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The European Food Safety Authority has suggested that EU countries implement the 2 × 24 h diet recall (2 × 24 h DR) method and physical activity (PA) measurements for national dietary surveys. Since 2000, Denmark has used 7 d food diaries (7 d FD) with PA questionnaires and measurements. The accuracy of the reported energy intakes (EI) from the two diet methods, pedometer-determined step counts and self-reported time spent in moderate-to-vigorous PA (MVPA) were compared with total energy expenditure measured by the doubly labelled water (TEEDLW) technique and with PA energy expenditure (PAEE), respectively. The study involved fifty-two male and sixty-eight female volunteers aged 18–60 years who were randomly assigned to start with either the 24 h DR or the web-based 7 d FD, and wore a pedometer for the first 7 d and filled in a step diary. The mean TEEDLW (11·5 MJ/d) was greater than the mean reported EI for the 7 d FD (9·5 MJ/d (P < 0·01)) but the same as the 2 × 24 h DR (11·5 MJ/d). The proportion of under-reporters was 34 % (7 d FD) and 4 % (2 × 24 h DR). Most participants preferred the 7 d DR as it was more flexible, despite altering their eating habits. Pearson’s correlation between steps corrected for cycling and PAEE was r = 0·44, P < 0·01. Spearman’s correlation for self-reported hours spent in MVPA and PAEE was r = 0·58, P < 0·01. The 2 × 24 h DR performs better than the existing 7 d FD method. Pedometer-determined steps and self-reported MVPA are good predictors of PAEE in adult Danes.

Purpose Dietary supplement use is common in Northern Europe. Many dietary supplements contain 100% of nutrient reference values (NRV) of micronutrients. This study investigates the contribution of dietary supplements to micronutrient intake, the prevalence of excess intake of micronutrients, and parental characteristics of dietary supplement use in Danish children. Methods Data on 499 4–10-year-old children from the Danish National Survey of Diet and Physical Activity 2011–2013 were analysed using non-parametric statistics to compare micronutrient intake from the diet and dietary supplements to the reference intake (RI), and to the tolerable Upper Intake Level (UL) for users and non-users of dietary supplements. Furthermore, characteristics of the parents of users and non-users of dietary supplements were examined by logistic regression analysis. Results Sixty-four percent of the children were dietary supplement users. Multivitamin-mineral supplements were the most frequently used type of supplement (60%). Children of never-smokers were more likely to use supplements than children of smokers. Users had significantly higher total intakes of 15 micronutrients compared to non-users. Intakes of vitamin A, zinc, and iodine from the diet alone exceeded ULs in 12–30% of the children. Use of dietary supplements gave rise to 21–73% of children in exceedance of the aforementioned three ULs as well as the UL for iron (6–45%). Conclusion Dietary supplement use was common among 4–10-year-old Danish children and resulted in a considerable proportion of users exceeding the ULs for vitamin A, zinc, iodine, and iron. The long-term health consequences of exceeding these ULs for children are unknown.

Bettina Ewers,1 Mette Rosenlund Sørensen,2 Sisse Fagt,2 Lars J Diaz,1 Tina Vilsbøll1,3 1Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark; 2The National Food Institute, Technical University of Denmark, Søborg, Denmark; 3Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, DenmarkCorrespondence: Bettina EwersClinical Research, Steno Diabetes Center Copenhagen, Niels Steensens Vej 2, Gentofte, DK-2820, DenmarkTel +45 3091 2997Email bettina.ewers@regionh.dkPurpose: Intention and perceptions of healthy eating may affect diet-related behavior. We assessed the intention and perceptions of eating healthily in patients with type 1 (T1D) and type 2 diabetes (T2D) compared with the general population. Secondly, differences in diet quality were assessed in patients with diabetes perceiving their dietary habits as more or less healthy.Materials and Methods: This cross-sectional study included data on socioeconomic status, dietary intake, and questions on healthy eating from adults with T1D (n=426), T2D (n=348) and from the general population (n=2899).Results: Patients with T2D were less likely to perceive their dietary habits as healthy compared with T1D and the general population. Patients with T1D or T2D perceiving their dietary habits as healthy reported higher intake of vegetables, fruit, fish, fibre and protein. In addition, patients with T1D with perceived healthy versus less healthy dietary habits had lower sugar intake and higher alcohol intake. Overall, adherence to dietary guidelines in patients with T1D and T2D was too low both in self-perceived healthy and less healthy eaters. In comparison with T1D patients, patients with T2D were less likely and the general population was more likely to strive to eat a healthy diet.Conclusion: Patients with T2D had poorer self-perception of their dietary healthiness and less intention of eating healthily, compared with patients with T1D and the general population. Actual diet quality was higher amongst patients with T1D and T2D perceiving their dietary habits as healthy than those perceiving their dietary habits as less healthy. But inadequate intakes were found in all groups. Health care providers should address and explore the patient’s intention and perceptions of healthy eating when discussing dietary changes in diabetes to improve nutritional support.Keywords: diabetes, dietary adherence, dietary intake, nutrition

The exposure to selected chemical contaminants from fish has been calculated for the Danish population, both for adults (15–75 years of age) and children (4–14 years of age). The Danish mean consumption of fish is 21 g person−1 day−1 for adults and 12 g person−1 day−1 for children. Fish consumption is the main food group contributor for exposure to mercury and dioxins and dioxin-like polychlorinated biphenyls (PCDD/F and DL-PCB) for the Danish population. Comparison of the mean exposure with the TDI or TWI values shows for these substances as well as for perfluorooctane sulphuric acid (PFOS) that the exposure is below the TDI/TWI values. However, even without taking other food groups into account, PCDD/Fs and DL-PCB exposure is close to the actual TWI-value. Calculation of the Margin of Exposure (MOE) for the sum of hexabromocyclododecanes (HBCDD) and polycyclic aromatic hydrocarbons (PAHs) revealed fish consumption to be of low concern for the consumer health regarding these contaminants.

The cumulative chronic dietary exposure for the Danish population were assessed using Danish food monitoring data for the period 2012–2017 and Danish food consumption data for the consumer groups children (age 1–2, age 4–6 and age 7–14 years), adults age 15–75, high consumers and consumers eating Danish produced fruit and vegetables whenever possible. Levels below the Limit of Reporting (LOR) were set to ½ LOR with correction. For risk assessment of the cumulative chronic dietary exposure we used the Hazard Index (HI) method where the Hazard Quotient (HQ) was calculated for each pesticide and summed up to a HI. The HI was calculated to be below 1 for all consumer groups; i.e. 0.36 for children age 4–6 years and 0.13 for adults, indicating that the cumulative chronic dietary pesticide exposure is unlikely to constitute a health risk for Danish consumers, even for high consumers eating 600 g or more of fruit and vegetables each day. By eating Danish produced commodities whenever possible, the HI was reduced by a factor of one third for both children and adults. 25 different commodities contributed to about 90% of the HI and to 84% of the exposure.

