Search

The increase in nutrition-related diseases in industrialized countries is alarming. Unhealthy eating habits, lack of physical activity, excessive alcohol consumption and tobacco are the main causes of this development. There is therefore great interest in prevention strategies. Such strategies have traditionally been based on public information or regulation, but in recent years the value of partnership has begun to be discussed. Design: Evaluation of 13 concrete Danish partnership initiatives for promoting healthy eating habits was carried out using a 10-step checklist. Results: The evaluation showed that the partnerships in general were quite successful. Most partnerships were assessed to have resulted in concrete output, to have been disseminated well in target groups, to have had high novelty value and to have brought new resources into play. Major weaknesses in the partnerships were reported to relate to the time-consuming task of setting up partnerships. Results also showed that a number of requirements should be met if partnerships were to be successful. Conclusions: The study indicates that partnerships are a promising tool in the promotion of healthy eating habits as seen from a public point of view. Partnerships should be seen as a supplement to tools such as information, regulation and state interventions, and therefore businesses and non-governmental organizations are important actors in partnerships. It is suggested that businesses, in particular, should develop their role in future partnerships and that they should aim develop their responsibility for the nutritional effects of the products they sell. The term corporate nutritional responsibility is suggested to describe such effort aimed at making nutritional issues a corporate management issue. [ABSTRACT FROM AUTHOR]

Assessing the environmental impacts of food, food systems and diets is highly complex due to the multitude of processes involved, the uncertainty in assessment models, the variability in production systems and the large range of products available. No single assessment method alone can provide a complete evidence base. The increasing number of Life Cycle Assessment and food system analyses, and more recently the integration of planetary boundaries offer insights from which we can draw some robust high-level conclusions, whilst recognising there is a need for more detailed analysis to capture the inherent nuances of more location and context-specific situations. Despite the complexity of assessing the environmental sustainability of food, diets and food systems, there are a number of key considerations that could be used to guide this process, and in doing so, they help to increase utility of the outcomes and limit unintended adverse consequences. We identified five key considerations that can be applied (consider the thresholds, consider the system, consider the variables, consider the context and consider the spillover) to ensure assessments are comprehensive., Competing Interests: The authors have not received any funding or benefits from industry or elsewhere to conduct this study., (© 2024 Tim G. Benton et al.)

This scoping review examines environmental impacts related to food production and consumption in Nordic and Baltic countries. The overarching advice to all Nordic and Baltic countries, in line with the current body of scientific literature, is to shift to a more plant-based dietary pattern and avoid food waste. Taking into account current consumption patterns, there is a high potential and necessity to shift food consumption across the countries to minimise its environmental impact. More specifically, a substantial reduction in meat and dairy consumption and increased consumption of legumes/pulses, whole grains, vegetables, fruits, nuts, and seeds are suggested as a priority intervention. Reducing the environmental impacts of seafoods is also key and suggestions include a shift to seafoods with lower environmental impacts such as seaweed and bivalves. As part of the suggested transition to a more plant-based diet, the scope for increasing the provision of plant-based foods through increasing the cultivation of legumes/pulses, vegetables, and grains and through feed-to-food shifts within the region should be explored., (© 2024 Helen Harwatt et al.)

