BACKGROUND:Parental weight status is a key predictor of childhood obesity. However, limited evidence exists on how longitudinal changes in parental BMI influence children's weight trajectories, particularly in families at elevated risk for type 2 diabetes. OBJECTIVES:To investigate children's body mass index-for-age z-score (BMIz) changes over a 2-year period, associated with independent and cumulative changes in parents' BMI. METHODS:In the Feel4Diabetes study, data from 12 280 children (age: 8.2 ± 1.0 years) and their parents were analysed to assess changes in child BMI-for-age z-scores over 2 years in relation to parental BMI changes. Analyses were adjusted for study design and baseline socio-demographic factors and were conducted in both the total sample (all-families) and high-risk for type 2 diabetes families (HR-families). RESULTS:In the all-families dataset, a 1 kg/m2 independent decrease in maternal and paternal BMI was associated with a -0.037 (-0.041, -0.033) and -0.027 (-0.031, -0.023) change in child's BMIz [mean (95% CI)]. The joint parental effect was stronger [-0.32 (-0.36, -0.28)], particularly in HR-families [-0.34 (-0.42, -0.26)]. CONCLUSIONS:Parental BMI reductions, especially when both parents are involved, contribute to favourable BMI changes in children. The changes were more pronounced in HR-families, underscoring the need for interventions targeting the whole family in populations at elevated risk for type 2 diabetes.

Background Chronic kidney disease (CKD) is a global health problem which is associated with poor outcomes, and its prevalence is expected to increase. Identifying novel risk factors for CKD may lead to improved outcomes. Circulating saturated fatty acids (SFAs) have been posited as contributors to CKD risk. Objectives We aimed to evaluate associations between circulating SFAs (measured in phospholipids in 7 cohorts, serum or plasma total in 5 cohorts, and cholesterol esters in 1 cohort) and incident CKD in 13 cohorts, and to pool results by meta-analysis across the studies. Methods SFAs were measured in 13 cohorts in the Fatty Acids Outcomes Research Consortium, including 18,193 participants with estimated glomerular filtration rate >60 mL/min/1.73 m2 across 9 countries. Associations between each SFA [palmitic acid (16:0), stearic acid (18:0), arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0)] and incident CKD (defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 and ≥25% decrease from baseline) were assessed by Cox or Poisson regressions. Results were pooled using inverse variance weighted meta-analysis. Results In total, 2554 participants developed CKD over a weighted median follow-up of 7.6 y. After adjustment, higher concentrations of 18:0 were associated with a lower risk of CKD with minimal heterogeneity (relative risk per interquintile range: 0.87; 95% confidence interval: 0.80, 0.95, P = 0.003, I2 = 14.7%). These associations remained consistent in secondary and sensitivity analyses. We did not observe significant associations of other SFAs with CKD. Conclusions In a meta-analysis of 18,193 participants across 9 countries, we observed no indication that SFA increased CKD risk, whereas higher 18:0 concentrations were associated with a lower risk of CKD. Future research is needed to assess mechanisms by which SFA 18:0 may exert kidney-protective effects, and how circulating SFA 18:0 concentrations may be altered.

AIM:Τo develop a revised version of the FINDRISC tailored to improve the identification of individuals at high risk for type 2 diabetes (T2D) across diverse populations. METHODS:The revised-FINDRISC was developed using pooled harmonized baseline data from the multinational Feel4Diabetes (NCT02393872; N = 3526) and DigiCare4You (NCT05648383; N = 2156) studies. Validation utilized data from the 20-year ATTICA cohort study in Greece. Original FINDRISC components were analyzed using Fisher's Linear Discriminant Analysis followed by supervised stepwise logistic regression to identify significant T2D cross-sectional predictors. The revised-FINDRISC was developed by re-scoring or excluding original items and incorporating new predictors, generating an integer-based score to enhance usability. RESULTS:The revised-FINDRISC significantly improved accuracy in identifying current T2D risk over the original, with an overall AUC of 0.911(95%CI: 0.901,0.922) versus 0.832(0.815,0.846). When stratified by country economic classification, the revised score outperformed the original across all groups: LMICs: 0.881(0.864,0.898) vs. 0.815(0.793,0.837), South European-HICs: 0.891(0.867,0.916) vs. 0.839(0.811,0.869), and North European-HICs: 0.921(0.872,0.971) vs. 0.844(0.742,0.949). A clinical threshold score of 13/24 in the revised-FINDRISC offers optimal sensitivity and specificity for identifying individuals at risk of T2D. CONCLUSION:Enhanced with demographic, socio-economic, and clinical factors, the revised-FINDRISC potentially represents a substantive advancement in T2D screening, supporting early detection and targeted prevention.

