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  • 51.
    Lehto, Elviira
    et al.
    Folkhälsan Research Center, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland.
    Ray, Carola
    Folkhälsan Research Center, Helsinki, Finland.
    Haukkala, Ari
    Department of Social Research, University of Helsinki, Helsinki, Finland.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Thorsdottir, Inga
    Unit for Nutrition Research, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
    Roos, Eva
    Folkhälsan Research Center, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland.
    Do descriptive norms related to parents and friends predict fruit and vegetable intake similarly among 11-year-old girls and boys?2015In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 115, no 1, p. 168-175Article in journal (Refereed)
    Abstract [en]

    We examined whether there are sex differences in children's fruit and vegetable (FV) intake and in descriptive norms (i.e. perceived FV intake) related to parents and friends. We also studied whether friends' impact is as important as that of parents on children's FV intake. Data from the PRO GREENS project in Finland were obtained from 424 children at the age 11 years at baseline. At baseline, 2009 children filled in a questionnaire about descriptive norms conceptualised as perceived FV intake of their parents and friends. They also filled in a validated FFQ that assessed their FV intake both at baseline and in the follow-up in 2010. The associations were examined with multi-level regression analyses with multi-group comparisons. Girls reported higher perceived FV intake of friends and higher own fruit intake at baseline, compared with boys, and higher vegetable intake both at baseline and in the follow-up. Perceived FV intake of parents and friends was positively associated with both girls' and boys' FV intake in both study years. The impact of perceived fruit intake of the mother was stronger among boys. The change in children's FV intake was affected only by perceived FV intake of father and friends. No large sex differences in descriptive norms were found, but the impact of friends on children's FV intake can generally be considered as important as that of parents. Future interventions could benefit from taking into account friends' impact as role models on children's FV intake.

  • 52.
    Lehto, Elviira
    et al.
    Folkhälsan Research Center, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland.
    Ray, Carola
    Folkhälsan Research Center, Helsinki, Finland.
    Haukkala, Ari
    Department of Social Research, University of Helsinki, Helsinki, Finland.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Thorsdottir, Inga
    Unit for Nutrition Research, Landspitali-University Hospital & Faculty of Food Science and Human Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
    Roos, Eva
    Folkhälsan Research Center, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland.
    Predicting gender differences in liking for vegetables and preference for a variety of vegetables among 11-year-old children2015In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 95, p. 285-292Article in journal (Refereed)
    Abstract [en]

    We studied the factors that predict liking for vegetables and preference for a variety of vegetables among schoolchildren. Additionally, we examined if there were gender differences in the predictors that explain the hypothesized higher scores in liking vegetables and preferences among girls. The data from the PRO GREENS project included 424 Finnish children (response rate 77%) aged 11 to 12. The children completed validated measures about social and environmental factors related to their liking for vegetables and preferences both at baseline 2009 and follow-up 2010. The associations were examined with regression and mediation analyses. The strongest predictors of both girls' and boys' liking and preferences were higher levels of eating vegetables together with the family, previous vegetable intake and a lower level of perceived barriers. Liking was additionally predicted by a lower level of parental demand that their child should eat vegetables. Girls reported higher levels of liking and preferences in the follow-up. This gender difference was mainly explained by girls' lower level of perceived barriers related to vegetable intake and girls' higher previous vegetable intake. Interventions that aim to increase the low vegetable intake among boys by increasing their liking for vegetables and preference for a variety of vegetables could benefit from targeting perceived barriers, namely boys' perception and values concerning the consumption of vegetables.

  • 53.
    Lehto, Elviira
    et al.
    Folkhälsan Research Center, Helsinki, Finland; Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland.
    Ray, Carola
    Folkhälsan Research Center, Helsinki, Finland.
    Te Velde, Saskia
    EMGO Institute for Health and Care Research and Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
    Petrova, Stefka
    National Center of Public Health and Analyses, Sofia, Bulgaria.
    Duleva, Vesselka
    National Center of Public Health and Analyses, Sofia, Bulgaria.
    Krawinkel, Michael
    Institute of Nutrition Sciences, Justus-Liebig-University Giessen, Giessen, Germany.
    Behrendt, Isabel
    Institute of Nutrition Sciences, Justus-Liebig-University Giessen, Giessen, Germany; Institute of Nutrition Physiology and Human Nutrition, University of Hannover, Hannover, Germany.
    Papadaki, Angeliki
    Department of Social Medicine, Preventive Medicine and Nutrition Clinic, University of Crete, Heraklion, Crete, Greece; Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
    Kristjansdottir, Åsa
    Unit for Nutrition Research, Landspitali-University Hospital and Faculty of Food Science and Human Nutrition, University of Iceland, Reykjavik, Iceland.
    Thorsdottir, Inga
    Unit for Nutrition Research, Landspitali-University Hospital and Faculty of Food Science and Human Nutrition, University of Iceland, Reykjavik, Iceland.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Lien, Nanna
    Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway.
    Lynch, Christel
    Department for Biosciences and Nutrition at Novum, Karolinska Institutet, Stockholm, Sweden.
    Ehrenblad, Bettina
    Department for Biosciences and Nutrition at Novum, Karolinska Institutet, Stockholm, Sweden.
    Vaz de Almeida, Maria Daniel
    Faculty of Nutrition and Food Sciences of Porto University, Porto, Portugal.
    Ribic, Cirila Hlastan
    National Institute of Public Health, Chronic Diseases Prevention Centre, Ljubljana, Slovenia.
    Simčic, Irena
    National Education Institute of the Republic of Slovenia, Ljubljana, Slovenia.
    Roos, Eva
    Folkhälsan Research Center, Helsinki, Finland: Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland.
    Mediation of parental educational level on fruit and vegetable intake among schoolchildren in ten European countries2015In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, no 1, p. 89-99Article in journal (Refereed)
    Abstract [en]

    Objective: To examine which factors act as mediators between parental educational level and children's fruit and vegetable (F&V) intake in ten European countries.

    Design: Cross-sectional data were collected in ten European countries participating in the PRO GREENS project (2009). Schoolchildren completed a validated FFQ about their daily F&V intake and filled in a questionnaire about availability of F&V at home, parental facilitation of F&V intake, knowledge of recommendations about F&V intake, self-efficacy to eat F&V and liking for F&V. Parental educational level was determined from a questionnaire given to parents. The associations were examined with multilevel mediation analyses.

    Setting: Schools in Bulgaria, Finland, Germany, Greece, Iceland, the Netherlands, Norway, Portugal, Slovenia and Sweden.

