Policy implementation and priorities to create healthy food environments using the Healthy Food Environment Policy Index (Food-EPI): A pooled level analysis across eleven European countries.

Background: Food environments have been recognised as highly influential on population diets. Government policies have great potential to create healthy food environments to promote healthy diets. This study aimed to evaluate food environment policy implementation in European countries and identify priority actions for governments to create healthy food environments. Methods: The Healthy Food Environment Policy Index (Food-EPI) was used to evaluate the level of food environment policy and infrastructure support implementation in Estonia, Finland, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Slovenia, and Spain in 2019-2021. Evidence of implementation of food environment policies was compiled in each country and validated by government officials. National experts evaluated the implementation of policies and identified priority recommendations. Findings: Finland had the highest proportion (32%, n = 7/22) of policies shaping food environments with a "high" level of implementation. Slovenia and Poland had the highest proportion of policies rated at very low implementation (42%, n = 10/24 and 36%, n = 9/25 respectively). Policies regarding food provision, promotion, retail, funding, monitoring, and health in all policies were identified as the most important gaps across the European countries. Experts recommended immediate action on setting standards for nutrients of concern in processed foods, improvement of school food environments, fruit and vegetable subsidies, unhealthy food and beverage taxation, and restrictions on unhealthy food marketing to children. Interpretation: Immediate implementation of policies and infrastructure support that prioritize action towards healthy food environments is urgently required to tackle the burden of obesity and diet-related non-communicable diseases in Europe. Funding: This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 774548 and from the Joint Programming Initiative "A Healthy Diet for a Healthy Life".

Successful nutrition policy: improvement of vitamin D intake and status in Finnish adults over the last decade.

Background: Due to vitamin D intake below recommendation (10 µg/day) and low (<50 nmol/l) serum 25-hydroxycholecalciferol (25(OH)D) concentration in Finnish population, the fortification of liquid dairy products with 0.5 µg vitamin D/100 g and fat spreads with 10 µg/100 g started in Finland in December 2002. In 2010, the fortification recommendation was doubled. The aim of this study was to investigate whether the vitamin D intake and status have improved among Finnish adults as a consequence of these nutrition policy actions. A further aim was to study the impact of vitamin supplement use to the total vitamin D intake. Methods: A cross-sectional survey was conducted every 5 years. The National FINDIET Survey was conducted in Finland as part of the National FINRISK health monitoring study. Dietary data were collected by using a computer-assisted 48-h dietary recall. In 2002, dietary data comprised 2007, in 2007, 1575 and 2012, 1295 working aged (25-64 years) Finns. Results: The mean D-vitamin intake increased from 5 µg/day to 17 µg/day in men and from 3 µg/day to 18 µg/day in women from 2002 to 2012. The most important food sources of vitamin D were milk products, fat spreads and fish dishes. The share of milk products was 39% among younger men and 38% among younger women, and 29% among older men and 28% among older women. Fat spreads covered on average 28% of vitamin D intake, except for younger men for which it covered 23%. Fish dishes provided 28% of vitamin D intake for older men and women, and approximately 18% for younger ones. In January-April 2012, the average serum 25-hydroxycholecalciferol (25(OH)D) concentration for men was 63 nmol/l for men and for women 67 nmol/l for women. Conclusions: The fortification of commonly used foods with vitamin D and vitamin D supplementation seems to be an efficient way to increase the vitamin D intake and the vitamin D status in the adult population.

From margarine to butter: predictors of changing bread spread in an 11-year population follow-up.

OBJECTIVE: Finland is known for a sharp decrease in the intake of saturated fat and cardiovascular mortality. Since 2000, however, the consumption of butter-containing spreads - an important source of saturated fats - has increased. We examined social and health-related predictors of the increase among Finnish men and women. DESIGN: An 11-year population follow-up. SETTING: A representative random sample of adult Finns, invited to a health survey in 2000. SUBJECTS: Altogether 5414 persons aged 30-64 years at baseline in 2000 were re-invited in 2011. Of men 1529 (59 %) and of women 1853 (66 %) answered the questions on bread spreads at both time points. Respondents reported the use of bread spreads by choosing one of the following alternatives: no fat, soft margarine, butter-vegetable oil mixture and butter, which were later categorized into margarine/no spread and butter/butter-vegetable oil mixture (= butter). The predictors included gender, age, marital status, education, employment status, place of residence, health behaviours, BMI and health. Multinomial regression models were fitted. RESULTS: Of the 2582 baseline margarine/no spread users, 24.6% shifted to butter. Only a few of the baseline sociodemographic or health-related determinants predicted the change. Finnish women were more likely to change to butter than men. Living with a spouse predicted the change among men. CONCLUSIONS: The change from margarine to butter between 2000 and 2011 seemed not to be a matter of compliance with official nutrition recommendations. Further longitudinal studies on social, behavioural and motivational predictors of dietary changes are needed.