Digital interventions provide a scalable, resource-saving approach to promote well-being and health and prevent lifestyle-related chronic health conditions, but their ability to engage and benefit diverse audiences remains a challenge. This study aims to evaluate a 6-month web-based wellness coaching program among working-age adults. The program is theory- and evidence-based, co-designed, and targets three behavioral domains (physical activity, diet, sleep) with an overarching focus on stress–recovery balance. The study follows a 2-arm parallel cluster randomized controlled design and lasts 12 months. Participants with age 18–65, proficiency in Finnish, and access to Internet were recruited from diverse worksites (n=13) in Central and Southwestern Finland. The sites were allocated 1:1 to intervention (coaching program) or waitlist control arm (general information on well-being). Data collection comprises fitness tests (handgrip strength, heart rate variability, body composition, waist circumference, BMI) and questionnaires conducted at months 0, 6, and 12, together with continuous monitoring of implementation costs, study uptake, dropout, and engagement (eg, visits to and time spent on the coaching platform). The primary outcome is the participant-level change in self-reported well-being (WHO-5 Well-Being Index) from baseline to 12 months. Secondary outcomes include changes in measures reflecting physical fitness, anthropometrics, lifestyle behaviors, health, and functional capacity. Further evaluation domains include health economic impact (eg, changes in well-being-, productivity-, and quality-adjusted life years), feasibility (study uptake, dropout, and engagement), and user experiences (acceptability, overall evaluation, and readiness to recommend the coaching program). Planned analyses will be conducted on the intention-to-treat principle and include linear mixed-effects models and health economic modelling. The study received ethical approval in May 2025. Participant registration was open in September–October 2025, informed consents were collected in October–November 2025, and baseline assessments were conducted in October–December 2025. Consents were obtained from 294 and complete baseline data from 268 participants. Data collection will be completed within 2026, data analysis is planned for 2026–2027, and the dissemination of results will begin in 2027. The study is conducted as a part of the European Union’s Joint Action on Cardiovascular Diseases and Diabetes (JACARDI) that has received funding from the EU4Health Programme 2021–2027. The study contributes to evidence on the potential of fully automated digital tools to enhance workforce well-being and save societal costs. ISRCTN Registry ISRCTN12097902 https://doi.org/10.1186/ISRCTN12097902 (date of registration: 06/08/2025)

INTRODUCTION:Obesity disproportionately affects children from socioeconomically disadvantaged backgrounds. This study assessed the effectiveness of the Feel4Diabetes intervention on weight outcomes among children from low socioeconomic settings. METHODS:Feel4Diabetes was a randomised pragmatic trial implemented in real-world school and community settings across Europe. Using a two-stage screening procedure, families were recruited and categorised as either 'all families' or 'high-risk families'. The intervention included a 2-year school-based health promotion for all families and additional counselling for high-risk families. Weight improvement was defined as a reduction of ≥ 0.2 BMI z-score units among children with overweight/obesity. Multiple logistic regressions identified predictors of improvement. RESULTS:Data from 2710 children from high-risk families and 7625 children from all families were analysed. After 2 years, a higher proportion of children from high-risk families in the intervention group reduced their BMI z-score compared to the control group (p = 0.002). Children from non-high-risk families showed only a marginal improvement. Multivariate analyses identified predictors of improvement: randomisation in the intervention group (OR = 1.46; 95% CI: 1.14-1.87), baseline obesity (OR = 1.55; 95% CI: 1.16-2.08), residence in LMICs (OR = 2.33; 95% CI: 1.65-3.30) or HICs facing economic crisis (OR = 2.12; 95% CI: 1.54-2.91), and reported financial difficulties (OR = 1.36; 95% CI: 1.06-1.74). Interestingly, maternal obesity was positively associated with BMI z-score improvement (OR = 1.31; 95% CI: 1.03-1.68), while higher maternal education was inversely related (OR = 0.64; 95% CI: 0.41-0.99). CONCLUSION:These findings underscore the importance of equity-oriented, long-term interventions addressing both behavioural and structural determinants of obesity.

