Lotte Holm

Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity.

OBJECTIVE: To study the effect on weight loss in obese subjects by replacement of carbohydrate by protein in ad libitum consumed fat-reduced diets.DESIGN: Randomized dietary intervention study over six months comparing two ad libitum fat reduced diets (30% of total energy) strictly controlled in composition: High-carbohydrate (HC, protein 12% of total energy) or high-protein (HP, protein 25% of total energy).SETTING AND PARTICIPANTS: Subjects were 65 healthy, overweight and obese subjects (50 women, 15 men, aged 18–55 y) randomly assigned to HC (n=25), HP (n=25) or a control group (C, n=15). All food was provided by self-selection in a shop at the department, and compliance to the diet composition was evaluated by urinary nitrogen excretion.MAIN OUTCOME MEASURE: Change in body weight, body composition and blood lipids.RESULTS: More than 90% completed the trial. Weight loss after six months was 5.1 kg in the HC group and 8.9 kg in the HP group (difference 3.7 kg, 95% confidence interval (CI)(1.3–6.2 kg) P<0.001), and fat loss was 4.3 kg and 7.6 kg, respectively (difference 3.3 kg (1.1–5.5 kg) P<0.0001), whereas no changes occurred in the control group. More subjects lost >10 kg in the HP group (35 %) than in the HC group (9 %). The HP diet only decreased fasting plasma triglycerides and free fatty acids significantly.CONCLUSIONS: Replacement of some dietary carbohydrate by protein in an ad libitum fat-reduced diet, improves weight loss and increases the proportion of subjects achieving a clinically relevant weight loss. More freedom to choose between protein-rich and complex carbohydrate-rich foods may allow obese subjects to choose more lean meat and dairy products, and hence improve adherence to low-fat diets in weight reduction programs.

Coenzyme Q10 in health and disease

The literature concerning the importance of coenzyme Q10 in health and disease has been reviewed. Usual dietary intake together with normal in vivo synthesis seems to fulfil the demands for Q10 in healthy individuals. The importance of Q10 supplementation for general health has not been investigated in controlled experiments. The literature allows no firm conclusions about the significance of Q10 in physical activity. In different cardiovascular diseases, including cardiomyopathy, relatively low levels of Q10 in myocardial tissue have been reported. Positive clinical and haemodynamic effects of oral Q10 supplementation have been observed in double-blind trials, especially in chronic heart failure. These effects should be further examined. No important adverse effects have been reported from experiments using daily supplements of up to 200 mg Q10 for 6–12 months and 100 mg daily for up to 6 y.

Preferences, quantities and concerns: socio-cultural perspectives on the gendered consumption of foods.

A review of the sociological research regarding the gendered features of food consumption is presented. The focus is upon differences between women and men in regard to their preferences for particular foods and types of meals, seen in relation to the cultural function of foods as symbolic markers of femininity or masculinity, assessments of the quantities of food consumed by women and men respectively, and differences between women and men in regard to concerns with food safety, health, weight reduction and fitness. Some methodological limitations of this research are discussed with particular reference to the need for interdisciplinary cooperation between sociologists and nutritionists in the design and analysis of dietary surveys. Suggestions are made in regard to future directions for sociological research in this field, with particular reference to the issue that dietary recommendations appear to focus upon increasing the consumption of foods that are markers of femininity and decreasing the consumption of foods that are markers of masculinity in Western food culture.Sponsorship: This research was supported by The National Food Agency, Denmark.

Overweight men's motivations and perceived barriers towards weight loss.

Objective:To explore motivation and perceived barriers towards weight loss among Danish men.Design:The study was of an explorative nature, using qualitative focus group interviews as a method.Setting:Copenhagen, Denmark.Subjects:Twenty-two overweight men, at the age of 25–44 years and motivated for weight loss, were recruited and distributed into four focus groups. The men were primarily unskilled workers. Overall 13 men participated and each group contained three or four participants.Intervention:The interview guide was partly structured, partly unstructured and the themes of the interviews were motives and perceived barriers towards weight loss.Results:Main barriers for losing weight appeared to be lack of motivation and the perception of the slimming diet. The men had a desire to have a lean appearance and avoid illness, but in all the interviews it appeared that the strongest motive for losing weight was a strong desire to become more effective and a greater asset for ones workplace. Overweight subjects were considered less effective and attractive for the labour market.Conclusion:This study indicates that if men from lower socioeconomic backgrounds are to be motivated to weight loss the focus should not be on leanness and good health but rather on increased effectiveness and performance, and the arena should include the working place.Sponsorship:The Royal Veterinary and Agricultural University supplied the necessary equipment and conference rooms.

