Environmental impact of Norwegian self-selected diets: comparing current intake with national dietary guidelines and EAT-Lancet targets.

OBJECTIVES: Dietary environmental impact in a Norwegian adult population was estimated for six environmental impact categories. Moreover, environmental benefits of scenario diets complying with the Norwegian Food-Based Dietary Guidelines (FBDG) and the EAT-Lancet reference diet were assessed. DESIGN: The current diet of Norwegian adults was estimated according to 24-h dietary recall data from a national dietary surveillance survey (Norkost 3). Scenario diets were modelled to represent the Norwegian FBDG and the EAT-Lancet healthy reference diet. Dietary environmental impact in terms of global warming potential, freshwater and marine eutrophication, terrestrial acidification, water use and transformation and use of land was estimated for the current and scenario diets using environmental impact data representative of the Norwegian market. Significant associations between impact and gender/educational attainment were assessed at P < 0·05. SETTING: Norway. PARTICIPANTS: Adults (n=1787) aged 18-70 years who participated in the Norkost 3 survey (2010-2011). RESULTS: Environmental impact varied significantly by gender and educational attainment. The food groups contributing most to environmental impact of Norwegian diets were meat, dairy, beverages, grains and composite dishes. Compared with the current Norwegian diet, the FBDG scenario reduced impacts from 2 % (freshwater eutrophication) to 32 % (water use), while the EAT-Lancet scenario reduced impacts from 7 % (marine eutrophication) to 61 % (land use). The EAT-Lancet scenario resulted in 3-48 % larger reductions in impact than the FBDG scenario. CONCLUSIONS: The Norwegian FBDG, while not as environmentally friendly as the EAT-Lancet reference diet, can still be an important tool in lessening environmental burden of Norwegian diets.

Effects of a kindergarten intervention on vegetables served and staff's food-related practices: results of a cluster randomised controlled trial - the BRA study.

OBJECTIVE: The aim of the current study was to evaluate the effect on frequency, variety and amount of vegetables served and staff's food-related practices in the multicomponent BRA intervention. DESIGN: Cluster randomised controlled trial, conducted between Spring 2015 and Spring 2016. For allocation of the kindergartens, a stratified block randomisation was used. Data were collected in three ways: (i) a questionnaire for pedagogical leaders assessing the variety and frequency of vegetables served, including staff's food-related practices assumed to be related to vegetable intake; (ii) a questionnaire for kindergarten assistants assessing staff's food-related practices; (iii) a 5-d weighted vegetable diary assessing amount of vegetables served in a department. SETTING: The target group for this study was public and private kindergartens in the counties of Vestfold and Buskerud, Norway. PARTICIPANTS: A total of seventy-three kindergartens participated. RESULTS: At follow-up I, the amount of vegetables served increased by approximately 20 g per person per day (P = 0·002), and the variety in served vegetables increased by one-and-a-half kind per month (P = 0·014) in the intervention group compared to the control group. No effects on the frequency of vegetables served or on staff's food-related practices were found. CONCLUSIONS: The BRA intervention was successful in increasing the amount and variety of vegetables served within intervention kindergartens. Further research is needed to understand the mechanisms that can affect the staff's food-related practices.

Effects of a cluster randomized controlled kindergarten-based intervention trial on vegetable consumption among Norwegian 3-5-year-olds: the BRA-study.

BACKGROUND: Early childhood represents a critical period for the establishment of long-lasting healthy dietary habits. Limited knowledge exists on how to successfully increase vegetable consumption among preschool children. The overall aim of the present study was to improve vegetable intake among preschool children in a kindergarten-based randomized controlled trial. METHODS: The target group was preschool children born in 2010 and 2011, attending public or private kindergartens in two counties in Norway. Data about child intake of vegetables were collected by three methods. First, parents filled in a web-based questionnaire of the child's vegetable intake. Second, among a subsample, trained researchers observed children's vegetable intake in the kindergarten. Thirdly, a parental web-based 24-h recall assessing the child's vegetable intake was filled in. For allocation of kindergartens to intervention and control groups, a stratified block randomization was used. Multiple intervention components were implemented from September 2015 to February 2016 and components focused at influencing the four determinants availability, accessibility, encouragement and role modelling. The effect of the intervention from baseline (spring 2015) to follow-up 1 (spring 2016) was assessed by mixed-model analysis taking the clustering effect of kindergartens into account. RESULTS: Parental consent was obtained for 38.8% of the children (633 out of 1631 eligible children). Based on the observational data in the kindergarten setting (n 218 in the control group and n 217 in the intervention group), a tendency to a small positive effect was seen as a mean difference of 13.3 g vegetables/day (95% CI: - 0.2, 26.9) (P = 0.054) was observed. No significant overall effects were found for the total daily vegetable intake or for the parental reported frequency or variety in vegetable intake. CONCLUSIONS: Based on the observational data in the kindergarten setting, a tendency to a small positive effect was seen with a mean difference of about 13 g vegetables/day, while no other effects on child vegetable intake were found. Additionally, further research to understand the best strategies to involve parents in dietary interventions studies is warranted. TRIAL REGISTRATION: International Standard Randomised Controlled Trials ISRCTN51962956 . Registered 21 June 2016 (retrospectively registered).

