Kerstin Trygg

Infant feeding practices and associated factors in the first six months of life: the Norwegian infant nutrition survey.

Aim: To describe and evaluate infant feeding practices during the first 6 mo of life in relation to recommendations, and to study infant feeding practices in relation to maternal and infant characteristics. Methods: Data from 2383 Norwegian infants aged 6 mo were collected by a self‐administered semi‐quantitative food‐frequency questionnaire measuring feeding practices at 6 mo and feeding practices retrospectively at ≤5.5 mo of age. Results: Only 1% of the infants had never been breastfed. The proportion of breastfed infants was 96% at 1 mo, 85% at 4 mo and 80% at 6 mo. The proportion of exclusively breastfed infants was 90% at 1 mo, 44% at 4 mo and 7% at 6 mo. Twenty‐one percent of the infants were introduced to solid foods before the age of 4 mo. For exclusive breastfeeding at 4 mo, breastfeeding at 6 mo and timely introduction of solid foods (not before 4 mo) significant positive trends were found for maternal age, education and degree of urbanization. Negative associations were found for maternal smoking. Furthermore, exclusive breastfeeding at 4 mo was associated with infant gender and marital status, and the odds of breastfeeding at 6 mo significantly decreased with decreasing infant birthweight. Finally, both the odds of exclusive breastfeeding at 4 mo and of breastfeeding at 6 mo increased with increasing numbers of children.

Dietary patterns and their socio-demographic determinants in 10 European countries: data from the DAFNE databank

Objective:To describe the dietary patterns of 10 European countries and their socio-demographic determinants, using the comparable between-countries DAFNE data.Design:Analysis of standardized and postharmonized data collected through the national household budget surveys.Setting:Nationally representative surveys undertaken in 10 European countries, generally in the second half of the 1990s.Results:The differences in the fruit and vegetable consumption previously identified between Mediterranean and Northern European countries seem to be leveling out, particularly in relation to fruit consumption. Pulses, however, still characterize the diet of the Mediterraneans. Straying from their traditional food choices, Mediterraneans recorded high availability of unprocessed red meat, while Central and Northern Europeans preferably consumed meat products. The household availability of beverages (alcoholic and non-alcoholic) is generally higher among Central and Northern European populations. Principal component (PC) analysis led to the identification of two dietary patterns in each of the 10 countries. The first was similar in all countries and indicated ‘wide-range’ food buyers. The second was slightly more varied and described ‘beverage and convenience’ food buyers. PC1 was common among households of retired and elderly members, while PC2 was common among households located in urban or semi-urban areas and among adult Scandinavians living alone.Conclusions:The dietary patterns identified point towards a progressive narrowing of dietary differences between North and South European countries. The comparable between-countries DAFNE data could prove useful in ecological studies, in the formulation of dietary guidelines and public health initiatives addressing specific population groups.Sponsorship:European Commission.

Fruit and vegetable availability among ten European countries : how does it compare with the five-a-day' recommendation?

Recasting the role of fruit and vegetables (FV furthermore, interventions that would specifically focus on vegetables are probably needed.

Vegetable and fruit: the evidence in their favour and the public health perspective.

There is strong evidence that the intake of vegetables and fruits reduces the risk of cardiovascular disease (CVD) and is inversely associated with several forms of cancer. In contrast, information concerning specific macro- or micronutrients in relation to chronic diseases is limited and largely inconclusive. The beneficial role of vegetable and fruit consumption can also be inferred by considering the health effects of two dietary patterns, the Mediterranean and Japanese ones, in both of which the consumption of plant foods holds a prominent position. Time-trend data, retrieved from the DAFNE databank on the vegetable and fruit availability in four European countries (Greece, Ireland, Italy and Norway) indicate that, during the last decade, fruit availability decreased in Greece and Italy and increased in Ireland and Norway, whereas vegetable availability decreased only in Italy. In Greece, Italy and Norway, the daily fruit availability was higher than that of vegetables, a dietary pattern not in accordance to recommendations for higher vegetable consumption. This information, which is crucial for nutrition policies and health education, also demonstrates the value of the DAFNE surveillance system.

