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The aim of this study was to analyse concordance between Danish adults' recorded diet quality and their own assessment of the healthiness and to examine socio-demographic, health and behavioural characteristics associated with an optimistic or pessimistic self-assessment. Data were derived from The Danish National Survey of Diet and Physical Activity 2011-2013 and included a random sample of 3014 adults (18-75 y). Diet quality was evaluated on the basis of seven-day pre-coded food diaries and categorised 'unhealthy', 'somewhat healthy' and 'healthy'. Self-assessment of the healthiness of own diets was registered via personal interviews and categorised healthy enough 'to a high degree', 'to some degree' or 'not at all/only partly'. Highly and somewhat optimistic self-assessment, respectively, were defined as assessing own diets as healthy enough to a high degree or to some degree while having unhealthy diets. Highly and somewhat pessimistic self-assessment, respectively, were defined as assessing own diets as not healthy enough or healthy enough to some degree while having healthy diets. Multiple logistic regression models were used to examine characteristics associated with optimistic and pessimistic self-assessments, respectively. Among individuals with unhealthy diets, 13% were highly optimistic and 42% somewhat optimistic about the healthiness of their diets. Among individuals with healthy diets, 14% were highly pessimistic and 51% somewhat pessimistic about the healthiness of their diets. Highly optimistic self-assessment was associated with increasing age, excellent self-rated health, normal weight and a moderate activity level. Highly pessimistic self-assessment was associated with decreasing age, good self-rated health and being obese. The findings indicate that people seem to use personal health characteristics as important references when assessing the healthiness of their diets., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Diet has an important role in the management of diabetes. However, little is known about dietary intake in Danish diabetes patients. A food frequency questionnaire (FFQ) focusing on most relevant nutrients in diabetes including carbohydrates, dietary fibres and simple sugars was developed and validated., Objectives: To examine the relative validity of nutrients calculated by a web-based food frequency questionnaire for patients with diabetes., Design: The FFQ was validated against a 4-day pre-coded food diary (FD). Intakes of nutrients were calculated. Means of intake were compared and cross-classifications of individuals according to intake were performed. To assess the agreement between the two methods, Pearson and Spearman's correlation coefficients and weighted kappa coefficients were calculated., Subjects: Ninety patients (64 with type 1 diabetes and 26 with type 2 diabetes) accepted to participate in the study. Twenty-six were excluded from the final study population., Setting: 64 volunteer diabetes patients at the Steno Diabetes Center., Results: Intakes of carbohydrates, simple sugars, dietary fibres and total energy were higher according to the FFQ compared with the FD. However, intakes of nutrients were grossly classified in the same or adjacent quartiles with an average of 82% of the selected nutrients when comparing the two methods. In general, moderate agreement between the two methods was found., Conclusion: The FFQ was validated for assessment of a range of nutrients. Comparing the intakes of selected nutrients (carbohydrates, dietary fibres and simple sugars), patients were classified correctly according to low and high intakes. The FFQ is a reliable dietary assessment tool to use in research and evaluation of patient education for patients with diabetes.