    Subjects: Eleven-year-old children (n 8159, response rate 72%) and their parents.

    Results: In five of the ten countries, children with higher educated parents were more likely to report eating fruits daily. This association was mainly mediated by knowledge but self-efficacy, liking, availability and facilitation also acted as mediators in some countries. Parents' education was positively associated with their children's daily vegetable intake in seven countries, with knowledge and availability being the strongest mediators and self-efficacy and liking acting as mediators to some degree.

    Conclusions: Parental educational level correlated positively with children's daily F&V intake in most countries and the pattern of mediation varied among the participating countries. Future intervention studies that endeavour to decrease the educational-level differences in F&V intake should take into account country-specific features in the relevant determinants of F&V intake.

  • 54.
    Lehto, Elviira
    et al.
    Folkhälsan Research Center, Helsinki, Finland.
    Ray, Carola
    Folkhälsan Research Center, Helsinki, Finland.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Thorsdottir, Inga
    Unit for Nutrition Research, Landspitali-University Hospital & Faculty of Food Science and Human Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
    Roos, Eva
    Folkhälsan Research Center, Helsinki, Finland.
    The ones with lowest fruit and vegetable intake benefitted of the intervention only moderately2015In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 67, no Suppl. 1, p. 360-361Article in journal (Other academic)
    Abstract [en]

    Introduction: Infrequent fruit and vegetable (FV) intake is especially common among children with low parental educational level (PEL) and among boys.

    Objectives: Our aim was to examine whether a school-based intervention was efficient in increasing children’s FV intake especially among those whose FV intake is the lowest and which factors could explain the the group differences in the associations.

    Method / Design: In Finland 11-year-old (at baseline) children participated in the PRO GREENS intervention in winter 2009. In control schools were 424 and in intervention schools 386 children (response rate 77%). Children filled in validated food frequency questionnaire assessing FV intake (times/day) and a validated questionnaire about factors influencing FV intake (availability of FV, liking for FV, preferences, self-efficacy to eat FV, attitudes towards FV and knowledge of the recommendations) both at baseline May 2009 and follow-up May 2010. Parental educational level (low, middle, high) was reported by the parents. Associations were examined with linear regression and mediation analyses.

    Results: The intervention increased fruit intake among girls but not among boys. Intervention increased also children’s knowledge of the recommendations. Since knowledge had no impact on boys’ fruit intake, the increase in knowledge mediated only intervention’s effect on girls’ fruit intake. Intervention increased children’s fruit intake similarly in all PEL groups.Intervention increased vegetable intake only in the middle PEL group but no intervention effect was noted among children with low or high PEL. Knowledge, the only factor which mediated the intervention’s effect on children’s vegetable intake, could not explain PEL differences in the effectivity of the intervention.

    Conclusions: Increase in knowledge was not a sufficient prerequisite to increase FV intake among boys or the lowest PEL group. More in depth analyses are needed to find out which factors to target in interventions to reach an effect in the target groups.

  • 55.
    Lehto, Reetta
    et al.
    Folkhälsan Research Center, Paasikivenkatu 4, Helsinki, Finland .
    Määttä, Suvi
    Folkhälsan Research Center, Paasikivenkatu 4, Helsinki, Finland .
    Lehto, Elviira
    Folkhälsan Research Center, Paasikivenkatu 4, Helsinki, Finland; Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland .
    Ray, Carola
    Folkhälsan Research Center, Paasikivenkatu 4, Helsinki, Finland .
    Te Velde, Saskia
    Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
    Lien, Nanna
    Department of Nutrition, The Medical Faculty, University of Oslo, Oslo, Norway .
    Thorsdottir, Inga
    Unit for Nutrition Research, Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Reykjavík, Iceland .
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Roos, Eva
    Folkhälsan Research Center, Paasikivenkatu 4, Helsinki, Finland; Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland .
    The PRO GREENS intervention in Finnish schoolchildren: the degree of implementation affects both mediators and the intake of fruits and vegetables2014In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 112, no 7, p. 1185-1194Article in journal (Refereed)
    Abstract [en]

    Little is known about the mediating effects of the determinants of fruit and vegetable (FV) intake in school-based interventions that promote FV intake, and few studies have examined the impact of the degree of implementation on the effects of an intervention. The present study examined whether the degree of implementation of an intervention had an effect on children's fruit or vegetable intake and determined possible mediators of this effect. The study is part of the European PRO GREENS intervention study which aimed to develop effective strategies to promote consumption of fruit and vegetables in schoolchildren across Europe. Data from 727 Finnish children aged 11 years were used. The baseline study was conducted in spring 2009 and the follow-up study 12 months later. The intervention was conducted during the school year 2009-2010. The effects were examined using multilevel mediation analyses. A high degree of implementation of the intervention had an effect on children's fruit intake. Knowledge of recommendations for FV intake and liking mediated the association between a high degree of implementation of the intervention and an increase in the frequency of fruit intake. Knowledge of recommendations for FV intake and bringing fruits to school as a snack mediated the association between a low degree of implementation of the intervention and an increase in the frequency of fruit intake. Overall, the model accounted for 34 % of the variance in the change in fruit intake frequency. Knowledge of recommendations acted as a mediator between the degree of implementation of the intervention and the change in vegetable intake frequency. In conclusion, the degree of implementation had an effect on fruit intake, and thus in future intervention studies the actual degree of implementation of interventions should be assessed when considering the effects of interventions.

  • 56.
    Lin, Yulan
    et al.
    Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Lagergren, Jesper
    Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Division of Cancer Studies, King’s College London, London, UK.
    Lu, Yunxia
    Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
    A dietary pattern rich in lignans, quercetin and resveratrol decreases the risk of oesophageal cancer2014In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 112, no 12, p. 2002-2009Article in journal (Refereed)
    Abstract [en]

    Dietary lignans, quercetin and resveratrol have oestrogenic properties, and animal studies suggest that they synergistically decrease cancer risk. A protective effect of lignans on the development of oesophageal cancer in humans has recently been demonstrated, and the present study aimed to test whether these three phytochemicals synergistically decrease the risk of oesophageal cancer. Data from a Swedish nationwide population-based case-control study that recruited 181 cases of oesophageal adenocarcinoma (OAC), 158 cases of oesophageal squamous-cell carcinoma (OSCC), 255 cases of gastro-oesophageal junctional adenocarcinoma (JAC) and 806 controls were analysed. Exposure data were collected through face-to-face interviews and questionnaires. The intake of lignans, quercetin and resveratrol was assessed using a sixty-three-item FFQ. Reduced-rank regression was used to assess a dietary pattern, and a simplified dietary pattern score was categorised into quintiles on the basis of the distribution among the control subjects. Unconditional multivariable logistic regression provided OR with 95 % CI, adjusted for all the potential risk factors. A dietary pattern rich in lignans, quercetin and resveratrol was mainly characterised by a high intake of tea, wine, lettuce, mixed vegetables, tomatoes, and whole-grain bread and a low intake of milk. There were dose-dependent associations between simplified dietary pattern scores and all types of oesophageal cancer (all P for trend < 0·05). On comparing the highest quintiles with the lowest, the adjusted OR were found to be 0·24 (95 % CI 0·12, 0·49) for OAC, 0·31 (95 % CI 0·15, 0·65) for OSCC, and 0·49 (95 % CI 0·28, 0·84) for JAC. The results of the present study indicate that a dietary pattern characterised by the intake of lignans, quercetin and resveratrol may play a protective role in the development of oesophageal cancer in the Swedish population.