The overall aim of this paper was to provide background knowledge to the Nordic Nutrition Recommendations 2023 Committee for integrating environmental sustainability in a framework for national Food-Based Dietary Guidelines (FBDG) within the Nordics and Baltics. Additionally, this paper aims to give an overview of recent Nordic scientific literature on environmental impact of foods and dietary patterns and of the FBDG of the Nordics. Finally, we suggest methods for developing national sustainable FBDG. Nordic and Baltic studies on sustainability of diets were searched in August 2022 and complemented with additional relevant literature. The studies show that current diets are far from environmentally sustainable, exceeding planetary boundaries for most impact categories; meat and dairy products being the largest contributors to dietary greenhouse gas emissions (GHGEs) and land use. Scenario, modelling, optimisation and intervention studies confirm the potential of shifting towards more plant-based diets to improve overall diet quality in terms of both health and environmental sustainability. Such diets comprised of vegetables, fruits, legumes, potatoes, whole grain and refined cereal products, nuts, seeds and vegetable oils, with animal foods in moderate or limited amounts. The FBDG in the Nordics promotes more plant-based diets than the current average diet but could improve from further integration of environmental sustainability. To form basis for sustainable FBDG dietary modelling at the national level, prioritising health outcomes and nutritional adequacy is essential. Second, integrating environmental sustainability involves estimating the impact of food choices and amounts on GHGE, land and water use, eutrophication and biodiversity loss. Exploring positive and negative implications of fortified foods and supplementation in relation to nutrient intake, health and environmental sustainability may be needed. Implementing dietary transition requires solutions beyond FBDG to ensure affordability, acceptability and ease of adaption., Competing Interests: This study was funded by the Nordic Council of Ministers, and food and health authorities in Nordic countries. They had no role in the design of the paper, interpretation of results or in the writing of the manuscript. The authors state no conflict of interests. Comments from the public hearing were considered, and references checked for scientific relevance before they were taken into account. The authors solely performed and take full responsibility for interpretation of data and preparation of this manuscript., (© 2024 Ellen Trolle et al.)

The terms 'Nordic countries' or 'The Nordics' include the five countries Denmark, Finland, Island, Norway, and Sweden. This review includes evaluation of the Nordic countries against Food and Agricultural Organisation (FAO)/World Health Organizations' (WHO) guiding principles for healthy, sustainable diets with respect to environmental impact (principles #9 - #13) and sociocultural aspects (principles #14 - #16). A food systems perspective is taken to summarize and discuss the most important challenges and opportunities for achieving sustainable diets. Food system, food security, self-sufficiency, and resilience perspectives are applied. The information can underpin decisions when developing and implementing Food Based Dietary Guidelines (FBDG) in the Nordics. None of the Nordic countries are on track to reach the 2030 UN climate and biodiversity goals. We describe how food production, processing, and consumption contribute to these and other environmental challenges, and what kinds of dietary changes/transitions consistent with these goals are required. A major challenge is the high production and consumption of meat and too low consumption of fish, vegetables, and fruits. Meat production is a major source of emissions and, together with farmed fish, heavily dependent on imported feed ingredients, leaving a large land-use and water footprint in exporting countries while domestic land resources are not used optimally. Dietary patterns have changed drastically over the past 50 years, and in large parts of the population, meat consumption has doubled since the 1970s, rendering historic food culture less useful as a basis for present-day recommendations. The Nordics have Europe's lowest use of antibiotics in animal and fish production and have made some progress in reducing food waste along the food chain. A major opportunity is better alignment of food production and consumption based on local or regional production potentials, in conjunction with better and more constructive integration with the global food system while integrating novel technologies to reduce emissions and resource use., Competing Interests: The authors declare no potential conflicts of interest. The authors have not received any funding or benefits from industry or elsewhere to conduct this study., (© 2024 Helle Margrete Meltzer et al.)

