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Abstract Background Skipping breakfast is associated with negative health-related and school-related outcomes. Breakfast is the most frequently skipped meal among adolescents. Thus, there is a need to explore the reasons for breakfast skipping across population subgroups to better inform policy makers. The purpose of this study was to present the prevalence of adolescents skipping breakfast on schooldays, analyse the reasons for skipping breakfast and assess associations between the prevalence of skipping breakfast and the reasons for skipping breakfast according to sociodemographic variables. Methods The data of a random sample of 10 000 upper secondary school students (aged 16–18 years) from Viken County, Norway, were collected. Students completed a questionnaire measuring breakfast skipping, reasons for skipping breakfast, and sociodemographic variables. Chi-square tests were used to assess differences between the independent groups (family affluence scale (FAS), parental education, and gender) and skipping breakfast and reasons for skipping breakfast. Results 22% of adolescents reported that they usually skipped breakfast on all schooldays. Skipping breakfast was more prevalent among females, older students, students with lower socioeconomic status and students in vocational education programmes. The difference in breakfast skipping between students with low and high FAS scores was 31% versus 16%, respectively. The most common self-reported reasons for skipping breakfast were time (59%) and not wanting to eat breakfast (48%). Furthermore, 9% reported health issues, and 3% reported economic constraints as a reason for skipping breakfast. Not wanting to eat breakfast was related to a higher FAS score, health issues were more common among girls, and economic constraints were more common among those with low socioeconomic status. Conclusions Skipping breakfast was common among Norwegian upper secondary school students. Lack of time and not wanting breakfast were clearly the most cited reasons for skipping breakfast. Health issues and economic constraints were also cited but were less common. The results showed diverging associations between different demographic characteristics and reasons for skipping breakfast. These results are important for developing effective programs to improve diet among adolescents.

Ultra-processed foods (UPFs) are increasingly consumed worldwide and have been linked to several chronic diseases. This paper aims to describe the totality of the available evidence regarding UPFs in relation to health-related outcomes as a basis for setting food-based dietary guidelines for the Nordic Nutrition Recommendations 2023. Systematic literature searches were conducted to identify systematic reviews, meta-analyses, randomized controlled trials (RCTs), and prospective cohort studies examining the association between UPF intake and non-communicable diseases or mortality. A total of 12 systematic reviews (including five meta-analyses) and 44 original research studies (43 prospective cohort studies and one RCT) were included. All original research studies were deemed to be of good methodological quality. The current evidence supports that greater consumption of UPFs is associated with weight gain and increased risk of obesity, cardiovascular disease, type 2 diabetes, and all-cause mortality. The available literature also supports an association between UPFs and hypertension, cancer, and depression; however, the limited number of studies and subjects investigated preclude strong conclusions. Due to the highly diverse nature of UPFs, additional studies are warranted, with special emphasis on disentangling mediating mechanisms, whether nutritional or non-nutrient based. Nevertheless, the available evidence regarding UPFs in relation to weight gain, CVD, type 2 diabetes, and all-cause mortality is considered strong enough to support dietary recommendations to limit their consumption.

Abstract In past research, higher intake of fruit has been associated with better academic achievement. In Norway, the government required lower secondary schools to provide fruit to their pupils from 2007 to 2014. The present study assessed whether this policy improved academic performance. In addition to secondary schools, the policy covered schools with combined elementary and lower secondary education, but not ordinary elementary schools. This differentiation, in combination with administrative data on test scores before, during, and after the law was enforced, created a nationwide quasi-experiment. Population register data on parents’ sociodemographic characteristics allowed for targeted analyses on a subsample of boys with low sociodemographic status. In analyses of 5th grade tests, the free fruit policy coincided with a slight decline in test scores among eligible compared to non-eligible pupils in the subsample (B = − 0.18, 95%CI[− 0.35, − 0.01]) and entire population (B = − 0.14, 95%CI[− 0.24, − 0.05]). Exploratory analyses of exam data in 10th grade yielded similar results, and sensitivity tests either failed to detect any effect or demonstrated a negative tendency. In a Western country with low levels of food insecurity, a policy that required schools to provide free fruit to pupils did not appear to improve academic performance.

IntroductionThe study aims to evaluate the relationship between sociodemographic factors and changes in Norwegian outdoor activities between 2008 and 2018. Traditional outdoor activities, such as family trips in nature, the gathering of mushrooms and wild berries, and growing one's own plants to eat, are believed to have a positive impact on physical activity levels and health in general.MethodThis study includes repeated cross-sectional surveys conducted in 38 randomly selected schools across two Norwegian counties. In 2008, 1,012 parents of 6th and 7th grade students from 27 schools completed a questionnaire. In 2018, 609 new parents from 25 schools participated. Variables were dichotomized. Descriptive analyses between groups were conducted using chi-square statistics. Binary logistic regression analyses were performed with the three outdoor activities as dependent variables, including year only (model 1), and then also gender, age (continuous), education (own and partners), and household income as independent variables (model 2).ResultsParticipation in weekly family trips in nature increased from 22% to 28% (p = 0.002), the OR for year 2018 vs. year 2008 was 1.51. Adjusted for sociodemographic factors, the OR remained stable and significant. Education was the only significant sociodemographic factor (OR = 1.60), indicating the odds of those with a higher education to be 60% higher to engage in weekly family trips in nature. Gathering of wild mushrooms and plants remained stable with time. Being female (OR = 1.44), age (OR = 1.049) and education (OR = 1.49) was related to gathering. An increase in growing plants to eat was observed with an increase from 42% to 51% (p

BackgroundRegular physical activity provides several health benefits, and active transport is a convenient way to implement physical activity in everyday life. However, bikes’ lack of possibilities to carry cargo is a limitation. E-cargo bikes can help overcome barriers to cycling and increase levels of active transport while still providing the option to carry cargo such as groceries and children. As such, E-cargo bikes have a greater potential for being a substitute for cars, but relevance is not known as no study has assessed the energy expenditure and time used using E-cargo bikes with considerable cargo.ObjectivesThe aim of this study is to compare time spent riding and exercise intensity when (1) riding an electric-assisted bicycle with cargo (30 kg) and without cargo and (2) driving a car.MethodThis study has a randomised crossover design. Eleven participants (six women) were recruited through convenience sampling. The participants traversed through a 4.5 km route with three different forms of transportation: an electric-assisted bicycle (E-bike) with 30 kg cargo, an E-bike without cargo, and a car. Oxygen uptake was measured with a portable oxygen analyser (Metamax 3B), and time spent cycling was measured on site by the test leader using a stopwatch.ResultsRiding an E-bike with cargo was slightly slower than riding an E-bike without cargo (11.8 vs. 11.1 min, p = 0.017) and driving a car (8.8 min, p = 0.002). There was no significant difference in exercise intensity between E-bikes with and without cargo but riding an E-bike with cargo entailed significantly higher exercise intensity compared to driving a car [4.9 metabolic equivalents of task (METs) vs. 1.4 METs, p ≤ 0.001].ConclusionsE-biking with cargo was rather similar in time spent and exercise intensity to E-biking without cargo, and not much slower than driving a car. Using E-cargo bikes, therefore, appears a good alternative to driving a car when in need of carrying things such as grocery bags and children, resulting in increasing physical activity and, at the same time, decreasing greenhouse gas emissions.