The Daqing Diabetes Prevention Study II (Daqing DPS-II) builds on the landmark study Daqing Diabetes Prevention Study to develop real-world implementation strategies for preventing type 2 diabetes (T2DM). This study aims to evaluate the effectiveness of digital and complex lifestyle intervention in reducing the incidence of T2DM among adults with increased risk of T2DM, compared to usual care over a 36-month period. A three-arm, stratified, cluster-randomized controlled trial will be conducted in eight factories in Daqing, with clusters as the unit of randomization and individual participants as the unit of analysis. Fifty-seven clusters will be randomly allocated (1:1:1) to one of three groups: (1) Digital-based lifestyle intervention, (2) complex lifestyle intervention, or (3) usual care. Eligible participants will be adults aged 25–55 with increased risk of T2DM, defined by IFG, IGT, HbA1c 5.7–6.4

AIMS:Lifestyle interventions induce remission in people with type 2 diabetes (T2D) and those with impaired glucose tolerance (IGT). We examined the long-term remission of IGT in the participants of the Finnish Diabetes Prevention Study and evaluated factors predicting remission during extended follow-up. METHODS:505 participants were included in analyses. The median duration of lifestyle intervention was four years, and follow-up lasted up to 18 years. Remission was defined as normoglycaemia (fasting plasma glucose < 5.6 mmol/L, 2-h post-load glucose < 7.8 mmol/L, HbA1c < 39 mmol/mol). We examined predictors of remission (weight, fat distribution, physical activity, diet, and insulin sensitivity and insulin secretion based on repeated oral glucose tolerance tests). RESULTS:Remission rates were 32% at least once, 13%, 12%, and 11% at year 1, year 3, and the first post-intervention follow-up visit (median 5 years, range 4 - 8 years). Short-term predictors of remission included weight loss, reduction in waist circumference, higher intake of fibre and lower intake of saturated fats, physical activity, enhanced insulin sensitivity, and recovery of insulin secretion. In the longer term, only insulin secretory and sensitivity indices were associated with remission. CONCLUSION:IGT may be normalised in the long term through weight loss and healthier lifestyles choices.

Clinical studies often observe one interesting event in the presence of other competing events. When both types of events can occur at any time but are only observed at clinical visits (i.e., interval censored), standard survival models may introduce bias in the estimated incidence of the interesting event over time. This can also lead to inflated relative differences between treatment groups. We developed a multi-state model for competing risks analysis of interval censored data from the Finnish Diabetes Prevention Study. The developed model predicted the participants' clinical outcomes and demonstrated that lifestyle changes significantly decreased the risk of both diabetes and death. The model showed that those who dropped out were at lower risk of developing diabetes, neglecting the assumption of independent censoring. Furthermore, the model identified the most important covariates predicting the future development of diabetes, which should be targeted for therapeutic intervention in likely clinical scenarios. These covariates are baseline BMI, HbA1c, and insulin sensitivity measurements by QUICKI for the onset of developing T2DM, baseline BMI for dropping out, and sex and age as the predictive covariates of death. Trial Registration: ClinicalTrials.gov identifier: NCT00518167.