Acrylamide (AA) is a process-contaminant that potentially increases the risk of developing cancer in humans. AA is formed during heat treatment of starchy foods and detected in a wide range of commonly consumed products. Increased focus on risk ranking and prioritization of major causes of disease makes it relevant to estimate the impact that exposure to chemical contaminants and other hazards in food have on health. In this study, we estimated the burden of disease (BoD) caused by dietary exposure to AA, using disability adjusted life years (DALY) as health metric. We applied an exposure-based approach and proposed a model of three components: an exposure, health-outcome, and DALY-module. We estimated BoD using two approaches for estimating cancer risk based on toxicological data and two approaches for estimating DALY. In Denmark, 1.8 healthy life years per 100.000 inhabitants are lost each year due to exposure to AA through foods, as estimated by the most conservative approach. This result should be used to inform risk management decisions and for comparison with BoD of other food-borne hazards for prioritizing policies. However, our study shows that careful evaluation of methodological choices and assumptions used in BoD studies is necessary before use in policy making., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: To assess the relative validity of a semi-quantitative, web-based FFQ completed by female pregnancy planners in the Danish 'Snart Forældre' study., Design: We validated a web-based FFQ based on the FFQ used in the Danish National Birth Cohort against a 4 d food diary (FD) and assessed the relative validity of intakes of foods and nutrients. We compared means and medians of intakes, and calculated Pearson correlation coefficients and de-attenuated coefficients to assess agreement between the two methods. We also calculated the proportion correctly classified based on the same or adjacent quintile of intake and the proportion of grossly misclassified (extreme quintiles)., Setting: Participants (n 128) in the 'Snart Forældre' study who had completed the web-based FFQ were invited to participate in the validation study., Subjects: Participants in the 'Snart Forældre' study, in total ninety-seven women aged 20-42 years., Results: Reported intakes of dairy products, vegetables and potatoes were higher in the FFQ compared with the FD, whereas reported intakes of fruit, meat, sugar and beverages were lower in the FFQ than in the FD. Overall the de-attenuated correlation coefficients were acceptable, ranging from 0·33 for energy to 0·93 for vitamin D. The majority of the women were classified in the same or adjacent quintile and few women were misclassified (extreme quintiles)., Conclusion: The web-based FFQ performs well for ranking women of reproductive age according to high or low intake of foods and nutrients and, thus, provides a solid basis for investigating associations between diet and fertility.

A child's diet is an important determinant for later health, growth and development. In Denmark, most children in primary school bring their own packed lunch from home and attend an after-school care institution. The aim of the present study was to evaluate the food, energy and nutrient intake of Danish school children in relation to dietary guidelines and nutrient recommendations, and to assess the food intake during and outside school hours. In total, 834 children from nine public schools located in the eastern part of Denmark were included in this cross-sectional study and 798 children (95·7 %) completed the dietary assessment sufficiently (August-November 2011). The whole diet was recorded during seven consecutive days using the Web-based Dietary Assessment Software for Children (WebDASC). Compared with the food-based dietary guidelines and nutrient recommendations, 85 % of the children consumed excess amounts of red meat, 89 % consumed too much saturated fat, and 56 % consumed too much added sugar. Additionally 35 or 91 % of the children (depending on age group) consumed insufficient amounts of fruits and vegetables, 85 % consumed insufficient amounts of fish, 86 % consumed insufficient amounts of dietary fibre, 60 or 84 % had an insufficient Fe intake (depending on age group), and 96 % had an insufficient vitamin D intake. The study also showed that there is a higher intake of fruits and bread during school hours than outside school hours; this is not the case with, for example, fish and vegetables, and future studies should investigate strategies to increase fish and vegetable intake during school hours.

Aims: To examine the development in pedometer-determined physical activity from 2007-2008 to 2011-2012 in the adult Danish population., Methods: The study population comprised two random samples of 18-75-year-old individuals who took part in cross-sectional studies in 2007-2008 (n=224) and 2011-2012 (n=1515). Pedometer data (sealed Yamax SW 200) were obtained for seven consecutive days. Data for 1624 participants (48.2% men) were included in the analysis. An overall step-defined activity level was examined based on a graduated step index (sedentary, low active, somewhat active, active, highly active). The pedometer-determined outcomes were analysed using regression models., Results: A borderline significant decline (p=0.077) from 8788 to 8341 steps/day (-446 (95% confidence intervals -50, 943)) was found between 2007-2008 and 2011-2012. Furthermore, a 23.7% (95% confidence intervals -41.7%, -0.1%) lower overall step-defined activity level was observed in 2011-2012 compared to 2007-2008. These changes were primarily due to a reduced level of activity among women. The proportion of individuals taking ⩾10,000 steps/day decreased non-significantly from 34.8% to 29.3%, whereas the proportion taking <5000 steps/day did not differ between survey periods., Conclusions: This nationally representative survey suggests an overall reduction in the physical activity level among Danish adults. The reduction was due to a shift in the population distribution from higher to lower levels of activity. If this shift is true, it is worrying from a public health perspective. Our study result needs, however, to be confirmed by other population studies., (© 2015 the Nordic Societies of Public Health.)