A systematic review of methods to assess intake of saturated fat (SF) among healthy European adults and children: a DEDIPAC (Determinants of Diet and Physical Activity) study.

BACKGROUND: Dietary fat is an essential macronutrient. However, saturated fact has been associated with negative health outcomes including cardiovascular disease. Shifting consumption from saturated fat to unsaturated fats and limiting the level of saturated fat in the diet has been recommended. Currently, there is no standard method to measure saturated fat intake in etiologic studies. Therefore, it is difficult to obtain a reliable picture of saturated fat intake in Europe. To inform the development of the DEDIPAC (DEterminants of DIet and Physical Activity) toolbox of methods, we aimed to identify the assessment methods and specific instruments which have been used to assess saturated fat intake among children or adults in pan-European studies. METHODS: Three electronic databases were searched for English language studies of any design which assessed intake of saturated fat. Reference lists were hand-searched. Studies were included if they were conducted in two or more European countries, and involved healthy, free-living children and adults. RESULTS: The review identified 20 pan-European studies which assessed saturated fat intake. Food Frequency Questionnaires (n = 8) and diet records (n = 7) were most common, followed by 24-h recalls (n = 5). Methods differed in portion size estimation and the composition data which was used to calculate nutrient intake. Of the instruments used in more than two European countries, five Food Frequency Questionnaires had been specifically tested for validity to assess saturated fat intake; four among adults (Food4me, PURE, IMMIDIET, Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE)) and one among children (used by Piqueras et al.). CONCLUSIONS: A standardised approach to portion size estimation and a common source of food composition data are required to measure saturated fat intake across Europe effectively. Only five instruments had been used in more than two European countries and specifically tested for validity to assess saturated fat intake. These instruments may be most appropriate to evaluate intake of saturated fat in future pan-European studies. However, only two instruments had been tested for validity in more than one European country. Future work is needed to assess the validity of the identified instruments across European countries.

Associations between sociocultural home environmental factors and vegetable consumption among Norwegian 3-5-year olds: BRA-study.

The home environment is the first environment to shape childhood dietary habits and food preferences, hence greater understanding of home environmental factors associated with vegetable consumption among young children is needed. The objective has been to examine questionnaire items developed to measure the sociocultural home environment of children focusing on vegetables and to assess the psychometric properties of the resulting factors. Further, to explore associations between the environmental factors and vegetable consumption among Norwegian 3-5 year olds. Parents (n 633) were invited to participate and filled in a questionnaire assessing the child's vegetable intake and factors potentially influencing this, along with a 24-h recall of their child's fruit and vegetable intake. Children's fruit and vegetable intakes at two meals in one day in the kindergarten were observed by researchers. Principal components analysis was used to examine items assessing the sociocultural home environment. Encouragement items resulted in factors labelled "reactive encouragement", "child involvement" and "reward". Modelling items resulted in the factors labelled "active role model" and "practical role model". Items assessing negative parental attitudes resulted in the factor labelled "negative parental attitudes" and items assessing family pressure/demand resulted in the factor labelled "family demand". The psychometric properties of the factors were for most satisfactory. Linear regression of the associations between vegetable intake and the factors showed, as expected, generally positive associations with "child involvement", "practical role model" and "family demand", and negative associations with "negative parental attitudes" and "reward". Unexpectedly, "reactive encouragement" was negatively associated with vegetable consumption. In conclusion, associations between sociocultural home environmental factors and children's vegetable consumption showed both expected and unexpected associations some of which differed by maternal education - pointing to a need for further comparable studies.

Validation of energy intake from a web-based food recall for children and adolescents.

The purpose of this study was to validate estimated energy intake from a web-based food recall, designed for children and adolescents. We directly compared energy intake to estimates of total energy expenditure, calculated from accelerometer outputs, combined with data on weight and sex or resting energy expenditure prediction equations. Children (8-9 years) and adolescents (12-14 years) were recruited through schools in Norway in 2013 (N = 253). Results showed that more than one third (36-37%) were identified as under-reporters of energy. In contrast, only 2-4% were defined as over-reporters of energy. The mean energy intake was under-reported with -1.83 MJ/day for the entire study sample. Increased underestimation was observed for overweight and obese participants, the oldest age group (12-14 years), boys, those with parents/legal guardians with low educational level and those living in non-traditional families. In conclusion, energy intake from the web-based food recall is significantly underestimated compared with total energy expenditure, and should be used with caution in young people.

