Evalueringsrapport III. Fysisk aktivitet og måltider i videregående opplæring

Våren 2004 fikk Utdanningsdirektoratet og Sosial- og helsedirektoratet i oppdrag fra Utdannings- og forskningsdepartementet og Helse- og omsorgsdepartementet å kartlegge og initiere utvikling av gode modeller som tilrettelegger for daglig fysisk aktivitet og gode rammer for måltider i skolen. På denne bakgrunn initierte direktoratene prosjektet ”Fysisk aktivitet og måltider”. Videregående opplæring ble inkludert i satsningen fra og med skoleåret 2005/06 og kunne søke om støtte dette skoleåret og skoleåret etter. 18 videregående skoler ble plukket ut til å delta i satsningen. Denne rapporten oppsummerer erfaringer fra 10 av disse skolene. Utdanningsdirektoratet har ledet prosjektet og stått ansvarlig for alle samlinger for Fylkeskommunen og deltakende skoler fra videregående opplæring. Helsedirektoratet har hatt en aktiv faglig rådgiverrolle, både ved deltakelse på samlinger og ved gjennomføring av kompetansehevingskurs mht kantinemat i de aktuelle deltakerfylkene. Evalueringen av prosjektet legger derfor vekt på å studere organisatoriske og fysiske endringer i løpet av prosjektperioden, dvs. endringer på institusjons-/organisasjonsnivå (skolenivå), da disse vurderes å være en forutsetning for endring av elevatferd. Seks av de ti videregående skolene som har deltatt i undersøkelsen, inkluderte per våren 2008 satsning på skolemåltid i skolens handlingsplan og tre inkluderte fysisk aktivitet i handlingsplanen (figur 4). I forhold til 2006 ligger disse tallene stabilt for skolemåltidet, mens det har vært en halvering av skoler som har inkludert fysisk aktivitet som satsning i handlingsplanen. På rundt halvparten av skolene har lærere deltatt på kompetansehevende tiltak i form av konferanser, mens lærere på syv av skolene har deltatt på dagskurs. Dette omfanget gjelder både for skolemåltider og fysisk aktivitet. Alle de videregående skolene som deltok i undersøkelsen rapporterte at de setter av 20 minutter eller mer til matpause for elevene. Dette tallet har ligget stabilt fra 2006. Halvparten av skolene tilbød i 2005 salg av brus, mens ingen gjorde det i 2008. Ni av skolene har egen kantineansatt som står for tillaging og salg av mat og drikke til elevene. Flertallet av skolene solgte i 2008 maten til selvkost, mens i 2006 rapporterte halvparten av skolene at de la på litt fortjeneste. Jevnt over har det vært en økning i antallet skoler som tilbyr tilgang til arealer for fysisk aktivitet i form av tilfluktsrom, trimrom, skiløyper og sjø/elvtilgang. Videre har det vært økt tilbud i ballspill og utlån av utstyr til aktivitet fra 2006 til 2008. Den vanligste formen å tilrettelegge for fysisk aktivitet utenom kroppsøvingstimene er ved å organisere aktivitetsdager og turneringer og deretter å integrere fysisk aktivitet i undervisningen. Det er en nedgang i antall skoler som har midttimeordning til fysisk aktivitet fra 2006 til 2008. Det er også en nedgang i antall skoler som sier at de aldri tilrettelegger for fysisk aktivitet utenom kroppsøvingstimene. Det har videre vært en reduksjon i antall skoler som rapporterte fysiske hindringer fra 2006 til 2008. Den største nedgangen har vært på tilgjengelig utstyr. Omfanget av rapporterte organisatoriske hindringer har ligget nokså jevnt. De største organisatoriske hindringene erfares i forhold til tid og økonomi. Fire av skolene rapporterte i 2008 at de mente elevene var mer konsentrerte i undervisningen og ingen av skolene rapporterte at tid til fysisk aktivitet i løpet av skoledagen går ut over elevenes samlede læring. Samlet sett ser det ut for at tilrettelegging av skolemåltider har fungert tilfredsstillende i videregående opplæring. Et viktig suksesskriterium ser her ut til å være tilsatt kantinepersonell som kan stå for tilrettelegging av måltidet og sikre implementering av Helsedirektoratets nasjonale regningslinjer. I videre satsning for å sikre helsemessige gode skolemåltider vil det derfor være av stor betydning å tilrettelegge for at videregående skoler kan tilsette kantinepersonell og samtidig kunne tilby skolemåltider til lavest mulig pris til elevene. Når det gjelder fysisk aktivitet, har videregående opplæring i liten grad lyktes med tilnærminger som sikrer at elevene er daglig fysisk aktive i løpet av skoledagen. De fleste skolene har jobbet med tilrettelegging av inne- og utearealet. Dette gir et tilbud til elever som selv er motiverte for å drive fysisk aktivitet, men det er ikke et tilbud som når alle elevene. For å sikre at skolen blir en arena der alle barn og unge kan nå anbefalingen om å være en time daglig fysisk aktiv, synes det derfor nødvendig å sette av tid i elevenes undervisningsplan til fysisk aktivitet. I tilknytning til en satsning der det gis timeramme til daglig fysisk aktivitet er det vesentlig at lærernes kompetanse til å tilrettelegge for fysisk aktivitet, som når de minst aktive elevene, økes gjennom både grunnutdanning og etter- og videreutdanning