Aims: To examine social disparities in dietary-, alcohol- and leisure-time physical activity habits in Danish adults from 1995 to 2008 and to test the hypothesis of widening disparities., Methods: Four cross-sectional surveys of representative samples of the Danish population aged 20-75 years were analysed, a total of 7900 respondents. Dietary and alcohol habits were measured by a 7-day pre-coded food diary and physical activity and education by a face-to-face interview. Multivariate analyses were used to test associations between explanatory variables and response variables and the hypothesis of widening disparities., Results: In all analyses, both diet quality and physical inactivity differed systematically with educational group and with healthier habits for the group with long education. Only for alcohol habits was an opposite social gradient seen. Disparities persisted over all time periods. The analyses using "The Concentration Index" did not change any of the conclusions. Gender also influenced diet quality. Men had dietary and alcohol habits furthest away from the guidelines. A trend of healthier habits was also found over the time period., Conclusions: Social disparities in diet quality and leisure-time physical activity were seen for all examined time periods and with no significant change therefore, there is no support to the hypothesis of widening social disparities in all educational groups some improvement of dietary habits was found, especially for those foods where comprehensive initiatives had taken place however, social disparities still exist there is an ongoing need to address these disparities in order to reduce social inequality in health., (© 2014 the Nordic Societies of Public Health.)

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., (©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Objective: To 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., Design: Cross-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 χ 2 test was used to analyse changes over time and multiple logistic regression analysis was applied to identify factors associated with weight misperception., Setting: The Danish National Survey of Diet and Physical Activity in three periods: 1995, 2000-2004 and 2005-2008., Subjects: A random sample of 9623 Danes aged 15-75 years., Results: The 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)., Conclusions: The 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/objectives: To identify and describe dietary patterns in Danish adults and to examine which demographic and health-related lifestyle factors are associated with dietary patterns., Subjects/methods: 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., Results: 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., Conclusions: 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.

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.

Objective: To determine the relative validity of the pre-coded food diary applied in the Danish National Survey of Dietary Habits and Physical Activity., Design: A cross-over study among seventy-two adults (aged 20 to 69 years) recording diet by means of a pre-coded food diary over 4 d and a 4 d weighed food record. Intakes of foods and drinks were estimated, and nutrient intakes were calculated. Means and medians of intake were compared, and cross-classification of individuals according to intake was performed. To assess agreement between the two methods, Pearson and Spearman's correlation coefficients and weighted kappa coefficients were calculated., Setting: Validation study of the pre-coded food diary against a 4 d weighed food record., Subjects: Seventy-two volunteer, healthy free-living adults (thirty-five males, thirty-seven females)., Results: Intakes of cereals and vegetables were higher, and intakes of fruit, coffee and tea were lower, in the weighed food record compared with the food diary. Intakes of nutrients were grossly the same in the two methods, except for protein, where a higher intake was recorded in the weighed record. In general, moderate agreement between the two methods was found., Conclusions: Participants were classified moderately correct according to food and nutrient intakes assessed in the pre-coded food diary; however values of absolute food intakes should be used and interpreted with caution. Improvement of the methods to estimate portion size may increase the accuracy of the dietary intake estimates.

