Maria Waling

Energy Intake of Swedish Overweight and Obese Children Is Underestimated Using a Diet History Interview

Estimating energy intake (EI) of a child by using a diet history interview (DHI) method may be a challenge because of difficulty for the child to remember what has been eaten as well as to report portion sizes. The aim of this research was to validate reported EI from a DHI in children classified as overweight or obese by comparing the reported EI to total energy expenditure (TEE) measured by 2 objective measures. Eighty-five 10.5- +/- 1.1-y-old overweight and obese children, with help from 1 or 2 parents, reported their EI 2 wk retrospectively in a DHI. Reported EI was compared with TEE, as measured by SenseWear armband (n = 85) and the doubly-labeled water (DLW) method (n = 21), during the same period as the DHI. Reported EI was underestimated by 14% when validated against both the armband and DLW method. Underestimation did not differ between boys and girls. However, the EI of obese children was underestimated by 22%, which is twice the rate as for the overweight children (95% CI: 0.55, 3.08). Underestimated EI was negatively correlated with BMI (r = -0.38; P = <0.01) as well as age (r = -0.21; P = 0.05). EI is underestimated to a higher extent among children with higher BMI and higher age when using a DHI method. The findings show the importance of validating dietary intake of children in general and in overweight and obese children in particular.

A One-Year Intervention Has Modest Effects on Energy and Macronutrient Intakes of Overweight and Obese Swedish Children

To decrease BMI in overweight and obese children, improved dietary intake and increased physical activity are key elements. Our objective was to evaluate the impact of a 1-y food and physical activity intervention on energy and macronutrient intake in overweight and obese children. A randomized open trial was conducted with 92 overweight or obese 10.4 ± 1.08-y-old children. The intervention included 14 group sessions with different themes regarding food and physical activity. Dietary intake was assessed with diet history interviews covering 14 d at baseline and 4-d food records after 1 y and was evaluated according to national dietary recommendations. The control group participated in the same measurements as the intervention group but did not take part in group sessions. After 1 y, both groups had decreased their energy intake (EI) relative to total energy expenditure, but the effect was more pronounced for the intervention group than for the control group. At 1 y follow-up, a larger proportion of children in the intervention group compared with the control group met the recommended intake of refined sugar (P = 0.019). However, the groups did not differ in the proportion children who met the recommended intake of dietary fiber. Further, SFA intake relative to total EI did not differ between the groups at 1 y follow-up. In conclusion, despite a rather comprehensive intervention, only modest effects were achieved with respect to reduced EI and improved macronutrient intake.

Benefits of a Paleolithic diet with and without supervised exercise on fat mass, insulin sensitivity, and glycemic control: a randomized controlled trial in individuals with type 2 diabetes

Means to reduce future risk for cardiovascular disease in subjects with type 2 diabetes are urgently needed.

Overweight and Obese Children's Ability to Report Energy Intake Using Digital Camera Food Records during a 2-Year Study

The objective was to evaluate overweight and obese childrens ability to report reproducible and valid estimates of energy intake (EI) by using digital camera food records (FR) during a 2-year study, compared with objectively measured total energy expenditure (TEE). Seventy-three overweight/obese children, aged 8–12 years at inclusion, kept FR with the help of digital cameras for 16 days in total, on 7 occasions during a 2-year period. On the same days, their TEE was registered with SenseWear Armband (SWA). The children underestimated their EI by −2.8 (2.4) MJ/d on the first assessment occasion (95% CI: −3.3, −2.3). Reporting accuracy did not differ between the 7 assessment occasions (P = 0.15). Variables negatively associated with reporting accuracy relative to TEE were increased age (95% CI: −0.07, −0.01) and BMI z-score (95% CI: −0.18, −0.06). Further, reporting accuracy relative to TEE was lower for girls than boys (95% CI: −0.14, −0.01) and on weekdays compared with weekend days (95% CI: −0.08, −0.001). In conclusion, overweight and obese children were able to report their EI using a digital camera FR with good reproducibility over a 2-year period, even though their EI was underestimated compared with objectively measured TEE.

