Agneta Yngve

Fruit and vegetable intake in a sample of 11-year-old children in 9 European countries: The pro children cross-sectional survey

Background/Aims: An adequate fruit and vegetable intake provides essential nutrients and nutritive compounds and is considered an important part of a healthy lifestyle. No simple instrument has been available for the assessment of fruit and vegetable intake as well as its determinants in school-aged children applicable in different European countries. Within the Pro Children Project, such an instrument has been developed. This paper describes the cross-sectional survey in 11-year-olds in 9 countries. Methods: The cross-sectional survey used nationally, and in 2 countries regionally, representative samples of schools and classes. The questionnaires, including a precoded 24-hour recall component and a food frequency part, were completed in the classroom. Data were treated using common syntax files for portion sizes and for merging of vegetable types into four subgroups. Results: The results show that the fruit and vegetable intake in amounts and choice were highly diverse in the 9 participating countries. Vegetable intake was in general lower than fruit intake, boys consumed less fruit and vegetables than girls did. The highest total intake according to the 24-hour recall was found in Austria and Portugal, the lowest in Spain and Iceland. Conclusion: The fruit and vegetable intake in 11-year-old children was in all countries far from reaching population goals and food-based dietary guidelines on national and international levels.

Effect of monitor placement and of activity setting on the MTI accelerometer output

PURPOSE To examine the effect of monitor placement (hip vs back) and of activity setting (treadmill vs track) on the output from the Manufacturing Technology Inc. (MTI), activity monitor (model WAM 7164). METHODS In a laboratory study, 28 subjects (14 men, 14 women) walked at a normal pace, walked at a fast pace, and jogged at a comfortable pace on an indoor track. These activities were repeated on a treadmill using the individual speeds from the track locomotion. Oxygen uptake was measured simultaneously using a portable metabolic system. One activity monitor was worn on the hip and one on the lower back. In a field study, 34 subjects (18 men, 16 women) each wore two monitors (hip and low back placement) for seven consecutive days. In the laboratory study, ANOVA showed significant effects of placement ( P = 0.009) and setting ( P < 0.001), indicating that activity counts differ between different body sites and different settings (track vs treadmill). Gross energy expenditure predictive equations were developed and thereafter evaluated in the field study. Time spent at moderate and vigorous intensity of physical activity was 38% and 85% ( P < 0.001) higher when calculated from the treadmill-based equations as compared to the track-based equations. Free-living physical activity estimates were not affected by the placement. CONCLUSION The relationship between activity counts and energy expenditure during laboratory locomotion is placement and setting-specific. When habitual physical activity is assessed in free-living subjects, the treadmill derived relationship between energy expenditure and activity counts may overestimate time spent at moderate intensity of physical activity, whereas the placement of the monitor does not influence on the interpretation of the data.

Protection, promotion and support of breast-feeding in Europe: current situation

OBJECTIVE To describe the current situation regarding protection, promotion and support of breast-feeding in Europe, as a first step towards the development of a blueprint for action. DESIGN AND SETTING A questionnaire was completed by 29 key informants and 128 other informants in the EU, including member states, accession and candidate countries. RESULTS EU countries do not fully comply with the policies and recommendations of the Global Strategy on Infant and Young Child Feeding that they endorsed during the 55th World Health Assembly in 2002. Some countries do not even comply with the targets of the Innocenti Declaration (1990). Pre-service training on breast-feeding practice is inadequate and in-service training achieves only low to medium coverage. The Baby Friendly Hospital Initiative is well developed only in three countries; in 19 countries, less than 15% of births occur in baby-friendly hospitals. The International Code of Marketing of Breastmilk Substitutes, endorsed in 1981 by all countries, is not fully applied and submitted to independent monitoring. The legislation for working mothers meets on average the International Labour Organization standards, but covers only women with full formal employment. Voluntary mother-to-mother support groups and trained peer counsellors are present in 27 and 13 countries, respectively. Breast-feeding rates span over a wide range; comparisons are difficult due to use of non-standard methods. The rate of exclusive breast-feeding at 6 months is low everywhere, even in countries with high initiation rates. CONCLUSIONS EU countries need to revise their policies and practices to meet the principles inscribed in the Global Strategy on Infant and Young Child Feeding in order to better protect, promote and support breast-feeding.

