Vaivana herkkä vatsa - onko ravitsemusterapeutista apua?

•Ohutsuolessa imeytymättömien FODMAP-hiilihydraattien saannin rajoittaminen lievittää ärtyvästä suolesta kärsivien vatsaoireita. Samalla joidenkin terveyttä edistävinä pidettyjen suolistomikrobien määrä vähenee. •Gluteenitonta tai maidotonta ruokavaliota ei ole juuri tutkittu ärtyvän suolen oireyhtymän hoidossa. Joillekin potilaille niistä voi olla hyötyä. •Pitkällä aikavälillä erikoisruokavaliot voivat aiheuttaa ravitsemuksellisen riskin. •Ainakin hankalista oireista kärsivät, FODMAP-rajoituksen lisäksi muita erikoisruokavalioita noudattavat ”¬herkkävatsaiset” on syytä ohjata ravitsemusterapeutin vastaanotolle. •Terapeutti auttaa suunnittelemaan vatsaystävällisen ja kokonaisterveyttä edistävän ruokavalion.Peer reviewe

Trajectories in hypnotic use and approaching death : a register linked case–control study

Purpose: Whether the association between hypnotic and increased mortality risk is created by causation or confounding, has been long debated. We further examined the possibility of confounding by indication with a comprehensive approach. Methods: The National FINRISK Study cohorts of 1997, 2002, and 2007 (25,436 participants aged 25-74) were followed up until July 2012. There were 1822 deaths, and at least one gender, baseline age and cohort matched 'control' was found for 1728 'cases' yielding a final analytical sample of 3955 individuals. An index age, equivalent to the age at death of their respective cases' was set for each control. Hypnotic drug purchases were followed from the Finnish nationwide register during a 36-month run-up period before the date of death/index date. The prevalence and incidence of hypnotic purchases were compared between cases and matched controls. Moreover, latent developmental trajectories of purchases were modelled and their relations with specific and all-cause death risks were analysed. Results: An increasing difference between cases and controls was observed as regards the use of hypnotic drugs. During the last 30 months before the date of death/index date, the rate ratio of incident purchases between cases and controls was 2.37 (95% CL, 1.79-3.12) among older and 3.61 (95% CL, 2.37-5.89) among younger individuals. The developmental trajectories of hypnotic drug purchases were differently and by interpretation plausibly associated with specific mortality risks. Conclusions: In most cases the association between hypnotics and mortality risk is created by symptomatic treatment when death is approaching. (c) 2018 Elsevier B.V. All rights reserved.Peer reviewe

Measurement error as an explanation for the alcohol harm paradox : analysis of eight cohort studies

Background: Despite reporting lower levels of alcohol consumption, people with lower socio-economic status (SES) experience greater alcohol-related harm. Whether differential biases in the measurement of alcohol use could explain this apparent paradox is unknown. Using alcohol biomarkers to account for measurement error, we examined whether differential exposure to alcohol could explain the socio-economic differences in alcohol mortality. Methods: Participants from eight representative health surveys (n = 52 164, mean age 47.7 years) were linked to mortality data and followed up until December 2016. The primary outcome was alcohol-attributable mortality. We used income and education as proxies for SES. Exposures include self-reported alcohol use and four alcohol biomarkers [serum gamma-glutamyl transferase (available in all surveys), carbohydrate-deficient transferrin, alanine aminotransferase and aspartate aminotransferase (available in subsamples)]. We used shared frailty Cox proportional hazards to account for survey heterogeneity. Results: During a mean follow-up of 20.3 years, totalling 1056 844 person-years, there were 828 alcohol-attributable deaths. Lower SES was associated with higher alcohol mortality despite reporting lower alcohol use. Alcohol biomarkers were associated with alcohol mortality and improved the predictive ability when used in conjunction with self-reported alcohol use. Alcohol biomarkers explained a very small fraction of the socio-economic differences in alcohol mortality, since hazard ratios either slightly attenuated (percent attenuation range 1.0-12.1%) or increased. Conclusions: Using alcohol biomarkers in addition to self-reported alcohol use did not explain the socio-economic differences in alcohol mortality. Differential bias in the measurement of alcohol use is not a likely explanation for the alcohol-harm paradox.Peer reviewe

