Use of a Web-Based Dietary Assessment Tool (RiksmatenFlex) in Swedish Adolescents: Comparison and Validation Study

BACKGROUND: A Web-based dietary assessment tool-RiksmatenFlex-was developed for the national dietary survey of adolescents in Sweden. OBJECTIVE: This study aimed to describe the Web-based method RiksmatenFlex and to test the validity of the reported dietary intake by comparing dietary intake with 24-hour dietary recalls (recall interviews), estimated energy expenditure, and biomarkers. METHODS: Adolescents aged 11-12, 14-15, and 17-18 years were recruited through schools. In total, 78 students had complete dietary information and were included in the study. Diet was reported a few weeks apart with either RiksmatenFlexDiet (the day before and a random later day) or recall interviews (face-to-face, a random day later by phone) in a cross-over, randomized design. At a school visit, weight and height were measured and blood samples were drawn for biomarker analyses. Students wore an accelerometer for 7 days for physical activity measurements. Dietary intake captured by both dietary methods was compared, and energy intake captured by both methods was compared with the accelerometer-estimated energy expenditure (EEest). Intake of whole grain wheat and rye and fruit and vegetables by both methods was compared with alkylresorcinol and carotenoid concentrations in plasma, respectively. RESULTS: The mean of the reported energy intake was 8.92 (SD 2.77) MJ by RiksmatenFlexDiet and 8.04 (SD 2.67) MJ by the recall interviews (P=.01). Intake of fruit and vegetables was 224 (169) g and 227 (150) g, and whole grain wheat and rye intake was 12.4 (SD 13.2) g and 12.0 (SD 13.1) g, respectively; the intakes of fruit and vegetables as well as whole grain wheat and rye did not differ between methods. Intraclass correlation coefficients ranged from 0.57 for protein and carbohydrates to 0.23 for vegetables. Energy intake by RiksmatenFlexDiet was overreported by 8% (P=.03) but not by the recall interviews (P=.53) compared with EEest. The Spearman correlation coefficient between reported energy intake and EEest was 0.34 (P=.008) for RiksmatenFlexDiet and 0.16 (P=.21) for the recall interviews. Spearman correlation coefficient between whole grain wheat and rye and plasma total alkylresorcinol homologs was 0.36 (P=.002) for RiksmatenFlexDiet and 0.29 (P=.02) for the recall interviews. Spearman correlations between intake of fruit and vegetables and plasma carotenoids were weak for both dietary tools. The strongest correlations were observed between fruit and vegetable intake and lutein/zeaxanthin for RiksmatenFlexDiet (0.46; P<.001) and for recall interviews (0.28; P=.02). CONCLUSIONS: RiksmatenFlexDiet provides information on energy, fruit, vegetables, and whole grain wheat and rye intake, which is comparable with intake obtained from recall interviews in Swedish adolescents. The results are promising for cost-effective dietary data collection in upcoming national dietary surveys and other studies in Sweden. Future research should focus on how, and if, new technological solutions could reduce dietary reporting biases

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8–14.4 million) incident T2D cases, representing 70.3% (68.8–71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0–27.1%)), excess refined rice and wheat intake (24.6% (22.3–27.2%)) and excess processed meat intake (20.3% (18.3–23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4–87.7%)) and Latin America and the Caribbean (81.8% (80.1–83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1–60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.publishedVersio

Children’s and adolescents’ rising animal-source food intakes in 1990–2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents’ physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the world’s child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 15–19 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes.publishedVersio

The Contribution of Foods and Beverages of Low Nutritional Value to the Diets of Swedish Adolescents, by Food Group, Time and Place. A Nationally Representative Study

Adolescence is a time in life when lifestyle behaviours are acquired. One indicator of poor diet quality is the intake of foods and beverages with a relatively low nutritional value. Using the Australian classification of such foods, termed “discretionary”, we classified the intakes of Swedish adolescents who participated in the Riksmaten Adolescent 2016–17 national dietary survey. From selected schools, 3099 adolescents in age groups 11–12, 14–15 and 17–18 years provided two 24-h recalls. Intakes and healthy dietary scores were calculated. Plasma ferritin, folate and 25(OH)D were available for a third. Almost 40% of total energy came from discretionary foods/beverages. Adolescents with higher intakes were more likely to be female, older, from a low socioeconomic position-household and born in Sweden. Most discretionary foods/beverages were consumed on weekend days and during in-between meals, outside of the home and at school. Percent energy from discretionary intake was associated with healthy dietary scores but not nutritional status. A substantial amount of energy was obtained from discretionary foods/beverages, and we found that consumption is pervasive across sociodemographic factors, time and place. Addressing this pattern will require a comprehensive approach to food environments and behaviours to reach all adolescents in an equitable manner

Vitamin D status and associations with diet, objectively measured physical activity patterns and background characteristics among adolescents in a representative national cross-sectional survey.