  • 57.
    Lin, Yulan
    et al.
    Karolinska Inst, Unit Upper Gastrointestinal Res, Dept Mol Med & Surg, S-17176 Stockholm, Sweden.
    Yngve, Agneta
    Karolinska Inst, Huddinge Hosp, Dept Biosci & Nutr, S-10401 Stockholm, Sweden.
    Lagergren, Jesper
    Dietary intake of lignans and risk of adenocarcinoma of the esophagus and gastroesophageal junction; Kings Coll London, Div Canc Studies, London WC2R 2LS, England.
    Lu, Yunxia
    Karolinska Inst, Unit Upper Gastrointestinal Res, Dept Mol Med & Surg, S-17176 Stockholm, Sweden.
    Dietary intake of lignans and risk of adenocarcinoma of the esophagus and gastroesophageal junction2012In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 23, no 6, p. 837-844Article in journal (Refereed)
    Abstract [en]

    The strong male predominance in esophageal and gastroesophageal junctional adenocarcinoma remains unexplained. Sex hormonal influence has been suggested, but not proven. A protective role of dietary phytoestrogen lignans was hypothesized. A Swedish nationwide population-based case-control study was conducted in 1995-1997, including 181 cases of esophageal adenocarcinoma, 255 cases of gastroesophageal junctional adenocarcinoma, 158 cases of esophageal squamous cell carcinoma, and 806 control subjects. Data on various exposures, including dietary data, were collected through personal interviews and questionnaires. Dietary intake of lignans was assessed using a food frequency questionnaire and categorized into quartiles based on the consumption among the control participants. Unconditional logistic regression was used to calculate odds ratios (ORs) with 95 % confidence intervals (CIs), including adjustment for all established risk factors. Participants in the highest quartile of intake of lignans compared with the lowest quartile were at a decreased risk of esophageal adenocarcinoma (OR, 0.65; 95 % CI, 0.38-1.12; for trend =0.03), gastroesophageal junctional adenocarcinoma (OR, 0.37; 95 % CI, 0.23-0.58; for trend < 0.0001), and these adenocarcinomas combined (OR, 0.45; 95 % CI, 0.31-0.67; for trend < 0.0001). No clear associations were found between lignan intake and risk of esophageal squamous cell carcinoma. This population-based study indicates that a high dietary intake of lignans decreases the risk of adenocarcinoma of the esophagus and gastroesophageal junction.

  • 58.
    Lissner, L.
    et al.
    Section for Epidemiology and Community Medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Wijnhoven, T. M. A.
    Division of Noncommunicable Diseases and Promoting Health Through the Life-Course, WHO Regional Office for Europe, UN City, Copenhagen, Denmark .
    Mehlig, K.
    Section for Epidemiology and Community Medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Sjöberg, A.
    Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Kunesova, M.
    Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Petrauskiene, A.
    Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Duleva, V.
    Department of Food and Nutrition, National Center of Public Health and Analyses, Sofia, Bulgaria.
    Rito, A. I.
    Instituto Nacional de Saúde Dr Ricardo Jorge, Lisbon, Portugal.
    Breda, J.
    Division of Noncommunicable Diseases and Promoting Health Through the Life-Course, WHO Regional Office for Europe, UN City, Copenhagen, Denmark.
    Socioeconomic inequalities in childhood overweight: heterogeneity across five countries in the WHO European Childhood Obesity Surveillance Initiative (COSI-2008)2016In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 40, no 5, p. 796-802Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Excess risk of childhood overweight and obesity occurring in socioeconomically disadvantaged families has been demonstrated in numerous studies from high-income regions, including Europe. It is well known that socioeconomic characteristics such as parental education, income and occupation are etiologically relevant to childhood obesity. However, in the pan-European setting, there is reason to believe that inequalities in childhood weight status may vary among countries as a function of differing degrees of socioeconomic development and equity.

    SUBJECTS AND METHODS: In this cross-sectional study, we have examined socioeconomic differences in childhood obesity in different parts of the European region using nationally representative data from Bulgaria, the Czech Republic, Lithuania, Portugal and Sweden that were collected in 2008 during the first round of the World Health Organization ( WHO) European Childhood Obesity Surveillance Initiative.

    RESULTS: Heterogeneity in the association between parental socioeconomic indicators and childhood overweight or obesity was clearly observed across the five countries studied. Positive as well as negative associations were observed between parental socioeconomic indicators and childhood overweight, with statistically significant interactions between country and parental indicators.

    CONCLUSIONS: These findings have public health implications for the WHO European Region and underscore the necessity to continue documenting socioeconomic inequalities in obesity in all countries through international surveillance efforts in countries with diverse geographic, social and economic environments. This is a prerequisite for universal as well as targeted preventive actions.