Abstract Background The rapid neurodevelopment that occurs during the first years of life hinges on adequate nutrition throughout fetal life and early childhood. Therefore, adhering to a dietary pattern based on healthy foods during pregnancy and the first years of life may be beneficial for future development. The aim of this paper was to investigate the relationship between adherence to a healthy and potentially sustainable Nordic diet during pregnancy and in early childhood and child development. Methods This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa) and uses data from the Medical Birth Registry of Norway (MBRN). In 83,800 mother-child pairs, maternal pregnancy diet and child diet at 6 months, 18 months and 3 years were scored according to adherence to the New Nordic Diet (NND). NND scores were calculated both as a total score and categorized into low, medium, or high adherence. Child communication and motor development skills were reported by parents at 6 months, 18 months, 3 and 5 years, using short forms of the Ages and Stages Questionnaire and the Child Development Inventory. Associations of NND adherence with child development were estimated with linear and logistic regression in crude and adjusted models. Results When examining the NND and child developmental scores as percentages of the total scores, we found positive associations between the NND scores (both maternal pregnancy diet and child diet) and higher scoring on child development (adjusted $$\hat{\beta}$$ β ^ s [95% confidence intervals] ranging from 0.007 [0.004, 0.009] to 0.045 [0.040, 0.050]). We further found that low and medium adherence to NND were associated with higher odds of later emerging developmental skills compared to high NND adherence at nearly all measured timepoints (odds ratios [95% CI] ranging from significant values 1.15 [1.03–1.29] to 1.79 [1.55, 2.06] in adjusted analyses). Conclusions Our findings support that adherence to a healthy and potentially sustainable diet early in life is important for child development every step of the way from pregnancy until age 5 years.

The objective of the present study is to review and meta-analyze the effect of E-cycling on health outcomes. We included longitudinal experimental and cohort studies investigating the effect of E-cycling on health outcomes. The studies were identified from the seven electronic databases: Web of Science, Scopus, Medline, Embase, PsycINFO, Cinahl and SportDiscus and risk of bias was assessed with the revised Cochrane Collaboration Risk of Bias Tool (RoB2). We performed meta-analysis with random effects models on outcomes presented in more than one study. Our study includes one randomized controlled trial, five quasi experimental trials and two longitudinal cohort studies. The trials included 214 subjects of whom 77 were included in control groups, and the cohort studies included 10,222 respondents at baseline. Maximal oxygen consumption and maximal power output were assessed in four and tree trials including 78 and 57 subjects, respectively. E-cycling increased maximal oxygen consumption and maximal power output with 0.48 SMD (95%CI 0.16–0.80) and 0.62 SMD (95%CI 0.24–0.99). One trial reported a decrease in 2-h post plasma glucoses from 5.53 ± 1.18 to 5.03 ± 0.91 mmol L−1 and one cohort study reported that obese respondents performed 0.21 times more trips on E-bike than respondents with normal weight. All the included studies had a high risk of bias due to flaws in randomization. However, the outcomes investigated in most studies showed that E-cycling can improve health.

Abstract Background Family meal participation is associated with healthier eating among children and adolescents. Less is known about family meal participation among infants and toddlers. The objective of the present study was to explore whether family meal participation at 12 months of age is associated with dietary intake and whether a potential relationship differs according to maternal education or child sex. Methods Follow-up data from children born to mothers participating in the Norwegian Fit for Delivery (NFFD) trial during pregnancy were used to assess the frequency of intake of 11 dietary items according to frequency of participating in the respective family meals. Dietary differences according to seldom (0–3 times/week) or often (4–7 times/week) participating in each respective meal category were assessed in linear regression models. Potential dose-response associations with frequency of participation in all family meal categories combined were also estimated. Models were adjusted for maternal randomization status, education, and child sex. Results The sample comprised 408 children. A total of 74, 53 and 74% had breakfast, lunch, and dinner with family ≥4 times/week, respectively, while 39% had supper and 27% between-meal snacks with family ≥4 times/week. Having family dinner ≥4 times/week was associated with more frequent intake of vegetables, homemade infant cereal, milk, and water, and less frequent intake of commercial infant foods while the other family meal categories were associated with fewer dietary outcomes. For each additional meal category eaten with family ≥4 times/week, frequency of vegetable intake (β = 0.45), water (β = 0.17), and milk (β = 0.09) per day increased, while commercial infant cereal was eaten less frequently (β = − 0.18). The inverse association between family meals and commercial infant cereal was only evident in children born to mothers in the intervention group. Several associations with diet were stronger and only significant among boys. Conclusions Being fed in the context of family meals at 12 months of age was associated with a more favorable diet. Including the infant in family meals has potential in the promotion of early nutritional health.

Abstract Background Fiscal policies are used to promote a healthier diet; however, there is still a call for real-world evaluations of taxes on unhealthy foods and beverages. We aimed to evaluate the effect of an abrupt increase, of respectively 80 and 40%, in the excising Norwegian taxes on candy and beverages on volume sales of candy and soda. We expected sales to fall. Methods We analyzed electronic point of sale data covering approximately 98% of volume sales of grocery stores in Norway. In two pre-registered models with weekly (log-)sales of taxed candy and soda from 3884 individual stores, we modeled the difference between the jump (discontinuity) in the trend around the time of the increase in taxes and the corresponding jump in the trend in a control season from the previous years (Model 1). In addition, we modeled the difference between the intervention and the control season in their changes in average sales (Model 2). Results Model 1 showed a 6.1% (one-sided 95% CI: not applicable (NA), 23.4, p-value = 0.26) increase and a − 3.9% (95% CI: NA, 4.9, p-value = 0.23) reduction in the differences in the jump in the trends, for candy and soda, respectively. The second model showed a relative decrease of − 4.9% (95% CI: NA, 1.0, p-value = 0.08) in the average sales of candy and an increase of 1.5% (95% CI: NA, 5.0, p-value = 0.24) in sales of soda. Supplementary analyses suggested that the results were sensitive to clustering on the time dimension. Conclusions When using two different quasi-experimental designs to model changes in volume sales of taxed candy and soda, we were not able to detect reductions in sales that coincided with an increase in the taxes. Variation across time makes it difficult to detect potentially small changes in sales even when using an entire country’s worth of sales data on the level of individual stores. We speculate that the tax increases were too modest to affect the prices to alter sales sufficiently.

BackgroundSchool free fruit and vegetable (FFV) policies are used to promote healthy dietary habits and tackle obesity; however, our understanding of their effects on weight outcomes is limited. We assess the effect of a nationwide FFV policy on childhood and adolescent weight status and explore heterogeneity by sex and socioeconomic position.Methods and findingsThis study used a quasi-natural experimental design. Between 2007 and 2014, Norwegian combined schools (grades 1-10, age 6 to 16 years) were obligated to provide FFVs while elementary schools (grades 1-7) were not. We used 4 nationwide studies (n = 11,215 children) from the Norwegian Growth Cohort with longitudinal or cross-sectional anthropometric data up to age 8.5 and 13 years to capture variation in FFV exposure. Outcomes were body mass index standard deviation score (BMISDS), overweight and obesity (OW/OB), waist circumference (WC), and weight to height ratio (WtHR) at age 8.5 years, and BMISDS and OW/OB at age 13 years. Analyses included longitudinal models of the pre- and post-exposure trajectories to estimate the policy effect. The participation rate in each cohort was >80%, and in most analyses ConclusionsIn this study we observed little evidence that the Norwegian nationwide FFV policy had any notable beneficial effect or unintended consequence on weight status among Norwegian children and adolescents.

