How does the updated Nutri-Score discriminate and classify the nutritional quality of foods in a Norwegian setting?

BACKGROUND: The Nutri-Score is a candidate for the harmonized mandatory front-of-pack nutrition label enabling consumers in the European Union to make healthier food choices. Nutri-Score classifies foods (including beverages) from A (high nutritional quality) to E (low nutritional quality) based on the foods' qualifying and disqualifying components. We aimed to evaluate the updated Nutri-Score for foods (2022) and beverages (2023) in a Norwegian setting by exploring its ability to discriminate the nutritional quality of foods within categories. Additionally, we assessed Nutri-Scores' ability to classify foods in accordance with the Norwegian food-based dietary guidelines (FBDGs). METHODS: The updated Nutri-Score was calculated for 1,782 foods in a Norwegian food database. The discriminatory ability of the updated Nutri-Score was considered by exploring the distribution of Nutri-Score within categories of foods using boxplots and frequency tables, and by examining which qualifying and disqualifying components that contributed most to the Nutri-Score class. Accordance with the Norwegian FBDGs was assessed by exploring Nutri-Score for foods specifically mentioned in the guidelines. RESULTS: Overall, the updated Nutri-Score seemed to discriminate the nutritional quality of foods within categories, in a Norwegian setting. The foods' content of salt and the beverages' content of sugar were components contributing the most to Nutri-Scores' discriminatory ability. Furthermore, in most cases the updated Nutri-Score classified foods in accordance with the Norwegian FBDGs. However, there were minor inconsistencies in how Nutri-Score classified certain foods, such as the inabilities to discriminate between full-fat and low-fat/leaner cheeses, cremes and processed meats (sausages), and between whole grain and refined pasta/rice. CONCLUSIONS: We observed an overall acceptable discriminatory performance of the updated Nutri-Score in a Norwegian setting and in most cases the updated Nutri-Score classified foods in accordance with the Norwegian FBDGs. However, minor inconsistencies were observed. Together with the FBDGs, the updated Nutri-Score could be a useful tool in guiding consumers towards healthier food choices in Norway, but consumer evaluations are warranted to fully assess the performance of the updated Nutri-Score in a Norwegian context.

Diet quality on days without breakfast or lunch - Identifying targets to improve adolescents' diet.

Dietary intake in adolescents does often not align with the recommended dietary guidelines. Excess intakes of added sugar and saturated fat, and insufficient vegetable intake are among the identified challenges, which can affect future health negatively. Identifying targets to improve dietary practices is therefore essential. The current study aimed to examine the prevalence of meal skipping and if meal skipping days had a different diet quality than other days, using data from a recent Norwegian dietary survey in adolescents (n = 689, age 12-14 years). Their dietary intake was recorded for four days, using a web-based record system. Differences between days with, and without, breakfast or lunch were explored using mixed effect models, adjusting for correlated data and covariates, including weekday-weekend effect. In total, 8% and 11% were days without breakfast and lunch, respectively. Days with breakfast or lunch were associated with higher intake of fibre, and higher odds of consuming fruits and berries, juice and smoothie, than days without breakfast or lunch. Weekdays with lunch were also associated with lower intakes of added sugar and total fat (in % of energy), and discretionary foods, compared to weekdays without lunch. Skipping breakfast and lunch was associated with reduced diet quality in adolescents. Targeting these meals, and in particular school lunch, is a potential way forward to improve adolescents' dietary intake.

WebDASC: a web-based dietary assessment software for 8-11-year-old Danish children.

BACKGROUND: The present study describes the development and formative evaluation of the Web-based Dietary Assessment Software for Children (WebDASC). WebDASC is part of the OPUS project ('Optimal well-being, development and health for Danish children through a healthy New Nordic Diet') and was intended to measure dietary change resulting from a school-based intervention. METHODS: WebDASC was developed as a self-administered tool that could be used by 8-11-year-old children with or without parent's aid. The development of WebDASC followed a prototyping approach: focus groups, informal interviews, literature review, and usability tests preceded its release. Special consideration was given to age-appropriate design issues. RESULTS: In WebDASC an animated armadillo guides respondents through six daily eating occasions and helps them report foods and beverages previously consumed. A database of 1300 food items is available either through category browse or free text search, aided by a spell check application. A type-in format is available for foods not otherwise found through category browse or text search. Amount consumed is estimated by selecting the closest portion size among four different digital images. WebDASC includes internal checks for frequently forgotten foods, and the following features to create motivation: a food-meter displaying cumulative weight of foods reported, a most popular food ranking, and a computer game with a high score list. CONCLUSIONS: WebDASC was developed as an intuitive, cost-effective, and engaging method to collect detailed dietary data from 8- to 11-year-old children. Preliminary testing demonstrated that it was well accepted among children.