Sociodemographic differences in dietary habits described by food frequency questions — results from Denmark

Objectives: To investigate whether a modest number of food frequency questions are sufficient to describe sociodemographic differences in dietary habits, and to identify sociodemographic characteristics of subjects adhering to food-based dietary guidelines operationalised in a ‘healthy-diet index’.Design: Cross-sectional population survey.Subjects: A total of 480 men, 515 women, aged 15–90 y. Random sample of private telephone numbers drawn from regional telephone records, geographically stratified. Participation rate 62%.Methods: Computer-assisted telephone interviews, including six food frequency questions, a question on type of fat spreads used on bread, questions on seven sociodemographic variables.Results: The summary of the healthy-diet index showed that the subjects who adhered to food-based dietary guidelines (top quintile) compared to those who did not (bottom quintile) were most often women (odds ratio (OR)=6.07; confidence interval (CI): 3.91–9.43, women vs men), of older age (OR=9.72; CI: 3.02–31.31, old age vs young), highly educated (OR=3.69; CI: 1.53–8.92, high education vs low) and living in multiperson households including children (OR=4.66; CI: 2.47–8.80, multiperson household vs single household). The results also showed that gender difference in dietary habits is associated with other sociodemographic variables.Conclusions: The selected food frequency questions proved sufficient to describe sociodemographic differences in dietary habits, and this method may be a valuable supplement to traditional quantitative dietary surveys in monitoring sociodemographic changes in eating patterns. The results also underline the influence of sociodemographic status on dietary habits.Sponsorship: The Danish Nutrition Council funded the study.

Trust in food safety in Russia, Denmark and Norway

In this paper we argue that institutional conditions should be taken into consideration when consumers trust in food safety is analysed. Our survey results demonstrate that levels of trust in food safety varies considerably across our three selected countries: Russian consumers expressing the lowest level of trust, Norwegian consumers the highest and Danish consumers expressing levels of trust in food safety which were in between. We find empirical evidence in all countries that consumers trust in food safety is related to their evaluation of how their national food control authorities perform, as well as to what extend they trust market mechanisms to secure food quality. However, while trust in food safety in the Scandinavian countries is more likely to rest on trust in public food control, trust in food safety more often depend on trust in market mechanisms in the St. Petersburg region.

Shifting responsibilities for food safety in Europe: An introduction

Following the BSE crisis in 1996, the European food sector underwent profound regulatory and institutional change. The present introductory article introduces, and sketches the background to, seven studies of the institutional reactions and initiatives that were part of, or prompted by, this reorganisation. The studies analyse the way in which the division of responsibilities for food safety has changed both across the EU as a whole and, more specifically, in six European countries. Prepared as part of the comparative research project, Trust in Food, the studies attempt to go beyond traditional policy network analysis and work on regulation. They ask which constellations of societal actors and logics are important in the shifting responsibilities of public and private actors; and they treat this as an empirical question. It emerges that, at EU level, the main strategy for restoring consumer confidence in food was to enhance the institutional independence, transparency and consumer agency. In the countries covered by the remaining six studies, by contrast, institutional reactions in the food sector varied depending on the particular configurations of state, market and civil society.

