Body Mass Index, Overweight and Obesity Among Children in Finland - A Retrospective Epidemilogical Study in Pirkanmaa District Spanning Over Four Decades

Ylipaino, lihavuus ja painoindeksi suomalaisilla lapsilla Lasten ylipainon ja lihavuuden yleisyyden on raportoitu lisääntyneen maailmanlaajuisesti. Tässä väitöstutkimuksessa selvitettiin 2-15-vuotiaiden lasten alipainon, ylipainon ja lihavuuden esiintyvyyden sekä 0-15-vuotiaiden lasten kasvun ja painoindeksijakauman (BMI, kg/m²) ajallisia muutoksia neljän viimeisen vuosikymmenen aikana Pirkanmaan alueella. Tutkimuksessa käytettiin vuosina 1974, 1981, 1991, 1995 ja 2001 syntyneiden lasten neuvola- ja kouluterveydenhuollossa mitattuja kasvutietoja. Lisäksi tutkittiin vanhempien kykyä arvioida 5- ja 11-12-vuotiaiden lastensa painoluokka verrattuna kliinisin kriteerein tehtyyn luokitukseen. Vastasyntyneiden ja puolivuotiaiden lasten kasvussa ei ollut selvästi havaittavia muutoksia viimeisten neljän vuosikymmenen aikana. Erot lasten kasvussa viiden eri syntymäkohortin välillä alkoivat näkyä yksivuotiaana. 1970-luvun jälkeen taaperoikäiset (1-2-vuotiaat) lapset hoikistuivat. Kaksivuotiaana ylipainon ja lihavuuden yleisyys oli 2000-luvulla syntyneillä pojilla 6% ja tytöillä 11%. Viimeisten vuosikymmenien aikana viisivuotiaiden ikäryhmässä lasten ylipainon ja lihavuuden yleisyys säilyi vakaana (10% pojilla ja lähes 20% tytöillä). Lasten keskimääräisen painoindeksin kasvu alkoi viiden ikävuoden jälkeen. Murrosiän lähestyessä erityisesti pojista kasvoi pidempiä ja painavampia verrattuna 1974 syntymäkohorttiin. 2000-luvulla joka neljäs 12- ja 15-vuotias poika ja lähes joka viides tyttö oli ylipainoinen tai lihava. Alipainon yleisyydessä ei tapahtunut merkittäviä muutoksia 2-15-vuotiailla lapsilla viiden eri syntymäkohortin välillä. Ylipaino oli maaseudun lapsilla yleisempää kuin kaupunkilaisilla. Ero maaseudun ja kaupungin välillä oli suurempi yli 5-vuotiailla lapsilla kuin nuoremmilla lapsilla. Painoindeksin pieneneminen taaperoikäisillä ajan kuluessa voi viitata siihen, että normaaliin kasvuun liittyvä painoindeksin palauttava nousu (adiposity rebound) on saattanut varhaistua. Tässä tutkimuksessa alipainoisuus 2-vuotiaana ei kuitenkaan ollut riski 15-vuotiaan ylipainolle tai lihavuudelle. Sen sijaan varhaislapsuuden lihavuudella oli taipumus jatkua teini-ikään. Vanhempien oli vaikeaa arvioida lapsensa painoluokka. Useimmat 5-vuotiaiden lasten vanhemmista ja joka toinen 11-vuotiaiden lasten vanhemmista aliarvioivat lapsensa ylipainon. Terveydenhuoltoon tarvitaan lihavuuden ehkäisyohjelma ja olisi suositeltavaa aloittaa ohjaus jo varhaislapsuudessa. Terveydenhuoltohenkilöstön taitoa tarvitaan auttamaan vanhempia rakentamaan realistinen käsitys oman lapsensa koosta.Body mass index, overweight and obesity among children in Finland Increasing prevalence of overweight and obesity in childhood has been reported worldwide. The prevalence figures vary; approximately 30% in the USA and the Mediterranean countries, 20% in other parts of Europe with lower rates, under 10%, in Africa and Asia. The aims of present studies were to evaluate the secular trends in BMI distribution and the prevalence of overweight and