Type 2 diabetes can be prevented by lifestyle intervention. We aimed to identify metabolites that associate with glucose metabolism and respond to lifestyle intervention with evidence-based targets for nutrition and physical activity in individuals at high risk of type 2 diabetes. Standard oral glucose tolerance test (OGTT) was used to categorize 624 participants into those having normal glucose tolerance (NGT), isolated impaired glucose tolerance (IGT), IGT with increased fasting glucose (IGT + IFG), and type 2 diabetes. Plasma LC-MS metabolomics was performed to reveal metabolic signatures. The baseline group differences were analysed with the Kruskal–Wallis test and the effect of intervention with a linear mixed-effects model. Significant differences in the metabolite signature were observed between the baseline groups, particularly in amino acids, acylcarnitines, and phospholipids. Fatty acid amides, phospholipids, amino acids, dimethylguanidinovaleric acid, and 5-aminovaleric acid betaine responded most to the lifestyle intervention. Lysophosphatidylcholines containing odd-chain fatty acids showed associations with improved glucose metabolism. Twenty-five metabolites differed between the baseline groups, responded to the intervention, and were associated with changes in glucose metabolism. The findings suggest a metabolite panel could be used in distinguishing individuals with varying degrees of glucose metabolism and in predicting response to lifestyle interventions.

Participant dropout from interventional studies targeting healthy lifestyles can significantly undermine the validity of study outcomes. Accurate dropout prediction can help mitigate this issue by enabling proactive participant engagement strategies. This study aims to develop a robust Machine Learning (ML) model to predict dropout from a school and community-based interventional study to promote a healthy lifestyle and prevent type 2 diabetes: The Feel4Diabetes study. Using data from 3274 participants across 790 variables, we aim to identify key dropout determinants and enhanceML predictive accuracy. We evaluated three individual machine learning models-Random Forest, XGBoost, and Support Vector Machine (SVM)-based on performance metrics including accuracy, precision, recall, and F1-score. Among these, the Random Forest model emerged as the most effective, achieving an accuracy of 0.80 on the test set, with balanced precision and recall scores. Our study highlights the effectiveness of machine learning methods in predicting dropout in interventional studies promoting healthy lifestyles and preventing type 2 diabetes. Future research will concentrate on refining these models further and exploring additional data sources to enhance their generalizability.

Background: Gestational Diabetes Mellitus (GDM) prevalence is rising worldwide. GDM poses health risks for both mothers and offspring. Optimal dietary strategies for GDM remain unclear. The eMOM pilot compared a plant-protein rich Healthy Nordic Diet (HND) and a moderately carbohydrate restricted diet (MCRD) and their potential effects on glucose control and newborn body composition. Methods: Forty-two (HND, n = 20, MCRD, n = 22) participants were assigned to have dietary intervention and nutritional counseling from gestational weeks (GW) 24 + 0–28 + 6 (baseline) until delivery. Continuous glucose monitoring (Freestyle Libre, Abbott, USA) assessed glucose levels. Blood samples for glucose and lipid metabolism and 3-day food diaries were collected at baseline and at GW 34 + 0–35 + 6. Neonatal body composition was measured (Peapod, COSMED, USA). Difference between groups and newborn body composition was analysed with t-test and Wilcoxon test. Results: Thirty-two women completed the study. Both groups maintained the glucose time in range (≤ 7.8 mmol/L) during majority of the time (98.9 and 99.3% for MCRD and HND respectively, p = 0.921) in GW 34 + 0–35 + 6. The mean glucose was lower in the MCRD group compared to the HND group (5.0 SD 1.03 vs. 5.2 SD 0.96 mmol/l, p < 0.001). No differences were observed between the groups in glucose variability, lipid metabolism, gestational weight gain, or in the body composition of the newborns. There was no difference in the macronutrient composition between the groups as the HND had lower macronutrient adherence than the MCRD. The HND decreased intake of meat and increased fish consumption significantly compared to the MCRD. Conclusions: This pilot study indicates that both a moderately restricted carbohydrate diet and a diet focused on plant-based protein effectively maintained a large time within the treatment target range in women with GDM. Further research could explore the impact of protein quantity and sources in maternal diets on glycemic control and newborn outcomes. Trial registration The eMOM pilot trial is registered in Clinicaltrials.gov (21/09/2018, NCT03681054)

The long-term effects of breakfast on childhood z-BMI remain inconclusive. To prospectively assess the impact of stable and altered breakfast consumption habits on z-BMI change over two years, in school-aged children across six European countries. Data of 6,528 children (8.2 ± 1.0 years, 48.9

