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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

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.

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 Malnutrition linked to noncommunicable diseases presents major health problems across Europe. The World Health Organisation encourages countries to conduct national dietary surveys to obtain data to inform public health policies designed to prevent noncommunicable diseases. Methods Data on 27334 participants aged 19-64y were harmonised and pooled across national dietary survey datasets from 12 countries across the WHO European Region. Weighted mean nutrient intakes were age-standardised using the Eurostat 2013 European Standard Population. Associations between country-level Gross Domestic Product (GDP) and key nutrients and nutrient densities were investigated using linear regression. The potential mitigating influence of participant-level educational status was explored. Findings Higher GDP was positively associated with total sugar intake (5.0% energy for each 10% increase in GDP, 95% CI 0.6, 9.3). Scandinavian countries had the highest vitamin D intakes. Participants with higher educational status had better nutritional intakes, particularly within lower GDP countries. A 10% higher GDP was associated with lower total fat intakes (-0.2% energy, 95% CI -0.3, -0.1) and higher daily total folate intakes (14μg, 95% CI 12, 16) in higher educated individuals. Interpretation Lower income countries and lower education groups had poorer diet, particularly for micronutrients. We demonstrate for the first time that higher educational status appeared to have a mitigating effect on poorer diet in lower income countries. It illustrates the feasibility and value of harmonising national dietary survey data to inform European policy regarding access to healthy diets, particularly in disadvantaged groups. It specifically highlights the need for strong policies supporting nutritional intakes, prioritising lower education groups and lower income countries.

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.

Background Sufficient intake of fish and limited red meat intake is commonly encouraged by national dietary guidelines to prevent various lifestyle diseases. One way to fulfill these guidelines would be to substitute red meat by fish. However, quantitative evidence of the public health gain of such substitution is lacking. Moreover, contaminants in these foods may compromise nutritional benefits. We aimed to estimate the health impact of substituting red meat by fish in the Danish diet in a risk-benefit assessment (RBA). Our study can support policy makers in defining evidence-based public health strategies. Methods We quantified the health impact of substituting red meat by fish among Danish adults in terms of Disability-Adjusted Life Years (DALY) using data from a national dietary survey and food monitoring. We investigated the use of probabilistic methods to model variability in individual substitution behaviors and to assess health impact distributions in RBA of food. Results Health impact of the substitution varied largely by the type of fish consumed and by age and sex of the consumer. We estimated that 134 (95% uncertainty interval: 102; 169) DALYs/100,000 could be averted per year if a mix of lean and fatty fish is consumed in the Danish recommended amounts and intake of red meat decreased among Danish adults. The highest benefit was estimated for women in the childbearing age and for men above 50 years of age. However, a small fraction of women were assigned an overall health loss due to methylmercury exposure during pregnancy and the associated adverse effects in unborn children. Conclusions Our study estimated an overall health gain of substituting red meat by fish in the general Danish adult population, while providing insight in the variability in health impact at the level of individual consumers. Our approach can be applied in other RBAs and the results support the need for targeted public health strategies to ensure consumer health and safety. Key messages The health impact of substituting red meat by fish in Danish adults was quantified in terms of disability-adjusted life years (DALYs), while accounting for variability between individuals. We estimated that young women and men above 50 years of age will experience the largest health gain while a small fraction of the women were assigned a health loss due to chemical exposure.