Background: As part of the process of updating national dietary reference values (DRVs) and food-based dietary guidelines (FBDGs), the Nordic Nutrition Recommendations 2022 project (NNR2022) will select a limited number of topics for systematic reviews (SRs)., Objective: To develop and transparently describe the results of a procedure for prioritisation of topics that may be submitted for SRs in the NNR2022 project., Design: In an open call, scientists, health professionals, national food and health authorities, food manufacturers, other stakeholders and the general population in the Nordic and Baltic countries were invited to suggest SR topics. The NNR2022 Committee developed scoping reviews (ScRs) for 51 nutrients and food groups aimed at identifying potential SR topics. These ScRs included the relevant nominations from the open call. SR topics were categorised, ranked and prioritised by the NNR2022 Committee in a modified Delphi process. Existing qualified SRs were identified to omit duplication., Results: A total of 45 nominations with suggestion for more than 200 exposure-outcome pairs were received in the public call. A number of additional topics were identified in ScRs. In order to omit duplication with recently qualified SRs, we defined criteria and identified 76 qualified SRs. The NNR2022 Committee subsequently shortlisted 52 PI/ECOTSS statements, none of which overlapped with the qualified SRs. The PI/ECOTSS statements were then graded 'High' ( n = 21), 'Medium' ( n = 9) or 'Low' ( n = 22) importance, and the PI/ECOTSS statements with 'High' were ranked in a Delphi process. The nine top prioritised PI/ECOTSS included the following exposure-outcome pairs: 1) plant protein intake in children and body growth, 2) pulses/legumes intake, and cardiovascular disease and type 2 diabetes, 3) plant protein intake in adults, and atherosclerotic/cardiovascular disease and type 2 diabetes, 4) fat quality and mental health, 5) vitamin B 12 and vitamin B 12 status, 6) intake of white meat (no consumption vs. high consumption and white meat replaced with red meat), and all-cause mortality, type 2 diabetes and risk factors, 7) intake of n-3 LPUFAs from supplements during pregnancy, and asthma and allergies in the offspring, 8) nuts intake and cardiovascular disease (CVD) and type 2 diabetes in adults, 9) dietary fibre intake (high vs. low) in children and bowel function., Discussion: The selection of topics for de novo SRs is central in the NNR2022 project, as the results of these SRs may cause adjustment of existing DRVs and FBDGs. That is why we have developed this extensive process for the prioritisation of SR topics. For transparency, the results of the process are reported in this publication., Conclusion: The principles and methodologies developed in the NNR2022 project may serve as a framework for national health authorities or organisations when developing national DRVs and FBDGs. This collaboration between the food and health authorities in Denmark, Estonia, Finland, Iceland, Latvia, Lithuania, Norway and Sweden represents an international effort for harmonisation and sharing of resources and competence when developing national DRVs and FBDGs., Competing Interests: See sections on ‘Conflict of interest’ and ‘Sponsors of the NNR2022 project’ in the main text of the article by Christensen et al. (4)., (© 2021 Anne Høyer et al.)

Background: Systematic reviews (SRs) constitute a major part of the Nordic Nutrition Recommendations (NNRs). The step-by-step procedure used to develop SRs has evolved considerably over time and is often tailored to fit the exposure and outcomes in focus., Objective: To describe a detailed procedure for developing qualified SRs commissioned by the NNR2022 project., Design: Scrutinizing procedures of recent SRs commissioned by leading national food and health authorities or international food and health organizations., Results: The following eight steps must be included when developing qualified SRs for the NNR2022 project: 1) define research question, 2) protocol development, 3) literature search, 4) screening and selection of studies, 5) data extraction, 6) assessing risk of bias, 7) synthesis and grading of total strength of evidence, and 8) reporting according to certain standards., Discussion: This guide is based on the guidelines developed for the fifth edition of NNR but includes some important new domains in order to adhere to more recent, authoritative standards., Conclusion: All qualified SRs in the NNR2022 project will follow the protocol described here., Competing Interests: See sections on “Conflicts of interest” and “Sponsors of the NNR2022 project” in the main text of the companion article (1)., (© 2020 Erik Kristoffer Arnesen et al.)

