Vibeke Kildegaard Knudsen

Association between fruit and vegetable consumption and birth weight: A prospective study among 43,585 Danish women

Objective: To examine whether fruit and vegetable consumption in pregnancy is associated with birth weight in a Western population. Design: Prospective cohort study based on telephone interviews, a food frequency questionnaire (FFQ), and extractions of birth characteristics from national health registries. Subjects and setting: The 43,585 Danish women from the Danish National Birth Cohort who had completed the FFQ in mid-pregnancy and on whom information about birth outcome was available. The exposures were frequency of green leafy vegetable (GLV) intake and quantified intake of fruit, fruit and vegetables, and fruit and vegetables and juice. The outcomes were birth weight and z-score for expected birth weight adjusted for sex and gestation week. Information on maternal height, weight, smoking, and other potential confounders was obtained through telephone interviews. Results: Significant associations were found for all exposures to fruit and vegetable intake with birth weight and most with z-score. The strongest association was found for fruit intake in which case birth weight increased by 10.7 g (95% CI 7.3—14.2) per quintile. All associations were stronger among lean women (BMI<20, n=7,169), whose childrens birth weight increased by 14.6 g (95% CI 6.4—22.9) per quintile increase in fruit intake. For GLV the results were more inconclusive. When adjusted for confounders, but not for energy, the association between GLV and birth weight was significant, but the same was not the case for z-score. Conclusion: Fruit and vegetable consumption in pregnancy is positively associated with birth weight in well-nourished Danish women, especially among lean women.

Relative validity of the pre-coded food diary used in the Danish National Survey of Diet and Physical Activity

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 Spearmans 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.

Folic acid for the prevention of neural tube defects: the Danish experience.

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.

Reduction in pedometer-determined physical activity in the adult Danish population from 2007 to 2012.

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.

Disparities in dietary habits and physical activity in Denmark and trends from 1995 to 2008

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.

Burden of disease of dietary exposure to acrylamide in Denmark.

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.

The Nordic Monitoring System 2011-2014

This report describes the results of the first and second collection of data in the joint Nordic Monitoring System of diet, physical activity and overweight. It is well recognized that health in the European Region needs to be improved and Nordic public health researchers have since 2008 developed and validated a Nordic method to assess diet and physical activity among adults and children. Data has collected on health behaviour and overweight in 2011 and 2014 among 18,000 adults and 5,000 children. During the three year survey period, significant changes have occurred in the Nordic countries, especially among adults. The Nordic Monitoring System shows that lifestyle and weight status differ between the Nordic countries despite highly comparable societal structures. Favorable and unfavorable health behaviour is present in all countries and there are areas to be improved in all countries.

What do Danish children eat, and does the diet meet the recommendations? Baseline data from the OPUS School Meal Study

A childs 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.

The Nordic Monitoring of diet, physical activity, smoking, alcohol and overweight: 2011-2014

