Conventional and novel cardiovascular risk factors in young Finns and their associations with structural and functional vascular changes of subclinical atherosclerosis. The Cardiovascular Risk in Young Finns Study

Background: Atherosclerosis begins in early life progressing from asymptomatic to symptomatic as we age. Although substantial progress has been made in identifying the determinants of atherosclerosis in middle to older age adults at increased cardiovascular risk, there is lack of data examining determinants and prediction of atherosclerosis in young adults. Aims: The current study was designed to investigate levels of cardiovascular risk factors in young adults, subclinical measures of atherosclerosis, and prediction of subclinical arterial changes with conventional risk factor measures and novel metabolic profiling of serum samples. Subjects and Methods: This thesis utilised data from the follow-ups performed in 2001 and 2007 in the Cardiovascular Risk in Young Finns study, a Finnish population-based prospective cohort study that examined 2,204 subjects who were aged 30-45 years in 2007. Subclinical atherosclerosis was studied using noninvasive ultrasound measurements of carotid intima-media thickness (IMT), carotid arterial distensibility (CDist) and brachial flow-mediated dilation (FMD). Measurements included conventional risk factors and metabolic profiling using highthroughput nuclear magnetic resonance (NMR) methods that provided data on 42 lipid markers and 16 circulating metabolites. Results: Trends in lipids were favourable between 2001 and 2007, whereas waist circumference, fasting glucose, and blood pressure levels increased. To study the stability of noninvasive ultrasound markers, 6-year tracking (the likelihood to maintain the original fractile over time) in 6 years was examined. IMT tracked more strongly than CDist and FMD. Cardiovascular risk scores (Framingham, SCORE, Finrisk, Reynolds and PROCAM) predicted subclinical atherosclerosis equally. Lipoprotein subclass testing did not improve the prediction of subclinical atherosclerosis over and above conventional risk factors. However, circulating metabolites improved risk stratification. Tyrosine and docosahexaenoic acid were found to be novel biomarkers of high IMT. Conclusions: Prediction of cardiovascular risk in young Finnish adults can be performed with any of the existing risk scores. The addition of metabonomics to risk stratification improves prediction of subclinical changes and enables more accurate targeting of prevention at an early stage.

Reaaliaikaisen esikäsittelyn kehittäminen hemiselluloosa-analytiikalle

Tämän työn tavoitteena oli kehittää esikäsittelymenetelmä, jolla voidaan reaaliaikaisesti vähentää hydrolysaatin ligniinipitoisuutta ja näin vähentää fluoresenssia hemiselluloosan analysoimisessa. Työn kirjallisuusosassa käsitellään hemiselluloosien rakennetta sekä niiden erottamista puusta, sekä käydään läpi hemiselluloosien käyttömahdollisuuksia ja niiden reaaliaikaiseen analysointiin soveltuvia tekniikoita. Kokeellisessa osassa tutkittiin ultrasuodatusta sekä adsorptiohartsikäsittelyä hydrolysaatin esikäsittelynä ennen Raman-analyysiä. Esikäsittelyn tavoitteena oli vähentää Raman-analyysia häiritsevää ligniinistä johtuvaa fluoresenssia. Suodatukset tehtiin Amicon-suodatuslaitteistolla käyttäen viittä eri suodatuskalvoa. Hartsikäsittelyissä käytettiin Amberliten XAD16 ja XAD7HP adsorbtiohartseja. Hartsisuhteina käytettiin 1/80, 1/40, 1/19 ja 1/13. Käytetyt ultrauodatuskalvot osoittautuivat suodatusnäytteistä tehtyjen HPLC-analyysien perusteella cut-off-luvultaan liian pieniksi, sillä hemiselluloosien ja ligniinin erotus ei onnistunut, vaan molemmat väkevöityivät konsentraattiin. Hartsikäsittelyillä saatiin ligniiniä poistettua aiheuttamatta hemiselluloosahäviöitä. Parhaimmillaan ligniinin poistumista kuvaava UV-absorbanssi pieneni hartsilla XAD16 37 % ja hartsilla XAD7 25 %. Vaikka ligniinipitoisuus aleni, näytteet fluoresoivat edelleen voimakkaasti Raman-mittauksessa. Tulosten perusteella näyttäisi siltä, että hartsikäsittelyä optimoimalla analyysiä häiritsevää fluoresenssia olisi edelleen mahdollista vähentää.