Background: Qualified systematic reviews (SRs) will form the main basis for evaluating causal effects of nutrients or food groups on health outcomes in the sixth edition of Nordic Nutrition Recommendations to be published in 2022 (NNR2022)., Objective: To describe rationale and structure of SRs used in NNR2022., Design: The SR methodologies of the previous edition of NNR were used as a starting point. Methodologies of recent SRs commissioned by leading national food and health authorities or international food and health organizations were examined and scrutinized. Methodologies for developing SRs were agreed by the NNR2022 Committee in a consensus-driven process., Results: Qualified SRs will be developed by a cross-disciplinary group of experts and reported according to the requirements of the EQUATOR network. A number of additional requirements must also be fulfilled, including 1) a clearly stated set of objectives and research questions with pre-defined eligibility criteria for the studies, 2) an explicit, reproducible methodology, 3) a systematic search that attempts to identify all studies that would meet the eligibility criteria, 4) an assessment of the validity of the findings of the included studies through an assessment of 'risk of bias' of the studies, 5) a systematic presentation and synthesis of the characteristics and findings of the included studies, and 6) a grading of the overall evidence. The complete definition and requirements of a qualified SR are described., Discussion: Most SRs published in scientific journals do not fulfill all criteria of the qualified SRs in the NNR2022 project. This article discusses the structure and rationale for requirements of qualified SRs in NNR2022. National food and health authorities have only recently begun to use qualified SRs as a basis for nutrition recommendations., Conclusion: Qualified SRs will be used to inform dietary reference values (DRVs) and food-based dietary guidelines (FBDGs) in the NNR2022 project., (© 2020 Linlin Sun and Zhanjie Niu.)

Background: The Nordic Nutrition Recommendations (NNRs) constitute the scientific basis for national dietary reference values (DRVs) and food-based dietary guidelines (FBDGs) in the Nordic and Baltic countries., Objective: To define principles and methodologies for the sixth edition of NNR to be published in 2022 (NNR2022)., Design: The principles and methodologies of the previous edition of NNR were used as a starting point. Recent nutrition recommendations commissioned by other national food and health authorities or international food and health organizations were examined and dissected. Updated principles and methodologies were agreed by the NNR2022 Committee in a consensus-driven process., Results: An organizational model with 'checks and balances' was developed to minimize the influence of subjective biases of the committee members and experts. Individual chapters on all included nutrients and food groups will be updated as scoping reviews. Systematic reviews (SRs), which are the main basis for evaluating causal effects of nutrients or food groups on health outcomes, will be embedded in each chapter. A NNR SR Centre will be established for performing de novo SRs on prioritized topics. To avoid duplication and optimize the use of resources, qualified SRs commissioned by other national and international organizations and health authorities will also inform DRVs and FBDGs in NNR2022., Discussion: The evidence-based methods defined in the NNR2022 project are compatible with most contemporary methods used by leading national food and health authorities. Global harmonization of methodological approaches to nutrition recommendations is strongly encouraged., Conclusion: Evidence-informed principles and methodologies underpinned by SRs will ensure that DRVs and FBDGs defined in the NNR2022 project are based on the best available evidence and as far as possible free from overt bias., Competing Interests: See section on “Conflicts of interest” and “Sponsors of the NNR2022 project” in the main text above., (© 2020 Jacob Juel Christensen et al.)

Background: The OPUS (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet) project carried out a school meal study to assess the impact of a New Nordic Diet (NND). The random controlled trial involved 834 children aged 8-11 in nine local authority schools in Denmark. Dietary assessment was carried out using a program known as WebDASC (Web-based Dietary Assessment Software for Children) to collect data from the children., Objective: To compare the energy intake (EI) of schoolchildren aged 8-11 estimated using the WebDASC system against the total energy expenditure (TEE) as derived from accelerometers worn by the children during the same period. A second objective was to evaluate the WebDASC's usability., Design: Eighty-one schoolchildren took part in what was the pilot study for the OPUS project, and they recorded their total diet using WebDASC and wore an accelerometer for two periods of seven consecutive days: at baseline, when they ate their usual packed lunches and at intervention when they were served the NND. EI was estimated using WebDASC, and TEE was calculated from accelerometer-derived activity energy expenditure, basal metabolic rate, and diet-induced thermogenesis. WebDASC's usability was assessed using a questionnaire. Parents could help their children record their diet and answer the questionnaire., Results: Evaluated against TEE as derived from the accelerometers worn at the same time, the WebDASC performed just as well as other traditional methods of collecting dietary data and proved both effective and acceptable with children aged 8-11, even with perhaps less familiar foods of the NND., Conclusions: WebDASC is a useful method that provided a reasonably accurate measure of EI at group level when compared to TEE derived from accelerometer-determined physical activity in children. WebDASC will benefit future research in this area.