Effects on Metabolic Health after a 1-Year-Lifestyle Intervention in Overweight and Obese Children: A Randomized Controlled Trial

Objective. To evaluate the effect of a family-based intervention on anthropometric and metabolic markers in overweight and obese children. Methods. Overweight or obese 8–12 years olds (n = 93) were randomized into intervention or control groups. The intervention group participated in a program aiming for lifestyle changes regarding food habits and physical activity. Anthropometric measures and venous blood samples were collected from all children at baseline and after 1 year. Results. BMI z-scores decreased in both groups, 0.22 (P = 0.002) and 0.23 (P = 0.003) in intervention and control group, respectively, during the 1-year study, but there was no difference in BMI between the groups at 1-year measurement (P = 0.338). After 1 year, there was a significant difference in waist circumference, waist/hip ratio, and apolipoprotein B/A1 ratio between intervention and control group. Conclusions. The intervention had limited effects on anthropometrics and metabolic markers, which emphasizes the need of preventing childhood overweight and obesity.

Improved dietary intake among overweight and obese children followed from 8 to 12 years of age in a randomised controlled trial

More knowledge about improving dietary intake in secondary preventive actions against childhood overweight and obesity is needed. The objective was to evaluate the impact of a 2-year intervention on energy, macronutrient and food intake of overweight and obese children participating in a randomised controlled trial. Children (8–12 years old) living in Sweden were recruited to participate for 2 years between 2006 and 2009. The children were randomised into either an intervention group (n 58), participating in an intervention concerning food habits, physical activity and behavioural change, or a control group (n 47). Dietary intake at baseline and the 2-year measurement were assessed with a diet history interview covering 14 d. Energy intake (EI) of the intervention and control groups was underestimated by 28 and 21 %, respectively, after 2 years, but with no difference between the groups (P = 0·51). After 2 years of intervention, the intervention group, compared with the control group, had a lower intake of sugar-sweetened beverages (P = 0·015) as well as a higher intake of foods high in fibre, low in saturated fat, sugar and salt (P = 0·031). Further, a lower EI in relation to BMR, lower total fat, MUFA and cholesterol was seen in the intervention group compared with the control group. In conclusion, the food and nutrient intake of overweight and obese children was improved after participating in a 2-year intervention programme. Dietary counselling should be included in secondary preventive actions against childhood overweight and obesity to promote healthy food habits.

Development and Validation of a Photographic Method to Use for Dietary Assessment in School Settings

Objective To develop and validate a photographic method aimed at making assessment of dietary intake in school canteens non-obstrusive, practical and feasible. Methods The study was conducted in two elementary schools representing two different school canteen systems; main dish being served by canteen staff (Iceland), and complete self-serving (Sweden). Food items in serving and leftovers were weighed and photographed. Trained researchers estimated weights of food items by viewing the photographs and comparing them with pictures of half and full reference portions with known weights. Plates of servings and leftovers from 48 children during five school days (n = 448 plates) and a total of 5967 food items were estimated. The researchers’ estimates were then compared with the true weight of the foods and the energy content calculated. Results Weighed and estimated amounts correlated across meals both in grams and as total energy (0.853–0.977, p<0.001). The agreement between estimated energy content in school meals was close to the true measurement from weighed records; on average 4–19 kcal below true values. Organisation of meal service impacted the efficacy of the method as seen in the difference between countries; with Iceland (served by canteen staff) having higher rate of acceptable estimates than Sweden (self-serving), being 95% vs 73% for total amount (g) in serving. Iceland more often had serving size between or above the half and full reference plates compared with Sweden. Conclusions The photographic method provides acceptable estimates of food and energy intake in school canteens. However, greater accuracy can be expected when foods are served by canteen staff compared with self-serving.

School Meals Do Not Have a Given Place in Swedish School's Quality Management.

