Harnessing the untapped potential of food education in schools: Nurturing the school subject Food and Health.

Essential life skills related to food and meals have a potential triple dividend for children and adolescents, that is, short-term, medium-term and possible generational effects with regard to public health, sustainability and well-being of future citizens in local communities. While parents and childhood environments are a basis for learning about food and meals, systematic food education in the setting of primary and lower secondary schools may have a significant role that should be utilized more strongly, reaching and benefitting all pupils from a life course perspective. Through this article, we explore the current state of the art of the mandatory school subject Food and Health (FH) from the Nordic perspective. Our leading questions are: (1) What potential is currently utilized and which future potential does FH education have in primary and secondary schools in terms of food education for essential life skills and competencies, and (2) How can this untapped potential be better harnessed with a goal of facilitating better learning in FH? Drawing on data from Norway as a case study, supported by Swedish and Finnish data, we discuss the status, challenges and potential reformation of food education, focusing on FH. This includes perspectives on the prioritization of the FH subject and the organization of more systematic food education in schools, which might improve FH's status and significance. Combining theory-practice, creating room for discussion and focusing less on cooking-related activities may better facilitate learning in FH. Without proper FH, food education might be nonsystematic, thereby generating unequal outcomes for children and adolescents.

Association between sociodemographic determinants and health behaviors, and clustering of health risk behaviors among 28,047 adults: a cross-sectional study among adults from the general Norwegian population.

BACKGROUND: Understanding the associations between health behaviors and which subgroups are at risk of developing health risk behaviors is vital knowledge to develop effective public health interventions to reduce the high prevalence of non-communicable diseases (NCDs). The objective of the study was to assess the association between physical activity, diet, tobacco use, and alcohol consumption and sociodemographic determinants (sex and education), and to examine clustering patterns of these health behaviors. METHOD: Data was collected from an online self-reported questionnaire from the Norwegian public health survey conducted in 2019. The study sample consisted of 28,047 adults (≥ 18 years old) from Agder county in Southern Norway. Chi-square tests and logistic regression analysis were used to determine the association between sex and education according to physical activity, diet, tobacco use and alcohol consumption. Linear regression was used to examine the association between educational level and number of health risk behaviors, and cluster analysis were performed to determine cluster patterns. RESULTS: Females were more likely than men to meet the national public health recommendations for diet (p < 0.001), tobacco use (p < 0.01), and alcohol consumption (p < 0.001). High education was associated with meeting the recommendations for each of the four health behaviors and with a lower risk of having three or four health risk behaviors simultaneously. Furthermore, clustering of health risk behaviors was observed in five of the sixteen health behavior patterns. CONCLUSION: Our findings show a higher risk of having multiple health risk behaviors for males and individuals with low education, and these subgroup findings could inform public health policy and be target goals in future public health interventions. Clustering patterns were observed in over 30% of the health behavior patterns. More research is needed on the causal relationship between health behaviors and socioeconomic factors, and the association between clustering and health outcomes to design effective interventions in the future.

Staff feeding practices, food neophobia, and educational level in early education and care settings: A cross-sectional study.

Feeding practices in early childhood education and care (ECEC) settings are important for the development of healthy eating habits early in life. However, there is limited research on feeding practices among ECEC staff working with infants and toddlers, and how these practices relate to staff education. This study assessed the feeding practices, level of food neophobia, and participation in shared meals among ECEC staff, and examined whether there were differences in feeding practices related to education and shared meals. Furthermore, we explored the association between food neophobia levels among ECEC staff and their respective feeding practices in ECEC. In total, 130 ECEC teachers and other staff from two Norwegian ECEC trials completed a questionnaire about feeding practices and level of food neophobia. Our results showed that ECEC staff commonly used modelling and encouraging balance and variety feeding practices, but used food as a reward and emotion regulation less often. These practices differed by staff educational level, favoring highly educated staff. We found that more than half of ECEC staff ate lunch together with the children every day, and those who did so used positive feeding practices (encouraging balance and variety and modelling) more than those who did not eat with children; however, they also used restriction for health more often. Higher scores on food neophobia were associated with less use of emotion regulation and restriction for health when adjusted for relevant variables. In conclusion, our results show there is potential to improve feeding practices in ECEC, especially focusing on ECEC staff with low education. Suggested ways forward are updating guidelines to cover feeding practices and working on implementing these guidelines.

