Developmental origins of health and disease knowledge is associated with diet quality in preconception young adult men and women.

The Developmental Origins of Health and Disease (DOHaD) approach supports that nutritional exposures in early life affect an individual's later health and risk of disease. Dietary exposure during the preconception period may also influence individual, and inter- and transgenerational health and disease risk, in both men and women. This study aimed to describe knowledge of the DOHaD approach (DOHaDKNOWLEDGE) and diet quality in preconception young adults in Norway, to assess associations between DOHaDKNOWLEDGE and a Diet Quality Score (DQS), and to assess gender differences in those above. Data from 1362 preconception young adults was obtained from the PREPARED study baseline dataset. The sample had 88% women participants, a mean age of 27 years, 36% had overweight or obesity, and 77% had higher level of education. DOHaDKNOWLEDGE was assessed by the participants' agreement to five statements using a Likert scale. Diet quality was assessed using aspects of diet quality and a DQS derived from a dietary screener. We found moderate level of both DOHaDKNOWLEDGE (12/20 points) and diet quality (DQS: 60/100 points), indicating potential for improvements. Specifically, the greatest potential for diet quality improvements were observed for sugary foods, red and processed meats, legumes, and unsalted nuts and seeds. Gender differences were observed for both DOHaDKNOWLEDGE and diet quality. DOHaDKNOWLEDGE was positively associated with DQS, adjusted for sociodemographic factors, with little evidence of an interaction effect by gender. This study indicates that knowledge of the DOHaD approach is positively associated with diet quality in preconception young men and women. Future studies should consider incorporating pregnancy intentions, relationship status, and health literacy.

Food literacy and diet quality in young vegans, lacto-ovo vegetarians, pescatarians, flexitarians and omnivores.

OBJECTIVE: To investigate whether food literacy competencies and diet quality vary between 16-to-24-year-olds vegans, lacto-ovo vegetarians, pescatarians, flexitarians and omnivores and to assess whether food literacy is associated with diet quality. DESIGN: Cross-sectional study. Food literacy (general nutrition knowledge, critical nutrition literacy and food skills) and diet quality were measured using an electronic questionnaire. SETTING: Southern Norway, September 2021 - March 2022. PARTICIPANTS: Healthy 16-24-year-olds (n 165). RESULTS: Overall, the mean general nutrition knowledge score was moderate (48·0 out of 67·0); the lowest mean score was found in omnivores and the highest in flexitarians (45·6 v. 51·5) (P = 0·034). The mean score of critical nutrition literacy was also moderate (3·7 out of 5·0); vegans showed higher scores compared to other dietary practices (P = 0·018). No difference was observed in food skills between the different dietary practices. The overall median diet quality score was 46·0 out of 80·0, lowest in omnivores and highest in vegans (42·0 v. 56·0) (P =< 0·001). In multivariate regression analyses, general nutrition knowledge, food skills and vegan dietary practice were significantly associated with higher diet quality. CONCLUSIONS: We found moderate levels of food literacy across all dietary practices. The food literacy competencies, general nutrition knowledge and food skills were associated with higher diet quality in our sample. Omnivores showed both the lowest general nutrition knowledge level and lowest diet quality scores. In contrast, both flexitarians and vegans scored highest on general nutrition knowledge and diet quality scores, despite being one of the less restrictive and one of the strictest plant-based dietary practices, respectively.

Food literacy competencies in youth - a mini-review.

Introduction: Young people's transition into adulthood is an opportunity in the life course to establish adequate eating behaviors, hence exploring food literacy competencies in this period of life is especially important. Food literacy has recently gained increased attention in adults, adolescents, and younger children, but less is published about youth. This paper aims to summarize what tools have been used to measure food literacy and the sub-competence nutrition literacy in youth aged 16-24 years in the previous 5 years. Methods: A mini-literature review was conducted in MEDLINE and EMBASE via Ovid, in September 2022. Study eligible criteria; had to be an original article, using a tool to quantitatively assess food literacy and/or nutrition literacy, including participants between 16-24 years, full text available in English, published between 2017-2022. Results: A total of 958 articles were identified, of which 385 duplicates were removed. Thus, 573 articles were screened by title/abstract. Finally, nine articles were eligible for data extraction of which four proposed a tool to measure food literacy and five proposed a tool to measure nutrition literacy. Discussion and conclusion: Although four studies claimed to measure food literacy, none of these used tools comprehensive enough to measure all aspects of food literacy, and only one was validated in young people. This study shows that only few tools exist for the measurement of food literacy in youth, and those available are scant. Further work is needed to develop a food literacy tool for youth.

Scaling up evidence-based digital early life nutrition interventions in a county setting: an implementation trial - protocol for Phase 2 of the Nutrition Now project.