Effect of changes in an FFQ: comparing data from two national dietary survey instruments among 2-year-olds.

In the interpretation of dietary trends, it is important to consider the potential effect of modifications in the dietary assessment method. Therefore, our objective was to explore the comparability of data obtained at two time points by a semi-quantitative FFQ (SFFQ) which has had slight modifications over time. In the national dietary surveys among Norwegian 2-year-olds, diet was assessed by an SFFQ which underwent modifications between the 1999 survey and the 2007 survey. In the present study, fifty-nine families with a 2-year-old child participated by completing both the SFFQ in a crossover design within a month's time. With regard to the reported intake of energy and nutrients, the largest significant differences observed between the two questionnaires were for carbohydrates and added sugar. According to intake of food groups, significant differences were observed for five out of sixteen food groups. Spearman's correlation coefficients for energy, nutrients and food groups ranged from 0.43 (Ca) to 0.85 (soft drinks). Most Bland-Altman plots indicated broad limits of agreement. The differences between the two questionnaires can be explained by changes in the questionnaires, changes in the food composition databases used and random variation. Comparing differences between the questionnaires by maternal educational level, number of children and type of day care revealed minor differences. In conclusion, this study showed that at the group level there was reasonable comparability between the two questionnaires, except for carbohydrates, added sugar and some food groups. Moreover, there were moderate to high correlations for energy, nutrients and food groups.

Dual-Energy X-Ray Absorptiometry Derived Adiposity Measures and Pre-Frailty/Frailty among Norwegian Adults: The Tromsø Study 2007-2015.

OBJECTIVES: Aging is associated with changes in body composition. Excess adiposity among older adults has been linked with metabolic syndromes and aggravated age-associated decline in physical functioning. Few longitudinal studies have explored the association between dual-energy X-ray absorptiometry (DXA)-derived total as well as central adiposity measures and frailty. We examined the association of DXA-derived total and central adiposity with pre-frailty/frailty among Norwegian adults after 8 years of follow-up. DESIGN: Prospective observational study. SETTING: Community-dwelling adults from Tromsø, Norway. MEASUREMENTS: Adiposity was defined by fat mass index (FMI) and visceral adipose tissue (VAT) mass assessed using DXA measures. Frailty status was assessed by low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity level. Pre-frail and frail participants at baseline were excluded. Sex-stratified multivariable logistic regression models were used to investigate the association. RESULTS: Participants comprised 234 women (mean age 68 years) and 146 men (mean age 69 years) attending the population-based Tromsø Study in 2007-2008 (Tromsø6) and 2015-2016 (Tromsø7). At the end of follow-up, 25.6% of the women and 27.4% of the men were pre-frail/frail. Compared with women in the lowest tertiles, those in the highest tertile of baseline FMI (odds ratio [OR] 4.42, 95% confidence interval [CI] 1.88-10.35) and VAT mass (OR 2.47, 95% CI 1.10-5.50), respectively had higher odds for pre-frailty/frailty at follow-up. CONCLUSION: We found a higher likelihood of pre-frailty/frailty in later years among women with general and central adiposity in adulthood, highlighting the importance of preventing excess adiposity for healthy aging.

Protein Intake and the Risk of Pre-Frailty and Frailty in Norwegian Older Adults. The Tromsø Study 1994-2016.