Breastfeeding in countries of the European Union and EFTA: current and proposed recommendations, rationale, prevalence, duration and trends.

UNLABELLED Recommendations suggest exclusive breast feeding for at least the first 4 to 6 months after birth. Paradoxically, an overwhelming proportion of breast feeding (BF) data in Europe refers to all BF, i.e. not only exclusive but also partial BF (including formula, juices, water, sweetened water etc). This makes it difficult to estimate to what extent the recommendations are met. There is currently strong evidence for recommending exclusive breast feeding for at least 6 months. Exclusive BF has progressively gained scientific support. Prevention of infections, allergies and chronic diseases and a favourable cognitive development are highlighted in the recent scientific literature. Further long-term studies on the effects of BF on prevention of chronic disease in the adult are needed. Great differences exist in BF prevalence and duration both within and between European countries. Trends point towards higher prevalence and duration, with some exceptions. Young mothers breast feed less than older mothers; single and/or less educated mothers breast feed less than married mothers with more education. However, inefficient and unreliable monitoring systems prevail, and the data are scarce, not only on exclusive BF but also on demographic, socio-economic, psychosocial and medical determinants of BF patterns. National BF coordinators have not been appointed in many countries, and only every second country has promotion of BF incorporated into their national plan of action for nutrition. CONCLUSIONS Efficient surveillance systems, comparable across Europe and using common definitions and methodology, need to be developed. These should include determinants of breast feeding. A European consensus conference should urgently be organised, in which strategies for successful promotion of exclusive BF should be particularly considered. There is now strong evidence for a recommendation to breast feed exclusively for about 6 months, which is more than the duration recommended previously.

Promoting Fruit and Vegetable Consumption among European Schoolchildren: Rationale, Conceptualization and Design of the Pro Children Project

Background/Aims: The Pro Children Project was designed to assess fruit and vegetable consumption in European schoolchildren and their parents, as well as determinants of the children’s consumption patterns. A second objective was to develop and test strategies, applicable across Europe, for promoting consumption of fruits and vegetables among schoolchildren and their parents. In this paper, the rationale, theoretical background, overall design and implementation of the project is presented. Methods: Surveys of national, representative samples of 11-year-old schoolchildren and their parents were conducted in 9 countries, i.e. in Austria, Belgium, Denmark, Iceland, the Netherlands, Norway, Portugal, Spain and Sweden. Comprehensive school-based educational programmes have been developed and tested in three settings, i.e. in Spain, the Netherlands and in Norway. A precoded 24-hour recall form combined with a set of food frequency questions assessing regular intake were used to assess fruit and vegetable consumption. Determinants were assessed employing a comprehensive theoretical framework including personal, social and environmental factors related to fruit and vegetable consumption. The intervention programmes have been tested employing a group-randomized trial design where schools have been randomly allocated to an intervention arm and a delayed intervention arm. Surveys among all participating children and their parents were conducted prior to the initiation of the intervention, immediately after the end of the intervention and at the end of the subsequent school year. Conclusion: The project is expected to provide new information of great importance for improving our understanding of consumption patterns of fruits and vegetables and for guiding future efforts to promote increased consumption patterns across Europe.

WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6-9-year-old children.

What is already known about this subject Overweight and obesity prevalence estimates among children based on International Obesity Task Force definitions are substantially lower than estimates based on World Health Organization definitions. Presence of a north–south gradient with the highest level of overweight found in southern European countries. Intercountry comparisons of overweight and obesity in primary‐school children in Europe based on measured data lack a similar data collection protocol.

Breastfeeding determinants and a suggested framework for action in Europe

This is a background paper for the EURODIET initiative. A number of international initiatives and documents were identified, such as the Baby-Friendly Hospital Initiative, the International Code of Marketing of Breast Milk Substitutes and a number of consensus reports from professional groups, that propose ways forward for breastfeeding promotion. These point at a range of initiatives on different levels. The determinants for successful breastfeeding have to be identified. They can be categorised into five groups; socio-demographic, psycho-social, health care related, community- and policy attributes. A framework for future breastfeeding promoting efforts on European level is suggested, within which these determinants are considered. A common surveillance system needs to be built in Europe, where determinants of breastfeeding are included. There is also a need for a surveillance system which makes it possible to use the collected data on local level, not only on national and supranational level. Combined with a thorough review of the effectiveness of already existing breastfeeding promotion programmes, a co-ordinated EU-EFTA action plan on breastfeeding should be formulated and implemented within a few years. Urgent action could take place in parallel, especially targeting young, low-income, less educated mothers.