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.

"It is really just brilliant to get credits for something that is so important to you!" Skills for Life: University students' perceptions of a planned dietary life skills course.

OBJECTIVE: Universities have a role in educating and empowering students to become healthy and literate citizens of the 21st century society. The aim of this study was to explore university students' perceptions regarding the relevance and utility of a planned dietary life skills course. DESIGN: Qualitative design including focus group discussions. SETTING: A Norwegian university with participating undergraduate students from seven different disciplines. METHOD: Data collection included 13 semi-structured focus group discussions involving 57 university students (35 women and 22 men aged 18-38 years). The focus group discussions were recorded and transcribed verbatim. To ensure in-depth knowledge of the research participants' thoughts and reflections, thematic analysis strategy was undertaken by a team of researchers. RESULTS: When presented to the idea of a dietary life skills course as a university course, the students were mostly positive regarding its relevance and utility, however both motivators and barriers for attending were put forward. Some mentioned potential academic course benefits, such as enhanced CV, and a few mentioned potential societal benefits such as a healthy population and sustainable food consumption. Several motivators for attending the course were launched, such as increased knowledge and cooking skills, having dinner and expanded network. The students wanted to learn about food, nutrients and health, and how to cook simple, affordable, healthy and sustainable meals. Potential barriers for attending were mostly related to practicalities, such as potential lack of alignment with ordinary study programme or too demanding lectures. CONCLUSION: Most students acknowledged the value of a dietary life skills course and thought that such a course could benefit their personal life. This encourages the offering of such courses at university level, tailored to consider both motivators and barriers for attending.

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.

Wow! They really like celeriac! Kindergarten teachers' experiences of an intervention to increase 1-year-olds' acceptance of vegetables.

Exposure to varied foods in early life is important for short- and long-term health and development. Strategically introducing toddlers to new vegetables is not a common practice in Norwegian kindergartens. Therefore, we developed, conducted, and evaluated a web-based cluster randomised kindergarten intervention, Pre-schoolers' Food Courage 2.0. The purpose of the current qualitative study was to explore kindergarten teachers' experience of implementing this intervention and what they thought facilitated the positive impact of the intervention reported in the quantitative evaluation. Ten individual telephonic interviews with kindergarten teachers who took part in the intervention study were conducted using a semi-structured interview guide. Data were transcribed verbatim and subjected to thematic analysis. Five main themes were identified: 1) One-year-olds love food and renewal of the menus was inspiring; 2) One-year-olds are surprisingly willing to try and accept novel foods; 3) Novel food at meals stimulate social interaction; and 4) The Sapere method is a fun and explorative activity for 1-year-olds. These four themes were the features perceived as the effective elements of the intervention by the kindergarten teachers. The fifth main theme was: 5) Sustained impact on kindergarten teachers' practices and beliefs. The kindergarten teachers found the intervention easy to implement, and they were surprised by the foods 1-year-olds like and how the intervention increased their food acceptance. This age window of opportunity seems to be underused in kindergartens. By using the strategies described in the intervention, kindergarten staff effectively took advantage of this opportunity and consequently, child and kindergarten staff behaviour in relation to food was enhanced. Interventions targeting healthy feeding practices may potentially have a long-term public health impact by increasing food variety and vegetable intake in toddlers. TRIAL REGISTRATION: ISRCTN98064772.

Effect of storage time, temperature, antioxidant and thawing on fatty acid composition of plasma, serum and red blood cells - A pilot biobank study.