BACKGROUND: Protein intake is suggested as an important dietary factor in the prevention of frailty, however, the influence of lifelong intake remains unclear. OBJECTIVES: The present study investigated the relationship between daily protein intake and patterns of protein intake over 21 years and the risk of pre-frailty/frailty. DESIGN: Prospective cohort study. SETTING: The population-based Tromsø Study in Tromsø municipality, Norway. PARTICIPANTS: In total, 1,906 women and 1,820 men aged ≥45 years in 1994 who participated in both Tromsø4 (1994-95) and Tromsø7 (2015-16). MEASUREMENTS: Frailty status in Tromsø7 was measured according to Fried's phenotype, classifying participants as "robust" (frailty components present: 0), "pre-frail" (1-2) or "frail" (≥3). Daily intake of protein was estimated from self-reported habitual dietary intake using food frequency questionnaires and assessed as grams per kilogram bodyweight (g/kg BW) and per megajoule energy intake (g/MJ). The protein-frailty association was assessed via longitudinal and cross-sectional multivariable logistic regression analyses. RESULTS: The prevalence of pre-frailty and frailty in this study was 27% and 1.0%, respectively. Longitudinal analysis showed that the odds of pre-frailty/frailty decreased by 57% (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.31;0.58, p<0.001) with the increase in intake of one additional gram of dietary protein per kg BW. The results obtained from cross-sectional analysis were similar. Tracking analysis showed that, compared to a stable high intake of protein in g/kg BW over time, other patterns of protein intake increased the risk of pre-frailty/frailty. No associations were found between intake of protein in g/MJ and pre-frailty/frailty. CONCLUSIONS: Intake of protein in g/kg BW both in mid-life and later in life was inversely associated with pre-frailty/frailty in older adults. This emphasizes the importance of an adequate protein intake to facilitate healthy ageing in Norwegian older adults.

Personal and social-environmental correlates of objectively measured physical activity in Norwegian pre-adolescent children.

The aim of this study was to examine modifiable biological, psychological, behavioral and social-environmental correlates of physical activity among 1129 Norwegian 11-year-old children within a cross-sectional sample from the HEalth In Adolescents study. Physical activity was assessed by accelerometer, and weight and height were measured objectively. Age- and gender-specific cut-off points proposed by the International Obesity Task Force were used to define body mass index. Social-environmental variables were self-reported by questionnaire. Hierarchical regression (linear mixed models) revealed that normal weight children scored higher on percentage daily moderate-to-vigorous physical activity [% daily moderate to vigorous physical activity (MVPA)] than overweight/obese children (P<0.001). Self-efficacy (P<0.01) and perceived social support from friends (P<0.01) were positively associated with children's % daily MVPA, and a negative association was found for computer/game-use on weekends (P<0.01). A moderator effect of weight category (normal vs overweight/obese) in the relationship between computer/game-use on weekends and % daily MVPA was detected (P<0.05), reflecting that higher computer/game-use on weekends was associated with lower % MVPA among the overweight/obese, but not among the normal weight. Modifiable correlates from multiple domains accounted for 14% of the variance in % daily MVPA. Prospective and intervention studies are needed to examine whether these factors act as mediators for physical activity change in pre-adolescent children.

Overweight and waist circumference among Norwegian 11-year-olds and associations with reported parental overweight and waist circumference: The HEIA study.

AIMS: The aim of this paper is to investigate anthropometric characteristics in 11-year-old Norwegian by gender and parental education, and to study associations between adolescents' overweight and waist circumference (WC) and maternal and paternal overweight and WC. METHODS: A total of 1483 adolescents, 1156 mothers, and 1016 fathers participated in the baseline survey of the HEalth In Adolescents (HEIA) study (September 2007). Anthropometric measures of the adolescents were assessed by project staff according to standard procedures. Self-reported data about pubertal status were collected through questionnaires. Parental education and anthropometric measures of parents were collected by self-report. RESULTS: The prevalence of overweight (including obesity) determined by the cut-offs for body mass index (BMI) suggested by the International Obesity Task Force was 14.6% among girls and 13.6% among boys. The highest prevalence of overweight was observed among adolescents with parents who had less than 12 years of education (18.8%). Overweight and WC in girls was strongly associated with maternal overweight and WC. For boys, overweight and WC was strongly associated with both maternal and paternal overweight and WC. CONCLUSIONS: There was a social gradient in anthropometric characteristics and overweight rates among Norwegian 11-year-old adolescents. Maternal overweight and WC was associated with overweight and WC in girls and boys, while paternal overweight and WC were associated with overweight and WC in boys. The results indicate that mothers are key persons in prevention of overweight among adolescents, despite gender. Fathers are important as role models for their sons. Targeting parental overweight/ obesity could be a strategy in future interventions.

