2. Materials and Methods
weight loss, Metabolic Syndrome
HEART, METABOLIC SYNDROME
Altogether, 628 men were recruited from the Metabolic Syndrome in Men (METSIM) study as previously described [Participants in the intervention groups had four visits with laboratory samples (0, 1, 2 and 3 years) as previously described [Group session 2 included dietary fiber intake, consumption of fruits, vegetables, and berries, and intake of salt and sugar. Group session 3 included the quality of dietary fat, protein intake, meal pattern, and physical activity. Optimal dietary choices were presented from food groups, e.g., cereal products, dairy products, meat products, and dietary fats and oils. Those participants whose BMI was >28 kg/mAt 1- and 2-year group sessions, the participants were further motivated for lifestyle modifications, and the principles of a health-promoting diet and physical activity were repeated. Furthermore, new optimal choices on the market for a health-promoting diet were presented.The spouses of the participants were welcome to all group sessions. Of the spouses, 30% participated in the motivation session and 16–22% in sessions 2 and 3. In weight loss sessions, the participation rate of the spouses was 14–15%. At the 1-year session, the participation rate of the spouses was 8%, and at the 2-year session it was 12%. Each session lasted about 90 min. The schedule, topics, and sizes of the groups are presented in Four-day food records were collected at baseline and at 6, 12, 24, and 36 months for dietary intake calculations (AivoDiet software, version 2.2.0.0, Mashie FoodTech Solutions Finland, Turku, Finland). Four-day food records were checked face-to-face upon being returned; these were checked by clinical nutritionists at all other time points except for at 6 months, when food records were collected via web portal or by mail and checked by phone. Each participant was given written detailed feedback on the results of the calculations, and, if needed, detailed tips were given to ensure participants were making optimal choices and reaching the aims set for dietary intake.The participants were invited to use the web portal designed for the study. They reported their body weight and physical activity weekly via the web portal. Manual recording was possible for those participants who did not have access to the internet. Physical activity was reported in three categories, i.e., light, moderate, or heavy activity. The goal was brisk walking or other types of exercise with comparable intensity a minimum of 30 min per day at least five days a week.The participants were also encouraged to fill simple, nationally-available questionnaires estimating their fiber intake, quality of dietary fat, and salt intake. Questionnaires on salt intake and quality of dietary fat were created by the Finnish Heart Association and the fiber test was modified from the version originally developed by the Finnish Bread Information Association (a general information service of bread business). The results were registered in the web portal, where the participants were able to follow their scores during the study (There was also a discussion forum in the web portal, where the participants could present questions, comments, and obtain answers from the clinical nutritionists throughout the intervention.Participants were contacted by the researchers monthly to provide information on health-promoting food choices and physical activity. In the materials, regarding the intake of certain food groups, e.g., fruits, some recipes suitable for a health-promoting diet were also included in the material provided. The topics of the monthly material are presented in During the second and the third years of the study, the participants were provided with four self-feedback tasks on the website. The topics were the following: dietary fiber, quality of dietary fat and sugar at 16 months, liquids and quality of fat at 20 months, dietary fiber at 28 months, and intake of fruits, vegetables, and berries at 32 months (The participants were encouraged to contact the researchers anytime they had questions or concerns for virtual discussion with the clinical nutritionists. With those who did not have access to the internet, a phone was used for communication (phone calls and SMS).