Background: The intake of plant-based foods is currently increasing in the Nordic countries and many of these products are based on soy. For example, soy-based products with appearances close to minced meat are marketed as substitutes for meat, and many soy-based milk alternatives are replacing cow’s milk. The rising interest in such products can partly be attributed to an increasing number of persons identifying themselves as vegetarians or vegans. An increased intake of soy-based products as replacements of milk and meat may be beneficial to health, but there is also a concern for adverse health effects in certain population groups. The natural content of estrogen-like substances (e.g. isoflavones) in soy gives rise to concern for endocrine disrupting effects in children and unborn children (i.e. pregnant women). Aims: The aims of this project were to: 1) Explore available data on soy intake,2) Propose intake scenarios for children and pregnant women from the Nordic countries with high intake of soy products,3) Estimate the nutritional impact of substituting conventional products of animal origin with soy products and4) Clarify whether health-based guidance values (HBGVs) can be determined for isoflavones for children and women of childbearing age. Methods: A dietary exposure scenario with substantial substitution of animal products with soy-based products in the diet of Danish women (age 18-45 years) and children (age 4-10 years) was established for the exploration of effects of soy-based products on dietary intake and nutrition. The basis of these calculations was the Danish National Survey of Diet and Physical Activity 2011-2013 (DANSDA); a nationwide, cross-sectional survey assessing diet and physical activity of the Danish population. In addition, dietary exposure to isoflavones from such a substantial soy-substituted diet was estimated based on recently published data on isoflavone content in different foods. A literature search including five different databases for the investigation of animal and human studies relevant for a risk assessment of isoflavones (genistein, daidzein and glycitein) was performed. Results: In the scenario of a substantial soy-substituted diet the intake of soy was higher in children than in women, due to higher intake of milk products among children. Approximately 60% of the intake of soy was derived from substituted dairy products (milk and cream products). Only minor changes occurred in the intake of energy, protein, carbohydrates and fats among women and children, while the intake of various micronutrients changed by this substitution. Intake of vitamin A, riboflavin and vitamin B12 was reduced 20% or more among both women and children, while the intake of vitamin E increased more than 20% among women and children. Among children, the intake of calcium and iodine decreased 20% or more, while the intake of magnesium increased. This does, however, not change the degree of fulfilling recommended intake levels of micronutrients, as the intake was near or above recommended intake both with and without substitution for most substances, except for vitamin D and iron, which was low regardless of substitution or not. In this scenario with substantial soy substitution, the estimated genistein exposure ranged between 0.04-0.06 mg/kg bw per day for women, 0.09-0.2 mg/kg bw per day for girls and 0.1-0.2 mg/kg bw per day for boys. The estimated daidzein exposure was similar to the genistein exposure, while estimated glycitein exposure was considerably lower for all groups. The total estimated isoflavone exposure (sum of genistein, daidzein and glycitein) ranged between 0.05-0.1 mg/kg bw per day for women, 0.1-0.3 mg/kg bw per day for girls and 0.2-0.4 mg/kg bw per day for boys. A total of 6,304 references were identified in the literature search for human and experimental animal toxicity data on soy and soy constituents. After assessment for relevance, five animal studies, 23 human studies and three review papers were included in the hazard identification and characterization. Among the human studies four major endpoints were identified, i.e., timing of puberty, breast cancer, hypospadias and thyroid function. These endpoints were also identified among the animal studies with the addition of fertility and markers of impaired reproductive development. Among the four included endpoints, no critical effect of isoflavones on children or pregnant women (unborn children) in the human studies was identified. Two animal studies were considered suitable for deriving an HGBV for genistein exposure of children and pregnant women. Results from a multi-generational study in rats were thus used for HBGV derivation for genistein exposure of pregnant women (0.09 mg/kg bw per day corresponding to 6.3 mg per day for a person weighing 70 kg). A study on post-weaning exposure of mice was used for HBGV derivation of genistein for exposure of children (0.07 mg/kg bw per day corresponding to 2.1 mg per day for a child weighing 30 kg). The critical effects for both HBGVs were timing of puberty and early mammary development. Conclusions: It was possible to address all aims of the project: The available data on soy intake among the general population in Denmark was explored by analysing data from the dietary survey and conducting research regarding available soy-based products on the Danish market.Intake of soy in women and children with high intake of soy was estimated in scenarios using substitution of foods that realistically could be substituted by soy-containing products. The results showed that intake of soy is higher in children than in women, due to higher intake of milk products among children.No adverse nutritious impacts on either macro- or micronutrients were identified when substituting animal-based products with soy-based varieties.An HGBV could be determined for genistein for children and pregnant women. Based on estimated intake of genistein from a substantial soy-substituted diet there is no concern for pregnant women (unborn children). On the other hand, for girls and boys (age 4-10 years), the HGBV for genistein is slightly exceeded after intake of a soy-substituted diet, indicating a potential health concern for children eating a substantial soy-substituted diet.

Individuals may perceive personalised dietary advice as more relevant and motivational than national guidelines. Personal preference and food cost are factors that can affect consumer decisions. The objective of this study was to present a method for modelling and analysing the trade-off between deviation from preference and food cost for optimised personalised dietary recommendations. Quadratic programming was applied to minimise deviation from fish preference and cost simultaneously with different weights on the cost for 3016 Danish adults (whose dietary intake and body weight were recorded in a national dietary survey). Model constraints included recommendations for EPA, DHA and vitamin D and tolerable levels for methyl mercury, dioxins and dioxin-like polychlorinated biphenyls. When only minimising deviation from preference, 50 % of the study population should be recommended to increase fish intake, 48 % should be suggested to maintain current consumption and 2 % should be suggested to decrease fish consumption. When only minimising cost, the vast majority (99 %) should be recommended to only consume herring, which is the least-expensive fish species. By minimising deviation from preference and cost simultaneously with different weights on the cost, personalised optimal trade-off curves between deviation from fish intake preference and fish cost could be generated for each individual in our study population, except for twenty-two individuals (0·7 %) whose contaminant background exposure was too high. In the future, the method of this paper could be applied in the personal communication of healthy and safe food recommendations that fit the preferences of individual consumers.

