Kasvisterolit ja -stanolit täydennetyissä elintarvikkeissa : vaikutukset kokeellisessa paksusuolisyöpämallissa ja saanti suomalaisväestössä

Plant sterols and stanols (collectively named as phytosterols) are plant-derived dietary compounds. The intake of natural phytosterols from a habitual Western diet varies between 150 to 400 mg/d. Phytosterols are added to functional foods for their serum cholesterol-lowering effect and their intake increases greatly when phytosterol enriched functional foods are consumed. Phytosterols reduce the absorption of dietary and biliary cholesterol from the intestine, leading to increased concentrations of cholesterol excreted in the feces. Increased fecal cholesterol may act as a carcinogen in the intestinal lumen. The focus of this thesis was to study the effect of plant sterols and stanols on the tumor formation in the ApcMin mouse, an experimental model of colon cancer. The ApcMin carries an inherited mutation in the Apc tumor-suppressor gene, which eventually leads to the development of adenomas in the intestine. Mice were fed a control diet or a 0.8% (w/w) plant sterol/ stanol diet. Commercial foods enriched with plant sterols or stanols were used to compose the experimental diets. The impact of phytosterol feeding on cell signaling pathways involved in intestinal tumorigenesis and the changes in sterol metabolism were studied in the intestinal mucosa of ApcMin mouse. The final part of this work assesses the intake of phytosterols from enrichment among Finnish men and women from the FINDIET 2007 Survey. Both plant sterols and plant stanols increased the number of adenomas in the small intestine of ApcMin mice. Plant stanol feeding increased the number of intestinal tumors in both genders, whereas plant sterol feeding increased the number of tumors more pronouncedly in female mice. Wnt- β-catenin and Egfr signaling were up-regulated in the intestinal mucosa of plant stanol fed ApcMin mice when compared with control mice. Plant sterol and stanol feeding increased fecal cholesterol concentration that positively associated with the number of intestinal adenomas. Significant changes in the composition of intestinal sterols were observed after plant sterol and stanol feeding. It appears that plant sterol feeding affects genders differently, and estrogen signaling may play a role in intestinal tumorigenesis in female ApcMin mice after plant sterol feeding. Overall, the mice responded in a different manner to plant sterol and plant stanol feeding in intestinal sterol handling, cell signaling, and tumor development. Finally, this thesis shows that according to the FINDIET 2007 Survey the intake of phytosterols from enrichment can go beyond the advised intake; for 20% of those using phytosterol enriched products the intake of phytosterols was more than 3 g/d. The consistency or duration of the consumption of phytosterol enriched products was not determined in this work. The results show that phytosterols at high intakes are harmful in the intestine of tumor-prone mice. Whether phytosterols from enrichment affect human intestinal health warrants for further research.Kasvisteroleita ja niiden tyydyttyneitä muotoja, kasvistanoleita, saadaan luontaisesti ravinnosta. Veren LDL-kolesterolia alentavan vaikutuksensa takia kasvisteroleita ja -stanoleita lisätään elintarvikkeisiin, kuten rasvalevitteisiin ja maitovalmisteisiin. Kasvisterolit ja kasvistanolit heikentävät kolesterolin imeytymistä suolistosta ja vaikuttavat elimistön kolesteroliaineenvaihduntaan. Kasvisterolit ja -stanolit imeytyvät itse heikosti suolistosta. Kasvisterolien ja -stanolien päivittäinen kokonaissaanti tavanomaisesta länsimaisesta ruokavaliosta on 150-400 mg, mutta saantimäärä saattaa kasvaa huomattavasti suuremmaksi täydennettyjä elintarvikkeita käyttävillä henkilöillä. Väitöskirjan tavoitteena oli selvittää kasvisterolin ja kasvistanolin vaikutuksia paksusuolisyövän kokeellisessa eläinmallissa käyttäen niillä täydennettyjä elintarvikkeita. Niin kasvisterolin kuin kasvistanolin saanti lisäsi suolistokasvainten määrää. Väitöstutkimus osoitti, että kasvisterolit ja kasvistanolit vaikuttavat eri tavoin solujen steroliaineenvaihduntaan suolistossa. Lisäksi kasvisterolit ja kasvistanolit näyttävät lisäävän suolistokasvainten muodostumista eri mekanismeilla. Kasvistanolin saanti lisäsi paksusuolisyövälle keskeisen solusignaalireitin, Wnt-reitin, aktivaatiota sekä lisäsi kasvutekijäreseptori Egfr:n määrää suoliston soluissa. Kasvisterolin kasvaimia aiheuttava vaikutus näyttäisi välittyvän muiden mekanismien kautta. Väitöskirjassa selvitettiin myös suomalaisväestön kasvisterolien ja -stanolien saantia luontaisista ravinnonlähteistä sekä täydennetyistä elintarvikkeista. Tulokset osoittivat, että n. 20% niistä, jotka käyttivät kasvisteroleilla tai -stanoleilla täydennettyjä elintarvikkeita, saivat enemmän kuin 3 g kasvisterolia/-stanolia päivässä, mikä on Euroopan elintarviketurvallisuusviranomaisen (EFSA) asettaman suositellun päivittäissaannin yläraja. Kasvisterolien ja -stanolien vaikutukset kokeellisessa paksusuolisyöpämallissa näyttävät olevan haitallisia saannin ollessa suurta. Jatkotutkimuksen tulisikin kohdistua kasvisterolien ja -stanolien pitkäaikaisiin vaikutuksiin ihmisväestössä, sillä niistä ei tiedetä vielä riittävästi. Täydennettyjen elintarvikkeiden pakkausmerkinnät ja käyttöohjeet eivät saavuta kaikkia kuluttajia, mikä saattaa johtaa suuriin saanteihin osalla suomalaisista