Validation of a semi-quantitative food-frequency questionnaire used among 2-year-old Norwegian children

OBJECTIVES An adequate diet is of profound importance in infancy and early childhood. To ensure an optimal diet, knowledge about actual intake must be obtained. The aims of this study were to assess the validity of a semi-quantitative food-frequency questionnaire (SFFQ) applied in a large nation-wide survey among 2-year-old children and to examine the validity of the SFFQ in relation to different background parameters. DESIGN The SFFQ was administered to the parents close to the childs second birthday, and one to two weeks later they started to weigh and record the childs diet for 7 days. SUBJECTS One-hundred and eighty-seven families with a 2-year-old child completed both methods. RESULTS There were no differences between the intakes of protein, saturated fatty acids, total carbohydrates and calcium estimated from the two methods. The average intake of all micronutrients, except for calcium, was overestimated by the SFFQ. Bland-Altman plots showed a systematic increase in difference between the two methods with increasing intake for most nutrients. Spearman correlation coefficients between methods for nutrient intakes ranged from 0.26 to 0.50, the median correlation was 0.38. The correlations increased when estimates were adjusted for energy intake, the median correlation being 0.52. Differences in observed validity were found according to the number of siblings. CONCLUSIONS This study indicates that the SFFQ may be a valuable tool for measuring average intakes of energy, macronutrients and several food items among a 2-year-old population in Norway. The ability of the questionnaire to rank children according to intakes of nutrients and food items was rather low.

Maternal Folate and Cobalamin Status Predicts Vitamin Status in Newborns and 6-Month-Old Infants

Our aim in this longitudinal study was to determine predictors of folate and cobalamin status in infancy. Data were collected from 364 mother-infant pairs with blood measurements from pregnancy ( approximately 18 wk; n = 149), newborns (cord serum; n = 361), and 6-mo-old partially or exclusively breast-fed children (n = 221). Serum/plasma folate, cobalamin, holotranscobalamin (holoTC), holohaptocorrin (holoHC), methylmalonic acid (MMA) and total homocysteine (tHcy) at birth and 6 mo were related to maternal vitamin status, parity, lifestyle variables, and anthropometry. In multivariate analyses, the strongest predictors of folate at birth and 6 mo were maternal folate and cord folate, respectively (P < 0.01). Maternal holoTC best predicted cobalamin status at birth (positively associated with cord cobalamin, holoTC, and holoHC; inversely with MMA and tHcy; P < or = 0.001), whereas maternal and cord holoHC were the strongest predictors of cobalamin status at 6 mo (positively associated with cobalamin, holoTC, holoHC; inversely with tHcy; P < 0.05). The association between cobalamin status and parity was negative at birth but positive at 6 mo. Birth weight, female sex, and smoking were associated with low cobalamin or high tHcy at birth but showed no or opposite associations at 6 mo. In conclusion, maternal folate and cobalamin status exerts a long-term positive effect on infant vitamin status. The effect of smoking, parity and female sex on cobalamin status did not persist beyond the newborn period. Maternal holoTC was the superior predictor of newborn cobalamin status, while holoHC could be a valuable marker for predicting cobalamin status later in infancy.

Breast-feeding at 12 months of age and dietary habits among breast-fed and non-breast-fed infants