Background: Few effective health interventions transition from smaller efficacy or effectiveness studies to real-world implementation at scale, representing a gap between evidence and practice. Recognising this, we have developed Nutrition Now - a tailored digital resource building on four efficacious dietary interventions, aiming to improve nutrition in the important first 1,000 days of life. Nutrition Now targets and guides expectant parents and parents of 0-2 year olds, serves as a reliable source of evidence-based information for midwives and public health nurses at maternal and child healthcare (MCH) centres, and offers pedagogical tools for early childhood education and care (ECEC) staff. The aim of this study is to implement Nutrition Now at scale and evaluate the impact of different sets of multifaceted implementation strategies on implementation outcomes. Methods: A quasi-experimental design with three study arms will be used, providing either low, medium or high implementation support, when rolled out in 50 municipalities in 2 counties in Norway. Nutrition Now will be implemented in MCH and ECEC settings and made available to expectant parents and parents of 0-2 year olds through social media and MCH. The implementation support builds on strategies described in the Expert Recommendations for Implementing Change (ERIC) implementation framework and is informed by dialogues with stakeholders. Impact of the different degree of implementation support will be assessed by examining reach, adoption, fidelity, and sustainability using usage data generated from the Nutrition Now resource, publicly available municipal data and qualitative interviews with MCH and ECEC staff. Discussion: Nutrition Now Phase 2 will break new ground by scaling up successively delivered and complementary dietary interventions in the first 1,000 days of life in a real-life context. The project also seeks to identify what level of implementation support is most effective when implementing digital, scalable, evidence-based early-life nutrition interventions in community settings. The project will inform implementation research and provide knowledge about effective implementation strategies to be used in a national scale-up of Nutrition Now. Trial registration: The study is registered prospectively (submitted 14/06/2022, registration date: 19/06/2022) in the International Standard Randomised Controlled Trial Number registry (ISRCTN): reg. Number: ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967.

Evaluation of a Web-Based Dietary Assessment Tool (myfood24) in Norwegian Women and Men Aged 60-74 Years: Usability Study.

BACKGROUND: A healthy diet throughout the life course improves health and reduces the risk of disease. There is a need for new knowledge of the relation between diet and health, but existing methods to collect information on food and nutrient intake have their limitations. Evaluations of new tools to assess dietary intake are needed, especially in old people, where the introduction of new technology might impose challenges. OBJECTIVE: We aimed to examine the usability of a new web-based dietary assessment tool in older adult women and men. METHODS: A total of 60 women and men (participation 83%, 57% women) aged 60-74 years recruited by convenience and snowball sampling completed a 24-hour web-based dietary recall using the newly developed Norwegian version of Measure Your Food On One Day (myfood24). Total energy and nutrient intakes were calculated in myfood24, primarily on the basis of the Norwegian Food Composition Table. No guidance or support was provided to complete the recall. Usability was assessed using the system usability scale (SUS), where an SUS score of ≥68 was considered satisfactory. We examined the responses to single SUS items and the mean (SD) SUS score in groups stratified by sex, age, educational level, and device used to complete the recall (smartphone, tablet device, or computer). RESULTS: The mean total energy intake was 5815 (SD 3093) kJ. A total of 14% of participants had an energy intake of <2100 kJ (ie, 500 kilocalories) and none had an intake of >16,800 kJ (ie, 4000 kilocalories). Mean energy proportions from carbohydrates, fat, protein, alcohol, and fiber was within the national recommendations. The mean SUS score was 55.5 (SD 18.6), and 27% of participants had SUS scores above the satisfactory product cut-off. Higher SUS scores were associated with younger age and lower education, but not with the type of device used. CONCLUSIONS: We found the overall usability of a new web-based dietary assessment tool to be less than satisfactory in accordance with standard usability criteria in a sample of 60-74-year-old Norwegians. The observed total energy intakes suggest that several of the participants underreported their intake during the completion of the dietary recall. Implementing web-based dietary assessment tools in older adults is feasible, but guidance and support might be needed to ensure valid completion.

Evaluating the effectiveness and implementation of evidence-based early-life nutrition interventions in a community setting a hybrid type 1 non-randomized trial - the Nutrition Now project protocol.