Analgesic purchases among older adults - a population-based study

Background: Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain among the aged population, and little is known about the prevalence of analgesics administration among community-dwelling older adults. The objective was to examine older adults' prescription analgesic purchases in relation to SF-36 pain in a population-based setting. Methods: One thousand four hundred twenty community-dwelling citizens aged 62-86 years self-reported SF-36 bodily pain (pain intensity and pain-related interference) scores for the previous 4 weeks. The Social Insurance Institution of Finland register data on analgesic purchases for 6 months prior to and 6 months after the questionnaire data collection were considered. Special interest was focused on factors related to opioid purchases. Results: Of all participants, 84% had purchased prescription analgesics during 1 year. NSAIDs were most frequently purchased (77%), while 41% had purchased paracetamol, 32% opioids, 17% gabapentinoids, and 7% tricyclic antidepressants. Age made no marked difference in purchasing prevalence. The number of morbidities was independently associated with analgesic purchases in all subjects and metabolic syndrome also with opioid purchases in subjects who had not reported any pain. Discussion: Substantial NSAID and opioid purchases emerged. The importance of proper pain assessment and individual deliberation in terms of analgesic contraindications and pain quality, as well as non-pharmacological pain management, need to be highlighted in order to optimize older adults' pain management.Peer reviewe

Cluster analysis to estimate the risk of preeclampsia in the high-risk Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction (PREDO) study