OBJECTIVE To analyse factors associated with breast-feeding and use of sweetened drinks at 12 months, and to compare dietary habits among breast-fed and non-breast-fed infants. DESIGN Data were collected by a semi-quantitative food-frequency questionnaire filled in by the parents. SETTING National dietary survey in Norway. SUBJECTS In total, 1932 12-month-old infants were included. RESULTS At 12 months, 36% of the infants were breast-fed. The odds of breast-feeding at this age were more than doubled both for mothers > or =35 years compared with mothers <25 years and for mothers in the highest educational group compared with mothers in the lowest. A negative association was found for maternal smoking, and the odds of breast-feeding were 40% lower for mothers who smoked than for non-smokers. Some dietary differences were observed between breast-fed and non-breast-fed infants apart from intake of milk. In particular, breast-fed infants had a significantly lower daily intake of sweetened drinks than non-breast-fed infants and a 16% lower mean daily intake of added sugars (P<0.001). Furthermore, breast-fed infants had 30% higher odds of not receiving sweetened drinks daily, compared with non-breast-fed infants. CONCLUSIONS Maternal age, education and smoking status were important factors for breast-feeding at 12 months. Breast-fed infants had lower intakes of sweetened drinks and added sugars than non-breast-fed infants. From a public health perspective, continued promotion of breast-feeding is needed to reduce inequalities in breast-feeding. Moreover, prevention of high intakes of sweetened drinks and added sugars should start in infancy.

Validation of a semi-quantitative food-frequency questionnaire used among 12-month-old Norwegian infants

Objective: To assess the validity of a semi-quantitative food-frequency questionnaire (SFFQ) used in a large nation-wide dietary survey among 12-month-old Norwegian infants.Methods: The SFFQ was administered to the parents about 1 week before the infants turned 12-month-old. The participants filled in the SFFQ and 1–2 weeks later they kept weighed food records for a total of 7 days. Both methods were completed for 64 infants.Results: The SFFQ overestimated energy intake with 25% and gave significantly higher estimates of all nutrients compared with the records, except for calcium. Much of the difference between the methods disappeared when nutrient density was compared. Spearman correlation coefficients between pairwise measurements of nutrient intakes from the food records and the SFFQ ranged from 0.18 for vitamin D to 0.72 for polyunsaturated fatty acid intake (median r=0.50). On average 38% of the infants were classified in the same quartile with the two methods, and 3% in the opposite quartile. The correlations for food items varied from 0.28 for sweetened drinks to 0.83 for commercial porridge (median r=0.62).Conclusions: This study indicated that the SFFQ overestimates average absolute nutrient intakes. However, the questionnaire gave better estimates for average nutrient densities than for absolute nutrient intakes. The capability of the questionnaire to rank infants according to intake of nutrients and food items was moderate, but at the same level as others have observed with food-frequency questionnaires.

Micronutrient status in children with cerebral palsy.

Aim: To investigate micronutrient status in a group of children with cerebral palsy (CP).

Household budget survey nutritional data in relation to mortality from coronary heart disease, colorectal cancer and female breast cancer in European countries

Objective: We have undertaken a study to examine whether Household Budget Survey (HBS)-derived nutritional patterns are related to mortality from diseases with strong nutritional components, namely coronary heart disease, colorectal cancer and cancer of the female breast.Design: Ecological correlation study. In the context of the Data Food Networking projects of the European Union, raw data from the national HBS of 10 European countries were provided. For each of the 10 participating countries, daily food availability per capita around 1990 was calculated. Individual foods were aggregated into 12 major food groups that were linked with the diseases under consideration. Mortality data were available from a World Health Organisation database. We have used a composite score to summarise the postulated influence of diet.Setting: Ten European countries circa 1990.Results: The correlation coefficients between the composite score and the age-adjusted mortality from each of the studied diseases were: +0.51 (P~0.14) for colorectal cancer; +0.72 (P~0.02) for female breast cancer; and +0.60 (P~0.07) for coronary heart disease, after adjustment for tobacco smoking.Conclusions: We conclude that dietary information from HBS is sufficiently reliable to reveal correlations with mortality rates from chronic diseases with fairly strong nutritional roots. HBS data could be used, with little cost, for monitoring secular trends in dietary patterns with a view to their health implications.Sponsorship: The DAFNE I and II projects were funded by the European Commission, in the context of the ‘Cooperation in Science and Technology with Central and Eastern European Countries’ and ‘Agriculture and Agro-Industry, including Fisheries’ programs respectively.