Background: In preparing the fifth edition of the Nordic Nutrition Recommendations (NNR), the scientific basis of specific food-based dietary guidelines (FBDG) was evaluated., Objective: A systematic review (SR) was conducted to update the NNR evidence based on the association between the consumption of potatoes, berries, whole grains, milk and milk products, and red and processed meat, and the risk of major diet-related chronic diseases., Design: The SR was based on predefined research questions and eligibility criteria for independent duplicate study selection, data extraction, and assessment of methodological quality and applicability. We considered scientific data from prospective observational studies and intervention studies, published since year 2000, targeting the general adult population. Studies of meat and iron status included children, adolescents, and women of childbearing age., Results: Based on 7,282 abstracts, 57 studies met the quality criteria and were evidence graded. The data were too limited to draw any conclusions regarding: red and processed meat intake in relation to cardiovascular disease (CVD) and iron status; potatoes and berries regarding any study outcomes; and dairy consumption in relation to risk of breast cancer and CVD. However, dairy consumption seemed unlikely to increase CVD risk (moderate-grade evidence). There was probable evidence (moderate-grade) for whole grains protecting against type 2 diabetes and CVD, and suggestive evidence (low-grade) for colorectal cancer and for dairy consumption being associated with decreased risk of type 2 diabetes and increased risk of prostate cancer. The WCRF/AICR concludes that red and processed meat is a convincing cause of colorectal cancer., Conclusions: Probable (moderate) evidence was only observed for whole grains protecting against type 2 diabetes and CVD. We identified a clear need for high-quality nutritional epidemiological and intervention studies and for studies of foods of the Nordic diet.

Objective: The objective of the present study was to evaluate energy intake (EI) estimated from two non-consecutive 24-hour recalls (24-HDRs) and a pre-coded seven-day food record (7-dFR) against objective measurements of energy expenditure (EE) in children., Design: A total of 67 7-8 year-olds and 64 12-13 year-olds completed the 2×24-HDRs, the 7-dFR, and wore ActiReg(®) (PreMed AS, Oslo, Norway), a combined position and motion recording instrument, during the same seven days as the 7-dFR was filled in., Results: In the 7-8 year-olds, EI from the 2×24-HDRs (EI(2×24-HDR)) was overestimated with 3% compared to EE (not significantly different), while EI from the 7-dFR (EI(7-dFR)) was underestimated with 7% compared to EE (P=0.001). In the 12-13 year-olds, the corresponding figures was underestimation by 10% with the 2×24-HDRs (P<0.001) and by 20% with the 7-dFR (P<0.001). For both age groups combined, the 95% limits of agreement were -4·38 and 3.52 MJ/d for the 2×24-HDRs, and -5.90 and 2.94 MJ/d for the 7-dFR. Pearson correlation coefficients between EI and EE were 0.51 for EI(2×24-HDR) and 0.29 for EI(7-dFR), respectively. The proportion classified in the same or adjacent quartiles was 76% for EI(2×24-HDR) and 73% for EI(7-dFR) in the 7-8 year-olds, and 83% for EI(2×24-HDR) and 70% for EI(7-dFR) in the 12-13 year-olds., Conclusion: Misreporting of EI seemed modest with both the 2×24-HDRs and the 7-dFR in the 7-8 year-olds when compared to EE measured with ActiReg(®). Under-reporting appeared to be more evident in the 12-13 year-olds, especially with the 7-dFR. Compared to measurements of EE, the 2×24-HDRs seemed to perform slightly better than the 7-dFR in terms of ranking of individuals according to EI.

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.