Exposure to chemical contaminants found in foods has been associated with diverse adverse health effects. The aim of this study was to estimate the burden of disease associated with dietary exposure to four chemicals in Denmark in 2019: lead (Pb), cadmium (Cd), methylmercury (MeHg) and inorganic arsenic (i-As). We collected national food consumption and chemical food monitoring data from Danish data bases, dose-response and severity data from the scientific literature, and disease incidence and population numbers from national statistics. We adopted a risk assessment approach to estimate disease burden, quantifying the incidence, mortality and Disability-Adjusted Life Years (DALYs) attributable to dietary exposure to the chemicals. In all models, we propagated uncertainty around the input parameters through the calculations using Monte Carlo simulation. We estimated that, among these chemicals, Pb and MeHg were responsible for the highest disease burden. MeHg led to the loss of nearly 600 healthy life years, or approximately 10 DALYs per 100,000 inhabitants. Dietary exposure to Pb was estimated to cause 383 to 1,261 DALYs, corresponding to 6.6 (lower bound) to 22 (upper bound) DALYs/100,000 per year. The foods contributing most to disease burden were fish (MeHg) and sweets, fruit, and bread and cereals (Pb). The burden attributed to dietary exposure to i-As (5 DALYs) and Cd (0.04 DALY) was substantially lower. These estimates are useful supplements to traditional risk assessment to guide food safety interventions and inform dietary guidelines for different population groups.

A Nordic working group was established in 2007 with the aim to describe a future Nordic Monitoring System on diet, physical activity and overweight. The system was validated in 2009 and in 2011 and 2014, the first data collections took place. The Nordic Monitoring Group has discussed future developments of the monitoring system based on experience from the first two data collections. The Nordic Monitoring Group has described how results from the monitoring have been communicated and used for several purposes. The current Nordic working paper sums up the deliveries from the Nordic Monitoring System and points forward to a new data collection.

Diets consisting of high amounts of animal-based protein have been associated with adverse public health effects and are often deemed environmentally unsustainable. Therefore, replacing red meat by pulses has been proposed to reduce the adverse impact on human health and environment. However, unprocessed red meat is an important source of nutrients, such as vitamin B12, iron, zinc and selenium, and the substitution may have negative impact on nutrient adequacy. Using a risk-benefit assessment (RBA) approach, we, therefore, estimated the health impact of substituting unprocessed red meat by pulses on the burden of non-communicable diseases in Denmark, using Disability-Adjusted Life Years (DALY). Furthermore, we assessed the impact of the substitution on nutrient adequacy. We found that 187 (95% UI: 209; 168) healthy years of life could be gained per 100,000 individuals per year by substituting 100% of unprocessed red meat by pulses in the Danish diet. We found a decrease in the intake of vitamin B12, zinc and selenium due to the substitution. An additional 10% of the Danish population will become at risk of vitamin B12 and selenium inadequacy, and an additional 20% will be at risk of zinc inadequacy due to the substitution. For iron, a small decrease in the proportion at risk of inadequacy was found. Substitution of unprocessed red meat by pulses was estimated to provide a beneficial health impact on the burden of non-communicable disease, expressed in DALY. Additionally, it was found that the complete substitution will lead to a higher risk of nutrient inadequacies.

Background Humans are exposed to heavy metals from certain foods, thus specific dietary patterns may lead to high burden of disease (BoD). By identifying diet, lifestyle and socio-demographic characteristics of population groups with highest BoD, targeted preventive strategies can be developed. We aimed at identifying clusters and characteristics of Danish individuals with highest BoD due to food exposure to three heavy metals: methylmercury (MeHg), cadmium and inorganic arsenic. Methods We collected diet, lifestyle and socio-demographic information of 3,946 individuals in the Danish National Survey of Diet and Physical Activity. Occurrence of heavy metals in food was obtained from Danish food monitoring. We applied machine learning self-organizing maps to group individuals according to similarities in diet, lifestyle and socio-demographics, and estimated BoD due to metal exposure in terms of Disease-Adjusted Life Years (DALY). We will present calculation steps of our approach in a tutorial-like way and demonstrate its applicability to other cases. Results We identified 13 population subgroups with distinct dietary and lifestyle characteristics. The estimated BoD varied largely between subgroups, with five subgroups experiencing a BoD > 10 DALY/100,000. The cluster bearing the highest BoD (26.2 (95% uncertainty interval (UI): 10.3, 50.6) DALY/100,000) was significantly different from the cluster with the lowest BoD (5.1 (95% UI: 2.5, 9.2) DALY/100,000) (preliminary). BoD was higher in subgroups with diet and lifestyle considered healthy. Most of the BoD was due to MeHg, particularly in female-dominant subgroups. Conclusions Linking machine learning, exposure assessment and burden of disease metrics, this novel approach identified population subgroups with higher BoD due to exposure to three heavy metals. It can be expanded to estimate BoD of other chemicals, and used to develop targeted preventive strategies to reduce BoD in more affected subgroups.

This study shows that dietary habits have an impact on contaminant exposures. A tool was developed to calculate chemical exposures for different Danish population groups. First, the tool divided the individuals into quartiles using a previously developed scoring system for how well their diet complies with the Danish dietary guidelines. Then the exposure was calculated for several contaminants for both children and adults within the quartiles. Comparisons were then performed between the exposures for the lowest and highest quartiles. The individuals having a diet more in compliance with the dietary guidelines have a higher exposure to contaminants than individuals having a diet less in compliance with the dietary guidelines. Standard deviations for the mean exposure were in general large indicating that the consumption patterns can be very different within each population group. A risk characterisation for each contaminant and population group was performed by calculation of Hazard Quotients (HQs). For dioxins and dioxin-like polychlorinated biphenyls (PCDD/F + DL-PCBs), inorganic arsenic, and lead all HQs were above 1 indicating a potential risk for all groups. For hexabromocyclododecane (HBCDD) and nickel, a potential risk was identified for at least one group. For all other contaminants the HQs were well below 1 for all groups.

Lifestyle and sociodemographics are likely to influence dietary patterns, and, as a result, human exposure to chemical contaminants in foods and their associated health impact. We aimed to characterize subgroups of the Danish population based on diet and sociodemographic indicators, and identify those bearing a higher disease burden due to exposure to methylmercury (MeHg), cadmium (Cd) and inorganic arsenic (i-As). We collected dietary, lifestyle, and sociodemographic data on the occurrence of chemical contaminants in foods from Danish surveys. We grouped participants according to similarities in diet, lifestyle, and sociodemographics using Self-Organizing Maps (SOM), and estimated disease burden in disability-adjusted life years (DALY). SOM clustering resulted in 12 population groups with distinct characteristics. Exposure to contaminants varied between clusters and was largely driven by intake of fish, seafood and cereal products. Five clusters had an estimated annual burden >20 DALY/100,000. The cluster with the highest burden had a high proportion of women of childbearing age, with most of the burden attributed to MeHg. Individuals belonging to the top three clusters had higher education and physical activity, were mainly non-smokers and lived in urban areas. Our findings may facilitate the development of preventive strategies targeted to the most affected subgroups.