Ultrafiltration of pulp mill bleaching effluents

Main objective of this research was to find suitable polymeric ultrafiltration membranes with high retentions, good capacities and low fouling tendencies for the E2- and EP-effluent ultrafiltration. Purpose was to treat alkaline bleaching effluents with ultrafiltration in a way that permeates of the filtrations could be recycled back to process and the consumption of fresh water in the pulp mill could be reduced significantly. In the theoretical part of this work the challenges set by the pulp and paper indus-try processes for membranes were examined. An overview of the membrane tech-nology in the pulp industry was also provided. In addition process conditions in the chemical pulp bleaching and properties of bleaching effluents were discussed in literature study. In experimental part the E2- and EP-stage bleaching effluents from Stora Enso Imatra kraft pulp mill were ultrafiltered with CR250- and CR200-filters. Suitable membranes for ultrafiltration were chosen after screening experiments. Concentra-tion experiment was made for the E2-effluent in order to estimate water saving potential. The E2-effluent was finally ultrafiltered in the pulp mill in order to test the feasibility of ultrafiltration in a real industrial environment. Good membrane for the EP-effluent ultrafiltration based on the EP-screening ex-periments was polyethersulfone membrane UP020 with cut-off value of 20 000 Da. Polysulfone membrane UFX05 with cut-off value of 5 000 Da was promising membrane for the ultrafiltration of the E2-effluent. Based on the concentration filtration of the E2-effluent with UFX05 membrane the water saving potential could be 2.2 m3/Adt for the industrial scale ultrafiltration process. Retention re-sults, such as average COD retention of 60 %, from the trial filtration at the pulp mill with UFX05 membrane were modest compared to the screening experiments, where average COD retention was 75 %. Therefore tighter ultrafiltration mem-branes should be tested for the ultrafiltration of the E2-effluent. The UP020 mem-brane seemed to be suitable for the ultrafiltration of the EP-effluent however con-centration and pilot scale ultrafiltration experiments are needed to verify this.

Application of morphometry, static DNA ploidy analysis, and steroid receptor expression in diagnosis and prognosis of Libyan breast cancer

The aim of this study was to describe the demographic, clinicopathological, biological and morphometric features of Libyan breast cancer patients. The supporting value of nuclear morphometry and static image cytometry in the sensitivity for detecting breast cancer in conventional fine-needle aspiration biopsies were estimated. The findings were compared with findings in breast cancer in Finland and Nigeria. In addation, the value of ER and PR were evaluated. There were 131 histological samples, 41 cytological samples, and demographic and clinicopathological data from 234 Libyan patients. The Libyan breast cancer is dominantly premenopausal and in this feature it is similar to breast cancer in sub-Saharan Africans, but clearly different from breast cancer in Europeans, whose cancers are dominantly postmenopausal in character. At presention most Libyan patients have locally advanced disease, which is associated with poor survival rates. Nuclear morphometry and image DNA cytometry agree with earlier published data in the Finnish population and indicate that nuclear size and DNA analysis of nuclear content can be used to increase the cytological sensitivity and specificity in doubtful breast lesions, particularly when free cell sampling method is used. Combination of the morphometric data with earlier free cell data gave the following diagnostic guidelines: Range of overlap in free cell samples: 55 μm2 -71 μm2. Cut-off values for diagnostic purposes: Mean nuclear area (MNA) >54 μm2 for 100% detection of malignant cases (specificity 84 %), MNA < 72 μm2 for 100% detection of benign cases (sensitivity 91%). Histomorphometry showed a significant correlation between the MNA and most clinicopathological features, with the strongest association observed for histological grade (p <0.0001). MNA seems to be a prognosticator in Libyan breast cancer (Pearson’s test r = - 0.29, p = 0.019), but at lower level of significance than in the European material. A corresponding relationship was not found in shape-related morphometric features. ER and PR staining scores were in correlation with the clinical stage (p= 0.017, and 0.015, respectively), and also associated with lymph node negative patients (p=0.03, p=0.05, respectively). Receptor-positive (HR+) patients had a better survival. The fraction of HR+ cases among Libyan breast cancers is about the same as the fraction of positive cases in European breast cancer. The study suggests that also weak staining (corresponding to as few as 1% positive cells) has prognostic value. The prognostic significance may be associated with the practice to use antihormonal therapy in HR+ cases. The low survival and advanced presentation is associated with active cell proliferation, atypical nuclear morphology and aneuploid nuclear DNA content in Libyan breast cancer patients. The findings support the idea that breast cancer is not one type of disease, but should probably be classified into premenopausal and post menopausal types.