Effect of changes in a food frequency questionnaire: comparing data from two national dietary survey instruments among 12-month-old infants.

BACKGROUND: National dietary surveys among Norwegian 12-months olds have been conducted twice: in 1999 and 2007. At both time-points diet were assessed by a semi-quantitative food frequency questionnaire (SFFQ) (the SFFQ-1999 and the SFFQ-2007). Modifications in the SFFQ-2007 compared to the SFFQ-1999 have been made; therefore, the objective of the present study has been to explore the comparability of the data obtained by the two questionnaires. Moreover, reliability of maternal recall of infant feeding practices was assessed. METHODS: Three hundred Norwegian infants born in April 2007 were invited to participate by completing both the SFFQ-1999 and the SFFQ-2007. An invitation letter and one of two questionnaires were sent by mail to the mother/parents about two weeks before the child turned 12 months of age. The study had a cross-over design where half of the sample received the SFFQ-1999 first and then about 2-3 weeks later they received the SFFQ-2007. The second half received the SFFQ-2007 first, and then 2-3 weeks later they received the SFFQ-1999. RESULTS: Ninety three participants completed both questionnaires (SFFQ-1999 and SFFQ-2007). For nutrients, the largest significant differences between the questionnaires were found for intake of vitamin D and added sugar, where added sugar was reported lower and vitamin D was reported higher with the SFFQ-2007 compared to the SFFQ-1999. For food items, lower intake of yoghurt and higher intake of vegetables and fish were observed with the SFFQ-2007 compared to the SFFQ-1999. In addition, reliable answers with regard to breastfeeding status, age for breastfeeding cessation and age for introducing solid foods were found. CONCLUSION: There was reasonable comparability between the two questionnaires for most nutrients and foods. The differences between the two questionnaires could mainly be explained by modifications that had occurred over time, where changes in the food composition databases used and especially changes in commercial recipes with regard to baby food products seemed to be of major importance. The differences are important to take into account when interpreting dietary trends among Norwegian 12 month-olds in the period from 1999 to 2007. This study also implies that maternal recall of infant feeding practices is reliable.

Maternal pre-pregnant body mass index, maternal weight change and offspring birthweight.

OBJECTIVE: To estimate the association between maternal pre-pregnant body mass index (BMI) and maternal weight change during pregnancy and offspring birthweight using the BMI classification developed by World Health Organization (WHO) and adopted by the Institute of Medicine (IOM) in 2009. DESIGN: The Norwegian Mother and Child Cohort Study (MoBa) is a population-based pregnancy cohort study conducted by The Norwegian Institute of Public Health. SETTING: Women were recruited from all geographic areas of Norway. POPULATION: The study includes 58,383 pregnant women. METHODS: Women were enrolled in 2000-2007 by a postal invitation offered to women in Norway at 17-18 weeks of gestation. Linear regression analyses are based on exposure data from two questionnaires during pregnancy and on birthweight data. MAIN OUTCOME MEASURES: Birthweight. RESULTS: Mean pre-pregnancy BMI was 24kg/m(2) (SD 4.3), mean maternal weight change in the first 30 weeks of gestation was 9.3kg (SD 4.4), mean birthweight was 3675g (SD 487) and mean age 30.3 years. Of the women, 65.2% had a normal pre-pregnancy weight, 2.9% were underweight, 22.3% overweight, and 9.5% obese (Classes 1-3). Linear regression analyses adjusted for potential confounders showed that offspring birthweight increased with increasing maternal pre-pregnant BMI, and with increasing maternal weight gain during pregnancy in all six categories of pre-pregnancy BMI. Women with the highest level of education had the highest offspring birthweight. CONCLUSION: Offspring birthweight increased with both increasing maternal pre-pregnant BMI and maternal weight gain during pregnancy in all six categories of maternal pre-pregnancy BMI.

The process of setting micronutrient recommendations: a cross-European comparison of nutrition-related scientific advisory bodies.

OBJECTIVE: To examine the workings of the nutrition-related scientific advisory bodies in Europe, paying particular attention to the internal and external contexts within which they operate. DESIGN: Desk research based on two data collection strategies: a questionnaire completed by key informants in the field of micronutrient recommendations and a case study that focused on mandatory folic acid (FA) fortification. SETTING: Questionnaire-based data were collected across thirty-five European countries. The FA fortification case study was conducted in the UK, Norway, Denmark, Germany, Spain, Czech Republic and Hungary. RESULTS: Varied bodies are responsible for setting micronutrient recommendations, each with different statutory and legal models of operation. Transparency is highest where there are standing scientific advisory committees (SAC). Where the standing SAC is created, the range of expertise and the terms of reference for the SAC are determined by the government. Where there is no dedicated SAC, the impetus for the development of micronutrient recommendations and the associated policies comes from interested specialists in the area. This is typically linked with an ad hoc selection of a problem area to consider, lack of openness and transparency in the decisions and over-reliance on international recommendations. CONCLUSIONS: Even when there is consensus about the science behind micronutrient recommendations, there is a range of other influences that will affect decisions about the policy approaches to nutrition-related public health. This indicates the need to document the evidence that is drawn upon in the decisions about nutrition policy related to micronutrient intake.