Breakfast is often referred to as the most important meal of the day and in recent years has been implicated in weight control, cardio-metabolic risk factors and cognitive performance although, at present, the literature remains inconclusive as to the precise health benefits of breakfast. There are extensive reports of breakfast’s contributions to daily food and nutrient intakes, as well as many studies that have compared daily food and nutrient intakes by breakfast consumers and skippers. However, significant variation exists in the definitions of breakfast and breakfast skippers, and in methods used to relate breakfast nutrient intakes to overall diet quality. The present review describes a novel and harmonised approach to the study of the nutritional impact of breakfast through The International Breakfast research Initiative involving national dietary survey data from Canada, Denmark, France, Spain, the UK and the USA. It is anticipated that the analysis of such data along harmonised lines, will allow the project to achieve its primary goal of exploring approaches to defining optimal breakfast food and nutrient intakes. Such data will be of value to public health nutrition policy-makers and food manufacturers and will also allow consistent messaging to help consumers to optimize food choices at breakfast.

The International Breakfast Research Initiative (IBRI) set out to derive nutritional recommendations for a balanced breakfast using a standardized analysis of national nutrition surveys from Canada, Denmark, France, Spain, UK and the US. In all countries, the frequency of breakfast consumption by age was high and U-shaped with children and older adults having a higher frequency of breakfast consumption. Breakfast contributed 16% to 21% of daily energy intake. In all countries, breakfast was a carbohydrate- and nutrient-rich meal, providing more carbohydrates (including sugars), thiamin, riboflavin, folate, calcium, potassium, and magnesium, and less vitamin A, fats and sodium relative to its contribution to daily energy intakes. Breakfast consumers were stratified by tertiles of the Nutrient Rich Foods (NRF) index, used as a measure of diet quality. Breakfast intakes associated with the top tertile of NRF, along with the Codex Alimentarius international food standards and World Health Organization (WHO) diet guidelines, were used to derive the proposed nutrient recommendations. The goal was to preserve the nutrient density of existing breakfasts, while addressing concerns regarding added sugars, saturated fats, dietary fiber, and vitamin D. This initiative is unique in seeking to derive nutrient recommendations for a specific meal using the observed nutritional profile of such meal.

Aim Little is known about whether the socio-economic status of parents is linked to their children becoming overweight. This study examined the association between parents' educational level and overweight Danish children in a nationally representative sample. Methods Body mass index was calculated for a random sample of 512 children aged from four to 14 from the Danish National Survey of Diet and Physical Activity 2005–2008. Their parents provided weight and height data during an interview, together with details of their own educational level. Children were classified as overweight/obese in accordance with the International Obesity Task Force. Frequency estimates of prevalence and logistic regression models were used to correlate childhood overweight/obesity with the mothers' and fathers' educational levels as the main outcome measures. Results Danish mothers tended to be more highly educated than fathers and their educational level was inversely associated with their child being overweight, especially if it was a boy. However, the highest educational level of the parents was the only significant educational variable, suggesting that education was associated with overweight children irrespective of the gender of the parent. Conclusion Public health initiatives should target parents with low educational levels to prevent, and reduce, social inequality in overweight children.

To identify and describe dietary patterns in Danish adults and to examine which demographic and health-related lifestyle factors are associated with dietary patterns.Data derived from the Danish national survey of diet and physical activity collected in 2003-2008 and included 1569 men and 1785 women. Diet was assessed by a 7-day pre-coded food diary. Information on age, gender, weight, height, physical activity, smoking habits, educational level and attitudes towards healthy eating habits was derived from face-to-face interviews. Principal component analysis was applied to explore dietary patterns. Associations with lifestyle factors were examined by means of multiple regression analyses.Three major dietary patterns were identified: a 'traditional' pattern correlated with intake of rye bread, white bread, fat on bread, cheese, jam, cold meat, minced meat, potatoes and gravy, and cake and biscuits; a 'health-conscious' pattern correlated with coarse bread, fruit, vegetables, low-fat dairy, nuts, water and tea; and a 'fast food' pattern correlated with pizza, hamburger/spring rolls, crisps, rice and pasta, sugar-sweetened soft drinks and sweets. The 'traditional' pattern was positively associated with male gender and age, whereas the 'health-conscious' pattern was positively associated with being female, increasing age and educational level. The 'fast food' pattern was inversely associated with age and smoking.Three distinct dietary patterns were identified, and associated lifestyle and demographic factors were characterised. The findings are valuable in targeting future nutrition education and will enable more focused strategies in communicating food-based dietary guidelines.

Although computational multivariate data analysis (MDA) already has been employed in the dietary survey area, the results reported are based mainly on classical exploratory (descriptive) techniques. Therefore, data of a Swedish and a Danish dietary survey on young consumers (4 to 5 years of age) were subjected not only to modern exploratory MDA, but also modern predictive MDA that via supervised learning yielded predictive classification models. The exploratory part, also encompassing Swedish 8 or 11-year old Swedish consumers, included new innovative forms of hierarchical clustering and bi-clustering. This resulted in several interesting multi-dimensional dietary patterns (dietary prototypes), including striking difference between those of the age-matched Danish and Swedish children. The predictive MDA disclosed additional multi-dimensional food consumption relationships. For instance, the consumption patterns associated with each of several key foods like bread, milk, potato and sweetened beverages, were found to differ markedly between the Danish and Swedish consumers. In conclusion, the joint application of modern descriptive and predictive MDA to dietary surveys may enable new levels of diet quality evaluation and perhaps also prototype-based toxicology risk assessment.

This report describes the results of the first and second collection of data in the joint Nordic Monitoring System of diet, physical activity and overweight. It is well recognized that health in the European Region needs to be improved and Nordic public health researchers have since 2008 developed and validated a Nordic method to assess diet and physical activity among adults and children. Data has collected on health behaviour and overweight in 2011 and 2014 among 18,000 adults and 5,000 children. During the three year survey period, significant changes have occurred in the Nordic countries, especially among adults. The Nordic Monitoring System shows that lifestyle and weight status differ between the Nordic countries despite highly comparable societal structures. Favorable and unfavorable health behaviour is present in all countries and there are areas to be improved in all countries.