Background: Few studies have examined the overall effect of maternal fish intake during pregnancy on child development or examined whether the developmental benefits of maternal fish intake are greater in infants breastfed for a shorter duration., Objective: We aimed to study associations of maternal prenatal fish intake and breastfeeding duration with child developmental milestones., Design: We studied 25 446 children born to mothers participating in the Danish National Birth Cohort, a prospective population-based cohort study including pregnant women enrolled between 1997 and 2002. Mothers reported child development by a standardized interview, which we used to generate developmental scores at ages 6 and 18 mo. We used multivariate cumulative ordinal logistic regression to evaluate the odds of higher developmental scores associated with maternal fish intake and breastfeeding, after adjustment for child age, sex, and growth; maternal size and pregnancy characteristics; and parental education and social status., Results: Higher maternal fish intake and greater duration of breastfeeding were associated with higher child developmental scores at 18 mo [odds ratio: 1.29 (95% CI: 1.20, 1.38) for the highest versus the lowest quintile of fish intake, and 1.28 (1.18, 1.38) for breastfeeding for > or =10 mo compared with breastfeeding for < or =1 mo]. Associations were similar for development at 6 mo. Associations of fish intake with child development did not differ by breastfeeding duration., Conclusions: Maternal fish intake during pregnancy and the duration of breastfeeding are independently associated with better early child development. Future research and consumption guidelines, incorporating nutritional benefits as well as contaminant risks, should consider the overall effect of prenatal fish consumption on child development.

Evidence from controlled trials suggests that ingestion of 0.4 mg of folic acid per day in the periconceptional period is effective in preventing neural tube defects (NTD). For this reason, most countries recommend that women planning pregnancy take folic acid supplements in the periconceptional period, and some countries even fortify stable foods with folic acid. Denmark exemplifies a country with a relatively conservative attitude with respect to taking action in these matters. In 1999, a national information campaign was launched that recommended women planning pregnancy take 0.4 mg of folic acid periconceptionally, but with the moderation that women who eat a healthy diet do not need to take folic acid supplement. The campaign was repeated during 2001. The results of the latter campaign were evaluated by using data from a national survey among pregnant women conducted simultaneously with the campaign by the Danish National Birth Cohort. An increase in the proportion of folic acid users took place concomitantly with the launching of the information events, but the increase was limited. Among women who did not plan their pregnancy, a small proportion had taken folic acid supplements periconceptionally, and this proportion did not change concomitantly with the campaign. Young age and low education were factors associated with low likelihood of taking folic acid. It seems that different and more efficient actions are needed if a more substantial proportion of Danish women and their fetuses are going to benefit from the knowledge that folic acid supplementation in the periconceptional period can prevent NTD.

Objectives: To investigate possible associations between maternal diet during pregnancy and fetal growth., Method: Factor analysis was used to explore dietary patterns among pregnant women. The association between maternal dietary patterns and fetal growth (in terms of small for gestational age, SGA) was investigated by logistic regression. Prospective cohort study, including information on 44 612 women in Denmark., Results: Two major dietary patterns were defined: the first pattern was characterized by red and processed meat, high-fat dairy, and the second pattern was characterized by intake of vegetables, fruits, poultry and fish. Women were classified into three classes according to their diet: the first class had high intake of foods of the first dietary pattern, and was classified as 'the Western diet', the second class preferred foods of the second pattern and was classified as the 'Health Conscious'; and the third one had eaten foods of both patterns, and was classified as the 'Intermediate'. The odds ratio of having a small for gestational-age infant (with a birth weight below the 2.5th percentile for gestational age and gender) was 0.74 (95% CI 0.64-0.86) for women in the Health Conscious class compared with women in the Western Diet class. The analyses were adjusted for parity, maternal smoking, age, height, pre-pregnancy weight and father's height., Conclusions: Our results indicated that a diet in pregnancy, based on red and processed meat and high-fat diary, was associated with increased risk for SGA. Further studies are warranted to identify specific macro-, or micronutrients that may be underlying these associations.