Design of a 20-month comprehensive, multicomponent school-based randomised trial to promote healthy weight development among 11-13 year olds: The HEalth In Adolescents study.

BACKGROUND AND PURPOSE: The lack of effective school-based interventions for preventing obesity in children has caused a call for longer duration of interventions and better reporting on design and evaluation methodology. The purpose of this paper is to present the development of the intervention, the design of the effectiveness study, and the test-retest reliability of the main outcome measures in the HEalth In Adolescents (HEIA) study. METHODS/DESIGN: The HEIA intervention programme was developed based on literature reviews, a social ecological framework, and focus groups. The intervention aimed to increase total physical activity (PA) and consumption of fruit and vegetables and to decrease screen time and consumption of sugar-sweetened beverages. The intervention programme consisted of a classroom component, including dietary behaviour lessons, computer tailoring, fruit/vegetable and PA breaks, and posters, and an environmental component including active transport campaigns, equipment, suggestions for easy improvements of schoolyards, inspirational courses for teachers (all with regards to PA), and fact sheets to parents. The effect of the intervention programme is evaluated in a cluster randomised controlled trial design (intervention = 12 schools, control = 25 schools) including process evaluation. Main outcomes include anthropometry, PA, screen time, and consumption of fruit, vegetables, and sugar-sweetened beverages. A 2-week test- retest study was conducted among 114 pupils. Determinants of the behaviours were assessed. Similar data were collected from parents. Children's PA was measured objectively by accelerometers. CONCLUSIONS: The HEIA study represents a theoretically informed randomised trial comprising a comprehensive set of multilevel intervention components with a thorough evaluation using reliable outcome measures. The study will contribute to a better understanding of determinants of healthy weight development among young people and how such determinants can be modified.

A randomized controlled trial of AMH-based individualized FSH dosing in a GnRH antagonist protocol for IVF.