The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) previously showed that a 2-year multidomain lifestyle intervention has a beneficial effect on cognitive function among at-risk older adults. Furthermore, both participation in the intervention activities and the lifestyle changes achieved were associated with more improvement in cognition. We investigated the long-term effects of the intervention on lifestyle and cognition over 11 years. FINGER included 1259 individuals, aged 60-77 years with an increased risk of dementia. The participants were randomized to receive either regular health advice (control) or an intervention comprising of exercise training, dietary counselling, cognitive training, and management of vascular risk factors (intervention) lasting for 2 years. Participants were invited to follow-up visits approximately 5, 7 and 11 years after the baseline visit. Lifestyles were measured with an index comprising self-reported questions on diet, physical activity, cognitive and social activities, smoking and alcohol use. The participants were categorized into 4 groups based on their engagement in intervention activities: the control group; the intervention group with low participation; the intervention group with intermediate participation; and the intervention group with high participation. Neuropsychological test battery composite score was applied to measure cognition. The beneficial effect of intervention on lifestyles was sustained until 7 years after baseline ( p  = 0.005 for intervention vs. control at 7 years). The lifestyles were maintained better among older participants and those with high participation during the intervention period, compared with the control group throughout the entire 11 y period. Early drop-out from the study was linked to worse lifestyles. Overall, cognitive performance level increased until 2 years and declined thereafter. Individuals with high intervention engagement had better cognitive trajectories compared with the control group until 7 years ( p  = 0.003) and compared with those with low engagement until 11 years ( p  = 0.002). This study provides the first evidence that multidomain, lifestyle-based interventions lasting for 2 years can have beneficial effects on lifestyles and cognition even several years after the intervention. Especially participants who adhered well to the intervention had sustained benefits. These findings further support the implementation of such preventive activities.

BACKGROUND:Curbing the rise in overweight and obesity in childhood is of top priority in the public health agenda. OBJECTIVE:To examine the effectiveness of a 2-year school-based intervention on children's body mass index (BMI) z-score, considering children's baseline weight status, as well as to identify socio-demographic factors that could predict a positive weight outcome. METHODS:Data were collected from 9255 children 5-12 years, from six European countries, participating in the Feel4Diabetes study. The intervention group received a lifestyle intervention, aiming to promote a healthy and active lifestyle. Children's anthropometrics were measured at baseline and 2-year follow-up. RESULTS:Children with overweight, but not with obesity, at baseline randomized in the intervention group had a higher reduction in BMI z-scores compared to the control group. In logistic regression models, older age, female sex, overweight or obesity increased the likelihood of any decrease in BMI z-score in the intervention group. Mother's obesity and a lower family income were associated with a decreased probability of a positive weight outcome from the intervention. CONCLUSIONS:The Feel4Diabetes school-based intervention demonstrated that it could effectively improve the BMI z-score among children with overweight, but not with obesity. Family's characteristics (mother's weight and family income) may affect the effectiveness of such interventions and should be considered in relevant public health efforts.

AIMS:Few longitudinal studies have explored Oral Glucose Tolerance Test markers (OGTT) and both cognitive and brain changes. We investigated OGTT and other glycaemia and insulin resistance markers, and cognitive and neuroimaging changes in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). MATERIALS AND METHODS:At-risk individuals aged 60-77 years without dementia (N = 1259) were randomly enrolled in a 2-year multidomain lifestyle intervention or regular health advice program. 1025 participants without previously diagnosed diabetes underwent OGTT. Brain MRI scans were available for 132 participants and amyloid (PiB)-PET and FDG-PET scans for 47. Cognition was assessed using the modified Neuropsychological Test Battery (mNTB). RESULTS:Higher baseline dysglycaemia measures, particularly those from the OGTT, were connected to less favourable changes in multiple cognitive measures and hippocampal volume. Higher baseline triglyceride-glucose (TyG) index was associated with higher amyloid accumulation and decline in brain glucose metabolism. Higher baseline glycated haemoglobin (HbA1c) was related to favourable changes in processing speed and cortical thickness. There were no significant intervention-control differences in the change in glycaemia markers. Baseline dysglycaemia and glycaemia-related markers did not modify the previously reported intervention benefits on cognition. CONCLUSIONS:Higher baseline dysglycaemia measures are linked to more deleterious changes in cognition. Specifically, OGTT measures may be the most sensitive for detecting subtle glycaemic abnormalities associated with both unfavourable cognitive and neuroimaging changes. However, HbA1c shows mixed associations with cognition and neuroimaging in people at risk of dementia without previously diagnosed diabetes. This study emphasises the importance of more accurate glucose-related markers when investigating early stages of glucose metabolism abnormalities and their relationship to subtle cognitive impairment and its structural brain correlates. TRIAL REGISTRATION:ID NCT01041989 https://clinicaltrials.gov.