Disappointingly few efficacious health interventions are successfully scaled up and implemented in real world settings. This represents an evidence-to-practice gap, with loss of opportunity to improve practice. Aiming to improve nutrition in the first 1000 days of life, we have combined four efficacious dietary interventions into a single adapted digital resource (Nutrition Now) for implementation in a Norwegian community setting. Nutrition Now targets pregnant women and parents of 0-2-year-olds with messages focusing on healthy dietary behaviours. Early childhood education and care (ECEC) staff are provided with pedagogical tools addressing healthy food exposure and child food acceptance. Objectives: a) evaluate the effectiveness of provision of the Nutrition Now resource on child diet and diet-related outcomes, with special attention to the influence of socio-economic position, b) gather information on the effectiveness of the implementation process to inform forthcoming scale-up and c) perform trial- and model-based economic evaluations. This is a hybrid type 1 implementation study, focusing on evaluation of effectiveness. A quasi-experimental design with pre- and post-tests, where one municipality gets access to the resource (n~800), while a matched non-equivalent control municipality (n~800) does not, will be used. Effectiveness will be assessed by examining e.g., diet outcomes, developmental outcomes, and feeding practices. The resource will be implemented in ECEC settings and made available to pregnant women and parents through the Norwegian system of maternal and child health (MCH) care. The implementation process includes iterative adjustments and implementation strategies from the implementation framework Expert Recommendations for Implementing Change (ERIC) informed by dialogues with stakeholders. Implementation outcomes (e.g., acceptability and adoption) will be assessed through questionnaires and interviews with parents, ECEC and MCH staff, with particular attention to ethnic diverse groups. Both within-trial and modelling-based economic evaluation will be performed. Nutrition Now will bridge the existing evidence-to-practice gap through rigorous scientific effectiveness evaluation of municipal scale up and inform subsequent county scale up. The study is the first to implement efficacious nutrition interventions in early life with potential for health improvement using technology to maximise the reach and impact of both parental and MCH dietary guidance and ECEC practice. Clinical Trial Registration: https://www.isrctn.com/, identified ISRCTN10694967.

Process Evaluation of an eHealth Intervention (Food4toddlers) to Improve Toddlers' Diet: Randomized Controlled Trial.

BACKGROUND: Parents seek trustworthy information online to promote healthy eating for their toddlers. Such information must be perceived as relevant and easy to implement and use. OBJECTIVE: The objectives of this study were to conduct a process evaluation of the electronic health (eHealth) intervention (Food4toddlers) targeting food environment, parental feeding practices, and toddlers' diet and to examine possible differences in these areas according to education and family composition. METHODS: A 2-armed randomized controlled trial, including 298 parent-toddler dyads from Norway, was conducted in 2017. In total, 148 parents in the intervention group received access to an intervention website for 6 months. Data on website usage were retrieved from the learning management platform used (NEO). Participants' satisfaction with the intervention was asked for in a postintervention questionnaire. Chi-square and t tests were used to examine differences in usage and satisfaction between education and family composition groups. RESULTS: Most participants were mothers (144/148, 97.2%), lived in two-adult households (148/148, 100%), and were born in Norway (132/148, 89.1%). Mean parental age was 31.5 years (SD 4.2). More than 87.8% (129/147) had a university education degree and 56.5% (83/147) had over 4 years of university education. Most (128/148, 86.5%) intervention participants entered the website at least once (mean days of access 7.4 [SD 7.1]). Most parents reported the website as appropriate to the child's age (71/83, 86%) and self-explanatory (79/83, 95%) and appreciated the interface (52/83, 63%) and layout (46/83, 55%). In total, 61% (51/83) stated that they learned something new from the intervention. Parents with over 4 years of university education and in 1-child households used the intervention website more than those with 4 years or less of university education (8.4 vs 5.9 days in total, P=.04) and households with more than 1 child (8.3 vs 5.8 days in total, P=.04), respectively. CONCLUSIONS: The Food4toddlers intervention website was found to be relevant by most participants in the intervention group, although usage of the website differed according to educational level and family composition. For eHealth interventions to be effective, intervention materials such as websites must be used by the target group. Our results highlight the need to include users from different groups when developing interventions. TRIAL REGISTRATION: ISRCTN Registry ISRCTN92980420; http://www.isrctn.com/ISRCTN92980420.

Long-term effects of a cluster randomized controlled kindergarten-based intervention trial on vegetable intake among Norwegian 3-5-year-olds: the BRA-study.

OBJECTIVE: To report on long-term effects of a cluster randomized controlled kindergarten-based intervention trial, which aimed to increase vegetable intake among Norwegian preschool children (3-5 years at baseline). The effects of the intervention at follow-up 1 (immediately post-intervention) have previously been published. This paper presents the effects of the intervention from baseline to follow-up 2 (12 months post-intervention). RESULTS: Parental consents were obtained for 633 out of 1631 eligible children (response rate 38.8%). The effects of the intervention from baseline to follow-up 2 were assessed by mixed-model analyses taking the clustering effect of kindergartens into account. Children's vegetable intake was reported by the parents at baseline (spring 2015), at follow-up 1 (spring 2016) and at follow-up 2 (spring 2017). No significant long-term effects in child vegetable intake were found. A mean difference of - 0.1 times per day (95% CI - 0.5, 0.2) (P = 0.44) was found for the daily frequency of vegetable intake. A mean difference of - 0.2 different kinds of vegetables eaten over a month (95% CI - 1.0, 0.7) (P = 0.70) was found and for daily amount of vegetables a mean difference of - 15.0 g vegetables (95% CI - 38.0, 8.0) (P = 0.19) was found. Trial registration International Standard Randomised Controlled Trials ISRCTN51962956 (http://www.isrctn.com/ISRCTN51962956). Registered 21 June 2016 (retrospectively registered).