STUDY QUESTION: Does an individualized serum anti-Müllerian hormone (AMH) based FSH dosing algorithm used in a GnRH antagonist protocol increase the proportion of patients with an intended number of oocytes (5-14) retrieved compared with a standard regimen? SUMMARY ANSWER: The AMH-based individualized algorithm did not increase the proportion of patients with an intended oocyte retrieval. WHAT IS KNOWN ALREADY: Individualizing treatment for ovarian stimulation by serum AMH or antral follicle count can theoretically improve the ratio between benefits and risks. Current data suggest that there may be a reduced risk of ovarian hyperstimulation syndrome (OHSS), but without improved pregnancy or live birth rates. Only two randomized controlled trials (RCTs) have examined the potential of AMH-based algorithms to optimize the FSH dosing in ovarian stimulation. STUDY DESIGN SIZE DURATION: A dual-center open-label investigator-driven RCT was conducted between January 2013 and November 2016. Eligibility was assessed in 269 women and 221 were randomized 2:1 between individualized and standard dosing groups. Women with pretreatment serum AMH > 24 pmol/L had 100 IU/day of recombinant FSH (rFSH); AMH 12-24 pmol/L had 150 IU/day of rFSH, and AMH < 12 pmol/L had maximal stimulation with corifollitropin 100 or 150 mg depending on bodyweight ±60 kg. The standard group had 150 IU/day of rFSH irrespective of pretreatment AMH. All patients followed the GnRH-antagonist protocol.The sample size calculation assumed that individualized dosing by AMH would reduce the proportion of unintended oocyte yield (outside the 5-14 range) by 50%, from 35 to 17.5%. In a 2:1 randomization this required 216 patients: 144 in the individualized and 72 patients in the standard group (80% power, 5% significance). PARTICIPANTS/MATERIALS SETTING METHODS: All women had a presumed ovulatory normal menstrual cycle, were aged 25-38 years, weighed < 75 kg, had pretreatment AMH 4-40 pmol/L, did their first IVF or ICSI cycle and had two ovaries accessible to oocyte retrieval. Recruitment was conducted from both participating sites. Women were excluded if diagnosed with anovulatory polycystic ovary syndrome, endometriosis grade III/IV, hydrosalpings on ultrasound, recurrent miscarriages (≥3), FSH > 12 IU/L or major medical disorders. MAIN RESULTS AND THE ROLE OF CHANCE: After randomization 149 women were allocated to the individualized group and 72 to the standard group. The primary outcome of women with an intended (5-14) number of oocytes retrieved was similar in the individualized (n = 105) versus the standard (n = 55) rFSH treatment group (72% [95% CI 64-79%] versus 78% [95% CI 67-86%], respectively, P = 0.68, between group standardized mean difference (SMD) -6%, 95% CI: -19-8%). In the high AMH stratum of the individualized group, significantly more women (n = 13) had an unintended low number of oocytes (<5) retrieved (38% [95% CI: 23-55%]) compared with the standard group (6% [95% CI 0.3-24%], P = 0.029, between group SMD 32%, 95% CI: 9-56%). Conversely, in the low pretreatment AMH stratum, individualized dosing using corifollitropin reduced the proportion of unintended low responders to 24% (95% CI: 12-40%) compared with 47% (95% CI: 26-69%) in the standard group, P = 0.10, between group SMD -23% (95% CI: -54-8%). OHSS was diagnosed in four women (two in each study arm), and all cases were mild. Daily luteal phase questionnaire reporting showed similar wellbeing in terms of abdominal distention, abdominal pain, dyspnea and occurrence of bleeding between groups. The cumulative live birth rate per started cycle was similar (32 and 35%) comparing the individualized with the standard group. LIMITATIONS REASONS FOR CAUTION: This study was powered for showing differences only in the distribution of oocyte retrieval when comparing individualized and standard groups, therefore additional results should be viewed with caution. In addition, there was a change of AMH assay halfway through the study period and the possibility that corifollitropin being introduced to a subgroup of the intervention has introduced confounding cannot be ruled out. WIDER IMPLICATIONS OF FINDINGS: In the expected high responder AMH stratum, 100 IU/day is an insufficient rFSH dose in a high proportion of patients. Further research might explore the 125 IU/day dose for the high AMH segment. STUDY FUNDING/COMPETING INTERESTS: None for the submitted work. ICMJE declared personal interests for two of the authors. TRIAL REGISTRATION NUMBER: EUDRACT registration number: 2012-004969-40. TRIAL REGISTRATION DATE: 27 November 2012. DATE OF FIRST PATIENT'S ENROLLMENT: 10 January 2013.

Sweets, snacking habits, and skipping meals in children and adolescents on intensive insulin treatment.

AIM: To examine the association between skipping meals and snacking events and dietary and clinical characteristics in children and adolescents using modern insulin treatment. METHODS: Dietary intake was recorded for 4 d in food diaries in 655 young diabetic patients. Number of meals and snacking events was recorded in a separated questionnaire, while clinical data were obtained from case record forms. Skipping meals refer to consuming a main meal (e.g., breakfast) five times a week or less. RESULTS: Modern insulin treatment may favor a more flexible lifestyle. This study shows that there are fewer young diabetic patients who skip meals than non-diabetic controls (p < 0.001) even when using modern intensified insulin treatment. However, skipping meals among young diabetic patients was associated with negative characteristics such as having suboptimal hemoglobin A1c (HbA1c) (OR 4.7, p = 0.02), higher low-density lipoprotein (LDL) cholesterol levels (OR 4.0, p < 0.001), watching more TV (OR 3.6, p < 0.001), being overweight (OR 2.8, p = 0.03), as well as having a higher intake of added sugar (OR 2.1, p = 0.01) and lower intake of fiber (OR 0.2, p = 0.04) compared with those not skipping meals. Having more than two snacking events during the day was associated with higher HbA1c, higher intake of added sugar and sweets, and spending more hours in front of the TV or personal computer. CONCLUSIONS: In general, fewer children and adolescents with type 1 diabetes skip meals compared with healthy peers. Those who skip meals and have more snacking events have poorer glycemic control and less healthy dietary and leisure habits.