Levels of organochlorine substances, including a number of organochlorine pesticides and PCB, are monitored in food, including meat, fish and dairy products. The substances are slowly degradable and therefore persist for long periods in the environment, where they accumulate in the fatty tissues of animals and humans. They are included, because of the potential health-hazardous effect of these compounds on humans. The highest average contents are found in cod liver and fatty fish. The Danish population’s average daily intake has been estimated at between 0.03 and 0.3 μg/day for organochlorine pesticides and 0.9 μg/day for the indicator PCB-sum. People with a relatively high intake of these substances (the 95th percentile) are estimated to consume approximately twice as much. In general, the highest contributions to the intake of the organochlorine environmental contaminants are from fish, meat and dairy products. However, children have a relatively higher intake from milk and milk products and a lower intake from fish compared to adults.

ObjectiveTo examine the impact of a 6-month participatory and empowerment-based intervention study on employees’ dietary habits and on changes in the canteen nutrition environment.DesignWorksites were stratified by company type and by the presence or absence of an in-house canteen, and randomly allocated to either an intervention group (five worksites) or a minimum intervention control group (three worksites). The study was carried out in partnership with a trade union and guided by an ecological framework targeting both individual and environment levels. Outcome measures included: (i) changes in employees’ dietary habits derived from 4 d pre-coded food diaries of a group of employees at the worksites (paired-data structure); and (ii) the canteen nutrition environment as identified by aggregating chemical nutritional analysis of individual canteen lunches (different participants at baseline and at endpoint).SettingEight blue-collar worksites (five of these with canteens).SubjectsEmployees.ResultsIn the intervention group (n102), several significant positive nutritional effects were observed among employees, including a median daily decrease in intake of fat (−2·2 %E,P= 0·002) and cake and sweets (−18 g/10 MJ,P= 0·002) and a median increase in intake of dietary fibre (3 g/10 MJ,P< 0·001) and fruit (55 g/d,P= 0·007 and 74 g/10 MJ,P= 0·009). With regard to the canteen nutrition environment, a significant reduction in the percentage of energy obtained from fat was found in the intervention group (median difference 11 %E,P< 0·001,n144).ConclusionsThe present study shows that moderate positive changes in dietary patterns can be achieved among employees in blue-collar worksites.

ObjectiveTo study the association between diet quality and the new health messages in the Danish Dietary Guidelines 2005, i.e. ‘Eat a varied diet’, ‘Engage in regular physical activity’ and ‘Maintain a healthy body weight’.Design/setting/subjectsThe study was cross-sectional, comprising a random sample of 3151 Danish adults aged 18–75 years. Dietary intake was estimated using a 7 d pre-coded food diary. Information on social background, leisure-time physical activity, height, body weight and intention to eat healthily was obtained by in-person interviews. Logistic regression models were used to explore the independent effects of energy intake, leisure-time physical activity, food variety, BMI, age, gender, education, household income, location of residence and intention to eat healthily on the likelihood to have high diet quality measured by an index based on the intake of dietary fibre and saturated fat.ResultsGreater food variety (OR = 1·32 for women, 1·13 for men), high leisure-time physical activity (OR = 2·20 for women, 1·91 for men), frequent intentions to eat healthily (OR = 8·19 for women, 5·40 for men) and low energy intake (OR=0·78 for women, 0·85 for men) were significantly associated with high diet quality. For women education was positively associated with diet quality. The study did not demonstrate any association between BMI and diet quality.ConclusionThe health behaviours ‘Eat a varied diet’ and ‘Engage in regular physical activity’ were positively associated with healthy eating. The dietary habits reported were strongly influenced by personal intentions. Thus, the biggest challenge for public health nutritionists will be to reach non-compliers who seldom have intentions to eat healthily.

The content of nitrite and nitrate in cured meat products has been monitored in Denmark seven times between 1995 and 2006. The maximum permitted added amounts of sodium nitrite in Denmark (60 mg kg(-1) for most products up to 150 mg kg(-1) for special products) have not been exceeded, except for a few samples back in 2002. The intake, mean and intake distribution of sodium nitrite have been calculated from 1998 to 2006 with data from the Danish dietary survey conducted in 2000-02 on Danes from four to 75 years of age. The amounts used by industry have been relatively stable through the whole period with levels varying between 6 and 20 mg sodium nitrite kg(-1) with sausages, meat for open sandwiches and salami-type sausages being the greatest contributors. The mean intake of sodium nitrate was around 1 mg day(-1), which is very low compared with the total intake of 61 mg day(-1). The mean intake of sodium nitrite was 0.017 and 0.014, 0.009 and 0.008, and 0.007 and 0.003 mg kg(-1) body weight day(-1) for men and women in the age groups 4-5, 6-14 and 15-75 years, respectively, which was much lower than the acceptable daily intake (ADI) of 0.09 mg kg(-1) body weight day(-1). The 99th percentile for the group of 4-year-olds was 0.107 and 0.123 mg kg(-1) body weight day(-1) for boys and girls, respectively, and the 95th percentile was 0.057 and 0.073 mg kg(-1) body weight day(-1) for boys and girls, respectively, highest for the girls. With fewer than 100 boys and girls in the 4-5-year age group, only very few persons were responsible for the high intake. The conversion of nitrate to nitrite in the saliva and the degradation of nitrite during production and storage must also be considered when evaluating the intake of nitrite.

Aim: To study the current prevalence and trends in overweight and obesity among children and adolescents in Denmark from 1995 to 2000—2002. Methods: Cross-sectional national dietary surveys were conducted in 1995 and 2000—2002. The analysis was based on two random population samples from the Danish civil registration system. Body mass index (BMI) was calculated from self-reported height and weight for 1,026 and 1,152 children and adolescents (4—18 years), who participated in 1995 and 2000—2002, respectively. The prevalence of overweight and obesity was defined according to the international age and gender-specific child BMI cut-off points. In the statistical analysis, overweight and obesity were included in the prevalence of overweight. Results: Mean BMI increased significantly between 1995 and 2000—2002 for all combinations of age groups (4—6, 7—10, 11—14 and 15—18 years) and genders. Prevalence of overweight increased between survey years for boys and girls for all age groups (4—6, 7—10, 11—14 and 15—18 years), although formal statistical significance was not reached (p>0.05). When all children and adolescents (4—18 years) were analysed, the prevalence of overweight rose significantly from 10.9% (95% confidence interval (CI) 9.0—12.8) to 14.4% (95% CI 12.5—16.3) between 1995 and 2000— 2002 (p=0.01), whereas the increase in the prevalence of obesity did not reach significance (1995, 2.3% (95% CI 1.3—3.3) vs. 2000—2002, 2.4% (95% CI 1.6—3.3); p=0.74). Conclusions: The present study revealed a significant increase from 1995 to 2000—2002 in mean BMI for boys and girls for all age groups and a significant increase in the prevalence of overweight when all Danish children and adolescents (4—18 years) were analysed.