OBJECTIVE: To report on vitamin D status, measured as plasma 25-hydroxyvitamin D concentration (25(OH)D), the prevalence of vitamin D insufficiency and deficiency, and to explore associations between Vitamin D status and background characteristics. DESIGN: Data was collected in a national dietary survey, Riksmaten adolescents 2016-17. The participants completed dietary assessment and questionnaires on the web and wore accelerometers. [25(OH)D] was measured with a mass spectrometry method. SETTING: Representative survey conducted in schools throughout Sweden. PARTICIPANTS: Participants attended school years 5 (Y5, mean age 12. 5 years), 8 (Y8, mean age 14. 5 years) and 11(Y11, mean age 18 years), and included 1100 participants. RESULTS: Overall, there was no difference in plasma 25(OH)D between girls and boys. Vitamin D insufficiency differed between the three school years. The prevalence of insufficiency in Y5 was 32 (boys) and 48 (girls) percent, while in Y11 62 (boys) and 43 (girls) percent. The prevalence of deficiency in Y11 was 16 and 15 percent in boys and girls, respectively. Being born outside of Sweden was associated with a 10-fold increased risk of being vitamin D deficient. Deficiency was also associated with longer time spent in sedentary intensity, a lower consumption of fortified dairy products, and fats and oils. CONCLUSIONS: Vitamin D deficiency was most common in the oldest age group and being born outside of Sweden increased the risk of being deficient. The present study will form a baseline for future follow-up studies of the implementation of a new mandatory vitamin D fortification policy in 2018

Riksmaten Adolescents 2016-17 : A national dietary survey in Sweden - design, methods, and participation

Background: Nationally representative information on food consumption data is essential to evaluate dietary habits, inform policy-making and nutritional guidelines, as well as forming a basis for risk assessment and identification of risk groups. Objective: To describe the methods used in the Swedish national dietary survey of adolescents, Riksmaten Adolescents 2016-2017. Design: Students in grades 5, 8, and 11 (mean ages 12, 15, and 18 years) were recruited in this school-based cross-sectional survey. A new, validated, web-based method was used to assess dietary intake. Information on physical activity, health, and socioeconomic background was collected through web questionnaires. Physical activity was also evaluated by accelerometers. Weight and height were measured in all participants, while blood and urine samples were collected in a subsample of 40% of the participants. Results: A total of 3,477 (68%) respondents participated and 3,099 (60%) had complete dietary information. In the subsample, 1,305 (55%) respondents participated and 1,105 (46%) had complete dietary information. The participants were overall representative for the population with regard to socioeconomic background and school organization (public or independent). All types of municipalities were represented in the survey and overall, the geographic distribution corresponded to the underlying population. Some differences by school grade were observed. Sample weights were calculated for the total sample and the subsample. Conclusion: The Riksmaten Adolescents 2016-2017 provides valuable national data on diet, physical activity, and markers of exposure in age groups where data have been lacking. The data will provide a valuable basis for risk assessment, public health policy, and in-depth analyses

Riksmaten Adolescents 2016-17 : A national dietary survey in Sweden - design, methods, and participation

Background: Nationally representative information on food consumption data is essential to evaluate dietary habits, inform policy-making and nutritional guidelines, as well as forming a basis for risk assessment and identification of risk groups. Objective: To describe the methods used in the Swedish national dietary survey of adolescents, Riksmaten Adolescents 2016-2017. Design: Students in grades 5, 8, and 11 (mean ages 12, 15, and 18 years) were recruited in this school-based cross-sectional survey. A new, validated, web-based method was used to assess dietary intake. Information on physical activity, health, and socioeconomic background was collected through web questionnaires. Physical activity was also evaluated by accelerometers. Weight and height were measured in all participants, while blood and urine samples were collected in a subsample of 40% of the participants. Results: A total of 3,477 (68%) respondents participated and 3,099 (60%) had complete dietary information. In the subsample, 1,305 (55%) respondents participated and 1,105 (46%) had complete dietary information. The participants were overall representative for the population with regard to socioeconomic background and school organization (public or independent). All types of municipalities were represented in the survey and overall, the geographic distribution corresponded to the underlying population. Some differences by school grade were observed. Sample weights were calculated for the total sample and the subsample. Conclusion: The Riksmaten Adolescents 2016-2017 provides valuable national data on diet, physical activity, and markers of exposure in age groups where data have been lacking. The data will provide a valuable basis for risk assessment, public health policy, and in-depth analyses