Relative validation of a pre-coded food diary among children, under-reporting varies with reporting day and time of the day.

OBJECTIVE: The aim of this study was to validate intake of energy, macro- and micronutrients assessed from pre-coded food diaries (PFDs) by using weighed records (WRs) as the reference method among a group of Norwegian 9-year-olds. We also examined how under-reporters (UR) differed from acceptable reporters (AR) according to the energy intake during the 4-day recording period and energy intake distribution during the day. SUBJECTS AND DESIGN: One hundred 9-year-olds, 45 girls and 55 boys, were recruited to complete a 4-day record with a PFD followed 3 days later with a 4-day WR. RESULTS: There were no differences between energy and nutrient intake from the two recording methods among boys, but girls reported significantly higher intakes with PFD compared with WR. The median Spearman correlation coefficient between PFD and WR for energy and nutrients was 0.43 for girls and 0.49 for boys. Twelve participants were classified as UR with the PDF method. Energy percentages from macronutrients were not significantly different between UR and AR with the PFD method. UR had significantly lower energy intake in the last two recording days and from 1000 to 2200 hours during the day compared to AR. CONCLUSIONS: The PFD method is promising as a tool for assessing food intake in large surveys among children. The present study indicates that the PFD gives more valid data for boys than girls according to the group intake and ranking of nutrient intake when WR is the reference method. However, UR seemed to develop a study fatigue during the day and during the recording period. Increased awareness about the tendency of study fatigue can lead to more specific instructions on how participants can handle the problem.

Intake of a Protein-Enriched Milk and Effects on Muscle Mass and Strength. A 12-Week Randomized Placebo Controlled Trial among Community-Dwelling Older Adults.

OBJECTIVES: To investigate the effect of 20 g protein with breakfast and evening meal on muscle mass, muscle strength and functional performance in older adults. DESIGN: A double-blinded randomized controlled study. SETTING: Oslo and Akershus University College of Applied Sciences, Norway. PARTICIPANTS: Healthy community-dwelling men and women (≥ 70 years) with reduced physical strength and/or performance. INTERVENTION: Subjects were randomly assigned to receive either protein-enriched milk (2 x 0.4 L/d; protein group) or an isocaloric carbohydrate drink (2 x 0.4 L/d; control group) with breakfast and evening meal for 12 weeks. MEASUREMENTS: The primary endpoints were muscle mass measured by dual X-ray absorptiometry, and tests of muscle strength (one repetition maximum test of chest press and leg press) and functional performance (handgrip strength, stair calimb and repeated chair rise). RESULTS: In total, 438 subjects were screened, 50 subjects were randomized and 36 completed the study. Chest press improved significantly in the protein (1.3 kg (0.1-2.5), p=0.03) and the control group (1.5 kg (0.0-3.0), p=0.048), but with no difference between the groups (p=0.85). No significant change in leg press (p=0.93) or muscle mass (p=0.54) were observed between the protein and the control group. Nor did we observe any significant differences in the functional performance tests (p>0.05 for all tests) between the groups. CONCLUSION: Increased protein intake (2 x 20 g/d) did not significantly improve muscle mass, muscle strength or functional performance in healthy older weight stable adults. Whether intake of > 20 g protein to each meal is necessary for preservation of muscle mass and strength in older adults should be further investigated in a larger study. This underscores the need for well-designed studies that can differentiate between the effect of protein intake and increased energy. This trial was registered at Clinicaltrials.gov (ID no. NCT02218333).

Validity of a questionnaire to assess fruit and vegetable intake in adults.