How dietary intake methodology is adapted for use in European immigrant population groups - a review.

Immigrants comprise a noteworthy segment of the European population whose numbers are increasing. Research on the dietary habits of immigrants is critical for correctly providing diet counselling and implementing effective interventions. The aim of the present study was to identify the presently used methods and adaptations required for measuring dietary intake in European immigrant groups. A comprehensive review strategy included a structured MEDLINE search, related references and key expert consultations. The review targeted adults from non-European union (European union-15 countries) ethnic groups having the largest populations in Europe. As studies evaluating nutrient intake were scarce, papers evaluating intake at the level of foods were included. Forty-six papers were selected. Although Eastern Europe, Turkey, Africa (North, Sub-Saharan and Afro-Caribbean), Asia and Latin America represented the most numerous immigrant groups, papers on dietary intake were not available for all populations. Interview-administered FFQ and repeated 24 hour recalls were the most frequently applied instruments. Inclusion of ethnic foods and quantification of specific portion sizes of traditional foods and dishes in assessment tools as well as food composition databases were commonly identified problems. For FFQ, food list elaboration required particular consideration to reflect key ethnic foods and relative contribution to nutrient intake. Extra efforts were observed to overcome cultural barriers to study participation. Evaluating dietary intake of immigrant populations requires special attention to various methodological aspects (sampling, recruiting, instruments used, method of administration, food composition database, acculturation, etc.) so as to adequately address the range of socio-cultural factors inherent in these nutritionally at risk target groups.

Evaluating the quality of dietary intake validation studies.

Within the EURopean micronutrient RECommendations Aligned Network of Excellence (EURRECA), a scoring system was developed to assess the quality of dietary intake validation studies. The scoring system included three steps. The first step was to give each study a quality score, which included five components: sample size, statistics used, data collection procedure, consideration of seasonality and supplement use. Scores ranged from 0 to 7, and validation studies classified as very good ( > or = 5), good (5-3.5), acceptable/reasonable (3.5-2.5) and poor ( < 2.5). The second and third steps included an adjustment/weighting of the correlation coefficient according to the quality score and moreover a rating of the adjusted/weighted correlation. The scoring system was tested in 124 validation studies that included at least one vitamin. Only 5.6 % of the 124 studies were judged to be of very good quality according to the quality score, 41.9 % of good quality and 16.9 % had a poor rating. When adjusting for the study quality scores, crude and adjusted mean correlations of vitamins A, C, D and E intakes were similar, but the percentage of correlation values classified as poor or very good was higher after adjustment. These results show the importance of considering the quality of studies validating dietary assessment methods and the correlations obtained for the micronutrient of interest when interpreting effects observed in epidemiological studies using dietary assessment methods. Without a doubt, this subject constitutes a key topic for research in nutritional epidemiology.

Validity and reproducibility of a precoded questionnaire to assess fruit and vegetable intake in European 11- to 12-year-old schoolchildren.

BACKGROUND/AIMS: Validity and reproducibility were evaluated of a new questionnaire to assess fruit and vegetable intakes in 11- to 12-year-old children. METHODS: The precoded teacher-assisted self-administered questionnaire included two sections: a 24-hour recall part and a food frequency part. Validity was tested in 4 countries (Denmark, Iceland, Norway, Portugal; n = 43-60 per country) using a 1-day weighed food record and 7-day food records as reference methods. Test-retest (7-12 days apart) reproducibility was assessed in 6 countries (Belgium, Denmark, Iceland, Norway, Portugal, Spain; n = 60-74 per country). RESULTS: Spearman rank correlations for fruit and vegetable intake according to the frequency part and the 7-day food record ranged between r = 0.40-0.53. Between 25-50% were classified into the same quartile and 70-88% into the same or adjacent quartile. Test-retest Spearman rank correlations for the food frequency part were r = 0.47-0.84. Three countries showed no significant difference between fruit intake as assessed with the 24-hour recall part and the 1-day weighed food record, and 2 countries showed no significant difference for vegetables. In the other countries, the 24-hour recall part resulted in substantially higher mean intake levels. CONCLUSION: Validity and reproducibility as to ranking of subjects were regarded to be satisfactory in all countries. Group mean intake, based on the original 24-hour part, was valid for fruit in 3 countries and for vegetables in 2 countries, and this part was subsequently adjusted to avoid overestimation, before the questionnaire was used in the Pro Children study.