Abstract Introduction The importance of healthy eating in adolescence is well established. The present study examined possible effects of the free Norwegian School Fruit Scheme (NSFS), changes in dietary habits between 1995 and 2008, and whether secular changes in dietary habits differed among schools who implemented the NSFS during September 2007. Method We used data from the Young-HUNT1 survey conducted from 1995 to 1997 and the Young-HUNT3 survey conducted from 2006 to 2008, which are part of the Nord-Trøndelag Health Study (HUNT), a longitudinal population health study. To evaluate the NSFS, the date Young-HUNT3 participants answered the questionnaire was used to identify affiliation to the intervention group (post-September 2007, n = 1892) or control group (pre-September 2007, n = 2855). To explore dietary habits over time, adolescents attending the same schools in Young-HUNT1 (n = 4137) and Young-HUNT3 (n = 4113) were included. Further, we investigated secular changes in dietary habits according to school type (intervention schools vs control schools). In all analysis, we explored possible differential effects according to socioeconomic status (SES) and gender. A questionnaire measured adolescents’ consumption of fruit, vegetables, candy, potato chips, sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB). Educational intention was used as a proxy for SES. Multilevel logistic regression was used. Results Within Young-HUNT3, the intervention group showed increased odds of daily consumption of fruit (aOR 1.7, 95% CI = 1.3–2.4) compared to the control group. Over time, adolescents were more likely to consume fruit (aOR = 1.48, 95% CI = 1.28–1.71), vegetables (OR = 1.41, 95% CI = 1.28–1.53), potato chips (aOR = 1.60, 95% CI = 1.26–2.04) and SSB (OR = 2.02, 95% CI = 1.66–2.45). Secular changes for fruit differed by school type: adolescents in intervention schools had higher odds of daily consumption (aOR = 1.82, 95% CI = 1.38–2.38) than those in control schools (aOR 1.26, 95% CI = 1.07–1.47). Conclusion The results indicated that the NSFS increased adolescents’ fruit consumption. In the period assessed, the study identified positive and negative changes in adolescents’ dietary habits.

Sports participations have the potential for both positive and negative health outcomes. We hence aimed (i) to assess systematically reviewed associations between organized sports participation in children and adolescents and their health, and (ii) to assess qualitative syntheses of experiences among children and adolescents concerning organized sports participation and health. A search was undertaken in April 2020 across the databases MEDLINE, EMBASE, APA PsycInfo (Ovid), Scopus, SPORTDiscus (EBSCOhost), and specialized databases for reviews. The recommended Joanna Briggs Institute approach to critical appraisal, study selection, data extraction, and data synthesis was used. Systematic reviews were included that covered children and/or adolescents aged ≤ 18 years, and adult participants with retrospective exposure to—or experiences of—organized sports participation before the age of 19 and examining health outcomes and experiences (Prospero protocol CRD 42020206677). Five reviews based mainly on cross-sectional data, two mainly on longitudinal data, and one on experimental studies were included. A causal relationship of moderate-to-high level of evidence between organized sports participation and moderate crude weight reduction accentuated by diet control and team sports was identified. Evidence of causal relationships between sports participation and reduced anxiety, and depression and increased physical activity was at a moderate level. Evidence of causal relationships between sports participation and health was of low-to-moderate level concerning obesity status (inconclusive), bone health (positive), and psychological and social health (positive and negative). Causal relationships between organized child and adolescent sports participation and health remain uncertain. Experimental and well-conducted longitudinal primary studies are highly warranted.

Abstract In recent years, examining dietary patterns has become a more common way of investigating potential associations between diet and adverse health outcomes. The New Nordic Diet (NND) is a potentially healthy and sustainable dietary pattern characterized by foods that are locally available and traditionally consumed in the Nordic countries. The diet has been typically examined in adult populations, and less is known about compliance to the NND from infancy throughout childhood. In the current study, we therefore aimed to develop and describe child age‐specific NND scores. This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa) and uses data from the Medical Birth Registry of Norway (MBRN). We have previously developed a NND score for the maternal diet during pregnancy, and the development of the child diet scores was based on the rationale of this score. Food frequency data from n = 89 715 at child age 6 months, n = 76 432 at 18 months, n = 58 884 at 3 years, and n = 35 978 at 7 years were used to construct subscales in accordance with the maternal diet score. Subscales were composed of responses to a selection of food and drink items or other questions and were dichotomized by the median, yielding four age‐specific diet scores where the possible scoring ranged from 0 to 6 at 6 months and 3 years and from 0 to 9 at 18 months and 7 years. The developed scores will be used to examine associations with childhood overweight and cognitive and mental development in future studies.

Abstract Background The rationale for promoting increased consumption of fruit and vegetables (FV) at an early age is based on results from previous tracking-studies, indicating that dietary habits learned in childhood sustain into adulthood. Previous tracking studies have several limitations (e.g. low study sample, few repeated measurements and/or short a follow-up period). In addition, to our knowledge, no study has shown that a dietary intervention initiated in childhood affects tracking of dietary behaviour. The main objectives in this study were therefore to assess tracking of FV and unhealthy snacks in a large sample with multiple follow-up surveys over 15-years, and whether exposure to free school fruit for one school year modified tracking. Method The longitudinal cohort-study, Fruit and Vegetables Make the Marks, included 38 randomly drawn schools in Norway; nine intervention schools received free fruit (or vegetable) in the school year 2001/2002 and 29 schools severed as control. The baseline sample included 1950 subjects, and 16–92% participated at five follow-up surveys (2002–2016). FV consumption and unhealthy snacks were measured by FFQ. Mixed models were applied to estimate overall tracking coefficients, and to assess whether the intervention modified tracking ((from baseline, from follow-up one (while intervention was running) and from follow-up two (after end of intervention)). Results Overall tracking coefficients were 0.33 for fruit, 0.36 for vegetables and differed by sex for unhealthy snacks: 0.46 males and 0.39 for females (interaction p = 0.065). Most analyses showed no significant difference in tracking between the intervention group and control group. However, from follow-up one, tracking coefficients were different for unhealthy snacks, 0.46 vs. 0.38 (interaction p = 0.036), and from follow-up two for vegetables, 0.35 vs 0.48 (p = 0.036), in the intervention group and control group, respectively. Conclusion Our results indicate low to moderate tracking of FV and unhealthy snacks from childhood to adulthood. We found little evidence that the free fruit intervention modified tracking of fruit, vegetables or unhealthy snacks. More research is needed on if or how we can influence the tracking of fruit, vegetables and unhealthy snacks consumption to improve public health.

Abstract The New Nordic Diet (NND) is a potentially healthy and sustainable dietary pattern represented by locally available and traditionally consumed foods in the Northern countries. The diet has been commonly examined in adult populations, but less is known regarding its potential associations with overweight/obesity in children. We have previously developed child diet scores measuring compliance to the NND at child age 6 and 18 months and 3 and 7 years. In this study, we aimed to describe child and maternal characteristics and assess potential associations between the age‐specific diet scores and child overweight at 8 years. This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa), including 14,989 mother–child pairs and uses data from the Medical Birth Registry of Norway (MBRN). The scores measured NND compliance as a total score and categorized into low, medium and high NND compliance at each age point. Using logistic regression models, we investigated the association between each age‐specific score and the odds of overweight at 8 years. In crude analyses, adherence to the NND at 6 months was inversely associated with odds of overweight at 8 years in the continuous score (odds ratio = 0.95, 95% CI [0.91, 0.98]) and when comparing high versus low NND adherence (odds ratio = 0.81, 95% CI [0.70, 0.94]). The association was almost entirely attenuated in the adjusted models. In conclusion, child NND adherence up to 7 years of age was not associated with odds of overweight at 8 years in adjusted analyses.

