTTC was found to be a very sensitive medium, the high degree of background growth of non-disinfected waters disturbed substantially the use of it.

In conclusion, our results suggest that Colilert, CC and CECM are potential alternative media for detection of coliform bacteria and E. coli from non-disinfected water.

A prospective investigation of height and prostate cancer risk

Sequoia, J. S. P., Wright, M. E., McCarron, P., Pietinen, P., Taylor, P. R., Virtamo, J. and Albanes, D.

Cancer Epidemiology Biomarkers & Prevention. 2006; 15(11): 2174-2178. Article. IF 4.460

Greater adult height, which reflects a combination of early nutrition, exposure to androgens, growth hormones, and other factors during growth and development, as well as heredity, has been associated with increased prostate cancer risk in several observational studies, but findings have been inconsistent.

We examined this relationship in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study cohort. At baseline, 29,119 Finnish male smokers 50 to 69 years old had height and weight measured by trained personnel, provided information on demographic, smoking, medical, and other characteristics, and completed an extensive diet history questionnaire. A total of 1,346 incident prostate cancer cases were identified during a follow-up period of up to 17.4 years (median, 14.1 years).

In age-adjusted Cox proportional hazards models, the hazard ratios and 95% confidence intervals for prostate cancer according to increasing quintiles of height [<= 168, 169-171, 172-175, 176-178, and > 178 cm] were 1.00 (reference), 1.11 (0.93-1.32), 1.11 (0.95-1.31), 1.30 (1.01-1.55), and 1.14 (0.96-1.35); P-trend = 0.04. In analyses stratified by disease stage (available for 916 cases), a strong dose-response relationship was observed between greater height and advanced, but not earlier-stage, disease [tumor-node-metastasis stage III-IV, hazard ratio and 95% confidence interval for increasing quintiles of height: 1.77 (1.18-2.65), 1.82 (1.25-2.65), 1.93 (1.29-2.90), and 2.02 (1.37-2.97); P-trend = 0.0008, P-interaction = 0.002].

Our study provides additional evidence that increased height is a risk factor for prostate cancer and suggests that taller men are particularly susceptible to advanced disease.

Prevalence and determinants of lateral and medial epicondylitis: A population study

Shiri, R., Viikari-Juntura, E., Varonen, H. and Heliövaara, M.

American Journal of Epidemiology. 2006; 164(11): 1065-1074. Article. IF 5.068

Epicondylitis is a common disorder of the arm, yet the role of individual- and work-related factors has not been addressed in a population study.

The aims of this study were to estimate the prevalence of lateral and medial epicondylitis and to investigate their risk factors. The target population of this study comprised a representative sample of people aged 30-64 years residing in Finland during 2000-2001. Of the 5,871 subjects, 4,783 (81.5%) were included in this study.

The prevalence of definite lateral epicondylitis was 1.3%, and that of medial epicondylitis was 0.4%. The prevalence did not differ between men and women and was highest in subjects aged 45-54 years. Current smoking (adjusted odds ratio (OR) = 3.4, 95% confidence interval (CI): 1.4, 8.3) and former smoking (OR = 3.0, 95% CI: 1.3, 6.6) were associated with definite lateral epicondylitis. An interaction (p = 0.002) was found between repetitive movements of the arms and forceful activities for the risk of possible or definite lateral epicondylitis (for both repetitive and forceful activities vs. no such activity: OR = 5.6, 95% CI: 1.9, 16.5).

Smoking, obesity, repetitive movements, and forceful activities independently of each other showed significant associations with medial epicondylitis. Epicondylitis is relatively common among working-age individuals in the general population. Physical load factors, smoking, and obesity are strong determinants of epicondylitis.

Association of smoking status with obesity and diabetes among elderly people

Sulander, T., Rahkonen, O., Nissinen, A. and Uutela, A.

Arch Gerontol Geriatr. 2006. IF 0.760

The present study was aimed to examine associations of current and ex-smoking status with obesity and diabetes among elderly people.

Nationwide study of Finnish elderly people based on biennial surveys from 1985 to 1995, were used to study 7482 people aged 65-79 years. Smoking status included non-, ex-light, ex-heavy, current light, and current heavy smokers. Obesity was set as body mass index (BMI)>/=30. Information of smoking, BMI, and diabetes was based on self-reports. Logistic regression was used as the main method of analyses.

Compared to non-smokers (reference category), ex-heavy smokers had higher (odds ratio, 1.42; 95% confidence interval: 1.09, 1.85) and current light smokers (OR, 0.46; 95% CI: 0.31, 0.69) lower relative risk of obesity. Current light smokers had also lower and ex-heavy smokers higher rate of diabetes than non-smokers. Ex-heavy smokers had a higher risk of obesity (OR, 1.75; 95% CI: 1.30, 2.36) and diabetes (OR, 1.48; 95% CI: 1.10, 2.01) than ex-light smokers. Same pattern for current smokers was found. Heavy ex- and current elderly smokers are at risk of obesity and diabetes.

Thus, heavy smokers should be emphasized in programs promoting smoking cessation.

Consumption of 'extra' foods (energy-dense, nutrient-poor) among children aged 16-24 months from western Sydney, Australia

Webb, K. L., Lahti-Koski, M., Rutishauser, I., Hector, D. J., Knezevic, N., Gill, T., Peat, J. K. and Leeder, S. R.

Public Health Nutrition. 2006; 9(8): 1035-1044. Article. IF 1.918

Objective: This study evaluates the contribution of energy-dense, nutrient-poor 'extra' foods to the diets of 16-24-month-old children from western Sydney, Australia.

Design: An analysis of cross-sectional data collected on participants in the Childhood Asthma Prevention Study (CAPS), a randomised trial investigating the primary prevention of asthma from birth to 5 years. We collected 3-day weighed food records, calculated nutrient intakes, classified recorded foods into major food groups, and further classified foods as either 'core' or 'extras' according to the Australian Guide to Healthy Eating.

Setting: Pregnant women, whose unborn child was at risk of developing asthma because of a family history, were recruited from all six hospitals in western Sydney, Australia. Data for this study were collected in clinic visits and at participants' homes at the 18-month assessment.

Participants: Four hundred and twenty-nine children participating in the CAPS study; 80% of the total cohort.

Results: The mean consumption of 'extra' foods was similar to150 g day(-1) and contributed 25-30% of the total energy, fat, carbohydrate and sodium to the diets of the study children. 'Extra' foods also contributed around 20% of fibre, 10% of protein and zinc, and about 5% of calcium. Children in the highest quintile of 'extra' foods intake had a slightly higher but not significantly different intake of energy from those in the lowest quintile. However, significant differences were evident for the percentage of energy provided by carbohydrate and sugars (higher) and protein and saturated fat (lower). The intake of most micronutrients was also significantly lower among children in the highest quintile of consumption. The intake of 'extra' foods was inversely associated with the intake of core foods.

Conclusions: The high percentage of energy contributed by 'extra' foods and their negative association with nutrient density emphasise the need for dietary guidance for parents of children aged 1-2 years. These preliminary data on commonly consumed 'extra' foods and portion sizes may inform age-specific dietary assessment methods.