  • 59.
    Lynch, Christel
    et al.
    Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Huddinge, Stockholm, Sweden .
    Kristjansdottir, Asa Gudrun
    Unit for Nutrition Research, School of Health Sciences, University of Iceland, Reykjavik, Iceland .
    Te Velde, Saskia J
    EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands .
    Lien, Nanna
    Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway .
    Roos, Eva
    Folkhälsan Research Center, Helsinki, Finland; Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland .
    Thorsdottir, Inga
    Unit for Nutrition Research, School of Health Sciences, University of Iceland, Reykjavik, Iceland .
    Krawinkel, Michael
    Institute of Nutritional Sciences, Faculty of Agricultural Nutrition, Environmental Sciences and Home Economics, Justus-Liebig University, Giessen, Germany .
    de Almeida, Maria Daniel Vaz
    Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal .
    Papadaki, Angeliki
    Department of Social Medicine, Preventive Medicine and Nutrition Clinic, University of Crete, Heraklion, Crete, Greece; Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom.
    Ribic, Cirila Hlastan
    National Institute of Public Health, Ljubljana, Slovenia .
    Petrova, Stefka
    National Center for Public Health Protection, Sofia, Bulgaria .
    Ehrenblad, Bettina
    Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Huddinge, Stockholm, Sweden .
    Halldorsson, Thorhallur I
    Unit for Nutrition Research, School of Health Sciences, University of Iceland, Reykjavik, Iceland .
    Poortvliet, Eric
    Department of Biosciences and Nutrition, Karolinska Institutet, NOVUM, Huddinge, Stockholm, Sweden .
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Fruit and vegetable consumption in a sample of 11-year-old children in ten European countries: the PRO GREENS cross-sectional survey2014In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 17, no 11, p. 2436-2444Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe fruit and vegetable intake of 11-year-old children in ten European countries and compare it with current dietary guidelines.

    DESIGN: Cross-sectional survey. Intake was assessed using a previously validated questionnaire containing a pre-coded 24 h recall and an FFQ which were completed in the classroom. Portion sizes were calculated using a standardized protocol.

    SETTING: Surveys were performed in schools regionally selected in eight countries and nationally representative in two countries.

    SUBJECTS: A total of 8158 children from 236 schools across Europe participating in the PRO GREENS project.

    RESULTS: The total mean consumption of fruit and vegetables was between 220 and 345 g/d in the ten participating countries. Mean intakes did not reach the WHO population goal of ≥400 g/d in any of the participating countries. Girls had a significantly higher intake of total fruit and vegetables than boys in five of the countries (Sweden, Finland, Iceland, Bulgaria and Slovenia). Mean total fruit intake ranged between 114 and 240 g/d and vegetable intake between 73 and 141 g/d. When using the level ≥400 g/d as a cut-off, only 23·5 % (13·8-37·0 %) of the studied children, depending on country and gender, met the WHO recommendation (fruit juice excluded).

    CONCLUSIONS: Fruit and vegetable consumption was below recommended levels among the schoolchildren in all countries and vegetable intake was lower than fruit intake. The survey shows that there is a need for promotional activities to improve fruit and vegetable consumption in this age group.

  • 60. Madeira, Teresa
    et al.
    Peixoto-Plácido, Catarina
    Sousa-Santos, Nuno
    Santos, Osvaldo
    Alarcão, Violeta
    Goulão, Beatriz
    Mendonça, Nuno
    Nicola, Paulo Jorge
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Bye, Asta
    Bergland, Astrid
    Amaral, Teresa F
    Lopes, Carla
    Gorjão Clara, João
    Malnutrition among older adults living in Portuguese nursing homes: the PEN-3S study.2019In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 22, no 3, p. 486-497Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To characterise the nutritional status and to identify malnutrition-associated variables of older adults living in Portuguese nursing homes.

    DESIGN: Cross-sectional study. Data on demographic and socio-economic characteristics, self-reported morbidity, eating-related problems, nutritional status, cognitive function, depression symptoms, loneliness feelings and functional status were collected by trained nutritionists through a computer-assisted face-to-face structured interview followed by standardised anthropometric measurements. Logistic regression was used to identify factors associated with being at risk of malnutrition/malnourished.

    SETTING: Portuguese nursing homes.

    SUBJECTS: Nationally representative sample of the Portuguese population aged 65 years or over living in nursing homes.

    RESULTS: A total of 1186 individuals (mean age 83·4 years; 72·8 % women) accepted to participate. According to the Mini Nutritional Assessment, 4·8 (95 % CI 3·2, 7·3) % were identified as malnourished and 38·7 (95 % CI 33·5, 44·2) % were at risk of malnutrition. These percentages increased with age and were significantly higher for women. Logistic regression showed (OR; 95 % CI) that older adults reporting no or little appetite (6·5; 2·7, 15·3), those revealing symptoms of depression (2·6; 1·6, 4·2) and those who were more dependent in their daily living activities (4·7; 2·0, 11·1) were also at higher odds of being malnourished or at risk of malnutrition.

    CONCLUSIONS: Malnutrition and risk of malnutrition are prevalent among nursing home residents in Portugal. It is crucial to routinely screen for nutritional disorders, as well as risk factors such as symptoms of depression and lower functional status, to prevent and treat malnutrition.

  • 61.
    Manios, Yannis
    et al.
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Grammatikaki, Eva
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Androutsos, O
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Chinapaw, MJ
    Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
    Gibson, EL
    Department of Psychology, Whitelands College, University of Roehampton, London, United Kingdom.
    Buijs, G
    Netherlands Institute for Health Promotion NIGZ, Woerden, Netherlands.
    Iotova, V
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    Socha, P
    The Children's Memorial Health Institute, Warsaw, Poland.
    Annemans, L
    Department of Public Health, Ghent University, Ghent, Belgium.
    Wildgruber, A
    State Institute for Early Childhood Research, Munich, Germany.
    Mouratidou, T
    GENUD (Growth Exercise NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.
    Yngve, Agneta
    Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Science, Lillestrøm, Norway.
    Duvinage, K
    Dr von Hauner Children's Hospital, University of Munich Medical Centre, München, Germany.
    de Bourdheaudhuij, Ilse
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    A systematic approach for the development of a kindergarten-based intervention for the prevention of obesity: the Toy Box-study2012In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 13, no suppl1, p. 3-12Article in journal (Refereed)
    Abstract [en]

    The increasing childhood obesity epidemic calls for appropriate measures and effective policies to be applied early in life. Large-scale socioecological frameworks providing a holistic multifactorial and cost-effective approach necessary to support obesity prevention initiatives in this age are however currently missing. To address this missing link, ToyBox-study aims to build and evaluate a cost-effective kindergarten-based, family-involved intervention scheme to prevent obesity in early childhood, which could potentially be expanded on a pan-European scale. A multidisciplinary team of researchers from 10 countries have joined forces and will work to realize this according to a systematic stepwise approach that combines the use of the PRECEDE-PROCEED model and intervention mapping protocol. ToyBox-study will conduct systematic and narrative reviews, secondary data analyses, focus group research and societal assessment to design, implement and evaluate outcome, impact, process and cost effectiveness of the intervention. This is the first time that such a holistic approach has been used on a pan-European scale to promote healthy weight and healthy energy balance-related behaviours for the prevention of early childhood obesity. The results of ToyBox-study will be disseminated among key stakeholders including researchers, policy makers, practitioners and the general population.