obesity of children in birth cohorts from four decades in Pirkanmaa district, Finland. The ability of parents to assess the weight class of their children was also analysed. The first part of this Tampere Children s Obesity Study (TCOS) consists of three retrospective studies of children representing birth cohorts from years 1974, 1981, 1991, 1995 and 2001. Studies I and II were epidemiological studies of the prevalence of overweight and obesity in 2 to 15-year-old children. Study III was a longitudinal growth study from birth to the age of 15 years. The second part of the TCO study (Study IV) was a cross-sectional study of 5 and 11 to 12-year-old children. The study was based on clinical examination of these children and the analysis of their parents ability to perceive their children s weight status. Most of the data collected from health records and the children studied were from the city of Tampere, and the rest from three rural municipalities in the same region: Virrat, Vilppula and Ruovesi. Data was analysed mainly by cross-sectional methods, additional analyses of growth trends between birth cohorts were performed utilizing longitudinal methods. Difference in the growth of the children in the five birth cohorts began to emerge starting from the age of one year. Instead, changes in the mean BMI of newborns or in 0.5-year-old children between birth cohorts were not obvious in the longitudinal analysis. During the past four decades, in contrast to the obesity epidemic, the entire BMI distribution of toddlers has shifted to a lower level and toddlers have become slimmer. The negative slope of BMI was significantly steeper in later birth cohorts than in birth cohort 1974 in 1 to 5-year-old children. Instead, no marked change was seen in BMI distribution or the prevalence of overweight and obesity at the age of 5 years. After 5 years of age the slope turned positive and mean BMI increased more in other birth cohorts than in birth cohort 1974, except in birth cohort 1995 in girls. Getting closer to puberty the BMI distribution started to skew to the right. In teenagers the upper parts of BMI distribution have risen to higher levels while lower BMI percentiles have remained quite stable. Young adolescents, especially boys, have become taller and heavier. Overweight seems to be more common in children living in rural than in urban areas. The rural vs. urban difference was greater in children over 5 years than at younger ages. The falling BMI seen in toddlers might indicate that the age of adiposity rebound now occurs earlier. Furthermore, obesity in early childhood seems to track to teenage years as obesity at the age of 2 years implies a high probability for overweight and obesity at the age of 15 years. Accurate perception of the weight class of their children is difficult for parents. Most parents of 5-year-old children and every second parent of 11-year-old children underestimated the overweight of their children An obesity prevention programme is needed in public health and education should start early in childhood. The skills of health care professionals are needed to help parents to build up a realistic perception of their child`s weight status