BACKGROUND: It studies on the factors that affect the stability of fatty acid profiles from human blood specimens are generally performed by evaluating the effect of a single factor on an individual fatty acid and excluding a considerable amount of data from the total fatty acid profiles. METHODS: The stability of fatty acids from plasma, serum and red blood cells (RBC) was evaluated in terms of time, temperature, antioxidant and thawing. The fatty acids were methylated and analyzed by gas chromatography. The large volume of data is evaluated simultaneously and automatically by observing an Excel-based colour scale that indicates whether the fatty acid profiles have changed significantly as a result of the storage time (0-52weeks), temperature (-20°C/-80°C), butylated hydroxytoluene (BHT) antioxidant (presence/absence) or thawing (single/multiple). RESULTS: Fatty acids from plasma were stable at both temperatures (-20°C/-80°C) regardless of BHT. Fatty acids from serum without BHT degrades faster at -80°C than -20°C and fatty acids from RBC without BHT degrades faster at -20°C than -80°C. Addition of BHT inhibits this effect in serum and RBC. Multiple thawing of RBC without BHT demonstrated that polyunsaturated fatty acids were generally more susceptible for changes at -80°C than at -20°C while BHT prevents partially this effect. CONCLUSIONS: This study draws attention to the importance of pre-analytical considerations when storing blood samples in biobanks and the need of careful judgments when analyzing fatty acids profiles.

A short food frequency questionnaire to assess intake of seafood and n-3 supplements: validation with biomarkers.

BACKGROUND: Seafood intake is associated with beneficial effects for human health. Seafood provides a number of nutrients beyond the traditionally known long chain marine n-3 fatty acids EPA, DPA and DHA, such as protein, vitamin D, iodine, selenium and vitamin B12. Valid assessment of dietary seafood and n-3 supplement intakes are becoming increasingly crucial when giving recommendations to populations as seafood consumption is regarded as an important part of a healthy and balanced diet. METHODS: The aim was to validate a short FFQ developed for assessment of dietary intake of seafood and n-3 supplements using the biomarkers marine n-3 fatty acids in erythrocytes and 25(OH)D in serum. RESULTS: Fifty-three healthy Norwegians aged 30-64 years with a mean BMI of 25 kg/m2 were compliant with the study protocol. 70% reported eating seafood for dinner one to two times per week, and 45% reported to eat seafood as spread, in salads or as snack meal three to five times or more per week. The FFQ correlated significantly with both the levels of marine n-3 fatty acids (r=0.73, p<0.0001) and with 25(OH)D (r=0.37, p<0.01). Mean level of marine n-3 and of 25(OH)D were 232±65 µg/g erythrocytes and 73±33 nmol/L serum, respectively. CONCLUSION: The present short FFQ predicted strongly the levels of marine n-3 fatty acids in erythrocytes, and predicted fairly good the level of serum 25(OH)D and may therefore be a valid method for assessment of seafood and n-3 supplements intake among adults.

Protocol for the Cognitive Interventions and Nutritional Supplements (CINS) trial: a randomized controlled multicenter trial of a brief intervention (BI) versus a BI plus cognitive behavioral treatment (CBT) versus nutritional supplements for patients with long-lasting muscle and back pain.