  • 62.
    Margetts, Barrie
    et al.
    Public Health Nutrition, Institute of Human Nutrition, University of Southampton, Southampton, UK.
    Warm, Daniel
    Public Health Nutrition, Institute of Human Nutrition, University of Southampton, Southampton, UK.
    Yngve, Agneta
    Unit for Preventive Nutrition, Karolinska Institute, Stockholm, Sweden.
    Sjöström, Michael
    Unit for Preventive Nutrition, Karolinska Institute, Stockholm, Sweden.
    Developing an evidence-based approach to Public Health Nutrition: translating evidence into policy2001In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 4, no 6A, p. 1393-1397Article in journal (Refereed)
    Abstract [en]

    The aim of this paper is to highlight the importance of an evidence-based approach to the development, implementation and evaluation of policies aimed at improving nutrition-related health in the population. Public Health Nutrition was established to realise a population-level approach to the prevention of the major nutrition-related health problems world-wide. The scope is broad and integrates activity from local, national, regional and international levels. The aim is to inform and develop coherent and effective policies that address the key rate-limiting steps critical to improving nutrition-related public health. This paper sets out the rationale for an evidence-based approach to Public Health Nutrition developed under the umbrella of the European Network for Public Health Nutrition.

  • 63.
    Monteagudo, Celia
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Univ Granada, Dept Nutr & Food Sci, Res Grp Nutr Diet & Risk Assessment AGR255, Granada, Spain..
    Scander, Henrik
    Örebro Univ, Sch Hospitality Culinary Arts & Meal Sci, Örebro, Sweden..
    Nilsen, Bente
    Örebro Univ, Sch Hospitality Culinary Arts & Meal Sci, Örebro, Sweden..
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Folate intake in a Swedish adult population: Food sources and predictive factors2017In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 61, no 1, article id 1328960Article in journal (Refereed)
    Abstract [en]

    Introduction: Folate plays an important role in cell metabolism, but international studies show that intake is currently below recommendations, especially among women. The study objective was to identify folate food sources by food group, gender, and age group, and to identify factors influencing folate intake, based on food consumption data for Swedish adults in the 2010-11 Riksmaten study.

    Methods: The sample included a representative Swedish population aged 18-80 years (n = 1657; 56.3% female). Food and nutrient intakes were estimated from self-reported food records during 4 consecutive days. Food consumption was categorized into 26 food groups. Stepwise regression was used to analyze food groups as folate sources for participants. Factors predicting the highest folate intake (third tertile) were determined by logistic regression analysis.

    Results: Vegetables and pulses represented the most important folate source for all age groups and both genders, especially in women aged 45-64 years (49.7% of total folate intake). The next folate source in importance was dairy products for the youngest group (18-30 years), bread for men, and fruit and berries for women. The likelihood of being in the highest tertile of folate intake (odds ratio = 1.69, 95% confidence interval 1.354-2.104) was higher for men. Influencing factors for folate intake in the highest tertile were low body mass index and high educational level in the men, and high educational level, vegetarian diet, organic product consumption, nonsmoking, and alcohol consumption within recommendations in the women.

    Conclusion: This study describes the folate intake per food group of Swedish adults according to the 2010-11 Riksmaten survey, identifying vegetables and pulses as the most important source. Data obtained on factors related to folate consumption may be useful for the development of specific nutrition education programs to increase the intake of this vitamin in high-risk groups.

  • 64.
    Moraeus, L.
    et al.
    Department of Public Health and Community Medicine, Public Health Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lissner, L.
    Department of Public Health and Community Medicine, Public Health Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Yngve, Agneta
    Department of Biosciences and Nutrition, Unit for Public Health Nutrition, Karolinska Institutet, Stockholm, Sweden; 3Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
    Poortvliet, E.
    Department of Biosciences and Nutrition, Unit for Public Health Nutrition, Karolinska Institutet, Stockholm, Sweden; 3Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
    Al-Ansari, U.
    Department of Biosciences and Nutrition, Unit for Public Health Nutrition, Karolinska Institutet, Stockholm, Sweden; 3Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
    Sjöberg, A.
    Department of Public Health and Community Medicine, Public Health Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Multi-level influences on childhood obesity in Sweden: societal factors, parental determinants and child's lifestyle2012In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 36, no 7, p. 969-976Article in journal (Refereed)
    Abstract [en]

    Background: Swedish school children living in rural areas and in areas with low education are at excess risk of becoming overweight. This study examines influences of societal and individual characteristics (children and their parents) on prevalence of overweight and obesity, in a national sample of 7-9-year-old children.

    Method: Anthropometric and lifestyle data were collected in a nationally representative sample of 3636 Swedish children. Overweight and obesity (International Obesity Task Force (IOTF)) data were analyzed in relation to lifestyle factors, parental weight, education and breast-feeding.

    Results: The prevalence of overweight was 15.6% including 2.6% obese. Urbanization level and parental characteristics (weight status and education) were related to risk of overweight. Overall less favorable lifestyle characteristics were observed in rural areas and for children of low/medium educated mothers. Boys had greater risk of obesity in semi-urban and rural areas but this was not true for girls. For children's overweight, the living area effect was attenuated in multivariate analysis, while there was an association with origin of parents, high parental weight and medium maternal education. For obesity, the living area effect remained in boys while having two non-Nordic parents predicted obesity in girls. Parental weight status was associated with obesity in both girls and boys.

    Conclusion: Individual and societal factors influence children's weight status, and parental weight status is a strong determinant. Including overweight and obese parents in future health promoting interventions could be a strategy to prevent children from becoming overweight, but identifying those parents may prove difficult. To ensure reaching children with the greatest needs, targeting high risk areas might be a more effective approach.

  • 65.
    Murto, Tiina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Altmäe, Signe
    Competence Ctr Hlth Technol, Tartu, Estonia.
    Salumets, Andres
    Competence Ctr Hlth Technol, Tartu, Estonia;Univ Tartu;Univ Helsinki;Helsinki Univ Hosp.
    Wånggren, Kjell
    Karolinska Inst.
    Stavreus-Evers, Anneli
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Compliance to the recommended use of folic acid supplements for women in Sweden is higher among those under treatment for infertility than among fertile controls and is also related to socioeconomic status and lifestyle2017In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 61, article id 1334483Article in journal (Refereed)
    Abstract [en]

    Background: Folate has been discussed in relation to fertility among women, but studies on women under treatment for infertility are lacking.