Vitamin B12 concentrations in milk from Norwegian women during the six first months of lactation

Background: Human milk vitamin B12 (B12) concentrations depend on maternal status and intake; only few data are available in high-income countries. Objective: We assessed human milk B12 concentrations during the first 6 months postpartum in Norwegian women and its association with maternal dietary B12 intake and maternal urinary methylmalonic acid (MMA) concentration. Methods: In this cross-sectional study, 175 mothers, exclusively (80%) or partially (20%) breastfeeding, were included. Milk B12 was measured by IMMULITE®/IMMULITE® 1000 B12 competitive protein binding assay and urinary MMA relative to creatinine (MMA/Cr) by liquid chromatography-tandem-mass spectrometry. Maternal habitual B12 intake and supplement use were estimated using a food frequency questionnaire. Results: Mean human milk B12 concentration was 327 pmol/L (range 140-1089), with 402 pmol/L at 1 month (n = 21), 333 pmol/L at four months (n = 32), and 299 pmol/L at 6 months (n = 21). Maternal B12 intake was 5 µg/d, 89% met the Estimated Average Requirement, and supplement use did not affect milk B12 concentrations. MMA/Cr was low in all women compared with published data. In exclusively breastfeeding women, MMA/Cr (beta (95% CI) -42.5 (-82.5, -2.5) and time since birth (-4.9 (-9.6, -0.3)) were significant predictors of human milk B12 concentrations. There was no association between total B12 intake and milk B12 concentration or between total B12 intake and MMA/Cr. Conclusions: Maternal B12 status and human milk B12 concentrations are likely sufficient, based on adequate maternal B12 dietary intake combined with low urinary MMA concentrations. Nevertheless, milk B12 concentration fell during 6 months postpartum while maternal B12 status did not change.publishedVersio

Bioavailability of iron, zinc, folate and vitamin A when fortified in condiments and seasonings

Seasonings and condiments can be candidate vehicles for micronutrient fortification if consumed consistently and if dietary practices ensure bioavailability of the nutrient. In this review, we identify factors that may affect the bioavailability of iron, vitamin A, zinc, and folic acid when added to seasonings and condiments and evaluate their effects on micronutrient status. We take into consideration the chemical and physical properties of different forms of the micronutrients, the influence of the physical and chemical properties of foods and meals to which fortified seasonings and condiments are typically added, and interactions between micronutrients and the physiological and nutritional status of the target population. Bioavailable fortificants of iron have been developed for use in dry or fluid vehicles. For example, sodium iron ethylenediaminetetraacetic acid (NaFeEDTA) and ferrous sulfate with citric acid are options for iron fortification of fish and soy sauce. Furthermore, NaFeEDTA, microencapsulated ferrous fumarate, and micronized elemental iron are potential fortificants in curry powder and salt. Dry forms of retinyl acetate or palmitate are bioavailable fortificants of vitamin A in dry candidate vehicles, but there are no published studies of these fortificants in fluid vehicles. Studies of zinc and folic acid bioavailability in seasonings and condiments are also lacking

Vitamin B12 concentrations in milk from Norwegian women duringthe six first months of lactation

Background: Human milk vitamin B12 (B12) concentrations depend on maternal status and intake; only few data are available in high-income countries. Objective: We assessed human milk B12 concentrations during the first 6 months postpartum in Norwegian women and its association with maternal dietary B12 intake and maternal urinary methylmalonic acid (MMA) concentration. Methods: In this cross-sectional study, 175 mothers, exclusively (80%) or partially (20%) breastfeeding, were included. Milk B12 was measured by IMMULITE®/IMMULITE® 1000 B12 competitive protein binding assay and urinary MMA relative to creatinine (MMA/Cr) by liquid chromatography-tandem-mass spectrometry. Maternal habitual B12 intake and supplement use were estimated using a food frequency questionnaire. Results: Mean human milk B12 concentration was 327 pmol/L (range 140-1089), with 402 pmol/L at 1 month (n = 21), 333 pmol/L at four months (n = 32), and 299 pmol/L at 6 months (n = 21). Maternal B12 intake was 5 µg/d, 89% met the Estimated Average Requirement, and supplement use did not affect milk B12 concentrations. MMA/Cr was low in all women compared with published data. In exclusively breastfeeding women, MMA/Cr (beta (95% CI) -42.5 (-82.5, -2.5) and time since birth (-4.9 (-9.6, -0.3)) were significant predictors of human milk B12 concentrations. There was no association between total B12 intake and milk B12 concentration or between total B12 intake and MMA/Cr. Conclusions: Maternal B12 status and human milk B12 concentrations are likely sufficient, based on adequate maternal B12 dietary intake combined with low urinary MMA concentrations. Nevertheless, milk B12 concentration fell during 6 months postpartum while maternal B12 status did not change

