Liikunta, raskaus ja henkinen hyvinvointi : tarkastelussa raskausdiabeteksen riskiryhmä

Physical inactivity, mental health problems and obesity, whilst interrelated, each represent a major global health challenge. Furthermore, obesity substantially contributes to the increasing prevalence of gestational diabetes mellitus (GDM), an emerging worldwide epidemic amongst pregnant women. Life events such as pregnancy may affect physical activity as well as mental well-being. This doctoral thesis systemically reviews the literature concerning the effects of life events, especially pregnancy, on physical activity, and examines mental wellbeing and physical activity in women at risk for GDM. The thesis also evaluates the effects of a randomised lifestyle intervention aimed at preventing GDM on self-rated health from early pregnancy throughout the first year following birth. The systematic review consisted of studies amongst healthy adults. In addition, this doctoral thesis includes participants from two randomised controlled trials: the Finnish Gestational Diabetes Prevention Study (RADIEL) and the Finnish Gestational Diabetes Prevention Study Part II: Autonomic Nervous System and Exercise (ANS-EXE). The participants consisted of 482 pregnant women and 39 women planning a pregnancy at high risk for GDM (a history of GDM or a prepregnancy body mass index [BMI] ≥ 29 kg/m2 or both), and 358 pregnant women in the general Finnish population. A proportion of the pregnant women at risk for GDM received diet and physical activity counselling from early pregnancy to one-year postpartum. The studies included in the systematic review showed statistically significant changes in leisure-time physical activity after life events. Changes varied according to different life events and the age and gender of the study population. Physical activity decreased both from prepregnancy to pregnancy, and from prepregnancy to the postpartum period. Pregnant women at risk for GDM exhibited higher Edinburgh Postnatal Depression Scale scores compared to pregnant women in the general population during early pregnancy, but this difference disappeared after adjusting for age, BMI and income. In addition, cardiorespiratory fitness, as assessed by measuring the maximal oxygen consumption (VO2max) during a cycle ergometer test, and self-reported leisure-time physical activity were positively associated with the self-rated general health and physical well-being domains of the 36-Item Short-Form Health Survey in women planning a pregnancy and at risk for GDM, which held when controlling for BMI. Furthermore, self-rated general health and physical well-being differed between those women with very poor or poor cardiorespiratory fitness. The self-rated health of women at risk for GDM tended to improve amongst the lifestyle counselling group and to deteriorate in the control group from pregnancy to one-year postpartum, although the difference between groups was not statistically significant. Life events affect leisure-time physical activity; for example, pregnancy tends to decrease physical activity levels. The prevalence of depressive symptoms during early pregnancy is higher amongst women at risk for GDM compared to women in the general pregnant population. The higher prevalence seems to be explained by characteristics such as age, BMI and income. Moreover, even a slightly better cardiorespiratory fitness could be beneficial for the health-related quality of life amongst women at risk for GDM who are planning a pregnancy. The effectiveness of lifestyle counselling for high-risk pregnant women aimed at improving self-rated well-being requires further research.Vähäinen liikunta, mielenterveyden ongelmat ja lihavuus ovat merkittäviä väestön terveyteen liittyviä haasteita. Lihavuus puolestaan on läheisesti yhteydessä raskausdiabetekseen, joka on kehittymässä maailmanlaajuiseksi epidemiaksi raskaana olevien naisten keskuudessa. Raskauden kaltaiset elämäntapahtumat saattavat vaikuttaa sekä liikunta-aktiivisuuteen että henkiseen hyvinvointiin. Tässä väitöskirjassa koottiin yhteen tutkimusnäyttö merkittävien elämäntapahtumien, erityisesti raskauden, vaikutuksista liikunta-aktiivisuuteen, sekä tutkittiin henkistä hyvinvointia ja liikuntaa raskausdiabeteksen riskiryhmään kuuluvilla naisilla. Lisäksi selvitettiin raskausdiabeteksen ehkäisyyn tähtäävän elintapaohjauksen vaikutuksia koettuun terveyteen alkuraskaudesta siihen asti, kun synnytyksestä oli kulunut vuosi. Elämäntapahtumien vaikutusta liikunta-aktiivisuuteen selvitettiin terveillä aikuisilla. Lisäksi väitöskirjassa oli mukana 482 raskaana olevaa ja 39 raskautta suunnittelevaa naista, joilla oli suurentunut raskausdiabeteksen riski (raskausdiabetes aiemmassa raskaudessa ja/tai raskautta edeltävä painoindeksi ≥ 29 kg/m2), sekä 358 Suomen yleiseen väestöön kuuluvaa raskaana olevaa naista. Osa suurentuneessa raskausdiabeteksen riskissä olevista naisista sai ravitsemus- ja liikuntaohjausta alkuraskaudesta siihen asti, kun synnytyksestä oli kulunut vuosi. Naisten masennusoireet, terveyteen liittyvä elämänlaatu, koettu terveys ja liikunta-aktiivisuus kysyttiin lomakkeilla, ja raskautta suunnittelevien naisten hengitys- ja verenkiertoelimistön kunto selvitettiin mittaamalla maksimaalinen hapenottokyky polkupyöräergometritestin aikana. Tulokset osoittivat, että merkittävät elämäntapahtumat vaikuttavat vapaa-ajan liikunta-aktiivisuuteen. Vaikutukset riippuvat iästä, sukupuolesta ja elämäntapahtumasta; esimerkiksi raskaus vähentää liikunta-aktiivisuutta yleisessä väestössä. Raskausdiabeteksen riskiryhmään kuuluvilla naisilla on enemmän masennusoireita kuin naisilla yleisesti alkuraskaudessa, mutta ero näyttäisi selittyvän taustatekijöillä, kuten iällä, painoindeksillä ja tulotasolla. Raskausdiabeteksen riskiryhmään kuuluvilla raskautta suunnittelevilla naisilla hengitys- ja verenkiertoelimistön kunto ja vapaa-ajan liikunta-aktiivisuus olivat positiivisesti yhteydessä koettuun terveyteen ja koettuun fyysiseen hyvinvointiin, myös painoindeksillä vakioinnin jälkeen. Naiset, joilla oli hyvin huono kunto, kokivat terveytensä ja fyysisen hyvinvointinsa kaikkein huonoimmaksi, jopa verrattuna naisiin, joilla oli huono kunto. Koettu terveys näytti paranevan alkuraskaudesta siihen asti, kun synnytyksestä oli kulunut vuosi raskausdiabeteksen riskiryhmään kuuluvilla naisilla, jotka saivat elintapaohjausta. Koettu terveys näytti sen sijaan huononevan kontrolliryhmässä. Ero ryhmien välillä ei kuitenkaan ollut tilastollisesti merkitsevä. Merkittävät elämäntapahtumat, kuten raskaus, vaikuttavat vapaa-ajan liikunta-aktiivisuuteen, joten elämäntapahtumat voisivat olla otollinen aika liikunta-aktiivisuuden edistämiselle. Raskausdiabeteksen riskiryhmään kuuluvilla naisilla on enemmän masennusoireita kuin naisilla yleisesti alkuraskaudessa, ja ero näyttäisi selittyvän taustatekijöillä, kuten iällä, painoindeksillä ja tulotasolla. Raskausdiabeteksen riskiryhmään kuuluvilla raskautta suunnittelevilla naisilla jo hieman parempi hengitys-ja verenkiertoelimistön kunto saattaisi parantaa terveyteen liittyvää elämänlaatua. Lisää tutkimuksia tarvitaan selvittämään, voidaanko raskausdiabeteksen riskiryhmään kuuluvien naisten koettua hyvinvointia parantaa elintapaohjauksella