Validation of energy intake from a web-based food recall for children and adolescents.

The purpose of this study was to validate estimated energy intake from a web-based food recall, designed for children and adolescents. We directly compared energy intake to estimates of total energy expenditure, calculated from accelerometer outputs, combined with data on weight and sex or resting energy expenditure prediction equations. Children (8-9 years) and adolescents (12-14 years) were recruited through schools in Norway in 2013 (N = 253). Results showed that more than one third (36-37%) were identified as under-reporters of energy. In contrast, only 2-4% were defined as over-reporters of energy. The mean energy intake was under-reported with -1.83 MJ/day for the entire study sample. Increased underestimation was observed for overweight and obese participants, the oldest age group (12-14 years), boys, those with parents/legal guardians with low educational level and those living in non-traditional families. In conclusion, energy intake from the web-based food recall is significantly underestimated compared with total energy expenditure, and should be used with caution in young people.

Associations between reported intakes of carotenoid-rich foods and concentrations of carotenoids in plasma: a validation study of a web-based food recall for children and adolescents.

OBJECTIVE: To validate estimated intakes of carotenoid-rich foods from a web-based food recall (WebFR) using carotenoids in blood as an objective reference method. DESIGN: Cross-sectional validation study using carotenoids in plasma to evaluate estimated intakes of selected carotenoid-rich foods. Participants recorded their food intake in the WebFR and plasma concentrations of ß-carotene, α-carotene, ß-cryptoxanthin, lycopene, lutein and zeaxanthin were measured. SETTING: Schools and homes of families in a suburb of the capital of Norway. SUBJECTS: A total of 261 participants in the age groups 8-9 and 12-14 years. RESULTS: Spearman's rank correlation coefficients ranged from 0·30 to 0·44, and cross-classification showed that 71·6-76·6 % of the participants were correctly classified, when comparing the reported intakes of carotenoid-rich foods and concentrations of the corresponding carotenoids in plasma, not including lutein and zeaxanthin. CONCLUSIONS: Correlations were acceptable and cross-classification analyses demonstrated that the WebFR was able to rank participants according to their reported intake of foods rich in α-carotene, ß-carotene, ß-cryptoxanthin and lycopene. The WebFR is a promising tool for dietary assessment among children and adolescents.

Evaluation of a Web-Based Food Record for Children Using Direct Unobtrusive Lunch Observations: A Validation Study.

BACKGROUND: High-quality, Web-based dietary assessment tools for children are needed to reduce cost and improve user-friendliness when studying children's dietary practices. OBJECTIVE: To evaluate the first Web-based dietary assessment tool for children in Norway, the Web-based Food Record (WebFR), by comparing children's true school lunch intake with recordings in the WebFR, using direct unobtrusive observation as the reference method. METHODS: A total of 117 children, 8-9 years, from Bærum, Norway, were recruited from September to December 2013. Children completed 4 days of recordings in the WebFR, with parental assistance, and were observed during school lunch in the same period by 3 observers. Interobserver reliability assessments were satisfactory. Match, omission, and intrusion rates were calculated to assess the quality of the recordings in the WebFR for different food categories, and for all foods combined. Logistic regression analyses were used to investigate whether body mass index (BMI), parental educational level, parental ethnicity or family structure were associated with having a "low match rate" (≤70%). RESULTS: Bread and milk were recorded with less bias than spreads, fruits, and vegetables. Mean (SD) for match, omission, and intrusion rates for all foods combined were 73% (27%), 27% (27%), and 19% (26%), respectively. Match rates were statistically significantly associated with parental educational level (low education 52% [32%] versus high 77% [24%], P=.008) and parental ethnicity (non-Norwegian 57% [28%] versus others 75% [26%], P=.04). Only parental ethnicity remained statistically significant in the logistic regression model, showing an adjusted odds ratio of 6.9 and a 95% confidence interval between 1.3 and 36.4. CONCLUSIONS: Compared with other similar studies, our results indicate that the WebFR is in line with, or better than most of other similar tools, yet enhancements could further improve the WebFR.