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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.

Dialogipartikkelit joo ja niin pikaviestikeskusteluissa

Tutkimukseni käsittelee dialogipartikkeleita joo ja niin pikaviestikeskusteluissa. Otan huomioon myös partikkeliketjut, jotka sisältävät dialogipartikkelin joo tai niin. Aineistona tutkimuksessa käytän kahta Whatsapp-pikaviestiohjelmalla käytyä keskusteluketjua. Keskustelut on käyty reaaliaikaisesti älypuhelimella. Tavoitteenani on selvittää, minkälaisia tehtäviä dialogipartikkelit joo ja niin saavat pikaviestikeskusteluissa ja eroavatko niiden tehtävät puhutuissa keskusteluissa käytettyjen dialogipartikkelien tehtävistä. Vertaan tuloksiani Marja-Leena Sorjosen tekemiin tutkimuksiin dialogipartikkeleista. Tarkastelen dialogipartikkeleita keskustelunanalyyttisin metodein. Huomioin dialogipartikkelia edeltävän vuoron ja sen, miten keskustelu etenee partikkelin sisältävän vuoron jälkeen. Otan myös huomioon laajemman sekvenssin ja toiminnan, johon partikkelin sisältävä ja sitä edeltävä vuoro kuuluvat. Lisäksi tarkastelen sitä, miten pikaviestikeskusteluissa prosodian puuttuminen ja vierusparien jakautuneisuus vaikuttavat dialogipartikkelien joo ja niin käyttöön. Dialogipartikkelit saavat keskusteluissa pääosin samoja tehtäviä kuin puhutuissa keskusteluissa. Suurimman poikkeuksen muodostaa jatkajina toimivien dialogipartikkelien ryhmä. Pikaviestikeskusteluissa jatkajina toimivat dialogipartikkelit eivät koskaan vastaa jaoteltuun tietoon ja kehottavat erittäin harvoin keskustelukumppaniaan jatkamaan. Keskustelukumppania saatetaan pyytää jatkamaan kysyvällä dialogipartikkelilla joo tai niin, jos keskustelija ei koe saaneen tarpeeksi tietoa toiselta keskustelijalta. Tällöin partikkelin lopussa on kysymysmerkki. Prosodian puuttumista pikaviestikeskusteluista keskustelijat kompensoivat venyttämällä dialogipartikkelien kirjoitusasua, esimerkiksi muotoon jooo tai niii. Dialogipartikkelien sävyyn vaikutetaan myös välimerkeillä, kuten huutomerkillä tai kysymysmerkillä. Dialogipartikkelin sisältämä sävy ja se, sisältääkö partikkeli esimerkiksi erimielisyyttä, on kuitenkin aina tulkittava suhteessa dialogipartikkelin esiintymiskontekstiin. Vierusparien jakautuneisuus pikaviestikeskusteluissa ei vaikuta dialogipartikkelien käyttöön. Tutkimukseni laajentaa dialogipartikkelien tutkimusta, sillä tutkimukseni aineisto koostuu puhuttujen keskustelujen sijaan kirjoitetuista pikaviestikeskusteluita. Pikaviestikeskustelut muistuttavat paljon puhuttuja keskusteluja, ja siksi niihin keskittyvä tutkimus tarjoaa mielenkiintoisen näkökulman puhutun ja kirjoitetun kielen rajankäyntiin. Tutkimukseni paneutuu tähän rajankäyntiin tietyn kieliopillisen kategorian, dialogipartikkelien,

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