Bone health in women with a history of gestational diabetes or obesity

Introduction Type 2 diabetes is associated with an increased risk of bone fractures. However, bone health of women with a history of gestational diabetes (GDM) has received little attention. This cross-sectional study compares bone health between premenopausal women with and without a history of GDM, and examines factors associated with bone health in women with a history of GDM or obesity. Material and methods We measured areal bone mineral density for total hip, lumbar spine and whole body, and total body fat percentage (fat%) with dual-energy X-ray absorptiometry in 224 women. In addition, we measured bone characteristics of radius and tibia with peripheral quantitative computed tomography. Results When compared with women without a history of GDM (mean age 39 years [SD 5], body mass index [BMI] 35 kg/m(2) [SD 6], fat% 48 [SD 7]), women with a history of GDM (age 41 years [SD 4], BMI 31 kg/m(2) [SD 7], fat% 43 [SD 10]) had lower hip and whole body bone mineral densities, and inferior tibia outcomes. However, the differences in bone characteristics disappeared after controlling for age, height, BMI and fat%. After controlling for age, height, BMI and smoking, physical activity and healthier diet were positively associated with bone outcomes, whereas fat%, HbA(1c) and screen time were negatively associated with bone outcomes. Particularly, fat% showed independent negative associations with whole body bone mineral density and several tibia and radius characteristics. Conclusions Fat% is associated with adverse bone health, independently of BMI, in women with a history of GDM or obesity. Promoting healthy lifestyle and reducing fat% in high-risk women could improve bone health and prevent future fractures.Peer reviewe