ObjectiveTo estimate the prevalence of overweight, obesity, and thinness among Norwegian 13-year-olds and the changes from childhood (age 8 years) to adolescence (age 13 years); and to explore associations with sex, region, and population density from childhood to adolescence.DesignWe used longitudinal, anthropometric data collected by school health nurses conducted in Norway. Weight status was classified according to the International Obesity Task Force cut-offs for overweight, obesity, and thinness, and according to mean body mass index (kg/m2).ParticipantsThe Norwegian Youth Growth Study, consisting of a nationally representative sample of Norwegian 13-year-olds (n = 1852; 50.7% girls), which is a part of The Norwegian Growth Cohort.ResultsAmong 13-year-old Norwegians, the prevalence of overweight (including obesity), obesity, and thinness was 15.8%, 2.5%, and 7.3%, respectively. There was little evidence that these had changed from 8 to 13 years. From 8 to 13 years, the odds of obesity was highest in the Northern region of Norway compared to the South-East (odds ratio (OR): 3.78 (95% confidence interval (CI): 1.13, 12.65; p = 0.036) and in rural areas (OR: 4.76 (95% CI: 1.52, 14.90; p = 0.027). Over the same age period, girls had a trend towards a higher odds of thinness compared to boys (OR: 1.65 (95% CI: 0.98, 2.78; p = 0.057).ConclusionsIn Norway, the prevalence of overweight, obesity, and thinness among 13-year-olds seem to be established by age 8 years. The prevalence of obesity was higher in the North and in rural areas. The results indicate the continued need for early prevention and treatment, and targeted interventions to certain areas.

Introduction: Increased physical activity (PA) is a major component in promoting public health, and active commuting could make an important contribution. Using an electric bicycle (e-bike) is reported to be of at least moderate intensity PA and is an alternative to other modes of transport for commuting. We aimed to explore the experience of commuting by e-bike in an intervention study. Methods: Focus group interviews with 21 previously inactive participants from three cities in Norway, who were given access to an e-bike for commuting for three (N = 2) or eight months (N = 19). Participants cycled for 226 days on average. The interviews were analyzed using systematic text condensation. Results: The use of e-bikes and active commuting stimulated some participants to take on additional PA in their leisure time. Others preferred active commuting to be their daily PA. Participants’ experiences of commuting by e-bike were characterized by a motivational shift from external reasons for e-biking, such as pressure to get fit, to feelings of well-being, enjoyment and recognition of the health benefits. Conclusion: Commuting by e-bike was convenient and promoted good health. Promoting e-bikes could lead to long term changes among inactive people because positive experiences stimulate autonomous reasons for active commuting.

OBJECTIVE:The purpose of the present study was to examine fruit and vegetable consumption according to gender, educational attainment and regional affiliation in Europe. DESIGN:Cross-sectional study. SETTING:21 European countries. PARTICIPANTS:37 672 adults participating in the 7th round of the European Social Survey. MAIN OUTCOME MEASURES:Fruit and vegetable consumption was measured using two single frequency questions. Responses were dichotomized into low (

IntroductionCycling for transport could integrate physical activity (PA) into daily routines and potentially increase total PA levels. However, for parents with young children, most factors affecting transport mode choice tend to facilitate car use. Greater insight is necessary into reasons for (not) using sustainable transport modes in parents with young children. Therefore, the objective of this study was to explore the experiences, including motives, perceptions, attitudes, and norms, of parents of young children by using an e-bike, a longtail bike, and a traditional bike for everyday travel to the workplace, kindergarten, and the grocery store during the autumn, winter, and spring, in nine months.MethodsSemistructured focus group interviews were conducted with 18 parents of young children residing in southern Norway. Parents were recruited through Facebook announcements and direct contact with kindergartens, selected organisations, and companies in the Kristiansand municipality. Data were analysed by systematic text condensation by using NVivo V.11.ResultsParticipants' experiences were summarised by three main themes: 'cycling is cumbersome', 'cycling reflects the desirable me', and 'breaking the cycling code'. Time use, planning, logistics, wet and cold weather, long distances, and no cycling habit were frequently mentioned barriers, and the most notable facilitator was the children's attitude towards cycling. In general, children loved to cycle and preferred cycling to driving. Additionally, the freedom and independence of cycling were emphasised and valued.ConclusionIn challenging weather conditions, parents of young children may experience cycling as cumbersome but desirable, and bike access could increase the feasibility of daily cycling.

Background: Randomized controlled trials targeting maternal dietary and physical activity behaviors during pregnancy have generally failed to accomplish reductions in the prevalence of adverse maternal and neonatal outcomes. Interventions carried out during pregnancy could thus be missing the mark in maximizing intervention health benefit. Objective: To investigate whether pre-pregnancy and early pregnancy dietary behavior as reported at inclusion into the Norwegian Fit for Delivery (NFFD) trial was associated with maternal and neonatal outcomes irrespective of subsequent randomization assignment. Design: The study is a post-hoc observational analysis of data from a randomized controlled lifestyle intervention. We constructed two diet scores from participant responses to a 43-item questionnaire that addressed dietary behavior in retrospect (pre-pregnancy diet score) and dietary behavior at inclusion (early pregnancy diet score), respectively. The diet scores ranged from 0 to 10, with higher score reflecting healthier dietary behavior. Associations between diet scores and maternal and neonatal health outcomes were estimated in multivariate logistic regression models. Results: A total of 591 women were eligible for analysis. A one-point increase in pre-pregnancy diet score was associated with lower odds of excessive gestational weight gain (GWG) (odds ratio [OR]adj: 0.92; 95% confidence interval [CI]: 0.84–1.00, p = 0.050), preterm delivery (ORadj: 0.81; 95% CI: 0.68–0.97, p = 0.019), and birthweight ≥ 4,000 g (ORadj: 0.88; 95% CI: 0.78–0.99, p = 0.038). A one-point increase in early pregnancy diet score was associated with lower odds of excessive GWG (ORadj: 0.88; 95% CI: 0.79–0.97, p = 0.009), preterm delivery (ORadj: 0.82; 95% CI: 0.67–0.99, p = 0.038), and preeclampsia (ORadj: 0.78; 95% CI: 0.62–0.99, p = 0.038). Discussion: Higher diet score either pre-pregnancy or in early pregnancy was protectively associated with excessive GWG and preterm delivery, whereas the protective association with high birthweight was confined to pre-pregnancy diet and with preeclampsia to early pregnancy diet. Conclusions: Both pre-pregnancy and early pregnancy dietary behavior was associated with important maternal and neonatal health outcomes in the NFFD dataset.

Abstract Background In Norway, social inequalities in health and health-related behaviors have been reported despite the well-developed welfare state. The objective of the present study was to analyze; (i) the development in frequency of consumption of sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB) from childhood to adulthood; (ii) socioeconomic inequalities in the consumption of SSB and ASB using different indicators of socioeconomic status (SES); (iii) time trends in potential disparities in SSB and ASB consumption among different socioeconomic groups to assess the development in socioeconomic inequality from childhood to adulthood. Methods This study uses data from the Fruits and Vegetables Make the Marks (FVMM) longitudinal cohort, including participants (n = 437) from 20 random schools from two Norwegian counties. Data from the first survey in 2001 (mean age 11.8) and follow-up surveys in 2005 (mean age 15.5) and 2016 (mean age 26.5) were used. Consumption of SSB and ASB were measured using a food frequency questionnaire, which the participants completed at school in 2001 and 2005, and online in 2016. Various indicators of SES were included; in 2001, parental education and income were measured, in 2005, participants’ educational intentions in adolescence were measured, and in 2016, participants’ own education and income were measured. The main analyses conducted were linear mixed effects analysis of the repeated measures. Results Between 2001 and 2016, a decrease in frequency of consumption of SSB (2.8 v 1.3 times/week; p =