OBJECTIVE: To validate a method for assessing fruit and vegetable intake among adults in a population of low intake. The method assesses mean intake and ranks individuals by their usual intake. DESIGN: A precoded fruit and vegetable Questionnaire included a 24-h recall and a food frequency. The participants filled in the Questionnaire, a week later they started a 7-day food record, 1-day weighed record and 6 days using household measures. SUBJECTS: Following advertisements 40 participants were recruited, 36 returned food records(mean age=37 years). RESULTS: No difference was observed between the average intake yielded by the 24-h recall and that from the 1-day weighed food record of fruits or vegetables. Correlation coefficients between results from the food frequency questionnaire and the 7-day food records were 0.45 (P=0.007) for vegetables, 0.63 (P<0.001) for fruits and 0.73 (P<0.001) for fruits and vegetables combined. Cross-classification into quartiles showed that the proportion of participants in the same or the adjacent quartile of the intake distribution were 94% for fruit intake and 80% for vegetable intake. Registered intake of fruits and vegetables was higher the first 4 days of the record than the last 3 days (P=0.002). The 4-day food record correlated with the food frequency questionnaire in similar manner as the 7-day record. CONCLUSION: The present study indicates that the precoded 24-h recall may be valuable tool for measuring average intake of fruits and vegetables among adults in a population of low intake. Moreover, the food frequency questionnaire was valid for ranking individuals according to their usual intake. A 4-day food record might be sufficient when validating food frequency questionnaires for fruits and vegetables.

Can children and adolescents use photographs of food to estimate portion sizes?

OBJECTIVE: The goals of this study were to investigate whether children and adolescents can accurately estimate portion sizes of preweighed food by viewing photographs of food, and whether age influences the ability to estimate food portion sizes. SUBJECTS: A total of 63 male and female volunteers aged 9-19 y participated in the study. DESIGN: Each participant received a photographic booklet with photograph series of 13 food items. Participants over 10 y of age were asked to estimate portion sizes of food on 34 plates placed in front of them by comparing the different portions to corresponding photographs of food. Younger participants were asked to estimate portion sizes of food on 17 plates by comparing the portions to photographs. RESULTS: Participants made 2019 comparisons between actual food portion sizes and photographs of food portion sizes. On average, 60% of the comparisons were made correctly. A photograph directly adjacent to the photograph depicting the correct portion size was chosen in 35% of the comparisons and 5% of the comparisons were made incorrectly. Portion sizes were estimated more accurately when the actual served portions of food had exactly the same appearance as the foods portrayed in the photographic booklet. No differences existed between children's and adolescents' abilities to estimate portion sizes using photographs. CONCLUSIONS: Large variability may exist in an individual's capability of choosing a photograph that correctly depicts food portion sizes, but the error at the group level is quite small. These data indicate that a photographic booklet of foods can be a useful tool for portion size estimates in these age groups. SPONSORSHIP: The Norwegian Foundation for Health and Rehabilitation through Norwegian Health Association.

Evaluation of the odd fatty acids 15:0 and 17:0 in serum and adipose tissue as markers of intake of milk and dairy fat.

BACKGROUND: There is a need for biomarkers of dietary saturated fatty acids, because several diseases have been related to intake of these fatty acids. OBJECTIVE: To examine the relation between intake of dairy fat and the proportion of pentadecanoic (15:0) and heptadecanoic (17:0) acid in serum and adipose tissue. DESIGN: Healthy men aged 21-55 y provided serum (n = 110) and adipose tissue samples (n = 107) and completed both 14 days weighed records (WR) and a 180-item food frequency questionnaire (FFQ). The proportions of 15:0 and 17:0 acid in serum and adipose tissue as measured by gas liquid chromatography were evaluated as biomarkers for fat intake from dairy products using Pearsons correlation coefficient and the method of triads. RESULTS: The strongest correlation coefficients were observed between total intake of dairy fat estimated from WR and relative content of 15:0 in adipose tissue (0.52, 95% CI: 0.37, 0.65) and total serum (0.43, 95% CI 0.26, 0.57). A consistent inverse association was observed between the intake of milk fat and relative serum content of 17:0. The validity coefficients observed for the intake of dairy fat estimated from weighed records, the 180-item FFQ and by the relative content of 15:0 in serum and adipose tissue were 0.94 (95% CI: 0.68, 1.00), 0.50 (95% CI: 0.29, 0.67), 0.49 (95% CI: 0.32, 0.67) and 0.56 (95% CI: 0.28, 0.82), respectively. CONCLUSION: Relative content of 15:0 in serum and adipose tissue may be a useful biomarker for the intake of total dairy fat, whereas FFQs and WRs may provide better estimates of the intake of fat from milk.

Modulation of COX-2 expression in peripheral blood cells by increased intake of fruit and vegetables?