Central obesity in school-aged children increases the likelihood of developing paediatric autoimmune diseases

Background The incidences of both paediatric obesity and autoimmune diseases have been increasing, but their relationship with one another is unclear. Objective To determine whether obesity or particular dietary patterns in school-aged children are potential risk factors for autoimmune diseases during adolescence. Methods This matched case-control study included 525 children, followed up from a median age of 11.3 to 16.7 years. Of them, 105 children received primary autoimmune diagnoses (diabetes, thyroiditis, arthritis, or inflammatory bowel diseases) after baseline and generated the case group. Four children with matching age, sex, and residential area generated the control group of 420 children. At baseline, age- and sex-specific body mass index categories were acquired and waist-to-height ratio (WHTR) was calculated. Central obesity was present when WHTR >= 0.5. Dietary patterns were analysed using a food frequency questionnaire (FFQ). Results School-aged children with central obesity were 2.11 (OR, 95% CI 1.11-3.98) times more likely to develop autoimmune diseases before age of 19 years than those without central obesity. Being overweight was not related to the onset of these diseases (OR 1.60, 95% CI 0.89-2.87, nor were dietary patterns. Conclusion Central obesity in school-aged children was related to the development of autoimmune diseases, while being overweight and dietary patterns were not.Peer reviewe

Heavy Screen Use on Weekends in Childhood Predicts Increased Body Mass Index in Adolescence : A Three-Year Follow-Up Study

Purpose We aimed to examine whether sedentary screen time changes when transitioning from childhood to adolescence and whether children's screen time, separately for school days and weekends, affects body mass index (BMI) in adolescents. Methods This prospective 3-year follow-up study included 5,084 children with a mean (standard deviation) age of 11 (1) years at baseline and 14 (1) years at follow-up. Children reported screen time, more specifically, time spent viewing TV programs and using a computer outside school while sitting. We categorized children into light, medium, and heavy TV viewers and computer users separately for school days and weekends. We also calculated the age- and gender-specific BMI z-score (BMIz). Results Time spent viewing TV changed from baseline to follow-up on school days and on weekends (p <.001 for both); the proportion of heavy TV viewers on school days (≥3 h/d) increased from 16% to 23% and on weekends (≥4 h/d) from 19% to 30%. Heavy TV viewers and computer users on both school days and on weekends had a higher BMIz 3 years later (p <.001 for all). After adjusting for age, gender, language, baseline BMIz, sleep duration, eating habits, exercise, and the other screen-time variables, heavy TV viewing on weekends remained significantly associated with an increased BMIz at follow-up (B = .078; p = .013). Conclusions The proportion of heavy screen users increases when transitioning from childhood to adolescence. Moreover, heavy screen use, especially on weekends in 11-year-old children, is associated with an increased BMI 3 years later.Peer reviewe

High abundance of sugar metabolisers in saliva of children with caries

Dental caries is a biofilm-mediated, dynamic disease with early onset. A balanced salivary microbiota is a foundation of oral health, while dysbiosis causes tooth decay. We compared the saliva microbiota profiles in children with and without caries. The study consisted of 617 children aged 9-12 years from the Finnish Health in Teens (Fin-HIT) study with available register data on oral health. Caries status was summarised based on Decayed, Missing, and Filled Teeth (DMFT) index in permanent dentition. The children were then classified into the following two groups: DMFT value >= 1 was considered as cavitated caries lesions (hereafter called 'caries') (n=208) and DMFT=0 as 'cavity free' (n=409). Bacterial 16S rRNA gene (V3-V4 regions) was amplified using PCR and sequenced by Illumina HiSeq. The mean age (SD) of the children was 11.7 (0.4) years and 56% were girls. The children had relatively good dental health with mean DMFT of 0.86 (1.97). Since sex was the key determinant of microbiota composition (p=0.014), we focused on sex-stratified analysis. Alpha diversity indexes did not differ between caries and cavity free groups in either sexes (Shannon: p=0.40 and 0.58; Inverse Simpson: p=0.51 and 0.60, in boys and girls, respectively); neither did the composition differ between the groups (p=0.070 for boys and p=0.230 for girls). At the genus level, Paludibacter and Labrenzia had higher abundances in the caries group compared to cavity free group in both sexes (pPeer reviewe

