357. Obesity-Related Metabolic Risk Factors

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357. Obesity-Related Metabolic Risk Factors

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Syllabus

Abstract……………………………………………………………………………………………………….. 5
Tiivistelma …………………………………………………………………………………………………… 7
List of original papers………………………………………………………………………………….. 11
Abbreviations……………………………………………………………………………………………… 12
1 Introduction……………………………………………………………………………………………… 15
2 Review of the literature……………………………………………………………………………… 17
2.1 Obesity…………………………………………………………………………………………….. 17
2.1.1 Definition …………………………………………………………………………………. 17
2.1.2 Prevalence and trends…………………………………………………………………. 18
2.1.3 Adipose tissue as an endocrine organ …………………………………………… 20
2.1.4 Links to altered metabolism and chronic diseases………………………….. 22
2.2 The role of diet in the development of obesity and obesity-related risk
factors …………………………………………………………………………………………………… 23
2.2.1 Protecting factors ………………………………………………………………………. 24
2.2.2 Inconclusive factors …………………………………………………………………… 26
2.2.3 Predisposing factors…………………………………………………………………… 28
2.2.4 Dietary factors, inflammation, CVD and T2D……………………………….. 29
2.2.5 Summary ………………………………………………………………………………….. 30
2.3 The whole-diet approach ……………………………………………………………………. 31
2.3.1 Rationale ………………………………………………………………………………….. 31
2.3.2 Dietary score methodology …………………………………………………………. 34
2.3.3 Dietary scores and the risk of obesity …………………………………………… 37
2.3.4 Dietary scores and metabolic risk factors ……………………………………… 38
2.3.5 Dietary scores and the risk of CVD and T2D ………………………………… 39
2.3.6 Whole-diet approach in randomized controlled trials……………………… 39
2.3.7 Summary ………………………………………………………………………………….. 40
2.4 Towards a health enhancing Nordic diet………………………………………………. 41
2.4.1 Studies on the healthy Nordic diet ……………………………………………….. 42
2.4.2 Dietary scores based on the healthy Nordic diet…………………………….. 46
3 Aims of the study ……………………………………………………………………………………… 47
4 Methods…………………………………………………………………………………………………… 49
4.1 Study of DIetary, Lifestyle and Genetic determinants of Obesity and
Metabolic syndrome (DILGOM) (I-IV)…………………………………………………….. 49
4.2 The Helsinki Birth Cohort Study (HBCS) (III-V)………………………………….. 49
4.3 The National Health 2000 Survey (Health 2000) (III-V)………………………… 50
4.4 Ethical approval………………………………………………………………………………… 51
4.5 Diet assessment ………………………………………………………………………………… 51
4.5.1 The FFQ …………………………………………………………………………………… 51
4.5.2 The Baltic Sea Diet Score (BSDS)……………………………………………….. 52

4.6 Clinical examinations………………………………………………………………………… 53
4.7 Laboratory analysis …………………………………………………………………………… 54
4.8 Obesity-related metabolic risk factors (III, V) ………………………………………. 54
4.9 Register data (III-V) ………………………………………………………………………….. 55
4.10 Assessment of background variables………………………………………………….. 56
4.11 Study design and exclusion criteria……………………………………………………. 57
4.12 Statistical methods…………………………………………………………………………… 57
4.12.1 Studies of single datasets (I, II, IV)…………………………………………….. 58
4.12.2 Studies of meta-analysis (III, V)………………………………………………… 59
5 Results…………………………………………………………………………………………………….. 61
5.1 The BSDS and socioeconomic and lifestyle factors (I)…………………………… 61
5.2 Nutrient intakes (I) ……………………………………………………………………………. 64
5.3 Obesity (II) ………………………………………………………………………………………. 66
5.4 Cardiometabolic risk factors (III)………………………………………………………… 68
5.5 Obesity-related inflammatory markers (IV)………………………………………….. 71
5.6 Incidence of T2D during 10 years of follow-up (V) ………………………………. 72
6 Discussion ……………………………………………………………………………………………….. 75
6.1 Nutrient intakes (I) ……………………………………………………………………………. 75
6.2 Obesity (II) ………………………………………………………………………………………. 77
6.3 Metabolic risk factors………………………………………………………………………… 78
6.3.1 inflammation (III, IV) ………………………………………………………………… 78
6.3.2 Lipid fractions (III) ……………………………………………………………………. 79
6.4 T2D (V) …………………………………………………………………………………………… 80
6.5 The single foods and nutrients vs. whole-diet approach………………………….. 81
6.6 Methodological issues……………………………………………………………………….. 82
6.6.1 Participants and study design………………………………………………………. 82
6.6.2 FFQ …………………………………………………………………………………………. 83
6.6.3 The Baltic Sea Diet Score …………………………………………………………… 85
6.6.4 Measurements and data handling …………………………………………………. 86
6.7 Implications for further research …………………………………………………………. 87
7 Conclusions……………………………………………………………………………………………… 89
Acknowledgements……………………………………………………………………………………… 91
References………………………………………………………………………………………………….. 93

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