Body Mass Index, Overweight and Obesity Among Children in Finland - A Retrospective Epidemilogical Study in Pirkanmaa District Spanning Over Four Decades

Ylipaino, lihavuus ja painoindeksi suomalaisilla lapsilla Lasten ylipainon ja lihavuuden yleisyyden on raportoitu lisääntyneen maailmanlaajuisesti. Tässä väitöstutkimuksessa selvitettiin 2-15-vuotiaiden lasten alipainon, ylipainon ja lihavuuden esiintyvyyden sekä 0-15-vuotiaiden lasten kasvun ja painoindeksijakauman (BMI, kg/m²) ajallisia muutoksia neljän viimeisen vuosikymmenen aikana Pirkanmaan alueella. Tutkimuksessa käytettiin vuosina 1974, 1981, 1991, 1995 ja 2001 syntyneiden lasten neuvola- ja kouluterveydenhuollossa mitattuja kasvutietoja. Lisäksi tutkittiin vanhempien kykyä arvioida 5- ja 11-12-vuotiaiden lastensa painoluokka verrattuna kliinisin kriteerein tehtyyn luokitukseen. Vastasyntyneiden ja puolivuotiaiden lasten kasvussa ei ollut selvästi havaittavia muutoksia viimeisten neljän vuosikymmenen aikana. Erot lasten kasvussa viiden eri syntymäkohortin välillä alkoivat näkyä yksivuotiaana. 1970-luvun jälkeen taaperoikäiset (1-2-vuotiaat) lapset hoikistuivat. Kaksivuotiaana ylipainon ja lihavuuden yleisyys oli 2000-luvulla syntyneillä pojilla 6% ja tytöillä 11%. Viimeisten vuosikymmenien aikana viisivuotiaiden ikäryhmässä lasten ylipainon ja lihavuuden yleisyys säilyi vakaana (10% pojilla ja lähes 20% tytöillä). Lasten keskimääräisen painoindeksin kasvu alkoi viiden ikävuoden jälkeen. Murrosiän lähestyessä erityisesti pojista kasvoi pidempiä ja painavampia verrattuna 1974 syntymäkohorttiin. 2000-luvulla joka neljäs 12- ja 15-vuotias poika ja lähes joka viides tyttö oli ylipainoinen tai lihava. Alipainon yleisyydessä ei tapahtunut merkittäviä muutoksia 2-15-vuotiailla lapsilla viiden eri syntymäkohortin välillä. Ylipaino oli maaseudun lapsilla yleisempää kuin kaupunkilaisilla. Ero maaseudun ja kaupungin välillä oli suurempi yli 5-vuotiailla lapsilla kuin nuoremmilla lapsilla. Painoindeksin pieneneminen taaperoikäisillä ajan kuluessa voi viitata siihen, että normaaliin kasvuun liittyvä painoindeksin palauttava nousu (adiposity rebound) on saattanut varhaistua. Tässä tutkimuksessa alipainoisuus 2-vuotiaana ei kuitenkaan ollut riski 15-vuotiaan ylipainolle tai lihavuudelle. Sen sijaan varhaislapsuuden lihavuudella oli taipumus jatkua teini-ikään. Vanhempien oli vaikeaa arvioida lapsensa painoluokka. Useimmat 5-vuotiaiden lasten vanhemmista ja joka toinen 11-vuotiaiden lasten vanhemmista aliarvioivat lapsensa ylipainon. Terveydenhuoltoon tarvitaan lihavuuden ehkäisyohjelma ja olisi suositeltavaa aloittaa ohjaus jo varhaislapsuudessa. Terveydenhuoltohenkilöstön taitoa tarvitaan auttamaan vanhempia rakentamaan realistinen käsitys oman lapsensa koosta.Body mass index, overweight and obesity among children in Finland Increasing prevalence of overweight and obesity in childhood has been reported worldwide. The prevalence figures vary; approximately 30% in the USA and the Mediterranean countries, 20% in other parts of Europe with lower rates, under 10%, in Africa and Asia. The aims of present studies were to evaluate the secular trends in BMI distribution and the prevalence of overweight and obesity of children in birth cohorts from four decades in Pirkanmaa district, Finland. The ability of parents to assess the weight class of their children was also analysed. The first part of this Tampere Children s Obesity Study (TCOS) consists of three retrospective studies of children representing birth cohorts from years 1974, 1981, 1991, 1995 and 2001. Studies I and II were epidemiological studies of the prevalence of overweight and obesity in 2 to 15-year-old children. Study III was a longitudinal growth study from birth to the age of 15 years. The second part of the TCO study (Study IV) was a cross-sectional study of 5 and 11 to 12-year-old children. The study was based on clinical examination of these children and the analysis of their parents ability to perceive their children s weight status. Most of the data collected from health records and the children studied were from the city of Tampere, and the rest from three rural municipalities in the same region: Virrat, Vilppula and Ruovesi. Data was analysed mainly by cross-sectional methods, additional analyses of growth trends between birth cohorts were performed utilizing longitudinal methods. Difference in the growth of the children in the five birth cohorts began to emerge starting from the age of one year. Instead, changes in the mean BMI of newborns or in 0.5-year-old children between birth cohorts were not obvious in the longitudinal analysis. During the past four decades, in contrast to the obesity epidemic, the entire BMI distribution of toddlers has shifted to a lower level and toddlers have become slimmer. The negative slope of BMI was significantly steeper in later birth cohorts than in birth cohort 1974 in 1 to 5-year-old children. Instead, no marked change was seen in BMI distribution or the prevalence of overweight and obesity at the age of 5 years. After 5 years of age the slope turned positive and mean BMI increased more in other birth cohorts than in birth cohort 1974, except in birth cohort 1995 in girls. Getting closer to puberty the BMI distribution started to skew to the right. In teenagers the upper parts of BMI distribution have risen to higher levels while lower BMI percentiles have remained quite stable. Young adolescents, especially boys, have become taller and heavier. Overweight seems to be more common in children living in rural than in urban areas. The rural vs. urban difference was greater in children over 5 years than at younger ages. The falling BMI seen in toddlers might indicate that the age of adiposity rebound now occurs earlier. Furthermore, obesity in early childhood seems to track to teenage years as obesity at the age of 2 years implies a high probability for overweight and obesity at the age of 15 years. Accurate perception of the weight class of their children is difficult for parents. Most parents of 5-year-old children and every second parent of 11-year-old children underestimated the overweight of their children An obesity prevention programme is needed in public health and education should start early in childhood. The skills of health care professionals are needed to help parents to build up a realistic perception of their child`s weight status