Personal, social and environmental predictors of daily fruit and vegetable intake in 11-year-old children in nine European countries

Objective:To investigate potential personal, social and physical environmental predictors of daily fruit intake and daily vegetable intake in 11-year-old boys and girls in nine European countries.Subjects:The total sample size was 13 305 (90.4% participation rate).Results:Overall, 43.2% of the children reported to eat fruit every day, 46.1% reported to eat vegetables every day. Daily fruit intake and daily vegetable intake was mainly associated with knowledge of the national recommendations, positive self-efficacy, positive liking and preference, parental modeling and demand and bringing fruit to school (odds ratio between 1.40 and 2.42, P<0.02). These factors were associated fairly consistently with daily fruit intake across all nine European countries, implying that a rather uniform intervention strategy to promote fruit can be used across Europe. For vegetables, the pattern was, however, less consistent. Differences between countries in cooking and preparing vegetables might be responsible for this larger diversity.Conclusions:This study showed that especially a combination of personal and social factors is related to daily fruit and vegetable intake in schoolchildren. This shows that a comprehensive multilevel intervention strategy based upon a series of individual and social correlates will be most promising in the promotion of daily fruit and vegetable intake in children.

Overweight and obesity in a representative sample of schoolchildren – exploring the urban–rural gradient in Sweden

To present the prevalence and urban‐rural differences of overweight and obesity in 7–9‐year‐old Swedish schoolchildren, we used anthropometric data from a nationally representative survey performed in 2008. Trained staff weighed and measured 4538 children in grades 1 and 2 in 94 primary schools. Weight classification was performed using the IOTF reference and school areas were classified based on level of urbanization and area‐level education. Overweight was found in 17% of the children including 3% obese. For overweight, odds‐ratios were 1.33 and 1.61 (significant) in semi‐urban and rural areas, relative to urban areas. After adjusting for area‐level education, differences by degree of urbanisation were greatly attenuated and non‐significant. For obesity urban‐rural differences were observed in boys only and remained after adjustment for area‐level education. For area‐level education, risk estimates were significantly elevated and unaffected by urbanization and gender, odds‐ratios 1.75 and 2.21 for overweight and 2.62 and 3.69 for obesity, in medium‐ and low‐education areas compared to high‐education areas. This supports earlier reports identifying areas with low socioeconomic status as high‐risk areas for overweight and obesity. However, this study also suggests that gender should be considered when targeting children in urban as well as rural communities for health promoting interventions.

Comparative analysis of nutrition data from national, household, and individual levels: results from a WHO-CINDI collaborative project in Canada, Finland, Poland, and Spain

Study objective: This project determined to what extent data on diet and nutrition, which were collected in a non-uniform manner, could be harmonised and pooled for international and national comparison. Design: Direct comparisons of dietary data between studies were made using food balance sheets (FBS), household budget surveys (HBS), and individual dietary data (IDS); comparisons were also made within countries. Differences in study design and methodological approaches were taken into consideration. Data from research projects from the following four World Health Organisation (WHO) Countrywide Integrated Noncommunicable Disease Intervention (CINDI) countries were included—Canada, Finland, Poland, and Spain. Main results: FBS overestimated food consumption and nutrient intake compared to IDS. Results between HBS and IDS were quite similar, except for fish, meat, pulses and vegetables, which were underestimated by HBS, and sugar and honey and cereals, which were overestimated. Percentages of energy from fat, carbohydrates and proteins were higher when estimated from FBS, HBS, and IDS respectively. Conclusions: Results suggest that estimations from these three sources of dietary data are difficult to compare because they are measuring different levels of dietary information. The understanding of their relations may be important in formulating and evaluating a nutrition policy.