    Objective: The objective of this study was to investigate folic acid supplement use and folate status among women under treatment for infertility (hereafter infertile) and fertile women also in regard to socioeconomic and lifestyle factors.

    Design: Lifestyle and dietary habits, and use of dietary supplements were assessed using a questionnaire. Blood samples were obtained for analysis of folate status. 24-hour recall interviews were also performed.

    Results: Highly educated, employed and infertile women were most prone to using folic acid supplements. The infertile women had a significantly better folate status than the fertile women. Folate status did not correlate with socioeconomic or lifestyle factors. The infertile women were physically more active, smoked less and were employed. Our questionnaire data had only fair agreement with the data from 24-hour recalls, but the folate status data was clearly correlated to our questionnaire results.

    Conclusions: Infertile women were most prone to using folic acid supplements and had better folate status than the controls. High educational and employment status were found to be key factors for high compliance to the recommended use folic acid supplements.

  • 66.
    Nethe, A
    et al.
    Netherlands Institute for Health Promotion NIGZ, Woerden, Netherlands.
    Dorgelo, A
    Netherlands Institute for Health Promotion NIGZ, Woerden, Netherlands.
    Kugelberg, S
    Department for Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
    van Aasche, J
    Department of Political Science, Ghent University, Ghent, Belgium.
    Buijs, Goof
    Netherlands Institute for Health Promotion NIGZ, Woerden, Netherlands.
    Yngve, Agneta
    Department for Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
    de Henauw, Stefan
    Department for Public Health, Ghent University, Ghent, Belgium.
    Boskou, G
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Existing policies, regulation, legislation and ongoing health promotion activities related to physical activity and nutrition in pre-primary education settings: an overview2012In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 13, no suppl 1, p. 118-128Article in journal (Refereed)
    Abstract [en]

    Obesity prevention efforts for school-aged children and adolescents are increasing in number. However, little has been done to address the problem in the preschool age. To address this age group, an evidence-based preschool programme on physical activity (PA) and nutrition is developed within the ToyBox project. Environmental influencing factors such as policies and competitive health promotion activities could inhibit or induce a successful health promotion programme. This paper describes an overview of existing policies, legislation and/or regulations and health promotion activities in the preschool setting. Method: data were gathered on policies and activities aiming to improve healthy eating and PA of young children (age group 4-6 years) in Belgium-Flanders, Bulgaria, Germany, Greece, Poland and Spain. A limited number of influencing policies, regulations and/or legislation exists; agenda setting of health promotion and policy evaluations in all relevant policy areas was lacking. Also, health promotion activities in preschool the setting did not exist in all six European countries and high-quality preschool-based health interventions existed in three of the six ToyBox countries.

  • 67.
    Neuman, Nicklas
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Aspects of Food, Nutrition, and Health in Sweden2018In: Nutritional and Health Aspects of Traditional and Ethnic Foods of Nordic Countries / [ed] Veslemøy Andersen; Eirin Bar; Gun Wirtanen, Amsterdam: Elsevier, 2018, 1, p. 73-97Chapter in book (Other academic)
    Abstract [en]

    This chapter outlines aspects of food consumption, nutrition, and health in Sweden. It starts out with a brief contextualization of the contemporary conditions of food and nutrition in the country and is followed by a presentation of results and comparisons between the few large-scale dietary surveys. The chapter then discusses the survey results in more detail, with a sociological view on dietary habits in relation to sociodemographics. The subsequent section consists of discussions about the country’s (and the whole planet’s) most recent dietary concerns that are becoming just as important as that of public health: food consumption and climate change. The final section of the chapter then provides some concluding remarks about the prospects of public health nutrition in relation to climate change in Sweden.

  • 68.
    Nilsen, Bente B
    et al.
    School of Hospitality, Culinary Arts and Meal Sciences, Örebro University, Grythyttan, Sweden; Department of Nursing and Health Promotion, Oslo and Akershus University College, Oslo, Norway.
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Monteagudo, Celia
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Research Group Nutrition, Diet and Risk Assessment, Department of Nutrition and Food Science, University of Granada, Granada, Spain.
    Tellström, Richard
    School of Hospitality, Culinary Arts and Meal Sciences, Örebro University, Grythyttan, Sweden.
    Scander, Henrik
    School of Hospitality, Culinary Arts and Meal Sciences, Örebro University, Grythyttan, Sweden.
    Werner, Bo
    School of Hospitality, Culinary Arts and Meal Sciences, Örebro University, Grythyttan, Sweden.
    Reported habitual intake of breakfast and selected foods in relation to overweight status among seven- to nine-year-old Swedish children.2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 8, p. 886-894Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to examine the reported frequency of breakfast intake and selected food and beverages in the investigated group of Swedish children in comparison with recommended intakes. Furthermore, the study analyses these food habits and some demographic and lifestyle factors in relation to overweight and obesity.

    METHODS: This cross-sectional study builds on data collected in 2008 and 2010. Measured anthropometric data and parent questionnaire data were collected. A total of 2620 Swedish children (52.1% boys) aged seven to nine years were included.

    RESULTS: The majority of parents reported that their children (95.4%) had breakfast every day. The majority of children had fresh fruit (84.7%) and vegetables (83.9%) most days a week. Only 1.6% of the children were reported to have fast food and 6.0% to have sugar containing soft drinks, four days a week or more. The prevalence of overweight including obesity (OW/OB) was 17.8% for boys, 18.6% for girls. The odds of being OW/OB was higher among those not having breakfast every day (odds ratio (OR) 1.9, 95% confidence interval (CI) 1.20-2.96), drinking diet soft drink (OR 2.6, 95% CI 1.52-4.42) and skimmed/semi-skimmed milk (OR 1.8, 95% CI 1.37-2.36) four days a week or more. Parents being overweight and having low education levels were also related to a higher risk of their children being overweight.

    CONCLUSIONS: The parental reports of children's food habits pointed at favourable eating patterns for most investigated children. Breakfast skipping, diet soft drinks and low-fat milk consumption were more frequent among OW/OB children. Longitudinal studies are needed to determine the causal relationships.

  • 69.
    Nilsen, Bente B.
    et al.
    Örebro universitet, Restaurang- och hotellhögskolan.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Sjöberg, Agneta
    Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Moraeus, Lotta
    Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Lissner, Lauren
    Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Werner, Bo
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Using different growth references to measure thinness and overweight among Swedish primary school children showed considerable variations2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 10, p. 1158-1165Article in journal (Refereed)
    Abstract [en]

    Aim: The study compared how four different growth references determined the prevalence of thinness and overweight, based on height and weight measurements from a nationally representative sample of Swedish children from seven to nine years of age.