Abstract Background The present study aims to increase bicycling and level of physical activity (PA), and thereby promote health in parents of toddlers, by giving access to different bicycle types. There is a need for greater understanding of e-bikes and their role in the transportation network, and further effects on PA levels and health. Moreover, longtail bikes could meet certain practical needs not fulfilled by e-bikes or traditional bikes, hence increased knowledge regarding their feasibility should be obtained. No previous studies have investigated whether providing an e-bike or a longtail bike over an extended period in a sample of parents of toddlers influence objectively assessed amount of bicycling and total PA level, transportation habits, cardiorespiratory fitness, body composition and blood pressure. Methods A randomized cross-over trial will be performed, entailing that participants in the intervention group (n = 18) complete the following intervention arms in random order: (i) three months access to an e-bicycle with trailer for child transportation (n = 6), (ii) three months access to a longtail bicycle (n = 6), and (iii) three months access to a regular bicycle with trailer (n = 6), in total nine months. Also, a control group (n = 18) maintaining usual transportation and PA habits will be included. A convenience sample consisting of 36 parents of toddlers residing in Kristiansand municipality, Southern Norway, will be recruited. Total amount of bicycling (distance and time), total level of PA, and transportation habits will be measured at baseline and in connection to each intervention arm. Cardiorespiratory fitness, body composition and blood pressure will be measured at baseline and post-intervention. Main outcome will be bicycling distance and time spent cycling. Discussion New knowledge relevant for the timely issues of public health and environmental sustainability will be provided among parents of toddlers, representing a target group of greatest importance. There is a call for research on the influence of e-bikes and longtail bikes on travel behavior and PA levels, and whether voluntary cycling could improve health. If the present study reveals promising results, it should be replicated in larger and more representative samples. Eventually, inclusion in national public health policies should be considered. Trial registration ID NCT03131518 , made public 26.04.2017.

Abstract Background The effectiveness of prenatal lifestyle intervention to prevent gestational diabetes and improve maternal glucose metabolism remains to be established. The Norwegian Fit for Delivery (NFFD) randomized, controlled trial studied the effect of a combined lifestyle intervention provided to a general population, and found significantly lower gestational weight gain among intervention participants but no improvement in obstetrical outcomes or the proportion of large infants. The aim of the present study is to examine the effect of the NFFD intervention on glucose metabolism, including an assessment of the subgroups of normal-weight and overweight/obese participants. Methods Healthy, non-diabetic women expecting their first child, with pre-pregnancy body mass index (BMI) ≥19 kg/m2, age ≥ 18 years and a singleton pregnancy of ≤20 gestational-weeks were enrolled from healthcare clinics in southern Norway. Gestational weight gain was the primary endpoint. Participants (n = 606) were individually randomized to intervention (two dietary consultations and access to twice-weekly exercise groups) or control group (routine prenatal care). The effect of intervention on glucose metabolism was a secondary endpoint, measuring glucose (fasting and 2-h following 75-g glucose load), insulin, homeostatic assessment of insulin resistance (HOMA-IR) and leptin levels at gestational-week 30. Results Blood samples from 557 (91.9%) women were analyzed. For the total group, intervention resulted in reduced insulin (adj. Mean diff −0.91 mU/l, p = 0.045) and leptin levels (adj. Mean diff -207 pmol/l, p = 0.021) compared to routine care, while glucose levels were unchanged. However, the effect of intervention on both fasting and 2-h glucose was modified by pre-pregnancy BMI (interaction p = 0.030 and p = 0.039, respectively). For overweight/obese women (n = 158), intervention was associated with increased risk of at least one glucose measurement exceeding International Association of Pregnancy and Diabetes Study Group thresholds (33.7% vs. 13.9%, adj. OR 3.89, p = 0.004). Conclusions The Norwegian Fit for Delivery intervention lowered neither glucose levels nor GDM incidence, despite reductions in insulin and leptin. Prenatal combined lifestyle interventions designed for a general population may be unsuited to reduce GDM risk, particularly among overweight/obese women, who may require earlier and more targeted interventions. Trial registration ClinicalTrials.gov ID NCT01001689 , registered July 2, 2009, confirmed completed October 26, 2009 (retrospectively registered).

Abstract Background This study examined the frequency of and differences in sedentary bouts of different durations and the total time spent in sedentary bouts on a weekday, a weekend day, during school hours, during after-school hours and in the evening period in a sample of 10- to 12-year-old Belgian children. Methods Accelerometer data were collected as part of the ENERGY-project in Belgium (n = 577, 10.9 ± 0.7 years, 53% girls) in 2011. Differences in total sedentary time, sedentary bouts of 2–5, 5–10, 10–20, 20–30 and ≥30 min and total time accumulated in those bouts were examined on a weekday, a weekend day, during school hours, during after-school hours and in the evening period, using multilevel analyses in MLwiN 2.22. Results More than 60% of the participants’ waking time was spent sedentary. Children typically engaged in short sedentary bouts of 2–5 and 5–10 min, which contributed almost 50% towards their total daily sedentary time. Although the differences were very small, children engaged in significantly fewer sedentary bouts of nearly all durations during after-school hours compared to during school hours and in the evening period. Children also engaged in significantly fewer sedentary bouts of 5–10, 10–20, and 20–30 min per hour on a weekend day than on a weekday. Conclusions Although primary school children spend more than 60% of their waking time sedentary, they generally engaged in short sedentary bouts. Children’s sedentary bouts were slightly longer on weekdays, particularly during school hours and in the evening period, although the differences were very small. These results suggest that in this age group, interventions focusing on reducing total sedentary time rather than interrupting prolonged sedentary time are needed.

Abstract Background Use of ultra-processed foods has expanded rapidly over the last decades and high consumption has been positively associated with risk of e.g. overweight, obesity and type 2 diabetes. Ultra-processed foods offer convenience as they require minimal time for preparation. It is therefore reasonable to assume that such foods are consumed more often among people who experience time scarcity. The main aim of this study was to investigate the association between time scarcity and consumption of ultra-processed foods among parents of 2-year olds in Norway. A secondary aim was to investigate the association between sociodemographic correlates, weight status and consumption of ultra-processed foods. Methods This cross-sectional study included 497 participants. Chi-square and cross tabulations were used to calculate proportions of high vs. low consumption of ultra-processed foods in relation to time scarcity, sociodemographic correlates and weight status. Binary logistic regression analyses were performed to test the relationship between independent variables and consumption of ultra-processed foods. Results Participants reporting medium and high time scarcity were more likely to have a high consumption of ultra-processed dinner products (OR = 3. 68, 95% CI = 2. 32–5.84 and OR = 3.10, 1.80–5.35, respectively) and fast foods (OR = 2.60, 1.62–4.18 and OR = 1.90, 1.08–3.32, respectively) compared to those with low time scarcity. Further, participants with medium time scarcity were more likely to have a high consumption of snacks and soft drinks compared to participants with low time scarcity (OR = 1.63, 1.06–2.49). Finally, gender, ethnicity, educational level, number of children in the household and weight status were identified as important factors associated with the consumption of certain types of ultra-processed foods. Conclusions Results from the present study showed that time scarcity, various sociodemographic factors and weight status was associated with consumption of processed foods. Future studies with a longitudinal design are needed to further explore these patterns over a longer period of time.