Nordic network on dietary survey methodology 2019-2020

In 2019, the Nordic network on dietary surveys compared results regarding 24 h recalls, if the method was used in a systematic Nordic set up. A standardized central food list for 7 days was entered into national nutrients calculation systems and the intakes of individual food groups and nutrients on each day and as a daily average of the 7 days were compared.  Results were presented at an online workshop on November 20th, 2020. In addition to the country specific presentations of the analysis, each country also gave a presentation on the latest national dietary survey.  Despite standardized input, there were many differences in the results. The presentations on national dietary surveys showed differences and similarities of conducting dietary surveys and elucidated a lot of the common challenges researchers face. Many topics could be further elucidated on future network meetings

Food composition data and labelling : a challenging dialogue

This report describes the activities of two projects that were carried out using the infrastructure of the Nordic Food Analysis Network, i.e. the ‘Nordic Food Composition Data for Labelling (NordCoLa)’ project carried out between 2018 and 2020, and the preceding project ‘Fostering the quality and use of Nordic food composition data’, carried out under the Finnish Presidency of the NCM in 2016. The primary aim of the NordCoLa project was to evaluate the needs, synergies and critical points of the Nordic FCDBs (e.g. food ingredient and nutrient value gaps) in relation to the composition data to be used to implement the new European nutrient labelling legislation. This was to ensure quality food composition data in the Nordic countries for food producers and other users for nutrient labelling purposes. The most important gaps were evaluated and summarised by this project. This project included an exercise comparing calculated and analysed nutrient information of selected Nordic food samples. This information was then compared with the acceptable tolerance limits in use in the EU. As part of the projects, two open seminars were organised in Helsinki; the first one on 16 October 2016 and the second on 17 April 2019. The seminars gathered a total of around 150 participants together to hear about challenges in the area of food composition data and their use in food labelling and related quality issues. In addition, the project included research on food label information in order to evaluate the usefulness of the Mintel Global New Products’ Database (Mintel GNPD) and GS1 in the work of updating and compiling information used in food composition databases. The network’s main conclusions and strategical proposals are as follows: • There is a need for more analyses and continuous compiling work in order to ensure updated FCDBs for the users. Opportunities for Nordic collaboration in food analyses should be carefully evaluated. • More industrial ingredients need to be analysed and added to FCDBs. Obtaining such information is important to keep the databases useful, especially for SMEs in the food business. • The calculated values are of overall good quality when compared with analysed values, with the exception of protein, sugars and salt. This warrants more attention to take carbohydrates and especially simple sugars into account when planning future national food analysis programmes. Collecting more information on salt content and comparing it with the analysed information on food products is also needed. • There is no legislation for the methods to be used in the food analysis. This means that different methods are used and even different components may be measured resulting variation in nutrient contents. Sugars are an example of that, since different techniques measure total sugar content or different 7 sugar components separately and both ways are accepted for labelling purposes. • Calculating nutrient contents of food items according to a standardised method is a good and affordable way of producing values for food composition databases and food labelling purposes, if the data quality of the FCDBs are based on analysed values. • The acceptable variation in nutrient label information based on EC legislation tolerances is very large. The tolerances may even threaten the meaningful reformulation of food products and reliable consumer information due to uncertainties over the labelled nutrient values. • More information is needed regarding the validity of nutrient labelling at the Nordic and European level. To avoid misleading consumer information, food analyses should be used to check the validity of nutrient labelling and to monitor reformulation efforts. • Nutrient label data from commercial food label databases, for example, is not recommended to be used, in general, for updating nutrient values of foods in the national FCDBs. However, such databases were found to be partially useful in updating the coverage, i.e. food lists of national FCDBs, if the used databases cover most of the national market. • Nordic collaboration should be further intensified in the fields of analysing nutrient content of missing ingredients in FCDBs, harmonising nutrient label calculation procedures and proposing improvements to the European legislation concerning tolerances of nutrient values in labelling