Objective To compare the Danish Physical Activity Questionnaire (DPAQ) estimating physical activity energy expenditure (PAEE) and physical activity level (PAL) and the pattern of physical activity (including health-related physical activity) with measurements from a validated position and motion instrument (ActiReg®). Methods One hundred and thirty-eight healthy Danish volunteers aged 20–59 years participated. Participants filled in the DPAQ at the end of the day every day for seven consecutive days and carried the ActiReg® on the same days as the DPAQ were filled in. Results A small, but statistically significant difference was seen between the DPAQ and the ActiReg® for PAEE (mean: −0.32 MJ·d−1; 95% limits of agreement: ((−2.88)–2.24 MJ·d−1); P = 0.003) and PAL (−0.03; ((−0.37)–0.31); P = 0.02) for the whole group and for women (P

The online version of the original article can be found under doi:10.1186/s12937-015-0103-3.

A workshop has discussed how to recruit adolescents to dietary surveys and how to reduce the burden of participation. Following results came up: Personal contact is very important both with regard ...

An analytical method for analysing acrylamide in coffee was validated. The analysis of prepared coffee includes a comprehensive clean-up using multimode solid-phase extraction (SPE) by automatic SPE equipment and detection by liquid chromatography tandem mass spectrometry using electrospray in the positive mode. The recoveries of acrylamide in ready-to-drink coffee spiked with 5 and 10 μg l−1 were 96±14% and 100±8%, respectively. Within laboratory reproducibility for the same spiking levels were 14% and 9%, respectively. Coffee samples (n = 25) prepared twice by coffee machines and twice by a French Press Cafetiere coffee maker contained 8±3 μg l−1 and 9±3 μg l−1 acrylamide. Five ready-to-drink instant coffee prepared twice contained 8±2 μg l−1. Hence, the results do not show significant differences in the acrylamide contents in ready-to-drink coffee prepared by coffee machine, French Press or from instant coffee. Medium roasted coffee contained more acrylamide (∼10 μg l−1) than dark roasted coffee (∼5 μg l−1). Males aged 35–45 years, drinking on average 1.1 l coffee per day are exposed to the highest doses of acrylamide from coffee. The dietary intake of acrylamide from coffee comprises, on an average, 10 μg day−1 for males and 9 μg day−1 for females aged 35–45 years. Probabilistic modelling of the exposure of Danish consumers (all adults) to acrylamide from coffee shows a mean exposure of 6.5 μg day−1 and a 95 percentile of 18 μg day−1.

Aims: To examine the hypotheses that an overall levelling off in the prevalence of overweight and obesity during the period 2000–2008 has occurred, and that increasing social inequality in overweight and obesity exists in a nationally representative sample of Danish children and adolescents. Methods: The population comprised a random sample of 1849 children aged 4–14 years who participated in the Danish National Survey of Diet and Physical Activity in 2000–2002, 2003–2004 and 2005–2008. Parental education was chosen as an indicator of children’s socioeconomic status. Body mass index (BMI) was calculated from parent-reported weight and height. Subjects were classified as overweight and obese according to the International Obesity Task Force age- and gender-specific BMI cut-off values. Crude prevalence estimates and logistic regression models were used to analyse trends in overweight and obesity as the main outcome measures. Results: An increase was found in the crude prevalence of overweight (including obesity) in boys (12.8–21.7%, p = 0.0006), but not in girls (17.6–15.9%, p = 0.56), between 2000–2002 and 2005–2008. The prevalence of overweight increased significantly in boys of parents with low educational level only. A strong inverse social gradient in overweight and obesity was documented for boys and girls during the whole survey period. Conclusions: The present study showed an increase in the prevalence of overweight in Danish boys, but not in girls. This increase was due to increasing social inequality in overweight among boys. Public health initiatives aimed at preventing and reducing overweight and obesity should consider gender difference and especially target boys with parents of low educational level.

This Nordic study encompasses multivariate data analysis (MDA) of preschool Danish as well as pre- and elementary school Swedish consumers. Contrary to other counterparts the study incorporates two ...

ObjectiveTo examine changes in the prevalence of overweight and weight misperception among overweight Danes from 1995 to 2008, and to identify factors associated with weight misperception.DesignCross-sectional studies, in which data on self-reported weight, height and self-perception of overweight status were obtained through face-to-face interviews. ‘Overweight’ includes obesity. Weight misperception was defined as overweight individuals who did not perceive themselves as overweight. The χ2 test was used to analyse changes over time and multiple logistic regression analysis was applied to identify factors associated with weight misperception.SettingThe Danish National Survey of Diet and Physical Activity in three periods: 1995, 2000–2004 and 2005–2008.SubjectsA random sample of 9623 Danes aged 15–75 years.ResultsThe prevalence of overweight increased in men and women from 1995 to 2005–2008 (from 35·1 % to 43·0 %, P < 0·001). Concurrently, there was a reduction in the proportion of overweight men (from 77·5 % to 71·4 %, P = 0·001) and women (from 54·8 % to 51·9 %, P = 0·24) who misperceived their weight. Factors associated with weight misperception were ‘never intend to eat healthily’ (men), high levels of leisure-time physical activity, ‘very good/excellent’ self-rated health and survey year (higher misperception in 2000–2004 than 2005–2008; P < 0·05).ConclusionsThe increase in overweight from 1995 to 2005–2008 was accompanied by a reduction in the proportion of overweight men misperceiving their weight. This may indicate that more men see overweight as a personally relevant health problem. Our findings also suggest that overweight individuals who are more physically active and have better self-rated health may not consider their excess weight a health problem.

National dietary surveys have been completed in all five Nordic countries for purposes of nutritional assessment. The NORDIRA project started in 2009 with objectives of sharing experiences within c ...