Abstract Background The objectives of the present study were to compare time spent cycling, exercise intensity, and time spent in moderate- (MPA) and vigorous intensity physical activity (VPA) when cycling on an E-bike and a conventional bicycle on two “cycling-to-work” routes with differences in topography, defined as a hilly and a flat route. Methods Eight adults (23–54 years, two women) cycled outdoors on a conventional bicycle and an E-bike, on a flat (8.2 km) and a hilly (7.1 km) route, resulting in 32 journeys. Duration, elevation, and oxygen consumption were recorded using a portable oxygen analyser with GPS. A maximal cardiorespiratory fitness test was performed on a cycle ergometer. Resting metabolic rate was obtained by indirect calorimetry with a canopy hood. Results The participants spent less time (median (IQR)) cycling on the E-bike compared with the conventional bicycle, on both the hilly (18.8 (4.9) vs. 26.3 (6.4) minutes) and the flat (20.0 (2.9) vs. 23.8 (1.8) minutes) routes. Lower exercise intensity was observed with the E-bike compared with the conventional bicycle, both on the hilly (50 (18) vs. 60 (22) % of maximal oxygen uptake) and the flat (52 (19) vs. 55 (12) % of maximal oxygen uptake) routes. In both cycling modes, most time was spent in MVPA (92–99%). However, fewer minutes were spent in MVPA with the E-bike than the conventional bicycle, for both the hilly (26% lower) and the flat (17% lower) routes. Cycling on the E-bike also resulted in 35 and 15% fewer minutes in vigorous intensity, respectively on the hilly and flat routes. Conclusion Cycling on the E-bike resulted in lower trip duration and exercise intensity, compared with the conventional bicycle. However, most of the time was spent in MVPA. This suggests that changing the commuting mode from car to E-bike will significantly increase levels of physical activity while commuting.

Abstract Background A healthy diet is important for pregnancy outcome and the current and future health of woman and child. The aims of the study were to explore the changes from pre-pregnancy to early pregnancy in consumption of fruits and vegetables (FV), and to describe associations with maternal educational level, body mass index (BMI) and age. Methods Healthy nulliparous women were included in the Norwegian Fit for Delivery (NFFD) trial from September 2009 to February 2013, recruited from eight antenatal clinics in southern Norway. At inclusion, in median gestational week 15 (range 9–20), 575 participants answered a food frequency questionnaire (FFQ) where they reported consumption of FV, both current intake and recollection of pre-pregnancy intake. Data were analysed using a linear mixed model. Results The percentage of women consuming FV daily or more frequently in the following categories increased from pre-pregnancy to early pregnancy: vegetables on sandwiches (13 vs. 17%, p

Large-scale analyses on the travel behavior of e-bikes are scarce, and current knowledge regarding who the e-bike owners are is inconsistent. Also, commuters represent a relevant user group with an unexploited potential. Therefore, the purpose of the present study was to examine (i) associations between type of bike (e-bike vs. regular bike) with place of residence (county), sociodemographic variables (age, sex, educational level, income and ethnicity) and habitual physical activity level, and (ii) if public employees possessing an e-bike cycle more often and longer distances to work. A cross-sectional survey was conducted in 2017 among 1977 (5.2% of eligible subjects) public employees in Southern and Western Norway. Binary and multinomial logistic regression analyses were conducted. Respondents possessing an e-bike were less likely to perform high levels of leisure time physical activity (OR 0.56 (CI 0.39-0.82)), compared to those possessing a regular bike only. For those residing in Agder, the likelihood of possessing an e-bike (vs. regular bike) was almost 4 times higher (OR 3.98 (CI 2.53-6.26)), compared with participants residing in Sogn og Fjordane. Compared with those possessing a regular bike only, e-bike users cycled more frequently to work, both occasionally (OR 3.71 (CI 2.44-5.65)) and most of the time (OR 4.28 (CI 2.79-6.55)), and they had higher odds of cycling medium distances to the workplace (OR 1.74 (CI 1.04-2.90)). In conclusion, e-bike access could result in increased commuter cycling, both in terms of cycling frequency and cycling distance, which in turn could contribute to enhanced physical activity levels. Keywords: E-bike, Bicycle, Active travel, Active commuting, Public employees, Southern Norway, Western Norway

IntroductionWe aimed to investigate whether providing parents with children in kindergarten with access to different bicycle types could influence (i) travel behavior and cycling amount, and (ii) intrinsic motivation for cycling and psychological constructs related to car use.MethodsA randomized, controlled trial was conducted in Southern Norway from September 2017 to June 2018. In total 36 parents were recruited and randomly drawn into an intervention (n = 18) or control group (n = 18). The intervention group was in random order equipped with an e-bike with trailer (n = 6), a cargo (longtail) bike (n = 6) and a traditional bike with trailer (n = 6).ResultsAt follow-up, more participants from the intervention group (vs. the control group) were classified as cyclists to the workplace (n = 7 (38.9%) vs. n = 1 (5.9%), p = 0.04), but not to the kindergarten (n = 6 (33.3%) vs. n = 2 (11.8%), p = 0.23) or to the grocery store (n = 2 (11.1%) vs. n = 0 (0%), p = 0.49). A significant (p = ≤0.05) increase in cycling frequency (0.1 to 2.0 days/week) from baseline to follow-up was found in the intervention group for all destinations and seasons, except to the grocery store during winter (p = 0.16). A decrease in frequency of car driving (-0.2 to -1.7 days/week) was found to be apparent in terms of travelling to the workplace and the kindergarten for all seasons, yet not to the grocery store for any season (p = 0.15-0.49). The intervention group (vs. the control group) reported significantly higher "intrinsic regulation" for cycling (p = 0.01) at follow-up.ConclusionAccess to different bike types for parents with children attending kindergarten resulted in overall increased cycling, decreased car use and higher intrinsic motivation for cycling. E-bikes obtained the greatest cycling amount in total, with the smallest sample variability. Hence, providing parents with children in kindergarten with access to e-bikes might result in increased and sustained cycling, also during the winter season.

Abstract Background Cycling and brisk-walking to work represents an opportunity to incorporate sustainable transport related moderate- to- vigorous physical activity (MVPA) into daily routine among adults, and thus, may make an important contributing to health. Despite the fact that walking and cycling is an option for many commuters and also brings a number of benefits, a considerable proportion of commuters choose to use other means of transport when cycling and walking would be a highly appropriate transport mode. The object of this study was to assess the associations between modes of commuting to the workplace among parental adults; taking socio-demographic, personal, environmental and behavioral factors into account. Methods Data from a cross- sectional questionnaire were collected from a sample of 709 parents (23 % men and 77 % women) of children aged 10–12 years-old in two Norwegian counties, Hedmark and Telemark. Commuting behavior, socio- demographic determinants, personal and environmental factors were ascertained using questionnaire data from the Fruit and Vegetables Makes the Marks project (FVMM). Multivariate logistic regressions were applied. Results In total, 70 % of adults were categorized as car commuters to and from work, 12 % was categorized as a cyclist and 7 % as a walker. The multivariate analyses showed that active commuters were more likely to have a shorter distance to work and perceived the traffic as more safe. Moreover, those who actively commute to the workplace considered commuting as a way to obtain health benefits and a way to reduce CO2 emissions. Active commuters also considered weather to be an obstacle to active commuting. Conclusion In this cross-sectional study of parents living in sub-urban Norway, we found that active commuting to and from the workplace were associated with a shorter distance to work, traffic safety, environmental concern, health benefits and weather condition. In light of these findings, cycling to work seems to be the most appropriate target for interventions and public health campaigns within this population.