Hearing Impairment and Tinnitus in the Elderly

The purpose of this study was to gather information on hearing impairment and related factors among elderly people. The HHIE-S questionnaire (Hearing Handicap Inventory for Elderly-Screening) and a single hearing question (”Do you feel you have a hearing loss”) were compared to audiometric hearing thresholds (N=164). HHIE-S was reliable for detecting moderate or worse hearing impairment. The single question was equally sensitive and more specific in identifying mild hearing impairment. The prevalence of hearing impairment was evaluated in four age cohorts (70, 75, 80 and 85 years, N=4067) in Turku, Finland. The HHIE-S cut-off score >8 as an indicator of at least mild hearing impairment yielded prevalence values of 37.7% - 54.1%, and a score >18 (moderate or more severe hearing impairment) was 21.1% - 38.9%. The single question test was positive in 25.5% - 46.2%. Hearing aid compliance and problems experienced by hearing aid users were recorded as informed by the participants in a mailed interview (N=249/4067). The hearing aids were used daily by 55.4%, and never by 10.7%. Use sank with advancing age. The disturbance caused by tinnitus among 583 subjects was compared to their level of alexithymia (TAS-20) and depressiveness (BDI). Depressiveness was weakly associated with annoying tinnitus, but not alexithymia. The prevalence of hearing impairment can be measured by enquiry. Hearing aid compliance should be improved by technical means and better counseling. The factors affecting the distress experienced by tinnitus patients need further study.

Individual dietary counselling during and after pregnancy: Impact on diet and body weight

In Finland, maternity and child health clinics play a key role in promoting health in young families. Currently, obesity causes the greatest challenges to clinics. In obese pregnant women, an increased risk for metabolic diseases exist which can affect both the mother and child. The purpose of this thesis was to explore the role of dietary counselling: in Finnish health clinics; in the regulation of dietary intake; and in affecting the body weight of women. The main aim was to test the effect of dietary counselling and probiotic intervention on dietary intake and maternal body weight during and after pregnancy. In addition to dietary counselling, the effect of other factors, such as eating behaviour on dietary intake and body weight control after pregnancy was assessed. Another aim was also to evaluate dietary counselling practices by nurses (n = 327) in Finnish health clinics assessed by a questionnaire. At the beginning of the pregnancy, women (n = 256) enrolled in a dietary intervention study, were randomised into three groups. One group received dietary counselling with probiotics, one had counselling with placebo and the third group was the control group. The control group consisted of women whom did not receive counselling and took placebo. Probiotics and placebo supplements were used until the end of exclusive breastfeeding or six months after pregnancy. Women were followed from early pregnancy up to four years after pregnancy. Follow-up visits took place three times during pregnancy, at one and six months, and one, two and four years after pregnancy. Dietary counselling, provided by a nutritionist, aimed to influence the quality of dietary fat intake. Dietary counselling is important to provide in clinics, as determined by the nurses, and these nurses expressed a want to improve their own nutritional knowledge through education. The nurses had varying knowledge of current dietary recommendations. Dietary counselling for women during and after pregnancy resulted in beneficial changes in dietary intake up to one year after pregnancy and body weight and waist circumference up to four years after pregnancy. Probiotics had a beneficial effect together with dietary counselling on waist circumference until one year after pregnancy, but not throughout the long term, four years after pregnancy. Other factors, such as eating behaviour, associated with dietary intake and body weight control after pregnancy. Specifically, dietary recommendations are reached amongst women whom had high cognitive restraint in their eating behaviour and did not demonstrate uncontrolled eating. Overweight women more frequently emotionally ate compared to normal weight women and women with central adiposity related more frequently to having an uncontrolled eating behaviour than women with normal waist circumference. In addition, being overweight prior to pregnancy and excessive weight gain during pregnancy associated with increased body weight retention after pregnancy. This study showed that individual dietary counselling is useful in influencing dietary intake which adheres to dietary recommendations and this counselling influences, favourably, body weight after pregnancy. Especially, women with the risk for weight retention, such as women who have emotional and uncontrolled eating behaviours, who were overweight prior to pregnancy or those who had excessive weight gain during pregnancy, may benefit from individual dietary counselling. This study underscores the need to develop dietary counselling practices for pregnant women and their follow-up after pregnancy in Finnish health clinics. These practices include increasing the efficacy of the counselling such as collaboration with families, having knowledgable health professionals and having sufficient resources.