Under-reporting of energy intake (EI) is a well-known problem when measuring dietary intake in free-living populations. The present study aimed at quantifying misreporting by comparing EI estimated from the Danish pre-coded food diary against energy expenditure (EE) measured with a validated position-and-motion instrument (ActiReg®). Further, the influence of recording length on EI:BMR, percentage consumers, the number of meal occasions and recorded food items per meal was examined. A total of 138 Danish volunteers aged 20–59 years wore the ActiReg® and recorded their food intake for 7 consecutive days. Data for 2504 participants from the National Dietary Survey 2000–2 were used for comparison of characteristics and recording length. The results showed that EI was underestimated by 12 % on average compared with EE measured by ActiReg® (PreMed AS, Oslo, Norway). The 95 % limits of agreement for EI and EE were − 6·29 and 3·09 MJ/d. Of the participants, 73 % were classified as acceptable reporters, 26 % as under-reporters and 1 % as over-reporters. EI:BMR was significantly lower on 1–3 consecutive recording days compared with 4–7 recording days (P

Aims: The aim of this study was to examine the association between different dimensions of socioeconomic position, body mass index (BMI) and obesity in the Danish population. Possible interactions between the different dimensions and gender differences were also investigated. Methods: This was a cross-sectional survey conducted in 2000—2002 including a simple random sample from the civil registration system, comprising 1953 males and 2167 females aged 4—75 years. Information about different dimensions of socioeconomic position, height and weight was obtained by face-to-face interview. Associations between dimensions of socioeconomic position and weight status were examined by use of linear multiple regression analysis and logistic regression analysis. Results: BMI and prevalence of obesity were significantly associated with education for both men and women. Odds ratios (ORs) for obesity were 2.9 (95% confidence interval (CI) 1.4—5.9) and 6.5 (95% CI 2.3—18.7) for those with basic school as compared with those with long higher education for men and women, respectively. Women outside the labour market had higher BMIs and a greater prevalence of obesity (OR 2.5 (95% CI 1.6—3.9)) after adjustment for educational level. Conclusions: Education was the dimension most consistently associated with BMI and obesity, indicating the importance of cultural capital for weight status. The gender-specific pattern showed a stronger social gradient for women, and indicated that a high relative body weight was associated with less favourable social and material conditions for women, but not for men. A public health strategy to prevent and reduce obesity should be gender-specific, focus on groups with short education, and incorporate cultural norms.

Since 1995 the Danish national dietary surveys have shown an increased alcohol intake in the Danish population. The aim of this study is to investigate the association between diet quality, alcohol intake and drinking pattern.The Danish National Dietary Survey 2000-2002 included 3,151 adults (1,684 women, 1,467 men; 18-75 years). The participants recorded their intake of food and beverages daily for seven consecutive days. For each individual, a diet quality index was calculated based on the intake of dietary fibre and saturated fat in relation to the Nordic Nutrition Recommendations (NNR).A poorer diet quality was observed both with increased alcohol intake (units per week) and with number of weekly drinking days. In both cases, the trend was more pronounced for men than for women. The group of men and women with the highest diet quality had a mean alcohol consumption, which was in agreement with the NNR, and fewer drinking days per week than groups with a lower diet quality.Increased alcohol intake is associated with lower diet quality. The results from the present study support the NNR recommendations for alcohol intake and the introduction of a number of alcohol free days each week.

The aim of the present study was to assess if a simple dietary quality index (SDQI) is a useful indicator for nutritional quality in the Danish diet. Data from the Danish National Dietary Survey 2000-2 for adults (n 3151; age 18-75 years) were used to construct an SDQI based on the intake of dietary fibre and saturated fat. The SDQI was used to rank the individuals into three subgroups: the 25 % closest in meeting the recommended intakes of saturated fat and dietary fibre (compliers), the 25 % furthest away (non-compliers) and the 50 % in between (intermediates). Significant differences in food and nutrient intake between these subgroups were identified by intakes of food groups and intakes of nutrients followed by non-parametric tests. Compared with the Nordic Nutrition Recommendations 2004 and the Danish Dietary Guidelines 2005, compliers had a significantly better nutrient profile than intermediates and non-compliers, as the diet of compliers contained more whole-grain cereals, fruits, vegetables and fish, and more frequently low-fat dairy products, lean meats and boiled potatoes. The diet of all subgroups, especially non-compliers, had a high content of nutrient-poor, energy-dense foods, for example, salty snacks, confectionery, and beverages, for example, soft drinks and alcohol. The SDQI is a simple and useful tool to characterise the diet quality of Danish adults.

Objective:To elucidate status and trends in portion size of foods rich in fat and/or added sugars during the past decades, and to bring portion size into perspective in its role in obesity and dietary guidelines in Denmark.Data sources:Information about portion sizes of low-fat and full-fat food items was obtained from a 4-day weighed food record (Study 1). Trends in portion sizes of commercial foods were examined by gathering information from major food manufacturers and fast food chains (Study 2). Data on intakes and sales of sugar-sweetened soft drinks and confectionery were obtained through nation-wide dietary surveys and official sales statistics (Study 3).Results:Study 1: Subjects ate and drank significantly more when they chose low-fat food and meal items (milk used as a drink, sauce and sliced cold meat), compared with their counterparts who chose food and meal items with a higher fat content. As a result, almost the same amounts of energy and fat were consumed both ways, with the exception of sliced cold meat (energy and fat) and milk (fat). Study 2: Portion sizes of commercial energy-dense foods and beverages, and fast food meals rich in fat and/or added sugars, seem to have increased over time, and in particular in the last 10 years. Study 3: The development in portion sizes of commercial foods has been paralleled by a sharp increase of more than 50% in the sales of sugar-sweetened soft drinks and confectionery like sweets, chocolate and ice creams since the 1970s.Conclusions:Larger portion sizes of foods low in fat and commercial energy-dense foods and beverages could be important factors in maintaining a high energy intake, causing over-consumption and enhancing the prevalence of obesity in the population. In light of this development, portion size ought to take central place in dietary guidelines and public campaigns.