    Methods: The height and weight measurements of 4,518 Swedish schoolchildren aged seven to nine years were carried out in 2008 using a standardised protocol. The prevalence of different degrees of thinness and overweight were calculated using international growth references from the World Health Organization, the International Obesity Task Force and two Swedish growth references from Werner and Karlberg.

    Results: Depending on which growth reference we used, the prevalence of different degrees of thinness varied from 7.5%-16.9% for the boys and 6.9%-13.7% for the girls, while for the prevalence of overweight, including obesity and severe obesity, varied from 16.5%-25.7% for the boys and 18.2-25.2% for the girls. There were also significant gender differences depending on the growth reference we used.

    Conclusion: Using four different growth references, two international and two Swedish, produced wide variations in the prevalence of thinness and overweight, together with significant gender differences. In the absence of a global definition, we need both national and international growth references.

  • 70.
    Nilsen, Bente B
    et al.
    Örebro University, Örebro, Sweden.
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Werner, Bo
    Do substantial BMI reduction episodes among Swedish schoolchildren have any impact on their final height?2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 7, p. 1223-1229Article in journal (Refereed)
    Abstract [en]

    AIM: This study investigated whether substantial body mass index (BMI) reductions in Swedish schoolchildren aged 7-19 years, caused by disease, healthy or unhealthy behaviour, had any impact on their final height.

    METHODS: We used height and weight data on 6,572 subjects from two nationally representative longitudinal samples of Swedish children born in 1973 and 1981. These provided information on their final height and any BMI reduction episodes.

    RESULTS: Of the 6,572 subjects (50.9% boys), among individuals with information on final height, 1,118 had a BMI reduction of 5% and less than 10%, and 346 had at least one substantial BMI reduction of 10% of more. On a group level, there was no statistically significant difference in the final height of individuals with BMI reductions of 10% or more and those without. The findings were independent of age and the subject's BMI at the start of the reduction episode. However, there were a number of cases where a substantial BMI reduction probably had an impact on the subject's final height.

    CONCLUSION: Our study found no evidence that a substantial BMI reduction had any impact on final height on a group level, but further analyses of specific case studies are necessary to determine whether substantial BMI reduction might have an impact on final height.

  • 71.
    Nilsson, Andreas
    et al.
    Örebro universitet, Hälsoakademin.
    Ekelund, Ulf
    Örebro universitet, Hälsoakademin.
    Yngve, Agneta
    Sjöström, Michael
    Assessing physical activity among children with accelerometers using different time sampling intervals and placements2002In: Pediatric Exercise Science, ISSN 0899-8493, E-ISSN 1543-2920, Vol. 14, no 1, p. 87-96Article in journal (Refereed)
    Abstract [en]

    The aim was to investigate (a) the effect of five different time sampling intervals (epoch settings) on different intensity levels when assessing physical activity with an accelerometer (CSA, WAM 7164), and (b) whether the placement of the monitor (on the hip and back) would affect the outcome. Sixteen children (aged 7 yrs) were monitored for four consecutive days. A significant main epoch effect was found for time spent at very high (p < 01) and high (p < 01) intensity activities. No significant difference between the two placements regarding total amount of physical activity (cnts times mm super (-1)) or different intensity levels was observed. In conclusion, different time sampling intervals, but not placement, should be carefully considered when assessing physical activity.

  • 72.
    Nilsson, Andreas
    et al.
    Örebro universitet, Hälsoakademin.
    Ekelund, Ulf
    Örebro universitet, Hälsoakademin.
    Yngve, Agneta
    Sjöström, Michael
    Assessing physical activity among children with accelerometers using different time sampling intervals and placements2002In: Pediatric Exercise Science, ISSN 0899-8493, E-ISSN 1543-2920, Vol. 14, no 1, p. 87-96Article in journal (Refereed)
    Abstract [en]

    The aim was to investigate (a) the effect of five different time sampling intervals (epoch settings) on different intensity levels when assessing physical activity with an accelerometer (CSA, WAM 7164), and (b) whether the placement of the monitor (on the hip and back) would affect the outcome. Sixteen children (aged 7 yrs) were monitored for four consecutive days. A significant main epoch effect was found for time spent at very high (p < 01) and high (p < 01) intensity activities. No significant difference between the two placements regarding total amount of physical activity (cnts times mm super (-1)) or different intensity levels was observed. In conclusion, different time sampling intervals, but not placement, should be carefully considered when assessing physical activity.

  • 73.
    Nilsson, Torbjörn K.
    et al.
    Örebro universitet, Hälsoakademin.
    Yngve, Agneta
    Böttiger, Anna K.
    Hurtig-Wennlöf, Anita
    Örebro universitet, Hälsoakademin.
    Sjöström, Michael
    High folate intake is related to better academic achievement in Swedish adolescents2011In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 128, no 2, p. e358-e365Article in journal (Refereed)
    Abstract [en]

    Background: Adolescents are vulnerable to increased plasma total homocysteine (tHcy) and to insufficient folate status. Folate status and Hcy metabolism are linked to cognitive functions, but academic achievement by adolescents has not been studied in this respect.

    Objective: To assess a possible link between academic achievement in adolescents and tHcy and its determinants, dietary folate intake, MTHFR 677 TT homozygosity, and socioeconomic status (SES).

    Subjects and Methods: A study of 386 Swedish adolescents aged 15 years in whom plasma tHcy and MTHFR 677C →T genotype were assayed. The sum of school grades in 10 core subjects obtained in the final semester of compulsory 9 years of schooling was used as outcome measure of academic achievement. Lifestyle and SES data were obtained from questionnaires.

    Results: Academic achievement was strongly correlated to tertiles of tHcy (negatively; P = .023) and to tertiles of folate intake (positively; P < .001). Other significant predictors were gender, smoking, and SES (proxied by school, mother's education, and father's income). When these were controlled for, tertiles of folate intake (P < .002) but not tertiles of tHcy (P = .523) or MTHFR genotype remained significantly related to academic achievement.

    Conclusion: Folate intake had a positive association with academic achievement in the 15-year-olds, which was not attenuated by SES or MTHFR 677 TT homozygosity. These results provide new information that points to the importance of keeping a closer watch on folate status in childhood and adolescence. They may also have direct implications for school meal provisions, school teaching programs, and information to parents.