BackgroundChronic noncommunicable diseases (NCDs) remain a leading health challenge worldwide, and reducing modifiable lifestyle risk factors is a key prevention strategy. Digital health interventions (DHIs) offer scalable, cost-effective tools to support healthy behaviors, but concerns persist about their equitable reach and uptake across population groups. ObjectiveThis study aimed to examine how socioeconomic factors, health status, lifestyle behaviors, and attitudes and experiences related to the use of electronic services (e-services) are associated with the uptake of a DHI. MethodsIn this cross-sectional study, we invited (through mail or SMS) a subgroup of 6978 participants aged 20-74 years from the population-based Healthy Finland survey to take part in a DHI. The DHI, delivered via the web-based BitHabit app, aimed to support the adoption of healthy lifestyle habits. Uptake was defined as successful registration, agreeing to the terms of use, and accepting the invitation to participate. Predictor variables were drawn from national registry and self-reported survey data and included socioeconomic status, health indicators, lifestyle behaviors, and attitudes and experiences related to the use of e-services. Adjusted logistic regression models were used to identify significant predictors of DHI uptake. ResultsOf the final sample of 6975 participants, 1287 (18.5%) started using the DHI. Uptake was significantly higher among women (adjusted odds ratio [aOR] 1.69, 95% CI 1.49-1.93), middle-aged individuals (aOR 1.47, 95% CI 1.21-1.79), and those with higher income (aORs 1.76-1.97, 95% CIs 1.37-2.59) and more years of education (aOR 1.10, 95% CI 1.08-1.12). Healthier lifestyle indicators, including better diet quality (aOR 1.07, 95% CI 1.04-1.10), less frequent smoking or nonsmoking (aORs 1.59-2.29, 95% CIs 1.08-3.12), sleep (aOR 0.58, 95% CI 0.37-0.86), higher functional capacity (aOR 1.06, 95% CI 1.02-1.11), and good overall current health (aOR 1.46, 95% CI 1.15-1.89), were associated with increased likelihood of DHI uptake. The strongest predictors were related to the use of e-services: Individuals who used e-services (aORs 2.48-6.08, 95% CIs 1.19-11.92) reported higher competence to use e-services (aORs 2.00-4.10, 95% CIs 1.44-5.92), had low concerns about data security (aORs 1.37-1.76, 95% CIs 1.03-2.33), believed in the benefits of digital services (aOR 1.04, 95% CI 1.02-1.05), and had better internet connections had higher odds of uptake. ConclusionsOur findings show that DHI uptake is associated with socioeconomic status, health and lifestyle factors, and, especially, individuals’ experience and attitudes toward e-services. Individuals with lower education levels, lower income, and poorer health and lifestyle habits are less likely to adopt DHIs, raising concerns about potential digital health inequities. These results underscore the need for targeted strategies to reduce barriers and ensure more equitable reach and engagement in future DHI implementations.