Objectives: Sweden is one of three countries worldwide which has a legal requirement to ensure that pupils in compulsory school should be offered free, nutritious school meals. Furthermore, the law states that school meal provision should be included in schools’ internal quality management (IQM) system. The objective of this study was to examine to what extent schools in Sweden are following the legal requirement to include school meals in IQM and the relationship between this inclusion and the application of government advisory guidelines regarding school meals. Design: Cross-sectional study. Setting: Head teachers evenly distributed across all regions in Sweden representing municipality schools, independent schools and Sami schools. Method: Web-based questionnaire completed by 216 head teachers. Results: About half of the schools did not meet the legal requirement to include schools meals in the IQM. Furthermore, familiarity with and use of the National Food Agency (NFA) guidelines and the web-based tool School Food Sweden, as well as activities considered as part of a pedagogical school meal and the inclusion of school meals in interdisciplinary work, were reported to be less common in schools not including school meals in their IQM system. Conclusion: Findings suggest that when there is inclusion of school meals in a school’s quality management system, the school is also more likely to include school meals as part of educational activities. By acknowledging school meal provision as part of the educational process, possibilities are opened up for health-promoting activities to prevent non-communicable disease.

Treadmill workstations in office workers who are overweight or obese: a randomised controlled trial

BACKGROUND Treadmill workstations that enable office workers to walk on a treadmill while working at their computers might increase physical activity in offices, but long-term effects are unknown. We therefore investigated whether treadmill workstations in offices increased daily walking time. METHODS We did a randomised controlled trial of healthy office workers who were either overweight or obese. We recruited participants from 13 different companies, which comprised 17 offices, in Umeå, Sweden. We included people who were aged 40-67 years, had sedentary work tasks, and had a body-mass index (BMI) between 25 kg/m2 and 40 kg/m2. After the baseline measurement, we stratified participants by their BMI (25-30 kg/m2 and >30 to 40 kg/m2); subsequently, an external statistician randomly assigned these participants (1:1) to either the intervention group (who received treadmill workstations for optional use) or the control group (who continued to work at their sit-stand desks as usual). Participants in the intervention group received reminders in boosting emails sent out to them at four occasions during the study period. Researchers were masked to group assignment until after analysis of the primary outcome. After the baseline measurement, participants were not masked to group belongings. The primary outcome was total daily walking time at weekdays and weekends, measured at baseline, 2 months, 6 months, 10 months, and 13 months with the accelerometer activPAL (PAL Technologies, Glasgow, UK), which was worn on the thigh of participants for 24 h a day for 7 consecutive days. We used an intention-to-treat approach for our analyses. This trial is registered with ClinicalTrials.gov, number NCT01997970, and is closed to new participants. FINDINGS Between Nov 1, 2013, and June 30, 2014, a total of 80 participants were recruited and enrolled (n=40 in both the intervention and control groups). Daily walking time during total time awake at weekdays increased between baseline and 13 months by 18 min (95% CI 9 to 26) in the intervention group and 1 min (-7 to 9) in the control group (difference 22 min [95% CI 7 to 37], pinteraction=0·00045); for weekend walking, the change from baseline to 13 months was 5 min (-8 to 18) in the intervention group and 8 min (-5 to 21) in the control group (difference -1 min [-19 to 17]; pinteraction=0·00045). Neither measure met our predetermined primary outcome of 30 min difference in total walking time between the intervention and control group, so the primary outcome of the trial was not met. One adverse event was reported in a participant who accidently stepped on their Achilles tendon. INTERPRETATION In a sedentary work environment, treadmill workstations result in a statistically significant but smaller-than-expected increase in daily walking time. Future studies need to investigate how increasing physical activity at work might have potentially compensatory effects on non-work activity. FUNDING Umeå University, the Västerbotten County Council, and the Mayo Clinic Foundation for Research.

Composition of school meals in Sweden, Finland and Iceland: Official guidelines and comparison with practice and availability

BACKGROUND Nutritious and attractive school meals can improve health equality and public health. Current official guidelines and recommendations on food and nutrient composition of school meals in 3 Nordic countries; Sweden, Finland, and Iceland, are described and compared with actual practice, ie, availability of foods and nutrients in served reference meals in 3 selected areas in each country. METHODS A country comparison was made between official guidelines, and actual practice was studied in participating schools. Reference portions of school meals (N = 170) provided in 24 compulsory schools were photographed and weighed. Food and nutrient availability were compared with official guidelines in each country. RESULTS Emphasis of recommendations on whole-grain bread in Sweden, whole grains in Finland, and fish in Iceland were reflected in food availability. The energy content of the meals provided was lower than guidelines and there was a large variation in energy content between days. CONCLUSIONS The guidelines regarding food availability were quite well followed, but the large variation in energy and nutrient content of provided school meals between days indicates a need for standardization.