Objectives: To evaluate compliance with the national recommendation on supplemental iron to all pregnant women in Denmark and to explore differences between compliers and non-compliers with respect to dietary habits and other lifestyle factors., Design: Intake of supplemental iron from pure iron supplements and from multivitamin and mineral preparations was estimated in mid-pregnancy., Setting: Nationwide cohort study, the Danish National Birth Cohort (DNBC), comprising more than 100,000 women recruited in early pregnancy., Subjects: Information on diet and dietary supplements was available for 54,371 women. Of these, information on lifestyle factors was available for 50,902 women., Results: A high compliance with the recommendation was found, as approximately 77% of the women reported use of iron supplements during pregnancy. However, many of the compliers did not obtain the recommended doses of iron, which can partly be explained by the lack of iron preparations of appropriate doses available on the Danish market. Compliance with the recommendation was associated with age above 20 years, primiparity, body mass index<30 kg m- 2, non-smoking and long education. No major differences were seen in dietary intake between compliers and non-compliers.ConclusionOverall, a high compliance rate was found among participants of the DNBC but a clarification on daily dose is needed, and more concern should be paid to vulnerable groups such as young, smoking women and women with no or short education.

Objective: As a means to prevent neural tube defects (NTDs), women planning pregnancy in Denmark are recommended to take a dietary supplement of 400 microg folic acid daily during the periconceptional period. We examined compliance with this recommendation in a national survey., Design: Cohort study on pregnant women in Denmark., Setting: The Danish National Birth Cohort (DNBC)., Subjects: From November 2000 to February 2002, 22,000 pregnant women were recruited for DNBC. Use of dietary supplements was recorded at enrollment. Compliance with the recommendation was related to an information campaign that took place during the second half of 2001, and to lifestyle factors provided in a telephone interview by the end of the first trimester of pregnancy., Results: An increase was seen in the proportion of women complying with the recommendation in the study period and this coincided with the information campaign events. However, even at the end of the period, only 22.3% of the women who had planned their pregnancy fully complied with the recommendation. No increase at all was seen in periconceptional folic acid use among women with unplanned pregnancies. Young age, low education and smoking were identified as factors that determined non-compliance., Conclusions: Alternative and more effective strategies are needed if the Danish population is to benefit fully from the knowledge that folic acid prevents NTDs. Future strategies should not only target vulnerable groups, such as the less educated and the young, but also women who get pregnant without planning this. The only possible way to reach the last group may be through fortification of foods with folic acid.

Objectives: To describe the use of dietary supplements in a group of Danish adults and to investigate the differences between users and non-users with respect to age, gender, health and lifestyle factors., Design: Cross-sectional study in two Danish cities., Setting: The Danish Investigation on Iodine Intake and Thyroid Diseases, 1997-1998., Subjects: Participants were 3707 women (selected age groups between 18 and 65 years) and 942 men (60-65 years). Participation rate was 50%. Supplement data were collected in a personal interview. Data on education, smoking, alcohol intake, physical activity, use of medication and self-perceived health were derived from a self-administered questionnaire. Multiple logistic regression was used for the statistical analysis., Results: Participants were asked about all kinds of supplements, ranging from products containing vitamins and minerals, to fish oils and products of herbal origin. On average 59% reported use of some kind of dietary supplement. Most common were combined multivitamin/mineral products (48%) followed by single vitamin C products (10%). Twelve per cent used three or more different supplements. Supplement use was strongly associated with age and gender, being highest among elderly women (78%). Ex-smokers were more likely to use supplements than subjects who had never smoked (odds ratio (OR) 1.36, 95% confidence interval (CI) 1.09-1.76). Supplement use was more likely among subjects who had many days of illness 95% CI 1.12-1.66) and among users of medication 95% CI 1.04-1.42). Subjects who perceived their health as poor were more likely to use supplements other than just a multivitamin/mineral tablet 95% CI 1.31-3.77)., Conclusions: Use of dietary supplements was related to age, gender and smoking, but also to poor self-perceived health status and absence from work. This indicates that a group of people use supplements as a form of self-medication.