Vitamin B12 concentrations in milk from Norwegian women during the six first months of lactation

Background: Human milk vitamin B12 (B12) concentrations depend on maternal status and intake; only few data are available in high-income countries. Objective: We assessed human milk B12 concentrations during the first 6 months postpartum in Norwegian women and its association with maternal dietary B12 intake and maternal urinary methylmalonic acid (MMA) concentration. Methods: In this cross-sectional study, 175 mothers, exclusively (80%) or partially (20%) breastfeeding, were included. Milk B12 was measured by IMMULITE®/IMMULITE® 1000 B12 competitive protein binding assay and urinary MMA relative to creatinine (MMA/Cr) by liquid chromatography-tandem-mass spectrometry. Maternal habitual B12 intake and supplement use were estimated using a food frequency questionnaire. Results: Mean human milk B12 concentration was 327 pmol/L (range 140-1089), with 402 pmol/L at 1 month (n = 21), 333 pmol/L at four months (n = 32), and 299 pmol/L at 6 months (n = 21). Maternal B12 intake was 5 µg/d, 89% met the Estimated Average Requirement, and supplement use did not affect milk B12 concentrations. MMA/Cr was low in all women compared with published data. In exclusively breastfeeding women, MMA/Cr (beta (95% CI) -42.5 (-82.5, -2.5) and time since birth (-4.9 (-9.6, -0.3)) were significant predictors of human milk B12 concentrations. There was no association between total B12 intake and milk B12 concentration or between total B12 intake and MMA/Cr. Conclusions: Maternal B12 status and human milk B12 concentrations are likely sufficient, based on adequate maternal B12 dietary intake combined with low urinary MMA concentrations. Nevertheless, milk B12 concentration fell during 6 months postpartum while maternal B12 status did not change

Iron deficiency is uncommon among lactating women in urban Nepal, despite a high risk of inadequate dietary iron intake

The main objective of the present study was to examine the association between dietary Fe intake and dietary predictors of Fe status and Hb concentration among lactating women in Bhaktapur, Nepal. We included 500 randomly selected lactating women in a cross-sectional survey. Dietary information was obtained through three interactive 24 h recall interviews including personal recipes. Concentrations of Hb and plasma ferritin and soluble transferrin receptors were measured. The daily median Fe intake from food was 17·5 mg, and 70 % of the women were found to be at the risk of inadequate dietary Fe intake. Approximately 90 % of the women had taken Fe supplements in pregnancy. The prevalence of anaemia was 20 % (Hb levels < 123 g/l) and that of Fe deficiency was 5 % (plasma ferritin levels < 15 μg/l). In multiple regression analyses, there was a weak positive association between dietary Fe intake and body Fe (β 0·03, 95 % CI 0·014, 0·045). Among the women with children aged < 6 months, but not those with older infants, intake of Fe supplements in pregnancy for at least 6 months was positively associated with body Fe (P for interaction < 0·01). Due to a relatively high dietary intake of non-haem Fe combined with low bioavailability, a high proportion of the women in the present study were at the risk of inadequate intake of Fe. The low prevalence of anaemia and Fe deficiency may be explained by the majority of the women consuming Fe supplements in pregnancy

Iron deficiency is uncommon among lactating women in urban Nepal, despite a high risk of inadequate dietary iron intake

The main objective of the present study was to examine the association between dietary Fe intake and dietary predictors of Fe status and Hb concentration among lactating women in Bhaktapur, Nepal. We included 500 randomly selected lactating women in a cross-sectional survey. Dietary information was obtained through three interactive 24 h recall interviews including personal recipes. Concentrations of Hb and plasma ferritin and soluble transferrin receptors were measured. The daily median Fe intake from food was 17·5 mg, and 70 % of the women were found to be at the risk of inadequate dietary Fe intake. Approximately 90 % of the women had taken Fe supplements in pregnancy. The prevalence of anaemia was 20 % (Hb levels < 123 g/l) and that of Fe deficiency was 5 % (plasma ferritin levels < 15 μg/l). In multiple regression analyses, there was a weak positive association between dietary Fe intake and body Fe (β 0·03, 95 % CI 0·014, 0·045). Among the women with children aged < 6 months, but not those with older infants, intake of Fe supplements in pregnancy for at least 6 months was positively associated with body Fe (P for interaction < 0·01). Due to a relatively high dietary intake of non-haem Fe combined with low bioavailability, a high proportion of the women in the present study were at the risk of inadequate intake of Fe. The low prevalence of anaemia and Fe deficiency may be explained by the majority of the women consuming Fe supplements in pregnancy