School and workplace meals promote healthy food habits.

OBJECTIVE: The present study is to describe, on the basis of recent Finnish population surveys, (i) the frequencies of school and worksite canteen use, (ii) the determinants of having a hot lunch during school or working hours and (iii) the associations of lunch eating patterns with food habits. SETTING: The study summarises mainly basic reports and studies concerning catering services conducted in Finland based on nationally representative population surveys.Design and subjectsCross-sectional study. The most important surveys cited in this paper are the School Health Promotion Study, the Work and the Working Conditions survey, the National FINDIET 2002 Study, and the Health Behavior and Health among Finnish Adult Population survey. RESULTS: School lunch is eaten by on average 70-90 % of children aged 9-18 years. Of all employees, 30 % eat at a worksite canteen daily, whereas 30 % of men and 45 % of women eat packed lunches. Nationally representative cross-sectional population surveys show that the use of catering services is associated with more healthy food habits; schoolchildren eating school meals and employees eating lunch at a worksite canteen tend to make food choices closer to nutritional recommendations as compared to those not using catering services to the same degree. CONCLUSIONS: Some evidence exists that catering services in schools and worksites contribute to healthy eating habits in the population. In order to verify the positive role of catering services more scientific research with prospective and intervention design studies will be needed.

Can working conditions explain differences in eating patterns during working hours?

OBJECTIVE: The aim of this study was to examine whether there are associations between working conditions and the use of staff canteen or packed meals among Finnish employees. SETTING: Data were obtained from cross-sectional surveys on working conditions, conducted triennially (1997, 2000, 2003) since 1997. SUBJECTS: In each survey, the subjects were 25-64-year-old employed Finnish employees: 3096 men and 3273 women. RESULTS: Employees at large workplaces used canteens far more often than those at smaller workplaces. Working conditions played a different role in canteen use at small and large workplaces, as well as among the different sexes. At small workplaces, physically demanding jobs held by female employees and low job control encouraged employees to use the canteen. On the other hand, at large workplaces, low social support at work encouraged the use of canteens among men whereas high mental strain at work meant they used the canteen less. Among women, eating packed meals was not related to working conditions, but among men, low social support and high mental strain at work were associated with more frequent use of packed meals. CONCLUSIONS: The use of a staff canteen is largely determined by the size of the workplace and by employee education. The underlying factor could be the availability of canteens, a question which must be confirmed in further studies, since well-planned mass catering at workplaces has major effects on public health, well-being and the nutrition education of employees.

Liberal fortification of foods: the risks. A study relating to Finland.

STUDY OBJECTIVE: The free circulation of goods in the European Union (EU) has increased the number of fortified foods available to consumers in Finland. Fortification of foodstuffs with calcium is currently widespread. To assist decision making relating to fortification, the object of this study was to determine whether there might be a risk of excessive levels of calcium. The study was done using the dietary data of adult population by sex and calcium intake deciles, taking account of intakes of calcium from normal diets and from fortified foods. STUDY DESIGN: Calcium intakes for deciles were calculated from dietary data of the population involved in the 1992 FINDIET survey. Calcium fortification was evaluated by considering foodstuffs to which calcium has already been added or which producers might wish to fortify and market in Finland. Situations in which a fortified product replaced its unfortified equivalent were envisaged. Daily calcium intakes (mg) from particular foodstuffs were calculated based on known amounts of calcium (mg) per 100 g of each foodstuff and amounts of each product consumed per day. Total calcium intakes of people in different deciles were calculated by adding amounts of calcium contributed by each fortified product to normal dietary intakes. Calcium intakes were also calculated for consumption by persons of all foodstuffs that are or intended to be fortified with calcium. STUDY PARTICIPANTS: Adults aged 25 to 64 representing populations in four regions of Finland, who recorded food consumption over three day periods in spring 1992. STUDY SETTING: North Karelia, Kuopio Province, Turku-Loimaa, and the capital area Helsinki-Vantaa, Finland. MAIN STUDY RESULTS: The results indicate that the highest 10% of Finnish adult men receive on average 2315 mg calcium per day from diets that do not include fortified foodstuffs. These people whose energy consumption was high consumed substantial amounts of dairy products. Consumption of fortified foods would increase the calcium intake further to levels exceeding the tolerable upper intake level (2500 mg/d). CONCLUSIONS: Liberal addition of calcium to various groups of foodstuffs could increase the calcium intake in the highest decile to levels with potentially untoward health effects. In assessing benefits and possible disadvantages of fortification of foodstuffs, the dietary habits of the population concerned, probable consumption of fortified products and nutritional intakes, especially at extremes, need to be taken into account, by total risk assessment.