Saliva microbiota differs between children with low and high sedentary screen times

Publisher Copyright: © 2021 The Author(s)This study examined whether the diversity, composition and functional capacity of the saliva microbiota differed between children with low and high sedentary screen times. We analyzed the saliva microbiota using 16S rRNA (V3–V4) sequencing from 193 children with low and 183 children with high TV/screen viewing times while sitting. Microbiota diversity was higher among children with low screen times compared to children with high screen times. Furthermore, microbiota composition differed between the screen time groups. In addition, we identified ten differentially abundant taxonomic groups, including Veillonella, Prevotella and Streptococcus, and five differentially present metabolic pathways between the screen time groups. Children with high screen times exhibited a higher capacity to synthesize the fatigue- and activity-related amino acids ornithine and arginine. To conclude, children with high sedentary screen (sitting) times exhibited a lower diversity and a different composition and functionality of the microbiota compared to children with low screen times.Peer reviewe

Macronutrient intake during pregnancy in women with a history of obesity or gestational diabetes and offspring adiposity at 5 years of age

Background/objectives The impact of maternal macronutrient intake during pregnancy on offspring childhood adiposity is unclear. We assessed the associations between maternal macronutrient intake during and after pregnancy with offspring adiposity at 5 years of age. Additionally, we investigated whether gestational diabetes (GDM), BMI, or breastfeeding modified these associations. Subjects/methods Altogether, 301 mother-child dyads with maternal prepregnancy BMI >= 30 and/or previous GDM participated in the Finnish Gestational Diabetes Prevention Study (RADIEL) and its 5 years follow-up. Macronutrient intakes (E%) were calculated from 3-day food records collected at 5-18 weeks' gestation, in the third trimester, and at 12 months and 5 years after pregnancy. Offspring body fat mass (BFM) and fat percentage (BF%) at 5 years were measured by bioimpedance. Statistical analyses were multivariate linear regression. Results Mean (SD) prepregnancy BMI was 33(4) kg/m(2). GDM was diagnosed in 47%. In normoglycemic women, higher first half of pregnancy n-3 PUFA intake was associated with lower offspring BFM (g) (ss -0.90; 95% CI -1.62, -0.18) and BF% (ss -3.45; 95% CI -6.17, -0.72). In women with GDM, higher first half of pregnancy n-3 PUFA intake was associated with higher offspring BFM (ss 0.94; 95% CI 0.14, 1.75) and BF% (ss 3.21; 95% CI 0.43, 5.99). Higher SFA intake in the third trimester and cumulative intake across pregnancy (mean of the first half and late pregnancy) was associated with higher BFM and BF% (across pregnancy: ss 0.12; 95% CI 0.03, 0.20 and ss 0.44; 95% CI 0.15, 0.73, respectively). Higher carbohydrate intake across pregnancy was associated with lower BFM (ss -0.044; 95% CI -0.086, -0.003), and borderline associated with BF% (ss -0.15; 95% CI -0.31, 0.00). Conclusions The macronutrient composition of maternal diet during pregnancy is associated with offspring BFM and BF% at 5 years. GDM modifies the association between prenatal n-3 PUFA intake and offspring anthropometrics.Peer reviewe

Comparing estimates of physical activity in children across different cut-points and the associations with weight status