Abstract Aim To examine the association between the integrated care competencies and cross‐cultural competence of registered nurses prior to the integration of social and healthcare services in Finland. Design A descriptive correlational cross‐sectional questionnaire survey was conducted. Methods A simple random sample of 10,000 registered nurses was drawn from the Finnish Central Register of Valvira (National Supervisory Authority for Welfare and Health); 7000 of them were sent the online questionnaire, and a total of 1232 registered nurses participated in the study. We collected data using background questions, revised versions of the Competent Workforce for the Future tool in the four domains of client orientation, responsibility for personal or relative's welfare, fluency and clarity of services and access to the services and of the Cross‐Cultural Competence of Healthcare Professional tool in the four domains of motivation/curiosity, attitude, skill and emotion/empathy. Results Participants demonstrated a high level of integrated care competencies (mean = 4.00, SD ± 0.49). An association was observed between integrated care competencies and their domains of skills, motivation/curiosity, emotions/empathy, and cross‐cultural competence (p < 0.001). Female sex, older age, more working experience, employment in the private sector, and higher self‐rated competence for working in a multicultural environment were positively associated with higher integrated care competencies. Conclusion It is recommended that nurse managers and nurse educators emphasize the development of registered nurses' cross‐cultural competence alongside integrated care competencies to meet the needs of different individuals and communities when providing integrated care. Patient or Public Contribution Finnish registered nurses including all types of nurses, midwives and paramedics working the public and private healthcare, were involved in this study by responding to the online survey.

Background: A dietary pattern can be defined as the quantities, proportions, variety, or combination of foods and drinks typically consumed. The dietary pattern approach aims to place emphasis on the total diet as a long-term health determinant, instead of focussing on separate foods and nutrients, which may interact or confound each other. Aim: This scoping review describes the totality of evidence for the role of dietary patterns for health-related outcomes as a basis for setting and updating food-based dietary guidelines in the Nordic Nutrition Recommendations 2023 (NNR2023). Methods: We used evidence from 10 qualified systematic reviews identified by the NNR2023 project. No additional literature search was conducted. Results: Strong or moderate evidence linked dietary patterns high in vegetables, fruits, whole grains, fish, low-fat dairy and legumes, and low in red and processed meats, sugar-sweetened beverages, sugary foods- and refined grains with beneficial health outcomes, such as reduced risk of cardiovascular disease (CVD), type 2 diabetes, obesity, cancer, bone health, and premature death. We also found limited evidence suggesting a relationship with the described dietary patterns in childhood and decreased risk of obesity and hypertension later in life. Most studies have been conducted among adult populations, and thus, there is a need for studies in certain subgroups, such as children and adolescents as well as the elderly.

CONTEXT:Lifestyle intervention reduces the incidence of type 2 diabetes (T2D) in people with impaired glucose tolerance (IGT). OBJECTIVE:This work aimed to find out whether participation in an earlier lifestyle intervention had an effect on the occurrence of clinically diagnosed diabetic retinopathy (DR) during a median of 22 years of follow-up time. METHODS:The study included 505 individuals from the Finnish Diabetes Prevention Study (DPS) (mean age 55; range, 40-64 years at the onset of the study) with IGT who were originally randomly assigned to the intervention (weight loss, healthy diet, and physical activity) (N = 257) and usual care control groups (N = 248). The median follow-up was 22 years. Clinical retinopathy diagnoses were obtained from the Finnish national hospital Care Register for Health. Data on glycemic parameters, serum lipids, and blood pressure were available from both the intervention (median 4 years) and postintervention period (until year 7). RESULTS:No significant difference was found in the cumulative incidence of clinically diagnosed DR between the original intervention (N = 23, 8.9%) and control groups (N = 19, 7.7%) during the extended follow-up (odds ratio: 1.15; 95% CI, 0.61-2.21). A higher cumulative glycated hemoglobin A1c (HbA1c) was significantly associated with a higher risk of retinopathy (hazard ratio 1.4; 1.02-1.88, 95% posterior interval, adjusted for group, age, and sex). Furthermore, the incidence of retinopathy diagnosis was numerically more common among individuals who had developed diabetes during the follow-up (33/349) compared with those who had not (9/156); however, the comparison was not statistically significant (odds ratio: 1.86, 95% CI, 0.89-4.28, adjusted for group, age, and sex). CONCLUSION:A higher cumulative HbA1c was significantly associated with a higher risk of retinopathy. No evidence was found for a beneficial effect of a 4-year lifestyle intervention on the long-term occurrence of clinical DR during a median of 22-year follow-up.