Competence-Based Pharmacy Education in the University of Helsinki

In order to meet the expectations to act as an expert in the health care profession, it is of utmost importance that pharmacy education creates knowledge and skills needed in today’s working life. Thus, the planning of the curriculum should be based on relevant and up-to-date learning outcomes. In the University of Helsinki, a university wide curriculum reform called ‘the Big Wheel’ was launched in 2015. After the reform, the basic degrees of the university are two-cycle (Bachelor–Master) and competence-based, where the learning outcomes form a solid basis for the curriculum goals and implementation. In the Faculty of Pharmacy, this curriculum reform was conducted in two phases during 2012–2016. The construction of the curriculum was based on the most relevant learning outcomes concerning working life via high quality first (Bachelor of Science in Pharmacy) and second (Master of Science in Pharmacy) cycle degree programs. The reform was kicked off by interviewing all the relevant stakeholders: students, teachers, and pharmacists/experts in all the working life sectors of pharmacy. Based on these interviews, the intended learning outcomes of the Pharmacy degree programs were defined including both subject/contents-related and generic skills. The curriculum design was based on the principles of constructive alignment and new structures and methods were applied in order to foster the implementation of the learning outcomes. During the process, it became evident that a competence-based curriculum can be created only in close co-operation with the stakeholders, including teachers and students. Well-structured and facilitated co-operation amongst the teachers enabled the development of many new and innovative teaching practices. The European Union funded PHAR-QA project provided, at the same time, a highly relevant framework to compare the curriculum development in Helsinki against Europe-wide definitions of competences and learning outcomes in pharmacy education.Peer reviewe

Parental reports showed that snoring in infants at three and eight months associated with snoring parents and smoking mothers

Aim This prospective study examined the prevalence of snoring during infancy and the prenatal and postnatal risk factors for this condition. Methods The study population comprised 1388 infants from the CHILD-SLEEP birth cohort, who were recruited in the Pirkanmaa Hospital District, Finland, between 2011 and 2013. Sleep and background factor questionnaires were filled out prenatally by parents and when the infant was three and eight months old. Results The prevalence of habitual snoring was 3.2% at the age of three months and 3.0% at eight months, and snoring infants had more sleeping difficulties at those ages, with odds ratios (ORs) of 3.11 and 4.63, respectively. At three months, snoring infants slept for a shorter length of time (p = 0.001) and their sleep was more restless (p = 0.004). In ordinal logistic regression models, parental snoring (adjusted OR = 1.65 and 2.60) and maternal smoking (adjusted OR = 2.21 and 2.17) were significantly associated with infant snoring at three and eight months, while formula feeding and dummy use (adjusted OR = 1.48 and 1.56) were only associated with infant snoring at three months. Conclusion Parental snoring and maternal smoking increased the risk of snoring. Infants who snored also seemed to suffer more from other sleep difficulties.Peer reviewe

Association of concomitant autoimmunity with the disease features and long-term treatment and health outcomes in Celiac disease

Peer reviewe

Type 1 tyrosinemia in Finland: a nationwide study

Background Introduction of nitisinone and newborn screening (NBS) have transformed the treatment of type 1 tyrosinemia, but the effects of these changes on the long-term outcomes remain obscure. Also, the predictors for later complications, the significance of drug levels and the normalization of laboratory and imaging findings are poorly known. We investigated these issues in a nationwide study. Results Type 1 tyrosinemia was diagnosed in 22 children in 1978-2019 in Finland. Incidence was 1/90,102, with a significant enrichment in South Ostrobothnia (1/9990). Median age at diagnosis was 5 (range 0.5-36) months, 55% were girls and 13 had homozygotic Trp262X mutation. Four patients were detected through screening and 18 clinically, their main findings being liver failure (50% vs. 100%, respectively, p = 0.026), ascites (0% vs. 53%, p = 0.104), renal tubulopathy (0% vs. 65%, p = 0.035), rickets (25% vs. 65%, p = 0.272), growth failure (0% vs. 66%, p = 0.029), thrombocytopenia (25% vs. 88%, p = 0.028) and anaemia (0% vs. 47%, p = 0.131). One patient was treated with diet, seven with transplantation and 14 with nitisinone. Three late-diagnosed (6-33 months) nitisinone treated patients needed transplantation later. Kidney dysfunction (86% vs. 7%, p = 0.001), hypertension (57% vs. 7%, p = 0.025) and osteopenia/osteoporosis (71% vs. 14%, p = 0.017) were more frequent in transplanted than nitisinone-treated patients. Blood/serum alpha-fetoprotein decreased rapidly on nitisinone in all but one patient, who later developed intrahepatic hepatocellular carcinoma. Liver values normalized in 31 months and other laboratory values except thrombocytopenia within 18 months. Imaging findings normalized in 3-56 months excluding five patients with liver or splenic abnormalities. Low mean nitisinone concentration was associated with higher risk of severe complications (r = 0.758, p = 0.003) despite undetectable urine succinylacetone. Conclusions Prognosis of type 1 tyrosinemia has improved in the era of nitisinone, and NBS seems to provide further benefits. Nevertheless, the long-term risk for complications remains, particularly in the case of late diagnosis and/or insufficient nitisinone levels.Peer reviewe