Acceleration of Solar Energetic Particles in coronal shocks through self-generated turbulence

The acceleration of solar energetic particles (SEPs) by flares and coronal mass ejections (CMEs) has been a major topic of research for the solar-terrestrial physics and geophysics communities for decades. This thesis discusses theories describing first-order Fermi acceleration of SEPs through repeated crossings at a CME-driven shock. We propose that particle trapping occurs through self-generated Alfvén waves, leading to a turbulent trapping region in front of the shock. Decelerating coronal shocks are shown to be capable of efficient SEP acceleration, provided seed particle injection is sufficient. Quasi-parallel shocks are found to inject thermal particles with good efficiency. The roles of minimum injection velocities, cross-field diffusion, downstream scattering efficiency and cross-shock potential are investigated in detail, with downstream isotropisation timescales having a major effect on injection efficiency. Accelerated spectra of heavier elements up to iron are found to exhibit significantly harder spectra than protons. Accelerated spectra cut-off energies are found to scale proportional to (Q/A)^1.5, which is explained through analysis of the spectral shape of amplified Alfvénic turbulence. Acceleration times to different threshold energies are found to be non-linear, indicating that self-consistent time-dependent simulations are required in order to expose the full extent of acceleration dynamics. The well-established quasilinear theory (QLT) of particle scattering is investigated by comparing QLT scattering coefficients with those found via full-orbit simulations. QLT is found to overemphasise resonance conditions. This finding supports the simplifications implemented in the presented coronal shock acceleration (CSA) simulation software. The CSA software package is used to simulate a range of acceleration scenarios. The results are found to be in agreement with well-established particle acceleration theory. At the same time, new spatial and temporal dynamics of particle population trapping and wave evolution are revealed.

Sellutehtaan prosessien jätevesien puhdistaminen membraanitekniikalla

Tässä työssä tarkoituksena on tutkia mahdollisuuksia sellutehtaan eri jätevesien puhdistukseen uudelleenkäyttöä varten. Yleensä tutkimuksen kohteena ovat yleensä valkaisun alkalisen suodokset, koska niiden suodattaminen on ollut helppoa membraanitekniikalla. Tässä tutkimuksessa kuitenkin kiinnostuksen kohteena ovat valkaisun happamat suodokset ja kuorimon jätevedet. Tutkimuksessa käytettiin viittä membraania, joista kolme on ultrasuodatusmembraaneja ja kaksi nanosuodatusmembraaneja. Näiden katkaisukoot ovat väillä 30 000 -200 Da. Konsentraatiosuodatukset suoritettiin CR 250 -suodattimella. Syötöstä, konsentraatista ja permeaatista otettujen näytteiden analyysien pohjalta laskettujen retentioiden perusteella nanosuodatusmembraani NF270 antoi parhaan tuloksen. Tällä membraanilla kuorimon jätevesien suodatuksessa retentioksi saatiin kaikilla osa-alueilla vähintään 80 %, mutta valkaisun happamien suodosten tulokset olivat alhaisempia. Suodatusten perusteella voitiin laskea tarvittava kapasiteetti ja suodatuspinta-ala suodatus yksiköille. Kummassakin tapauksessa suodatuksen syöttömäärät määräytyivät erään suomalaisen sellutehtaan valkaisussa ja kuorimolla syntyvien jätevesimäärien mukaan. Suodatusyksiköiden kooksi saatiin valkaisun happamien suodosten suodattamiseen 54 CR 1010 -suodatinta ja kuorimon jätevesien suodattamiseen 4 CR 1010-suodatinta.