Industrially produced trans fatty acids (ITFA) increase the LDL:HDL ratio and hereby the risk of cardiovascular disease (CVD). Therefore, ITFA has been reduced in Western Europe over the last decades but is still high in Eastern Europe and in subgroups of the EU population. Regulatory interventions are the only way to minimize ITFA intake for all. The Danish ITFA ban (2004) can elucidate the impact of elimination of ITFA on CVD. In Denmark cardiac mortality declined by 70% through 1980-2009. Data on ITFA intake and blood lipids from the 1990s, where the average Danish ITFA intake was about 3 g/d, and up to today are needed to study the correlation between intake of ITFA and serum cholesterol (CHOL). The Danish food composition databank has been updated with TFA intake values. Hereby the correlation between ITFA intake and CHOL level in Denmark from 1993 -2006 can be investigated. Methods Ecological analyses of ITFA and CHOL in participants from 3 cohorts: Diet, Cancer and Health (1993-1997); n = 57,054; 50-64 yrInter99 (1999-2001); n = 6,784, 30-60 yrHealth 2006 (2006); n = 3,471, 18-69 yr Results ITFA-intake was 0.02 g/d in Inter99. Data will be extended to include ITFA intake data of all cohorts as well as age adjusted correlations with CHOL. Mean CHOL all men (n = 31,675) declined from 6.3 ± 1.0 in 1993 to 5.4± 1.0 in 2006 Mean CHOL all women (n = 34,675) declined from 6.6 ± 1.5 in 1993 to 5.4± 1.1 in 2006 Similar declines were found in participants without self-reported hypercholesterolemia: Mean CHOL men (n = 28,999) declined from 6.1 ± 0.9 in 1993 to 5.1± 1.0 in 2006 Mean CHOL women (n = 32,593) declined from 6.5 ± 1.5 in 1993 to 5.2± 1.1 in 2006 There was a significant decrease in CHOL (p < 0.0001) from 1993, where average Danish intake of ITFA was about 3 g/d to 2006 where ITFA was banned Conclusions Data show a non-treatment related significant decline in CHOL. Data from 2000 and 2006 are collected in younger populations, which may explain lower CHOL levels. Key messages Cholesterol decline significantly in Danish participants simultaneously with ITFA elimination. Results are important for decision makers in countries which consider ITFA regulation.

Breakfast is considered by many to be the most important meal of the day. This study examined the intake of nutrients and foods at breakfast among Danes and the relation to the overall dietary quality. Data were derived from the Danish National Survey on Diet and Physical Activity 2011&ndash, 2013, a cross-sectional national food consumption study. A total of 3680 participants aged 6&ndash, 75 years were included in the analyses of breakfast consumption. The Nutrient Rich Food Index 9.3 method was used to examine the overall dietary quality of the diet. The intake of nutrients and foods at breakfast were compared across dietary quality score tertiles by ANCOVA adjusted for energy and socio economic status. Breakfast was eaten frequently by children and adults and contributed with 18&ndash, 20% of total energy intake. Breakfast was relatively high in dietary fibre, B vitamins, calcium and magnesium and low in added sugar, total fat, sodium, vitamin A and D. A decrease in the intake of added sugar, total fat and saturated fat and an increase in the intake of dietary fibre and most micronutrients were seen across tertiles of dietary quality scores. Commonly consumed foods provided at breakfast in Denmark included bread, breakfast cereals and dairy products as well as water, coffee and juice, while intakes of fruits, vegetables, cakes and soft drinks were low.

Background Visual aids, such as food photographs, are widely used in estimating food quantities in dietary surveys. The present study aimed to assess how accurately Danish adults and children can estimate food portion sizes using 37 series of photographs illustrating four to six different portion sizes under real-life conditions; determine whether adults were more accurate than children; and estimate the error caused by using portion size photographs to estimate weights of foods consumed in macronutrient calculation. Methods Six hundred and twenty-two adults and 109 children were recruited in three workplace canteens and in two schools, respectively, to estimate their lunchtime portions based on photographs. Participants were instructed to keep the foods separated on their plate when taking lunch. Participants thereafter estimated their own portions by looking at the relevant series of photographs. The actual food portions were then weighed. Results The proportion of correct estimations was 42% overall (range 19–77%). The mean difference (%) between estimated and actual weight was 17% (range 1–111%). Small portion size photographs were more often used correctly compared to larger portion photographs. Children had as many correct estimations as adults, although they overestimated portions more. Participants using fractions of (or more than) one photograph to estimate the portion of a food had significantly larger errors. When calculating the macronutrient content of a weekly menu using the estimated portion sizes, protein had the largest error (29%). Conclusions When used in a real-life situation, the portion size photographs validated in the present study showed a certain inaccuracy compared to the actual weights.