This study aimed to compare sedentary time (SED) and intensity-specific physical activity (PA) estimates and the associations of SED and PA with body mass index (BMI) and waist circumference (WC) using three different sets of cut-points in preschool-aged children. A total of 751 children (4.7 +/- 0.9 years, boys 52.7%) wore an ActiGraph GT3X+BT accelerometer on their hip for 7 days (24 h). Euclidean norm -1 G with negative values rounded to zero (ENMO) and activity counts from vertical axis (VACounts) and vector magnitude (VMCounts) were derived. Estimates of SED and light, moderate, vigorous, and moderate-to-vigorous PA (MVPA) were calculated for commonly used cut-points by Hildebrand et al., Butte et al., and Evenson et al. Furthermore, the prevalence of meeting the PA recommendation, 180 min/day of which at least 60 min/day being MVPA, were assessed for the cut-points. Multilevel mixed analysis was used to examine associations of SED and PA with BMI and WC. In accordance with the results, SED and PA intensity estimates differed largely across cut-points (i.e., SED = 22-341 min/day; light PA = 52-257 min/day; moderate PA = 5-18 min/day; vigorous PA = 7-17 min/day; MVPA = 13-35 min/day), and the prevalence of children meeting the PA recommendation varied from 4% to 70%. Associations of SED and PA with BMI or WC varied between the cut-points. Our results indicate that SED and PA estimates in preschool-aged children between studies using these cut-points are poorly comparable. Methods facilitating accelerometer-derived PA estimate comparison between studies are highly warranted.Peer reviewe

The longitudinal associations between mental health indicators and digital media use and physical activity during adolescence : A latent class approach

Introduction: Evidence for the relationship between movement behaviors and mental health among adolescents is inconclusive. We aimed to identify profiles of digital media use (including related bedtime delay) and leisuretime physical activity (LTPA) in adolescence, and to examine whether preadolescent mental health predicted later behavior profiles.Methods: This study included 1285 participants assessed at 11 years of age, and followed-up four years later. Participants completed the Self-Perception Profile for Children (SPPC), Center for Epidemiological Studies Depression Scale for Children (CES-DC) and Screen for Child Anxiety-Related Emotional Disorders (SCARED) at baseline, and reported digital media use (active and passive use, gaming, and related bedtime delays) and LTPA at follow-up. A latent class approach was employed to identify behavior profiles, membership of which was then predicted with mental health and covariates, including baseline digital media use and LTPA. Results: We identified four behavior profiles: 1) high digital media use/moderate LTPA (20% of adolescents; 78% boys), 2) moderate digital media use/high LTPA (31%; 28%), 3) high digital media use/high LTPA (26%; 15%), 4) high passive digital media use and gaming/low LTPA (23%; 89%). After adjusting for covariates, higher LTPA and better perception of athletic competence at baseline associated with higher odds of belonging to any other profile than to the unhealthiest profile (4) at follow-up. Symptoms of depression or anxiety did not associate with later behavior profiles.Conclusions: LTPA and related self-esteem seem to be stronger predictors of future digital media use and LTPA behavior during adolescence than mental health symptoms alone.Peer reviewe

Antibiotic exposures and the development of pediatric autoimmune diseases : a register-based case-control study

Background Antibiotics have been associated with several individual autoimmune diseases (ADs). This study aims to discover whether pre-diagnostic antibiotics are associated with the onset of ADs in general. Methods From a cohort of 11,407 children, 242 developed ADs (type 1 diabetes, autoimmune thyroiditis, juvenile idiopathic arthritis (JIA), or inflammatory bowel diseases) by a median age of 16 years. Antibiotic purchases from birth until the date of diagnosis (or respective date in the matched controls n = 708) were traced from national registers. Results Total number of antibiotic purchases was not related to the onset of ADs when studied as a group. Of specific diagnoses, JIA was associated with the total number of antibiotics throughout the childhood and with broad-spectrum antibiotics before the age of 3 years. Intriguingly, recent and frequent antibiotic use (within 2 years before diagnosis and >= 3 purchases) was associated with the onset of ADs (OR 1.72, 95% CI 1.08-2.74). Regardless of frequent use in childhood (40% of all antibiotics), penicillin group antibiotics were not related to any ADs. Conclusions Use of antibiotics was relatively safe regarding the overall development of ADs. However, broad-spectrum antibiotics should be used considerately as they may associate with an increased likelihood of JIA. Impact Increasing numbers of antibiotic purchases before the age of 3 years or throughout childhood were not associated with the development of pediatric autoimmune diseases. Broad-spectrum antibiotics were related to the development of autoimmune diseases, especially juvenile idiopathic arthritis in children, while penicillin group antibiotics were not. The use of broad-spectrum antibiotics in children should be cautious as they may carry along a risk for autoimmune disease development.Peer reviewe