BACKGROUND: Brief intervention programs are clinically beneficial, and cost efficient treatments for low back pain, when offered at 8-12 weeks, compared with treatment as usual. However, about 30% of the patients do not return to work. The European Guidelines for treatment of chronic low back pain recommends Cognitive Behavioral Therapy (CBT), but conclude that further research is needed to evaluate the effectiveness of CBT for chronic low back pain. METHODS/DESIGN: The aim of the multicenter CINS trial (Cognitive Interventions and Nutritional Supplements) is to compare the effectiveness of 4 different interventions; Brief Intervention, Brief Intervention and CBT, Brief Intervention and nutritional supplements of seal oil, and Brief Intervention and nutritional supplements of soy oil. All participants will be randomly assigned to the interventions. The nutritional supplements will be tested in a double blind design. 400 patients will be recruited from a population of chronic low back pain patients that have been sick listed for 2-10 months. Four outpatient clinics, located in different parts of Norway, will participate in recruitment and treatment of the patients.The Brief Intervention is a one session cognitive, clinical examination program based on a non-injury model, where return to normal activity and work is the main goal, and is followed by two booster sessions. The CBT is a tailored treatment involving 7 sessions, following a detailed manual. The nutritional supplements consist of a dosage of 10 grams of either soy or seal oil (capsules) per day for 3 months, administered in a double blind design. All patients will be followed up with questionnaires after 3, 6 and 12 months, while sick leave data will be collected up to at least 24 months after randomization. The primary outcome of the study is sick leave and will be based on register data from the National Insurance Administration. Secondary outcomes include self-reported data on disability, pain, and psychological variables. CONCLUSIONS: To our knowledge, the CINS trial will be the largest, randomized trial of psychological and nutritional interventions for chronic low back pain patients to date. It will provide important information regarding the effectiveness of CBT and seal oil for chronic low back pain patients. TRIAL REGISTRATION: http://www.clinicaltrials.gov, with registration number NCT00463970.

Duodenal administered seal oil for patients with subjective food hypersensitivity: an explorative open pilot study.

Short-term duodenal administration of n-3 polyunsaturated fatty acid (PUFA)-rich seal oil may improve gastrointestinal complaints in patients with subjective food hypersensitivity, as well as joint pain in patients with inflammatory bowel disease (IBD). The aim of the present explorative pilot study was to investigate whether 10-day open treatment with seal oil, 10 mL self-administrated via a nasoduodenal tube 3 times daily, could also benefit nongastrointestinal complaints and quality of life (QoL) in patients with subjective food hypersensitivity. Twenty-six patients with subjective food hypersensitivity, of whom 25 had irritable bowel syndrome (IBS), were included in the present study. Before and after treatment and 1 month posttreatment, patients filled in the Ulcer Esophagitis Subjective Symptoms Scale (UESS) and the Gastrointestinal Symptom Rating Scale (GSRS) for gastrointestinal symptoms and subjective health complaints (SHC) inventory for nongastrointestinal symptoms in addition to short form of the Nepean dyspepsia index (SF-NDI) for evaluation of QoL. Compared with baseline, gastrointestinal, as well as nongastrointestinal, complaints and QoL improved significantly, both at end of treatment and 1 month posttreatment. The consistent improvements following seal oil administration warrant further placebo-controlled trials for confirmation of effect.

A randomized double blind comparison of short-term duodenally administrated whale and seal blubber oils in patients with inflammatory bowel disease and joint pain.

Compared with soy oil, 10 days treatment with seal oil (SO), 10mLx3 daily, self-administrated through a nasoduodenal feeding tube, relieves joint pain in patients with inflammatory bowel disease (IBD). This randomized, controlled, double blind pilot trial compares SO and whale oil (WO) administered similarly by duodenal tube, for 10 days in 18 patients with IBD-related joint pain (n=9 per group). Other long chain n-3 polyunsaturated fatty acids were prohibited 7-days prior to and during study. Significant changes from baseline to study end were observed in both groups: reduced plasma arachidonic acid to eicosapentaenoic acid ratio and prostaglandin E(2) (PGE(2)) levels (tendency in WO group), decreased IBD-related joint pain and IBD-disease activity, and improved quality of life. These changes were not significantly different between SO and WO groups. Inhibition of cyclooxygenase is consistent with amelioration of IBD-related joint pain, but, as active control was used, effects need confirmation.

Improved quantification of prostaglandins in biological samples by optimizing simultaneously the relationship eicosanoid/internal standard and using liquid chromatography tandem mass spectrometry.

Although a wide variety of articles on quantification of eicosanoids by using internal standards are published every year, little has been done on how much internal standard should be added. This article demonstrates that the application of experimental design enables estimating the interaction eicosanoid/internal standard and to select confidently an optimal amount of internal standard and a response factor (RF) for the analysis of eicosanoids in a high number of samples, where the amount of sample is limited and the unknown levels of eicosanoids are spanned in a wide range of concentrations. The results revealed that the interaction eicosanoid/internal standard is an important factor that affects the validity of the RF and subsequently the accuracy of the analysis.