National dietary guidelines are directed at the general population. However, these guidelines may be perceived as unrealistic by a substantial part of the population, as they differ considerably from individual consumption patterns and preferences. Personalised dietary recommendations will probably improve adherence, and it has been shown that these recommendations can be derived by mathematical optimisation methods. However, to better account for risks and benefits of specific foods, the background exposure to nutrients and contaminants needs to be considered as well. This background exposure may come from other foods and supplements, and also from environmental sources like the air and the sun. The objective of this study was therefore to analyse the effect of including individual variation in background exposure when modelling personalised dietary recommendations for fish. We used a quadratic programming model to generate recommended fish intake accounting for personal preference by deviating as little as possible from observed individual intake. Model constraints ensure that the modelled intake meets recommendations for EPA, DHA and vitamin D without violating tolerable exposure to methyl mercury, dioxins and dioxin-like polychlorinated biphenyls. Several background exposures were analysed for 3016 Danish adults, whose food intakes and body weights were reported in a national dietary survey. We found that the lower nutrient constraints were critical for the largest part of the study population, and that a total of 55% should be advised to increase their fish intake. The modelled fish intake recommendations were particularly sensitive to the vitamin D background exposure.

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.

PURPOSE: Celiac disease, an immunological response triggered by gluten, affects ~1 % of the Western population. Information concerning gluten intake in the general population is scarce. We determined intake of gluten from wheat, barley, rye and oat in the Danish National Survey of Diet and Physical Activity 2005-2008. The study population comprised a random cross-sectional sample of 1494 adults 20-75 years, selected from the Danish Civil Registration System.METHODS: Protein content in wheat, rye, barley and oat was determined from the National Danish Food Composition Table and multiplied with the amount of cereal used in recipes. Amount of gluten was calculated as amount of cereal protein ×0.80 for wheat and oat, ×0.65 for rye and ×0.50 for barley. Dietary intake was recorded daily during seven consecutive days in pre-coded food diaries with open-answer possibilities.RESULTS: Mean total gluten intake was 10.4 ± 4.4 g/day (10th-90th percentiles; 5.4-16.2 g/day), in men 12.0 ± 4.6 g/day and 9.0 ± 3.4 g/day in women. It was higher among men than among women in all age groups (20-75 years; P < 0.0001); however, this difference was eliminated when adjusting for energy intake. Intake of different gluten sources tended to be higher in men than in women with the exception of gluten from barley. Total gluten intake decreased with increasing age (P < 0.0001) as did gluten intake from wheat (P < 0.0001), whereas intake of gluten from rye (P < 0.0001) and barley (P = 0.001) increased with increasing age, also when adjusted for energy intake or body weight.CONCLUSION: This study presents representative population-based data on gluten intake in Danish adults. Total gluten intake decreased with increasing age.

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.

Background: The Nordic Plan of Action for better health and quality of life has been put forward by the Nordic Council of Ministers with the aim of reducing unhealthy lifestyles and overweight in the Nordic countries. Monitoring of health behaviour and overweight in the Nordic region is an important element in the plan. Two data collections have been carried out and this report describes status and trends from 2011 to 2014 in diet, physical activity and overweight among children and adults in the Nordic region. Aims: The aims of the Nordic Monitoring System are to provide status and temporal trend data of diet, physical activity and overweight among children and adults in the Nordic region. Furthermore, to compare results between the Nordic countries and to evaluate diet and physical activity with current recommendations, and to examine social inequality in health behaviour and overweight. The results are evaluated against Goals 2011 and Visions 2021 set by the Nordic Plan of Action. Methods: Data on diet, physical activity, overweight and socio-demographics have been collected in the autumn of 2011 and 2014. In 2014, data on alcohol and smoking among adults have been included as well. Data comprised simple random samples of 2479 and 2470 children (7–12 y) and 9153 and 8595 adults (18–65 y) drawn in 2011 and 2014, respectively, from the national registers in Denmark, Finland, Iceland, Norway and Sweden. The pooled participation rate among adults in the Nordic countries was 40% in 2011 and 32% in 2014 and among children 45% in both survey years. Data were collected by telephone interviews based on a short questionnaire with validated indicator questions about dietary intake (Food Frequency Questionnaire), physical activity, sedentary behaviour, and weight and height. A parent responded for their child in the telephone interview. Key variables have been used to report the current level and trends in health behaviour and overweight in the Nordic region between 2011 and 2014, i.e. unhealthy diet (low diet quality score for frequency of intake of fruits and vegetables, fish, whole grain bread, and foods rich in saturated fat or added sugar), physical inactivity, high recreational screen time (> 4 h/day), smoking (adults in 2014), daily smoking (adults in 2014), mean total alcohol consumption (adults in 2014), binge drinking during last month (adults in 2014), overweight (including obesity), and obesity. All data were weighted according to gender, age, educational level and population size to reflect the general populations in the Nordic region. Data were analysed using descriptive statistics (t-tests and chi-square tests, p

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.