Background: Previous studies have reported a positive association between scoring on healthy Nordic diet scales and the intake of healthy foods and nutrients, and also with higher intake of meat, sweets, cakes, and energy in general. These studies have used the same food frequency questionnaire (FFQ) responses for constructing the diet score as for calculating intakes of foods and nutrients. Thus, it is not clear whether the coexistence of healthy and less healthy dietary aspects among adherers to Nordic diets would occur even though separate methods were applied for exploring these relations. Objective: To assess the association between adherence to the New Nordic Diet (NND), derived from an FFQ, and diet quality, determined from two 24-h dietary recall interviews. Design: In total, 65 parents of toddlers in Southern Norway answered the NND FFQ and two 24-h dietary recall interviews. NND adherence was determined from the FFQ and categorized into low, medium, and high adherence. The two 24-h recalls provided data for the intake of specific foods and nutrients, selected on the basis of the Norwegian food-based guidelines as an indicator of a healthy diet. The Kruskal–Wallis test was used for assessing differences in food and nutrient intake across NND groups. Results: High NND adherence derived from FFQ was associated with a high intake of fruits (p=0.004) and fiber (p=0.02), and a low intake of meat (p=0.004) and margarines (p=0.05), derived from recalls. A larger proportion of high NND adherers (68%) complied with the national dietary recommendation targeting meat intake compared with low NND adherers (29%) (p=0.04). Conclusion: The present study showed that higher NND adherence measured with FFQ was associated with a higher intake of selected healthy foods and nutrients, measured with recalls. However, a higher intake of meat, sweets, and energy, as earlier reported, was not observed.

Abstract Background There is concern about the lack of diversity in children’s diets, particularly low intakes of fruit and vegetables and high intakes of unhealthy processed food. This may be a factor in the rising prevalence of obesity. A reason for the lack of diversity in children’s diets may be food neophobia. This study aimed to promote a healthy and varied diet among toddlers in kindergarten. The primary objectives were to reduce food neophobia in toddlers, and promote healthy feeding practices among kindergarten staff and parents. Secondary objectives were to increase food variety in toddlers’ diets and reduce future overweight and obesity in these children. Methods This is an ongoing, cluster randomized trial. The intervention finished in 2014, but follow-up data collection is not yet complete. Eighteen randomly selected kindergartens located in two counties in Norway with enrolled children born in 2012 participated in the intervention. The kindergartens were matched into pairs based on background information, and randomly assigned to the intervention or control groups. A 9-week multi-component intervention was implemented, with four main elements: 1) kindergarten staff implemented a pedagogical tool (Sapere method) in daily sessions to promote willingness to try new food; 2) kindergarten staff prepared and served the toddlers a cooked lunch from a menu corresponding to the pedagogical sessions; 3) kindergarten staff were encouraged to follow 10 meal principles on modeling, responsive feeding, repeated exposure, and enjoyable meals; and 4) parents were encouraged to read information and apply relevant feeding practices at home. The control group continued their usual practices. Preference taste tests were conducted to evaluate behavioral food neophobia, and children’s height and weight were measured. Parents and staff completed questionnaires before and after the intervention. Data have not yet been analyzed. Discussion This study provides new knowledge about whether or not a Sapere-sensory education and healthy meal intervention targeting children, kindergarten staff, and parents will: reduce levels of food neophobia in toddlers; improve parental and kindergarten feeding practices; improve children’s dietary variety; and reduce childhood overweight and obesity. Trial registration ISRCTN74823448 DOI 10.1186/ ISRCTN74823448

BACKGROUND:The obesity epidemic presents a major public health challenge, and a poor diet quality has been identified as one of the most important contributing factors. Whereas a sufficient fruit and vegetable consumption has been associated with several positive health outcomes, the long-term effect on overweight and obesity is unclear. Thus, the aims of this study were to investigate if one year with free school fruit had any effect on weight status 14 years later, and if it affected the birth weight of the participants' children. METHODS:In 2001, 10 -12-year old Norwegian children, received one year of free school fruit in the intervention study "Fruits and Vegetables Make the Marks" (FVMM) and in 2016, a total of 1081 participants of 2049 eligible responded to a follow-up survey. Multilevel logistic regression was used to investigate if one year of free school fruit was associated with weight status and with birthweight status of the offspring. The analyses were adjusted for gender, educational level, and the offspring analysis also for parents' weight status, and the nested design (child/parent). RESULTS:The odds ratios of being overweight (OR: 0.93, 95% CI: 0.70, 1.24) or having a child with high or low birth weight (OR: 0.52, 95% CI: 0.21, 1.30) in the intervention group compared to the control group were not statistically significant, 14 years after the intervention period. CONCLUSIONS:One year of free school fruit did not have an effect on weight status on the participants or birth weight of their offspring, 14 years after the intervention period. Although, results from the present study contribute to fill the knowledge gaps concerning long-term effects of public health efforts on weight status, more follow-up studies with larger samples are warranted.

Background: There is a growing interest in the New Nordic Diet (NND) as a potentially health promoting, environmentally friendly, and palatable regional diet. Also, dietary scores are gaining ground as a complementary approach for examining relations between dietary patterns and various health outcomes. A score assessing adherence to the NND has earlier been published, yet not tested for reliability. Objective: To assess the test–retest reliability of the NND score in a sample of parents of toddlers, residing in Southern Norway. Design: A questionnaire survey was completed on two occasions, approximately 14 days apart, by 67 parents of toddlers [85% females, mean age 34 years (SD=5.3 years)]. The NND score was constructed from 24 items and comprised 10 subscales that summarize meal pattern and intake of typical Nordic foods. Each subscale was dichotomized by the median and assigned values of ‘0’ or ‘1’. Adding the subscales yielded a score ranging from 0 to 10, which was further trichotomized. Test–retest reliability of the final NND score and individual subscales was assessed by Pearson's correlation coefficient and Spearman's rank correlation coefficient, respectively. Additionally, cross tabulation and kappa measure of agreement (k) were used to assess the test–retest agreement of classification into the NND score, and the subscales. Results: Test–retest correlations of the NND score and subscales were r=0.80 (Pearson) and r=0.54–0.84 (Spearman), respectively, all p

Objective: To describe changes in mode of transportation to work or school from pre-pregnancy to early pregnancy, to describe levels of physical activity related to mode of transportation to work or school, and to examine associations between changes in mode of transportation to work or school and educational level, body mass index (BMI) and age. Methods: Between September 2009 and February 2013, 575 healthy pregnant nulliparous women were included into the Norwegian Fit for Delivery (NFFD) trial. At inclusion they reported their current and their pre-pregnancy mode of transportation to work or school. Data were analysed by multilevel mixed models with dichotomized modes of transportation as dependent variables. Results: There was a significant change towards less active transportation to work or school and a decrease in level of physical activity from pre-pregnancy to early pregnancy. Pre-pregnancy, 58% used private transportation to work or school, compared to 64% in early pregnancy (p = 0.001). The percentage of women who biked (11% v. 5%, p

The aim of the present study was to explore if children who spend more time on screen-based sedentary behaviors (i.e.TV viewing and computer use) drink more sugar-sweetened soft drinks. The study also assessed whether these associations were independent of individual and home environmental correlates of soft drink consumption and whether they were moderated by parental education.Data were collected from 7886 children participating in the EuropeaN Energy balance Research to prevent excessive weight Gain among Youth (ENERGY) survey conducted in eight European countries. Self-report questionnaires were used. Multilevel linear regression analyses with soft drink consumption as dependent variable, TV viewing and computer use as independent variables and age, gender, parental education, attitude towards soft drinks, self-efficacy, parental modelling, parental rules and home availability of soft drinks as covariates were conducted. Further interactions were tested to explore if these associations were moderated by parental education. Country-specific analyses were conducted.In six of the eight included countries, a significant positive association was observed between TV viewing (min/day) and soft drink consumption (ml/day), independent of individual and home environmental correlates of soft drink consumption (B = 0.46 (0.26-0.66) in Greece, B = 0.77 (0.36-1.17) in Norway, B = 0.82 (0.12-1.51) in Hungary, B = 1.06 (0.67-1.46) in Spain, B = 1.21 (0.67-1.74) in Belgium and B = 1.49 (0.72-2.27) in Switzerland). There was no significant association between computer use and soft drink consumption in six of the eight included countries in the final models. Moderation effects of parental education in the association between TV viewing and soft drink consumption were found in Norway and Hungary, the association being stronger among those with low parental education.TV viewing appears to be independently associated with soft drink consumption and this association was moderated by parental education in two countries only. Reducing TV time might therefore favorably impact soft drink consumption.