Determinants of Bone Strength and Predictors of Hip Fracture among Finnish Adults. Results from the Health 2000 Survey and the Mini-Finland Health Survey

The objective of this thesis was to identify the determinants of bone strength and predictors of hip fracture in representative samples of Finnish adults. A secondary objective was to construct a simple multifactorial model for hip fracture prediction over a 10-year follow-up period. The study was based on the Health 2000 Survey conducted during 2000 to 2001 (men and women aged 30 years or over, n=6 035) and the Mini-Finland Health Survey conducted during 1978 to 1980 (women aged 45 years or over, n=2 039). Study subjects participated in health interviews and comprehensive health examination. In the Health 2000 Survey, bone strength was assessed by means of calcaneal quantitative ultrasound (QUS). The follow-up information about hip fractures was drawn from the National Hospital Discharge Register. In this study, age, weight, height, serum 25-hydroxyvitamin D (S-25(OH)D), physical activity, smoking and alcohol consumption as well as menopause and eventual HRT in women were found to be associated with calcaneal broadband ultrasound attenuation (BUA) and speed of sound (SOS). Parity was associated with a decreased risk of hip fracture in postmenopausal women. Age, height, weight or waist circumference, quantitative ultrasound index (QUI), S-25(OH)D and fall-related factors, such as maximal walking speed, Parkinson’s disease, and the number of prescribed CNS active medication were significant independent predictors of hip fracture. At the population level, the incremental value of QUS appeared to be minor in hip fracture prediction when the fall-related risk factors were taken into account. A simple multifactorial model for hip fracture prediction presented in this study was based on readily available factors (age, gender, height, waist circumference, and fallrelated factors). Prospective studies are needed to test this model in patient-based study populations.

Sedentary behaviour and health with special reference to obesity and fatty liver in early midlife. The Cardiovascular risk in Young Finns Study

Background: Physical inactivity and positive energy balance pose a risk to health. They increase the risk of obesity and associated non-communicable diseases. Recently, also sedentary behaviour has been associated with obesity and non-communicable diseases. Nevertheless, it has been unclear which type of sedentary behaviour is the most harmful. It is also unknown whether the relationship of sedentary behaviour with obesity is truly independent of other factors, for example physical activity and diet. Longitudinal data are limited, and the direction of causality and the mechanism of action are still unknown. Aims: The aim of this study was 1) to identify the type of sedentary behaviour having the strongest association with obesity, 2) to explore the causal relationship of sedentary behaviour and weight increase, and 3) to additionally, investigate the relationship of sedentary behaviour with fatty liver. These were studied in cross-sectional and/or longitudinal settings using data from the Cardiovascular Risk in Young Finns Study. Special emphasis was put on the evaluation of a wide range of other lifestyle factors and risks for obesity and fatty liver. Subjects: 2,060 subjects (aged 33-50 years in 2011, of which 55 % were female) from the Cardiovascular Risk in Young Finns Study participating in follow-ups in 2001, 2007, and 2011. Measures: Self-reported time spent in various types of sedentary behaviour (I), or TV viewing time (I-III). Measured body weight, height and waist circumference (I-III), and genetic variants for high BMI (I). Fasting plasma concentrations of gamma-glutamyltransferase enzyme and triglyceride, calculated Fatty Liver Index (based on gamma-glutamyltransferase and triglyceride concentration, BMI and waist circumference), and the amount of intrahepatic fat measured with ultrasound (III). Self-reported leisure-time physical activity and active commuting, occupational physical activity, energy intake, diet, alcohol consumption, smoking, socioeconomic status, and sleep duration as possible confounders were considered (I-III). Results: TV viewing is the sedentary behaviour type that has the strongest association with obesity. Sedentary behaviour (TV viewing) precedes weight increase, and not the other way around. Sedentary behaviour (TV viewing) is associated with increased risk of fatty liver. Conclusions: Sedentary behaviour (especially high TV viewing time) is associated with increased risks of obesity and fatty liver. Intervention studies are needed to assess whether reduction of TV time would prevent obesity and fatty liver.

Promoting Healthy Lifestyles with Personalized, APOE Genotype Based Health Information: The Effects on Psychological-, Health Behavioral and Clinical Factors