Objectives Preeclampsia is divided into early-onset (delivery before 34 weeks of gestation) and late-onset (delivery at or after 34 weeks) subtypes, which may rise from different etiopathogenic backgrounds. Early-onset disease is associated with placental dysfunction. Late-onset disease develops predominantly due to metabolic disturbances, obesity, diabetes, lipid dysfunction, and inflammation, which affect endothelial function. Our aim was to use cluster analysis to investigate clinical factors predicting the onset and severity of preeclampsia in a cohort of women with known clinical risk factors. Methods We recruited 903 pregnant women with risk factors for preeclampsia at gestational weeks 12(+0)-13(+6). Each individual outcome diagnosis was independently verified from medical records. We applied a Bayesian clustering algorithm to classify the study participants to clusters based on their particular risk factor combination. For each cluster, we computed the risk ratio of each disease outcome, relative to the risk in the general population. Results The risk of preeclampsia increased exponentially with respect to the number of risk factors. Our analysis revealed 25 number of clusters. Preeclampsia in a previous pregnancy (n = 138) increased the risk of preeclampsia 8.1 fold (95% confidence interval (CI) 5.711.2) compared to a general population of pregnant women. Having a small for gestational age infant (n = 57) in a previous pregnancy increased the risk of early-onset preeclampsia 17.5 fold (95%CI 2.160.5). Cluster of those two risk factors together (n = 21) increased the risk of severe preeclampsia to 23.8-fold (95%CI 5.160.6), intermediate onset (delivery between 34(+0)-36(+6) weeks of gestation) to 25.1-fold (95%CI 3.179.9) and preterm preeclampsia (delivery before 37(+0) weeks of gestation) to 16.4-fold (95%CI 2.052.4). Body mass index over 30 kg/m(2) (n = 228) as a sole risk factor increased the risk of preeclampsia to 2.1-fold (95%CI 1.13.6). Together with preeclampsia in an earlier pregnancy the risk increased to 11.4 (95%CI 4.520.9). Chronic hypertension (n = 60) increased the risk of preeclampsia 5.3-fold (95%CI 2.49.8), of severe preeclampsia 22.2-fold (95%CI 9.941.0), and risk of early-onset preeclampsia 16.7-fold (95%CI 2.057.6). If a woman had chronic hypertension combined with obesity, gestational diabetes and earlier preeclampsia, the risk of term preeclampsia increased 4.8-fold (95%CI 0.121.7). Women with type 1 diabetes mellitus had a high risk of all subgroups of preeclampsia. Conclusion The risk of preeclampsia increases exponentially with respect to the number of risk factors. Early-onset preeclampsia and severe preeclampsia have different risk profile from term preeclampsia.Peer reviewe

Mammografia-asiakkaiden arvioima asiakaspalvelun laatu Kuopion yliopistollisen sairaalan Kliinisen radiologian osastolla

Mammografia tarkoittaa rintojen röntgenkuvausta. Mammografiatutkimus tehdään aina, kun rinnassa todetaan epäilyttävä kyhmy. Mammografioita tehdään myös seulontatutkimuksena. Suomessa kunnat järjestävät seulontoja 50–69-vuotiaille. Rintasyövän ennuste on parantunut varhaisemman syövän toteamisen ja hoitomenetelmien kehittymisen ansiosta. Aikaisemmissa tutkimuksissa on todettu mammografian aiheuttavan asiakkaalle ainakin lievää kivun tuntemusta ja kuvaustilanne on jännittänyt asiakasta. Tässä tutkimuksessa tarkasteltiin, miten asiakkaat kokevat Kuopion yliopistollisen sairaalan kliinisen radiologian osaston mammografiatutkimusten palvelun laadun ennen tutkimusta, tutkimuksen aikana ja tutkimuksen jälkeen. Tämän tutkimuksen tarkoituksena oli selvittää Kuopion yliopistollisen sairaalan kliinisen radiologian osaston mammografian asiakaspalvelun laatua asiakkaiden näkökulmasta. Tutkimus toteutettiin kvantitatiivisena tutkimuksena keväällä 2010. Kohdejoukon muodosti 46 asiakasta. Aineisto kerättiin kyselylomakkeella, joka koostui strukturoiduista kysymyksistä sekä yhdestä avoimesta kysymyksestä. Tutkimustulokset analysoitiin SPSS for Windows -ohjelmalla ja Microsoft Office Excel -taulukkolaskentaohjelmalla. Tulokset esitettiin frekvensseinä, prosentteina, taulukoina, kuvioina sekä suorina lainauksina. Tutkimuksen tulokset osoittivat, että asiakkaat olivat pääosin tyytyväisiä saamansa palvelun laatuun. Kliinisen radiologian osaston henkilökunnan toimintaan ja ammattitaitoon oltiin tyytyväisiä, vaikka osa asiakkaista koki tutkimuksen kivuliaana. Kehittämiskohteeksi nousi valmistautumisohjeen parempi saatavuus, sillä suuri osa asiakkaista ei saanut sitä ollenkaan. Tulosten perusteella Kuopion yliopistollisen sairaalan kliinisen radiologian osasto voi kehittää asiakaspalvelun laatua mammografian osalta. Mammografia-asiakkailta voitaisiin kyselyn avulla mitata myös röntgenhoitajan ohjaustaitoja. Halutessaan osasto voi jatkossa käyttää tässä tutkimuksessa kehitettyä kyselylomaketta ja kerätä lisää aineistoa.Mammography is an x-ray examination of the breast tissue. Mammography is always performed when a suspicious lump is found in a customer’s breast. Mammography examinations are also performed as screening examinations. In Finland, communes organize screening examinations for women at the age of 50 to 69. Early detection of breast cancer and developed treatment methods has improved the prognosis of breast cancer. According to studies, it has been shown that mammography causes at least slight pain and tension. In this thesis the quality of service of the Kuopio university hospital clinical radiology department was analyzed from the customer’s point of view. The purpose of this thesis was to determine the quality of service at Kuopio university hospital clinical radiology department from the customer’s point of view. This thesis was a quantative and was performed in spring 2010. The target group for the thesis consisted of 46 customers. The data was collected with a questionnaire which included structured questions and an open question. The results were analyzed by SPSS for Windows and Microsoft Office Excel programs. The results were published by using frequencies, percentages, tables, diagrams and direct quotations. According to the results, customers were mainly satisfied with the quality of service. Though some of the customers experienced pain during mammography, they were content with customer service and radiographer’s professional skills. This thesis showed that the improved issue is the availability of preparation form, because big amount of the customers didn’t receive it. Kuopio University Hospital Clinical Radiology Department can improve the quality of customer service in mammography based on the results of this thesis. With a survey, the quality of radiographer’s customer instruction skills could be measured. As a topic for a further study, the department could collect more data with the questionnaire which was developed in this thesis