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 ...

Background Since information about macro- and micronutrient intake among vegans is limited we aimed to determine and evaluate their dietary and supplementary intake. Methods Seventy 18–61 years old Danish vegans completed a four-day weighed food record from which their daily intake of macro- and micronutrients was assessed and subsequently compared to an age-range-matched group of 1 257 omnivorous individuals from the general Danish population. Moreover, the vegan dietary and supplementary intake was compared to the 2012 Nordic Nutrition Recommendations (NNR). Results Dietary intake differed significantly between vegans and the general Danish population in all measured macro- and micronutrients (p

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.

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.

Background : Packed lunch is the dominant lunch format in many countries including Denmark. School lunch is consumed unsupervised, and self-reported recalls are appropriate in the school setting. However, little is known about the accuracy of recalls in relation to packed lunch. Objective : To assess the qualitative recall accuracy of self-reported consumption of packed lunch among Danish 11-year-old children in relation to gender and dietary assessment method. Design : A cross-sectional dietary recall study of packed lunch consumption. Digital images (DIs) served as an objective reference method to determine food items consumed. Recalls were collected with a lunch recall questionnaire (LRQ) comprising an open-ended recall (OE-Q) and a pre-coded food group prompted recall (PC-Q). Individual interviews (INTs) were conducted successively. The number of food items was identified and accuracy was calculated as match rates (% identified by DIs and reported correctly) and intrusion rates (% not identified by DIs but reported) were determined. Setting and subjects : Three Danish public schools from Copenhagen. A total of 114 Danish 11-year-old children, mean (SE) age = 11.1 (0.03), and body mass index = 18.2 (0.26). Results : The reference (DIs) showed that girls consumed a higher number of food items than boys [mean (SE) 5.4 (0.25) vs. 4.6 (0.29) items ( p =0.05)]. The number of food items recalled differed between genders with OE-Q recalls ( p =0.005) only. Girls’ interview recalls were more accurate than boys’ with higher match rates ( p =0.04) and lower intrusion rates ( p =0.05). Match rates ranged from 6790% and intrusion rates ranged from 1339% with little differences between girls and boys using the OE-Q and PC-Q methods. Conclusion : Dietary recall validation studies should not only consider match rates as an account of accuracy. Intrusions contribute to over-reporting in non-validation studies, and future studies should address recall accuracy and inaccuracies in relation to gender and recall method. Keywords : school lunch; self-reported intake; recall accuracy (Published: 6 March 2013) Citation: Food & Nutrition Research 2013. 57 : 19621 - http://dx.doi.org/10.3402/fnr.v57i0.19621

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.

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

A mathematical model is presented, which addresses individual hygiene practices during food preparation and consumption patterns in private homes. Further, the model links food preparers and consumers based on their relationship to household types. For different age and gender groups, the model estimates (i) the probability of ingesting a meal where precautions have not been taken to avoid the transfer of microorganisms from raw food to final meal (a risk meal), exemplified by the event that the cutting board was not washed during food preparation, and (ii) the probability of ingesting a risk meal in a private home, where chicken was the prepared food item (a chicken risk meal). Chicken was included in the model, as chickens are believed to be the major source of human exposure to the foodborne pathogen Campylobacter. Monte Carlo simulations showed that the probability of ingesting a risk meal was highest for young males (aged 18-29 years) and lowest for the elderly above 60 years of age. Children aged 0-4 years had a higher probability of ingesting a risk meal than children aged 5-17 years. This difference between age and gender groups was ascribed to the variations in the hygiene levels of food preparers. By including the probability of ingesting a chicken meal at home, simulations revealed that all age groups, except the group above 60 years of age, had approximately the same probability of ingesting a chicken risk meal, the probability of females being slightly higher than that of males. The simulated results show that the probability of ingesting a chicken risk meal at home does not only depend on the hygiene practices of the persons preparing the food, but also on the consumption patterns of consumers, and the relationship between people preparing and ingesting food. This finding supports the need of including information on consumer behavior and preparation hygiene in the consumer phase of exposure assessments.