There is an increasing demand for individualized, genotype-based health advice. The general population-based dietary recommendations do not always motivate people to change their life-style, and partly following this, cardiovascular diseases (CVD) are a major cause of death in worldwide. Using genotype-based nutrition and health information (e.g. nutrigenetics) in health education is a relatively new approach, although genetic variation is known to cause individual differences in response to dietary factors. Response to changes in dietary fat quality varies, for example, among different APOE genotypes. Research in this field is challenging, because several non-modifiable (genetic, age, sex) and modifiable (e.g. lifestyle, dietary, physical activity) factors together and with interaction affect the risk of life-style related diseases (e.g. CVD). The other challenge is the psychological factors (e.g. anxiety, threat, stress, motivation, attitude), which also have an effect on health behavior. The genotype-based information is always a very sensitive topic, because it can also cause some negative consequences and feelings (e.g. depression, increased anxiety). The aim of this series of studies was firstly to study how individual, genotype-based health information affects an individual’s health form three aspects, and secondly whether this could be one method in the future to prevent lifestyle-related diseases, such as CVD. The first study concentrated on the psychological effects; the focus of the second study was on health behavior effects, and the third study concentrated on clinical effects. In the fourth study of this series, the focus was on all these three aspects and their associations with each other. The genetic risk and health information was the APOE gene and its effects on CVD. To study the effect of APOE genotype-based health information in prevention of CVD, a total of 151 volunteers attended the baseline assessments (T0), of which 122 healthy adults (aged 20 – 67 y) passed the inclusion criteria and started the one-year intervention. The participants (n = 122) were randomized into a control group (n = 61) and an intervention group (n = 61). There were 21 participants in the intervention Ɛ4+ group (including APOE genotypes 3/4 and 4/4) and 40 participants in the intervention Ɛ4- group (including APOE genotypes 2/3 and 3/3). The control group included 61 participants (including APOE genotypes 3/4, 4/4, 2/3, 3/3 and 2/2). The baseline (T0) and follow-up assessments (T1, T2, T3) included detailed measurements of psychological (threat and anxiety experience, stage of change), and behavioral (dietary fat quality, consumption of vegetables, - high fat/sugar foods and –alcohol, physical activity and health and taste attitudes) and clinical factors (total-, LDL- HDL cholesterol, triglycerides, blood pressure, blood glucose (0h and 2h), body mass index, waist circumference and body fat percentage). During the intervention six different communication sessions (lectures on healthy lifestyle and nutrigenomics, health messages by mail, and personal discussion with the doctor) were arranged. The intervention groups (Ɛ4+ and Ɛ4-) received their APOE genotype information and health message at the beginning of the intervention. The control group received their APOE genotype information after the intervention. For the analyses in this dissertation, the results for 106/107 participants were analyzed. In the intervention, there were 16 participants in the high-risk (Ɛ4+) group and 35 in the low-risk (Ɛ4-) group. The control group had 55 participants in studies III-IV and 56 participants in studies I-II. The intervention had both short-term (≤ 6 months) and long-term (12 months) effects on health behavior and clinical factors. The short-term effects were found in dietary fat quality and waist circumference. Dietary fat quality improved more in the Ɛ4+ group than the Ɛ4- and the control groups as the personal, genotype-based health information and waist circumference lowered more in the Ɛ4+ group compared with the control group. Both these changes differed significantly between the Ɛ4+ and control groups (p<0.05). A long-term effect was found in triglyceride values (p<0.05), which lowered more in Ɛ4+ compared with the control group during the intervention. Short-term effects were also found in the threat experience, which increased mostly in the Ɛ4+ group after the genetic feedback (p<0.05), but it decreased after 12 months, although remaining at a higher level compared to the baseline (T0). In addition, Study IV found that changes in the psychological factors (anxiety and threat experience, motivation), health and taste attitudes, and health behaviors (dietary, alcohol consumption, and physical activity) did not directly explain the changes in triglyceride values and waist circumference. However, change caused by a threat experience may have affected the change in triglycerides through total- and HDL cholesterol. In conclusion, this dissertation study has given some indications that individual, genotypebased health information could be one potential option in the future to prevent lifestyle-related diseases in public health care. The results of this study imply that personal genetic information, based on APOE, may have positive effects on dietary fat quality and some cardiovascular risk markers (e.g., improvement in triglyceride values and waist circumference). This study also suggests that psychological factors (e.g. anxiety and threat experience) may not be an obstacle for healthy people to use genotype-based health information to promote healthy lifestyles. However, even in the case of very personal health information, in order to achieve a permanent health behavior change, it is important to include attitudes and other psychological factors (e.g. motivation), as well as intensive repetition and a longer intervention duration. This research will serve as a basis for future studies and its information can be used to develop targeted interventions, including health information based on genotyping that would aim at preventing lifestyle diseases. People’s interest in personalized health advices has increased, while also the costs of genetic screening have decreased. Therefore, generally speaking, it can be assumed that genetic screening as a part of the prevention of lifestyle-related diseases may become more common in the future. In consequence, more research is required about how to make genetic screening a practical tool in public health care, and how to efficiently achieve long-term changes.