Type 1 tyrosinemia in Finland: a nationwide study

Background Introduction of nitisinone and newborn screening (NBS) have transformed the treatment of type 1 tyrosinemia, but the effects of these changes on the long-term outcomes remain obscure. Also, the predictors for later complications, the significance of drug levels and the normalization of laboratory and imaging findings are poorly known. We investigated these issues in a nationwide study. Results Type 1 tyrosinemia was diagnosed in 22 children in 1978-2019 in Finland. Incidence was 1/90,102, with a significant enrichment in South Ostrobothnia (1/9990). Median age at diagnosis was 5 (range 0.5-36) months, 55% were girls and 13 had homozygotic Trp262X mutation. Four patients were detected through screening and 18 clinically, their main findings being liver failure (50% vs. 100%, respectively, p = 0.026), ascites (0% vs. 53%, p = 0.104), renal tubulopathy (0% vs. 65%, p = 0.035), rickets (25% vs. 65%, p = 0.272), growth failure (0% vs. 66%, p = 0.029), thrombocytopenia (25% vs. 88%, p = 0.028) and anaemia (0% vs. 47%, p = 0.131). One patient was treated with diet, seven with transplantation and 14 with nitisinone. Three late-diagnosed (6-33 months) nitisinone treated patients needed transplantation later. Kidney dysfunction (86% vs. 7%, p = 0.001), hypertension (57% vs. 7%, p = 0.025) and osteopenia/osteoporosis (71% vs. 14%, p = 0.017) were more frequent in transplanted than nitisinone-treated patients. Blood/serum alpha-fetoprotein decreased rapidly on nitisinone in all but one patient, who later developed intrahepatic hepatocellular carcinoma. Liver values normalized in 31 months and other laboratory values except thrombocytopenia within 18 months. Imaging findings normalized in 3-56 months excluding five patients with liver or splenic abnormalities. Low mean nitisinone concentration was associated with higher risk of severe complications (r = 0.758, p = 0.003) despite undetectable urine succinylacetone. Conclusions Prognosis of type 1 tyrosinemia has improved in the era of nitisinone, and NBS seems to provide further benefits. Nevertheless, the long-term risk for complications remains, particularly in the case of late diagnosis and/or insufficient nitisinone levels.Peer reviewe

Lasten ja nuorten rasvamaksatauti

publishedVersionPeer reviewe

Lasten ja nuorten rasvamaksatauti

Vertaisarvioitu.Rasvamaksatauti on nykyisin lapsuusiän yleisin maksasairaus, joka hoitamattomana voi edetä kirroosiin saakka. Sekä kliininen kokemus että tutkimusnäyttö viittaavat sairauden merkittävään lisääntymiseen. Lapsilla esiintyy harvoin oireita. Tavallisin löydös ylipainon ohella on plasman suurentunut alaniiniaminotransferaasi (ALAT) -pitoisuus, jonka yleisesti käytetyn viiterajan 40 U/l tilalle on esitetty selvästi pienempiä seulontaraja-arvoja. Tilan seulonta ja alkuvaiheen tutkimukset voidaan yleensä toteuttaa perusterveydenhuollossa. Olennaista on varhainen epäily ja tilanteen kokonaisarvio sekä muiden sairauksien sulkeminen pois esitietojen, statuksen ja suunnattujen lisätutkimusten avulla. Erikoissairaanhoidossa tehdään mahdolliset jatkotutkimukset ja hoidetaan komplisoituneet tapaukset. Maksabiopsia on harvoin aiheellinen. Lasten rasvamaksataudin hoidossa korostuvat elintapamuutokset.Peer reviewe