Background: Several school fruit programs are initiated with the aim to improve diet and thereby contribute to reduce the prevalence of overweight. To date, no published studies have demonstrated that school fruit schemes do prevent overweight. Objective: The aim of the present study was to assess if increased consumption of fruits and vegetables, due to free school fruit, have an impact on future weight status. Design: An intervention study including 10- to 12-year-old children from nine schools in two Norwegian counties (Hedmark and Telemark) participating in the Norwegian School Fruit Program for free during the school year 2001/2002 and children from 29 control schools. Follow-up studies were performed in 2005 and 2009. The cohort includes 1950 pupils (984 boys, 966 girls) at baseline, 1,602 participants in 2005 and 320 participants in the 2009 survey, of which 282 also had participated in 2005. Results: In 2005, there was no significant difference between the free fruit group and the control group regarding weight status, Body mass index, or perceived weight status. In 2009, a significant difference in prevalence of overweight was observed (15% vs. 25%, p=0.04). In the crude logistic analysis, the OR for being overweight was 0.52 (95% CI: 0.28–0.97) for the intervention group compared to controls. When adjusting for school, sex, grade level and parental education, the association was no longer statistically significant. Conclusions: These results indicate that free school fruit might contribute to prevent future excessive weight gain. However, the study results are limited by low participation rate.

The UP4FUN intervention is a family-involved school-based intervention aiming at reducing and breaking up sitting time at home (with special emphasis on screen time), and breaking up sitting time in school among 10-12 year olds in Europe. The purpose of the present paper was to evaluate its short term effects.A total of 3147 pupils from Belgium, Germany, Greece, Hungary and Norway participated in a school-randomized controlled trial. The intervention included 1-2 school lessons per week for a period of six weeks, along with assignments for the children and their parents. Screen time and breaking up sitting time were registered by self-report and total sedentary time and breaking up sitting time by accelerometry. The effect of the intervention on these behaviors was evaluated by multilevel regression analyses. All analyses were adjusted for baseline values and gender. Significance level was p≤0.01. No significant intervention effects were observed, neither for self-reported TV/DVD or computer/game console time, nor for accelerometer-assessed total sedentary time and number of breaks in sitting time. The intervention group, however, reported more positive attitudes towards (β = 0.25 (95% CI 0.11, 0.38)) and preferences/liking for (β = 0.20 (95% CI 0.08, 0.32)) breaking up sitting time than the control group.No significant intervention effect on self-reported screen time or accelerometer-assessed sedentary time or breaks in sitting time was observed, but positive effects on beliefs regarding breaking up sitting time were found in favor of the intervention group. Overall, these results do not warrant wider dissemination of the present UP4FUN intervention.International Standard Randomized Controlled Trial Number Registry ISRCTN34562078.

ObjectiveTo design interventions that target energy balance-related behaviours, knowledge of primary schoolchildren's perceptions regarding soft drink intake, fruit juice intake, breakfast consumption, TV viewing and physical activity (PA) is essential. The current study describes personal beliefs and attitudes, home- and friend-related variables regarding these behaviours across Europe.DesignCross-sectional study in which personal, family and friend -related variables were assessed by validated questionnaires, and dichotomized as favourable versus unfavourable answers. Logistic regression analyses were conducted to estimate proportions of children giving unfavourable answers and test between-country differences.SettingA survey in eight European countries.SubjectsA total of 7903 10-12 year old primary schoolchildren.ResultsA majority of the children reported unfavourable attitudes, preferences and subjective norms regarding soft drink, fruit juice intake and TV viewing accompanied with high availability and accessibility at home. Few children reported unfavourable attitudes and preferences regarding breakfast consumption and PA. Many children reported unfavourable health beliefs regarding breakfast consumption and TV viewing. Substantial differences between countries were observed, especially for variables regarding soft drink intake, breakfast consumption and TV viewing.ConclusionThe surveyed children demonstrated favourable attitudes to some healthy behaviours (PA, breakfast intake) as well as to some unhealthy behaviours (soft drink consumption, TV viewing). Additionally, many children across Europe have personal beliefs and are exposed to social environments that are not supportive to engagement in healthy behaviours. Moreover, the large differences in personal, family and friend-related variables across Europe argue for implementing different strategies in the different European countries.

To investigate associations of family-related factors with children's breakfast consumption and BMI-z-score and to examine whether children's breakfast consumption mediates associations between family-related factors and children's BMI-z-score.Ten- to twelve-year-old children (n = 6374; mean age = 11.6 ± 0.7 years, 53.2% girls, mean BMI-z-score = 0.4 ± 1.2) and one of their parents (n = 6374; mean age = 41.4 ± 5.3 years, 82.7% female, mean BMI = 24.5 ± 4.2 kg/m(2)) were recruited from schools in eight European countries (Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia, Spain, and Switzerland). The children self-reported their breakfast frequency per week. The body weight and height of the children were objectively measured. The parents responded to items on family factors related to breakfast (automaticity, availability, encouragement, paying attention, permissiveness, negotiating, communicating health beliefs, parental self-efficacy to address children's nagging, praising, and family breakfast frequency). Mediation analyses were performed using multi-level regression analyses (child-school-country).Three of the eleven family-related variables were significantly associated with children's BMI-z-score. The family breakfast frequency was negatively associated with the BMI-z-score; permissiveness concerning skipping breakfast and negotiating about breakfast were positively associated with the BMI-z-score. Children's breakfast consumption was found to be a mediator of the two associations. All family-related variables except for negotiating, praising and communicating health beliefs, were significantly associated with children's breakfast consumption.Future breakfast promotion and obesity prevention interventions should focus on family-related factors including the physical home environment and parenting practices. Nevertheless, more longitudinal research and intervention studies to support these findings between family-related factors and both children's breakfast consumption and BMI-z-score are needed.

Current data on the prevalence of overweight and energy-balance behaviors among European children is necessary to inform overweight prevention interventions.A school-based survey among 10-12 year old children was conducted in seven European countries using a standardized protocol. Weight, height, and waist circumference were measured; Engagement in physical activity, sedentary and dietary behaviors, and sleep duration were self-reported. Descriptive analyses were conducted, looking at differences according to country, gender, and parental education. 7234 children (52%girls; 11.6 ± 0.7 years) participated. 25.8% and 5.4% of boys, and 21.8% and 4.1% of girls were overweight (including obese) and obese (according to International Obesity Task Force criteria), respectively. Higher prevalence of overweight/obesity was observed in Greece, Hungary, Slovenia and Spain than in Belgium, Netherlands and Norway. Large differences between countries were found in intakes of sugar-sweetened beverages, breakfast, active transport, TV and computer time. More favorable overweight status and behavior patterns were found in girls than boys and in children of higher educated parents than in children of lower educated parents.High levels and striking differences in overweight status and potential risk behaviors were found among schoolchildren across Europe.