The Danish tax on saturated fat: why it did not survive

Background/Objectives:Health promoters have repeatedly proposed using economic policy tools, taxes and subsidies, as a means of changing consumer behaviour. As the first country in the world, Denmark introduced a tax on saturated fat in 2011. It was repealed in 2012. In this paper, we present arguments and themes involved in the debates surrounding the introduction and the repeal.Subjects/Methods:An analysis of parliamentary debates, expert reports and media coverage; key informant interviews; and a review of studies about the effects of the tax on consumer behaviour.Results:A tax on saturated fat had been suggested by two expert committees and was introduced with a majority in parliament, as a part of a larger economic reform package. Many actors, including representatives from the food industry and nutrition researchers, opposed the tax both before and after its introduction, claiming that it harmed the economy and had no positive influence on health, rather the contrary. Few policy actors defended the tax. Public health had a prominent role in the politicians’ arguments for introducing the tax but was barely mentioned in the debate about the repeal. Shortly after the repeal of the tax, research was published showing that consumption of saturated fat had declined in Denmark.Conclusions:The analysis indicates that the Danish tax on fat was introduced mainly to increase public revenue. As the tax had no strong proponents and many influential adversaries, it was repealed. New research indicates that the tax was effective in changing consumer behaviour.

Determinants of appetite ratings: the role of age, gender, BMI, physical activity, smoking habits, and diet/weight concern

Background Appetite measures are often recorded by visual analogue scales (VAS), and are assumed to reflect central nervous system (CNS) perceptions and sensations. However, little is known about how physiological, psychological, social, and cultural factors influence VAS. Objective To investigate whether age, gender, body mass index (BMI), smoking habits, physical activity, diet behaviour, and menstruation cycle are determinants of appetite ratings. Design We investigated appetite ratings in different groups of a population during a single meal test, including 178 healthy women (98) and men (80), aged 20–60 years with a BMI of 18.5–35.0 kg/m2. Subjects consumed an evening meal composed to meet individual requirements of energy content and recommendations regarding macronutrient composition. Before and every half hour until 3 hours after the meal, subjects filled out VAS for satiety, fullness, hunger, and prospective food intake. They also filled in a questionnaire on eating/slimming behaviour. Results Multiple linear regression analyses showed that gender and age were the most powerful predictors of postprandial satiety (p<0.001, adj. R2=0.19) and hunger (p<0.001, adj. R2=0.15). Repeated measures general linear model (GLM) analyses revealed that women felt more satisfied than men (p<0.001) and older subjects felt more satisfied than younger (p<0.01). Furthermore, light/no exercisers felt more satisfied and less hungry than hard/moderate exercisers (p<0.05), but these differences disappeared after adjusting for age and gender. Smokers rated their prospective consumption lower than non-smokers (p<005) and women in the ovulation phase felt less hungry than women in the menstruation phase (p<005). Neither BMI nor diet/weight concern were significantly associated with appetite ratings. Conclusions Appetite ratings differed according to age, gender, and physical activity and to a lesser degree for smoking habits and menstruation cycle. Appetite ratings were not influenced by BMI and diet/weight concern. These factors should be considered when planning studies and analysing data concerning appetite sensations.

Blaming the consumer: On the free choice of consumers and the decline in food quality in Denmark

The concept of victim blaming appears in critical discussions of public health but it also has relevance in other political areas. In public debate in Denmark consumers are blamed for the decline in the quality of foods found on the Danish market, because they are seen as exclusively oriented towards cheap food and not interested in good quality fare. This paper addresses the way in which consumers relate to the issue of food quality in their everyday lives. Using a qualitative interview study, it asks how consumers view the foods they find on the Danish market and how they try to ensure that they get foods of the quality they prefer. Consumer conceptualizations of food quality not only related to the consumers personal world, or individual well-being, but readily included broader societal concerns. Most consumers, however, reported that they were unable to buy food of the quality they wanted and saw the food they did buy as a compromise between their own demands, the pressures of everyday life and the inscrutabilities of the food market. Interviews with a small sample of individuals from the food industry and retail sector contrasted with the reports of consumers. These individuals viewed consumers as either conservative or unpredictable, although they also thought consumers focused on cheap foods. Producers and retailers displayed conflicting understandings of what caused the decline in food quality, and described barriers to product development and improved quality of foods. In Denmark food quality is an important issue in the wider public debate on the future of Danish export income, as this income depends largely on food and agricultural products. A recent change in government policies on the food sector, following the latest election, suggests that in the future consumers will continue to be blamed for any decline in food quality on the Danish market.