Background Danish adolescents have poor dietary habits compared to current recommendations. The present study aimed to develop a recommended food intake pattern for adolescents consistent with Danish Dietary Guidelines (DDG), Nordic Nutrition Recommendations (NNR) and dietary preferences. Methods The nutrient content of a food intake pattern consistent with DDG was calculated using dietary intake data from a random sample of 11-15-year-old boys (n = 85) and girls (n = 70). A recommended food intake pattern was modelled to meet NNR. The discretionary energy allowance was calculated as the difference between the total energy level and the energy needed to meet recommended nutrient needs. The flexibility of the recommended food intake pattern was tested against various energy requirements and with the inclusion of basic foods with higher sugar and/or fat content. Results The developed food intake pattern meets all nutrient goals except for vitamin D. At low energy requirements, the intake of iron and selenium is of concern. To fulfil nutrient recommendations, half of the bread/cereals and vegetables consumed should be fibre-rich, and fats should be of plant origin. Conclusions The recommended food intake pattern meets most nutrient recommendations and makes it possible to advise on discretionary energy.

Objective and design: The study comprised three protocols. Protocol 1 compared a HPLC method with the commonly employed colorimetric diazocoupling method. Protocol 2 examined, if the last dosage of paminobenzoic acid (PABA) could be advanced in the old to allow for a delayed age-dependent urinary excretion of PABA. Protocol 3 established limits for recovery of PABA in 24 h urine applying the HPLC method. Subjects and setting: A total of 151 healthy volunteers participated in the study of which 140 were accepted. In protocol 1: 37 subjects aged 20‐78 y were included. All subjects took PABA as recommended (80 mg orally at 08.00, 12.00 and 18.00 h). Protocol 2: compared urinary PABA excretion in two groups of 80 y old subjects who had their last PABA dosage administered at 15.00 h (na 16) and at 18.00 h (na 31), respectively. Protocol 3: comprised 56 subjects aged 20‐80 y. In the younger age group (20‐59 y; na 34) PABA was taken as recommended, whereas in the older age group (60‐80 y; na 22) the last PABA dosage was advanced three hours. Results: Protocol 1: HPLC gave significantly lower PABA recovery results compared to colorimetry, the difference between methods being 23.9 8.5 mg/24 h (P< 0.001). Protocol 2: higher PABA recoveries were demonstrated with the advanced dosage schedule compared to the recommended schedule (208 14 mg/24 h vs 181 22 mg/24 h; P< 0.001). Protocol 3: PABA recovery with HPLC was 211 12 mg/24 h, and the lower limit comprising 95% of subjects was 187 mg/24 h. Similar PABA recoveries were demonstrated in the younger subjects and the older subjects (211 11 mg/24 h vs 211 13 mg/24 h; NS). Conclusion: An advanced dosage schedule for PABA in the aged is recommended. Because of lower recoveries with HPLC, the low limit for recovered PABA in a complete 24 h urine differs from the limit based on colorimetry. This study found a limit of 187 mg/24 h corresponding to the lower 95% confidence limit for a single subject. Sponsorship: Supported by the National Food Agency, the Velux Foundation of 1981, and the Health Insurance Foundation. Descriptors: Dietary survey; urine collection; PABA; HPLC

The occurrence of furan in home cooked food was studied. Cooking was found to reduce the level of furan in ready-to-eat foods, however on average around 50% of furan remain in the foods. The analysis of furan occurrence revealed that it is most commonly formed in foods with high levels of carbohydrates. Interestingly, breakfast cereals, dry bread products, and dried fruit products including raisins, plums and bananas contained furan at levels up to 387 mu g/kg. Furan was also found in the dry ingredients of cookies and bread, and in snacks such as crisps and popcorn. The 2-alkylfurans, 2-methylfuran, 2,5-dimethylfuran, 2-ethylfuran, and 2-pentylfuran were present at levels in the same range as furan (885 mu g/kg) and the level of 2-methylfuran (1328 mu g/kg) exceeded this level in coffee.