BACKGROUND: Enhanced cyclooxygenase-2 (COX-2) expression is associated with carcinogenesis, ischemia, angiogenesis, inflammation, and neurodegeneration. The preventing effect of aspirin and nonsteroidal anti-inflammatory drugs is partly due to inhibition of the COX-2 enzyme. Fruit and vegetables (FVs) contain numerous compounds that may decrease disease risk by several different mechanisms, for example through the inhibition of COX-2 activity. OBJECTIVE: We tested the hypothesis that an increased intake of FVs would modulate the COX-2 expression in peripheral blood cells. DESIGN: A strictly controlled dietary crossover study (n = 39). After 1 week run-in period with no FVs in the diet, one group was given two portions of FVs (2 FV), while another group was given five portions (5 FV) daily for 14 days. Following a 2 weeks washout period and 1 week run-in, the regimens were switched between the groups. Gene expression analysis of COX-2 mRNA in blood samples was performed by quantitative real-time-PCR. RESULTS: No significant treatment effect of diet intervention was found in the crossover analyses (P = 0.74). However, the individual variation in response may seem large. CONCLUSIONS: These data does not contradict the recommendations for an increased intake of FVs. Further studies on expression directly and indirectly, through analysis of factors regulating and being regulated by COX-2, should be carried out. A first step would be to evaluate the correspondence between COX-2 mRNA expression and products of the COX pathway, like prostaglandins. Naturally occurring polymorphisms of COX-2 promoters and coding regions might contribute to functional variations and response to different diets. SPONSORSHIP: Norwegian Research Council, National Nutrition Council, Throne Holst Foundation for Nutrition Research, Freia Chokoladefabriks Medisinske Fond and the Norwegian Cancer Society.

Relations between high ponderal index at birth, feeding practices and body mass index in infancy.

OBJECTIVE: We compared feeding practices between infants of high ponderal index (PI) at birth (PI above the 90th percentile) and normal PI at birth (PI between 10th and 90th percentiles), and examined how birth size and infant feeding practices were related to body mass index (BMI) at 12 months. DESIGN: In a cohort of 3000 infants invited to participate in a national Norwegian dietary survey, 1825 participated both at 6 and 12 months of age, and the present study included those born full term and with a PI (weight/length3) at birth > or =10th percentile (n=1441). Data on feeding practices were collected by food-frequency questionnaires, and anthropometrical data were measured by health-care personnel. RESULTS: A lower proportion of infants born with high PI were exclusively breastfed for at least 4 months compared with infants born with normal PI (37 and 47%, respectively; P=0.03). Earlier introduction of solid foods and higher consumption of some foods were also observed among infants of high PI. In a multivariate analysis, adjusted mean BMI (kg/m2) at 12 months was higher for infants of high PI at birth than for infants of normal PI (17.6 and 17.0, respectively; P<0.001) and higher for infants exclusively breastfed <3 months than for infants exclusively breastfed > or =3 months (17.5 and 17.2, respectively; P=0.001). CONCLUSIONS: High PI at birth was associated with a shorter duration of exclusive breastfeeding. Furthermore, high PI at birth and short-term exclusive breastfeeding were both associated with higher BMI at 12 months.

Associations between socioeconomic position and correlates of sedentary behaviour among youth: a systematic review.

Existing research evidence indicates that children and adolescents of parents with a low socioeconomic position spend more time on sedentary behaviour than their counterparts. However, the mechanisms driving these differences remain poorly understood. The main aim of this systematic review was to summarize the evidence regarding the association between socioeconomic position and correlates of sedentary behaviour among youth (0-18 years) from developed countries. The literature search was conducted using MEDLINE, Embase, CINAHL and PsycINFO. A total of 37 studies were included. All but three studies examined screen-based sedentary behaviours only. Methodological quality ranged from low to moderate. Education was the most commonly used indicator of socioeconomic position, followed by income. Socioeconomic position was inversely related to the presence of a TV in the child's bedroom, parental modelling for TV viewing, parental co-viewing and eating meals in front of the TV. We found no/indeterminate evidence for an association between socioeconomic position and rules and regulations about screen time. The findings suggest possible factors that could be targeted in future intervention studies to decrease screen-based sedentary behaviour in lower socioeconomic groups in particular.