Short-term duodenal seal oil administration normalised n-6 to n-3 fatty acid ratio in rectal mucosa and ameliorated bodily pain in patients with inflammatory bowel disease.

BACKGROUND: A high dietary intake of n-6 compared to n-3 fatty acids (FAs) may promote the production of pro-inflammatory eicosanoids and cytokines. In two recent studies, short-term (10-day) duodenal administration of n-3 polyunsaturated fatty acid rich seal oil ameliorated joint pain in patients with inflammatory bowel disease (IBD). Using unpublished data from these two studies we here investigated whether normalisation of the n-6 to n-3 FA ratio in blood and tissues by seal oil administration was associated with improved health related quality of life (HRQOL) as assessed by the generic short-form 36 (SF-36) questionnaire. RESULTS: In the first pilot study, baseline n-6 to n-3 FA ratio in rectal mucosal biopsies from 10 patients with IBD (9 of those had joint pain) was significantly increased compared with that in 10 control patients without IBD or joint pain. Following seal oil administration, the n-6 to n-3 FA ratio of the IBD-patients was significantly lowered to the level seen in untreated controls. In the subsequent, randomized controlled study (n = 19), seal oil administration reduced the n-6 to n-3 FA ratio in blood similarly and also the SF-36 assessed bodily pain, while n-6 FA rich soy oil administration had no such effect. CONCLUSION: In these two separate studies, short-term duodenal administration of seal oil normalised the n-6 to n-3 FA ratio in rectal mucosa and improved the bodily pain dimension of HRQOL of patients with IBD-related joint pain. The possibility of a causal relationship between n-6 to n-3 FA ratio in rectal mucosa and bodily pain in IBD-patients warrants further investigations.

Subjective improvement in patients with psoriatic arthritis after short-term oral treatment with seal oil. A pilot study with double blind comparison to soy oil.

OBJECTIVE: To investigate effects of short-term oral treatment with seal oil in patients with psoriatic arthritis (PsA). METHODS: Forty-three patients with polyarticular PsA were randomized to receive oral treatment for 2 weeks with either seal oil or soy oil in a double blind controlled trial. Clinical and biochemical variables were assessed at baseline, after treatment, and 4 weeks post-treatment. Patients were allowed to continue nonsteroidal antiinflammatory drugs (NSAID) and disease modifying antirheumatic drugs (DMARD) during the study. RESULTS: Forty patients completed the study, 20 in each treatment group. Patients in the seal oil group reported a significant improvement in global assessment of the disease 4 weeks post- treatment (p < 0.01), and both groups showed a trend toward improvement in tender joint count, but the differences between the groups were not significant. There was a fall in the ratio of n-6 to n-3 fatty acids and in arachidonic acid (AA) to eicosapentaenoic acid (EPA) in serum after treatment with seal oil (p < 0.01). Twenty-one percent of all patients had elevated values of calprotectin in feces suggestive of asymptomatic colitis. CONCLUSION: Treatment with seal oil was followed by a modest improvement in patient's global assessment of the disease and a trend towards a decrease in number of tender joints. There was a shift in fatty acid composition in serum toward a putative antiinflammatory profile. Oral treatment with seal oil may have NSAID-like effects in PsA.

[Fish--more than just omega 3]. / Fisk--ikke bare omega-3.

In the Norwegian governmental guidelines for food and nutrition, an increased intake of fish and other seafood is particularly recommended. Fish is a good source of many important nutrients, such as proteins, very long-chain omega 3 fatty acids, vitamin D, vitamin B12, selenium and iodine. The beneficial effect on health by including fish has been documented in several studies. Increasing interest in the health gains obtained by regular fish intake has put emphasis on the need for documentation of both nutrients and contaminants in fish and seafood, with a balanced risk assessment. In this paper, some of the positive health effects of fish in the diet are elucidated.