Objective: To investigate whether there is an association between socioeconomic status and a healthy diet, taking the possible influence of other social variables such as age, gender, income and household composition into consideration. Design: Cross-sectional study. Setting: Nationwide study in Denmark, 1995. Subjects: Random sample from the civil registration system. A total of 852 men and 870 women aged 18-80 y participated, a response rate of 58%. Interventions: A 7 day estimated dietary record was used to obtain information about the diet. Information about social background was gained through face-to-face interview. Results: The intake of fruit and vegetables and the percentage energy (E%) from fat in the diet were significantly associated with the educational level of both men and women. For men with only basic schooling, the mean intake of vegetables and fat was 84 g/10 MJ and 41 E% respectively. Men with long higher education had a mean intake of 119 g/10 MJ of vegetables and 37 E% of fat. For women, the corresponding figures for the intake of vegetables and fat were 131 g/10 MJ and 38 E% and 175 g/10 MJ and 37 E%, respectively. For women, age, income and household composition were also significantly associated with the intake of fruit and vegetables. Conclusions: Education seems to be the most important social variable to explain social differences in dietary habits. Additional variables are needed to explain dietary habits of women. Differences are seen for both foods and nutrients. Sponsorship: The data analysis was financially supported by the Health Insurance Fund. European Journal of Clinical Nutrition (2001) 55, 959–966

Background: Data on dietary intake and physical activity has been collected from a representative sample of the Danish population from 2003-2008. Objectives: The aim of the present study was to describe the habitual diet in Denmark and to evaluate the overall diet quality using a diet quality index based on the National Food-Based Dietary Guidelines (FBDG), which consists of seven guidelines regarding diet and one regarding physical activity. Design: Data from the Danish National Survey of Diet and Physical Activity 2003-2008 (n=3354) were included. The diet quality index was constructed based on five of the seven dietary guidelines. Individuals were categorised according to quartiles of the diet quality index, and food and nutrient intakes were estimated in each of the groups. Results: Macronutrient distribution did not meet recommendations in any of the groups, as energy from total fat and especially saturated fat was too high. A high intake of high-fat milk products, fat on bread and processed meat contributed to a high intake of total fat and saturated fat, and sugar-sweetened soft drinks contributed to a high intake of added sugars in the group below the lowest quartile of the diet quality index. Individuals above in the highest quartile had higher intakes of ‘healthy foods’ such as fish, fruit and vegetables, rye bread, and also a higher consumption of water and wine. Overall, intakes of micronutrients were sufficient in all groups. Conclusions: The diet quality index is a useful tool in assessing food and nutrient intake in individuals with high vs. low degree of compliance towards the dietary guidelines, and provides a valuable tool in future studies investigating variations in dietary intakes with respect to lifestyle, demographic and regional differences in Denmark. Keywords: diet habits; index; cross-sectional; 7-days pre-coded food diary; food-based dietary guidelines (Published: 20 April 2012) Citation: Food & Nutrition Research 2012. 56 17129 - http://dx.doi.org/10.3402/fnr.v56i0.17129

Background: A high salt (NaCl) intake is associated with high blood pressure, and knowledge of salt content in food and meals is important, if the salt intake has to be decreased in the general population. Objective: To determine the salt content in worksite canteen meals and fast food. Design: For the first part of this study, 180 canteen meals were collected from a total of 15 worksites with inhouse catering facilities. Duplicate portions of a lunch meal were collected from 12 randomly selected employees at each canteen on two non-consecutive days. For the second part of the study, a total of 250 fast food samples were collected from 52 retail places representing both city (Aarhus) and provincial towns. The canteen meals and fast food samples were analyzed for chloride by potentiometric titration with silver nitrate solution, and the salt content was estimated. Results: The salt content in lunch meals in worksite canteens were 3.891.8 g per meal and 14.795.1 g per 10 MJ for men (n109), and 2.891.2 g per meal and 14.496.2 g per 10 MJ for women (n71). Salt content in fast food ranged from 11.892.5 g per 10 MJ (burgers) to 16.394.4 g per 10 MJ (sausages) with a mean content of 13.893.8 g per 10 MJ. Conclusion: Salt content in both fast food and in worksite canteen meals is high and should be decreased. Keywords: catering; salt intake; meals; canteen meals; burgers; pizzas; sausages; salt (Published: 16 March 2010) Citation: Food & Nutrition Research 2010. 54 : 2100 - DOI: 10.3402/fnr.v54i0.2100

Der er stigende fokus på danskernes kødindtag i debatten om klima og sundhed, og ofte bliver meget forskellige tal fremhævet. Tallene afspejler forskellige måder at opgøre danskernes kødforbrug på. Den mest retvisende kilde til at belyse danskernes reelle indtag af kød er De nationale kostundersøgelser, som viser, hvem der spiser hvad.E-artiklen beskriver de datakilder, der findes om danskernes kødforbrug. Den belyser også kort data om antallet af vegetarer og veganere i Danmark.

Spiser danskerne sundt?Danskernes indtag af fødevarer og næringsstoffer kan vurderes på basis af bl.a. den nationale undersøgelse af danskernes kost og fysisk aktivitet. Undersøgelsen gennemføres blandt 4-75-årige danskere, som registrerer deres indtag af fødevarer i en uge. Den seneste undersøgelse2011-13 viser, at sammensætningen af kostens indhold af fødevarer og næringsstoffer har ændret sig siden 2003-08 i såvel positiv som negativ retning.I de observerede ændringer over tid skal der tages forbehold for, at deltagere med kort uddannelse i 2011-13 udgør en mindre del af populationen end i 2003-2008, hvorved positive ændringer kan overfortolkes, mens en negativ udvikling kan underfortolkes.Undersøgelserne viser, at kosten både blandt børn og voksne indeholder en større mængde af grøntsager og fisk i 2011-13 end i 2003-08, og kostens indhold af federe mælkeprodukter er mindsket, mens de fedtbegrænsede varianter er øget. Desuden er der sket et fald i de sukkersødede sodavand. Samtidig er kostens indhold af kartofler og rugbrød faldet, mens indholdet af kød og kødprodukter er steget. Ydermere er der sket et mindre fald i kostens indhold af frugt og grove, fiberrige grøntsager.Når kosten vurderes i forhold til de officielle kostråd, er det tydeligt, at mange danskere fortsat spiser for usundt. Dietary habits in DenmarkDietary habits in Denmark can be evaluated on basis of the Danish National Survey of diet and physical activity. The survey covers the dietary intake of Danes aged 4-75 y and the diet is recorded for 7 days. The latest survey 2011-13 shows that the dietary composition has changed both in a positive and negative direction since 2003-08.In the observed changes over time it is important to take into account that participants with low educations are underrepresented in 2011-13 compared to 2011-08. Positive dietary changes may therefore be overestimated while negative changes might be underestimated.The surveys show that the diet contains more vegetables and fish in 2011-13 than in 2003-08. The content of fatty milk products is reduced while the content of fat reduced milk products has increased. The content of sugar sweetened fizzy drinks has decreased. Simultaneously, the proportion of potatoes and whole meal rye bread has been reduced while the content of meat and meat products has increased. Furthermore, the dietary content of fruits and vegetables rich in dietary fiber has decreased slightly.Evaluation of the diet against the food based dietary guidelines shows that many Danes still eat unhealthily.