Evaluation of AUSDRISK as a screening tool for lifestyle modification programs: international implications for policy and cost-effectiveness

OBJECTIVE: To evaluate the current use of Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) as a screening tool to identify individuals at high risk of developing type 2 diabetes for entry into lifestyle modification programs. RESEARCH DESIGN AND METHODS: AUSDRISK scores were calculated from participants aged 40-74 years in the Greater Green Triangle Risk Factor Study, a cross-sectional population survey in 3 regions of Southwest Victoria, Australia, 2004-2006. Biomedical profiles of AUSDRISK risk categories were determined along with estimates of the Victorian population included at various cut-off scores. Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and receiver operating characteristics were calculated for AUSDRISK in determining fasting plasma glucose (FPG) ≥6.1 mmol/L. RESULTS: Increasing AUSDRISK scores were associated with an increase in weight, body mass index, FPG, and metabolic syndrome. Increasing the minimum cut-off score also increased the proportion of individuals who were obese and centrally obese, had impaired fasting glucose (IFG) and metabolic syndrome. An AUSDRISK score of ≥12 was estimated to include 39.5% of the Victorian population aged 40-74 (916 000), while a score of ≥20 would include only 5.2% of the same population (120 000). At AUSDRISK≥20, the PPV for detecting FPG≥6.1 mmol/L was 28.4%. CONCLUSIONS: AUSDRISK is powered to predict those with IFG and undiagnosed type 2 diabetes, but its effectiveness as the sole determinant for entry into a lifestyle modification program is questionable given the large proportion of the population screened-in using the current minimum cut-off of ≥12. AUSDRISK should be used in conjunction with oral glucose tolerance testing, fasting glucose, or glycated hemoglobin to identify those individuals at highest risk of progression to type 2 diabetes, who should be the primary targets for lifestyle modification

Diurnal evening type is associated with current smoking, nicotine dependence and nicotine intake in the population based national FINRISK 2007 study

Peer reviewe

Sepelvaltimotaudin ja aivohalvauksen riskin arviointi FINRISKI 2.0 -laskurilla

Lähtökohdat FINRISKI-laskuria on käytetty terveydenhuollossa sydän- ja verisuonisairauksien riskin arviointiin vuodesta 2007 lähtien. FINRISKI-aineistoon on tullut uusia väestökohortteja, minkä vuoksi ­päivitimme laskurin.Menetelmät Vuosien 1982, 1987, 1992, 1997, 2002 ja 2007 FINRISKI-väestötutkimuksiin osallistui 39 790 iältään 30–74-vuotiasta henkilöä, joiden kuolleisuutta ja sairastuvuutta akuuttiin sepelvaltimotautitapahtumaan tai aivohalvaukseen selvitettiin 10 vuoden seurannassa. Riskitekijöiden vaikutus laskettiin logistisella regressioanalyysillä. Lisäksi laskettiin todennäköisyys sairastua jompaankumpaan näitä taudeista. Saaduilla kaavoilla analysoitiin vuoden 2012 FINRISKI-tutkimukseen osallistuneiden riskit.Tulokset Korkea verenpaine, korkea kolesterolitaso, matala HDL-kolesterolitaso, tupakointi, diabetes ja vanhempien sairastama sydäninfarkti ennustivat sepelvaltimotaudin vaaraa seuraavan 10 vuoden aikana sekä miehillä että naisilla. Aivohalvausta ennustivat korkea verenpaine, tupakointi, matala HDL-kolesterolitaso ja diabetes.Päätelmät FINRISKI-tutkimukseen perustuvaa FINRISKI 2.0 -laskuria voidaan käyttää sepelvaltimotautiriskin, aivohalvausriskin ja yhdistetyn valtimotautiriskin arviointiin potilastyössä ja terveysneuvonnassa.</p