Daily berry consumption attenuates β-catenin signalling and genotoxicity in colon carcinoma cells exposed to faecal water from healthy volunteers in a clinical trial

Peer reviewe

Gut Microbiota, Probiotics and Physical Performance in Athletes and Physically Active Individuals

Among athletes, nutrition plays a key role, supporting training, performance, and post-exercise recovery. Research has primarily focused on the effects of diet in support of an athletic physique; however, the role played by intestinal microbiota has been much neglected. Emerging evidence has shown an association between the intestinal microbiota composition and physical activity, suggesting that modifications in the gut microbiota composition may contribute to physical performance of the host. Probiotics represent a potential means for beneficially influencing the gut microbiota composition/function but can also impact the overall health of the host. In this review, we provide an overview of the existing studies that have examined the reciprocal interactions between physical activity and gut microbiota. We further evaluate the clinical evidence that supports the effects of probiotics on physical performance, post-exercise recovery, and cognitive outcomes among athletes. In addition, we discuss the mechanisms of action through which probiotics affect exercise outcomes. In summary, beneficial microbes, including probiotics, may promote health in athletes and enhance physical performance and exercise capacity. Furthermore, high-quality clinical studies, with adequate power, remain necessary to uncover the roles that are played by gut microbiota populations and probiotics in physical performance and the modes of action behind their potential benefits

Enhancing Bioaccessibility of Plant Protein Using Probiotics: An In Vitro Study

As plant-based diets become more popular, there is an interest in developing innovations to improve the bioaccessibility of plant protein. In this study, seven probiotic strains (Bifidobacterium animalis subsp. lactis B420, B. lactis Bl-04, Lactobacillus acidophilus NCFM, Lacticaseibacillus rhamnosus HN001, Lacticaseibacillus paracasei subsp. paracasei Lpc-37, Lactiplantibacillus plantarum Lp-115, and Lactococcus lactis subsp. lactis Ll-23) were evaluated for their capacity to hydrolyze soy and pea protein ingredients in an in vitro digestion model of the upper gastrointestinal tract (UGIT). Compared to the control digestion of protein without a probiotic, all the studied strains were able to increase the digestion of soy or pea protein, as evidenced by an increase in free α-amino nitrogen (FAN) and/or free amino acid concentration. The increase in FAN varied between 13 and 33% depending on the protein substrate and probiotic strain. The survival of probiotic bacteria after exposure to digestive fluids was strain-dependent and may have affected the strain’s capacity to function and aid in protein digestion in the gastrointestinal environment. Overall, our results from the standardized in vitro digestion model provide an approach to explore probiotics for improved plant protein digestion and bioaccessibility of amino acids; however, human clinical research is needed to evaluate the efficacy of probiotics on amino acid absorption and bioavailability in vivo