Background: The Nordic Plan of Action for better health and quality of life has been put forward by the Nordic Council of Ministers with the aim of reducing unhealthy lifestyles and overweight in the Nordic countries. Monitoring of health behaviour and overweight in the Nordic region is an important element in the plan. Two data collections have been carried out and this report describes status and trends from 2011 to 2014 in diet, physical activity and overweight among children and adults in the Nordic region. Aims: The aims of the Nordic Monitoring System are to provide status and temporal trend data of diet, physical activity and overweight among children and adults in the Nordic region. Furthermore, to compare results between the Nordic countries and to evaluate diet and physical activity with current recommendations, and to examine social inequality in health behaviour and overweight. The results are evaluated against Goals 2011 and Visions 2021 set by the Nordic Plan of Action. Grey Literature Matthiessen et al.; EJNFS, 7(2): 128-130, 2017; Article no.EJNFS.2017.009 129 Methods: Data on diet, physical activity, overweight and socio-demographics have been collected in the autumn of 2011 and 2014. In 2014, data on alcohol and smoking among adults have been included as well. Data comprised simple random samples of 2479 and 2470 children (7–12 y) and 9153 and 8595 adults (18–65 y) drawn in 2011 and 2014, respectively, from the national registers in Denmark, Finland, Iceland, Norway and Sweden. The pooled participation rate among adults in the Nordic countries was 40% in 2011 and 32% in 2014 and among children 45% in both survey years. Data were collected by telephone interviews based on a short questionnaire with validated indicator questions about dietary intake (Food Frequency Questionnaire), physical activity, sedentary behaviour, and weight and height. A parent responded for their child in the telephone interview. Key variables have been used to report the current level and trends in health behaviour and overweight in the Nordic region between 2011 and 2014, i.e. unhealthy diet (low diet quality score for frequency of intake of fruits and vegetables, fish, whole grain bread, and foods rich in saturated fat or added sugar), physical inactivity, high recreational screen time (> 4 h/day), smoking (adults in 2014), daily smoking (adults in 2014), mean total alcohol consumption (adults in 2014), binge drinking during last month (adults in 2014), overweight (including obesity), and obesity. All data were weighted according to gender, age, educational level and population size to reflect the general populations in the Nordic region. Data were analysed using descriptive statistics (t-tests and chi-square tests, p<0.05). Results: In 2014, a high prevalence of unhealthy diet (7-12 y: 15.6% and 18-65 y: 21.4%), physical inactivity (7-12 y: 59.1% and 18-65 y: 33.6%), high recreational screen time (7-12 y: 15.5% and 18-65 y: 30.0%), overweight (7-12 y: 15.4% and 18-65 y: 46.7%), obesity (7-12 y: 3.2% and 18-65 y: 12.7%), smoking (18-65 y: 20.8%), daily smoking (18-65 y: 14.8%) and binge drinking during last month (18-65 y: 45.0%) were found among children and adults in the Nordic region. A high mean total alcohol consumption (18-65 y: 1.7 freq./wk) was also found. Results show that statistically significant changes have occurred in the Nordic region from 2011 to 2014, albeit some are modest in magnitude. The prevalence of obesity increased significantly among adults from 2011 to 2014 (from 11.4% to 12.7%). The proportion of adults with an unhealthy diet (from 18.2% to 21.5%) and with high recreational screen time (from 28.6% to 30.0%) increased significantly in the Nordic region. The increasing proportion with an unhealthy diet was mainly due to a decreasing frequency of intake of fish and wholegrain bread and an increasing intake of saturated fat. Among children in the Nordic region no changes in the overall diet, physical activity and overweight were found between 2011 and 2014. Social inequality in diet, physical activity and overweight was pronounced among adults in the Nordic region and did not change across the survey years. In children, we found a large relative social difference in diet that appeared more pronounced in 2014 than in 2011, a moderate and decreasing difference in overweight, and a small and unchanged difference in physical activity. Overall, trends in adults have mainly been unfavourable or unchanged in the five Nordic countries, while trends have mainly been unchanged or favourable in children. This is reflected in the evaluation of the results in relation to Goals 2011 and Visions 2021 in the Nordic Plan of Action where Goals 2011 aim at favourable trends in diet, physical activity and overweight, while Visions 2021 aim at reaching a certain population level in year 2021. Four in ten of the goals and one in ten of the visions have been fulfilled among adults, while seven in ten of the goals and three in ten of the visions have been fulfilled among children. Each of the five Nordic countries experiences public health challenges: Denmark is challenged with smoking and alcohol behaviour among adults. Sedentary behaviour may be an increasing challenge among adults in Finland where screen time is on the rise. The prevalence and trends in overweight and obesity indicate that this is a major public health challenge among adults in Iceland. The high proportion of physically inactive adults in Norway is of concern. Finally, the increasing proportion with an unhealthy diet among adults in Sweden is also of concern. In addition, the high proportion of inactive children in Sweden is worrying from a public health perspective. Conclusion: The Nordic region experienced an increase in unhealthy dietary habits, high recreational screen time and obesity prevalence among adults between 2011 and 2014. Among children, the picture is more optimistic; however, there is still room for improvement as unhealthy lifestyles and overweight are highly prevalent among children and adults in the Nordic region. Groups like men, 45–65-y-olds, and individuals with low education may be relevant to target to fulfil the common Nordic ambition of ensuring better health and quality of life on equal terms for all Nordic citizens. Matthiessen et al.; EJNFS, 7(2): 128-130, 2017; Article no.EJNFS.2017.009 130 The complete report can be downloaded for free from: http://norden.diva-portal.org/smash/get/diva2:1066553/FULLTEXT01.pdf Full report is also available as ‘Supplementary File’.

Discovery and characterisation of dietary patterns in two Nordic countries

This Nordic study encompasses multivariate data analysis (MDA) of preschool Danish as well as pre- and elementary school Swedish consumers. Contrary to other counterparts the study incorporates two ...