  • 74.
    Olang, Beheshteh
    et al.
    Department of Nutrition and Food Health, Faculty of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran; Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran.
    Abdollahi, Zahra
    Nutrition Department, Ministry of Health and Medical Education, Tehran, Iran.
    Neshati, Roshanak
    Unit for Public Health Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Ali, Mohamed Atiya
    Unit for Public Health Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Naghavi, Mohsen
    Global Health Department, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Vitamin A status in pregnant women in Iran in 2001 and its relationship with province and gestational age2014In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 58, p. 25707-Article in journal (Refereed)
    Abstract [en]

    Background: Vitamin A deficiency is considered as one of the public health problems among pregnant women worldwide. Population representative data on vitamin A status in pregnancy have not previously been published from Iran.

    Objectives: The aim of this study was to publish data on vitamin A status in pregnant women in all the provinces of Iran in 2001, including urban and rural areas, and to describe the association of vitamin A status with maternal age, gestational age, and parity.

    Design: This descriptive cross-sectional study was conducted on 3,270 healthy pregnant women from the entire country, 2,631 with gestational age <= 36 weeks, and 639 with gestational age > 36 weeks. Vitamin A status was determined in serum using high-performance liquid chromatography.

    Result: Retinol levels corresponding to deficiency were detected in 6.6% (<0.36 mu mol/L) and 18% had insufficient vitamin A levels (>= 0.36- <0.7 mu mol/L). Suboptimal level of serum retinol was observed in 55.3% of the pregnant women (0.7-1.4 mu mol/L). Only about 20% of the women had optimal values (> 1.4 mu mol/L). The level of serum retinol was lower in older pregnant women (p = 0.008), and at higher gestational age (p = 0.009). High vitamin A levels were observed in pregnant women in the central areas of Iran and the lowest values in those in the southern areas of Iran.

    Conclusions: The vitamin A status was good in 2001 but should be closely monitored also in the future. About 25% of pregnant women had a vitamin A status diagnosed as insufficient or deficient (<0.7 mu mol/L). The mean serum retinol decreased as the gestational age increased. The clinical significance of this finding should be further investigated, followed by a careful risk group approach to supplementation during pregnancy.

  • 75. Olang, Beheshteh
    et al.
    Naghavi, Mohsen
    Bastani, Delaram
    Strandvik, Birgitta
    Yngve, Agneta
    Karolinska Inst, Dept Biosci & Nutr, S-10401 Stockholm, Sweden.
    Optimal vitamin A and suboptimal vitamin D status are common in Iranian infants2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 3, p. 439-444Article in journal (Refereed)
    Abstract [en]

    Aim: Investigation of serum concentrations of vitamins A and D in Iranian infants. Methods: A descriptive cross-sectional study, investigating 7112 infants (1523 months of age) from all regions of Iran, who attended health care centres from May 25 to June 2, 2001. Unequal clusters with unequal household sizes were sampled. Vitamin A and D levels were analysed with high-performance liquid chromatography. Results: The mean (SD) concentration of vitamin A was 2.09 (0.83) mu mol/L. At a national level, 0.7% of the infants had a level indicating deficiency, and 0.5% of the infants had insufficient concentrations of vitamin A, defined as serum concentrations < 0.35 and < 0.7 mu mol/L retinol, respectively. A total of 88% of infants had optimal concentrations (> 1.4 mu mol /L). The mean (SD) concentration of vitamin D was 61.3 (31.4) nmol/L. Deficiency was found in 2.8% of infants (< 25 nmol/L), and insufficiency in 32.9% (< 50 nmol/L). Suboptimal and optimal concentrations were found in 44% and 20%, representing 50-75 and > 75 nmol/L, respectively. Girls had lower vitamin D concentrations than boys (p = 0.006). Conclusion: As in developed countries, vitamin A deficiency was rare in Iranian infants. Vitamin D deficiency was also rare, but 33% of infants had insufficient levels; this was more common in girls than boys.

  • 76.
    Olang, Beheshteh
    et al.
    Karolinska Inst, Huddinge, Sweden.
    Yngve, Agneta
    Karolinska Inst, Huddinge, Sweden.
    Farivar, Khalil
    Minist Healyh, Tehran, Iran.
    Strandvik, Birgitta
    Karolinska Inst, Huddinge, Sweden.
    Vitamin a and d status in iranian infants2009In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 55, p. 249-249Article in journal (Other academic)
  • 77.
    Pérez-Rodrigo, Carmen
    et al.
    Community Nutrition Unit, Bilbao Department of Public Health, Bilbao, Spain.
    Klepp, Knut-Inge
    nstitute for Nutrition Research, University of Oslo, Oslo, Norway.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Biosciences, Karolinska Institutet, Huddinge, Sweden.
    Sjöström, Michael
    Unit for Preventive Nutrition, Department of Biosciences, Karolinska Institutet, Huddinge, Sweden.
    Stockley, Lynn
    Food & Nutrition Consultant, Timberland, Mill Hill, Brockweir, nr Chepstow, Gloucestershire, UK.
    Aranceta, Javier
    Community Nutrition Unit, Bilbao Department of Public Health, Bilbao, Spain.
    The school setting: an opportunity for the implementation of dietary guidelines2001In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 4, no 2B, p. 717-724Article in journal (Refereed)
    Abstract [en]

    Nutrition, physical activity and health related promotion programmes in schools have developed into a mature field of research over the past decades. A number of success factors have been identified and evidence-based interventions have been performed. However, the school setting as an arena for evidence-based health promotion programmes, is still not used to its full potential. Schools provide an excellent arena for reaching large segments of the population, such as young people, school staff, families and the surrounding community.

    There is a need for an overview regarding the current status of nutrition, physical activity, related health as well as support structures in the EU member states. Based upon such an analysis, a consensus report should be written, pointing out the major problems at hand. Self-assessment tools for national as well as for school level should be produced, in order to guide changes, but also to include an element of continuous assessment of change, for evaluation purposes.

  • 78.
    Ray, Carola
    et al.
    Folkha ̈ lsan Research Center, Helsinki, Finland; Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland.
    Roos, Eva
    Folkha ̈ lsan Research Center, Helsinki, Finland; Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland.
    Brug, Johannes
    EMGO Institute for Health and Care Research and Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
    Behrendt, Isabel
    nstitute for Nutritional Sciences, Justus-Liebig-University of Giessen, Giessen, Germany.
    Ehrenblad, Bettina
    Unit for Public Health Nutrition, Department for Biosciences and Nutrition at Novum, Karolinska Institutet, Stockholm, Sweden.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    te Velde, Saskia J
    EMGO Institute for Health and Care Research and Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
    Role of free school lunch in the associations between family-environmental factors and children's fruit and vegetable intake in four European countries2013In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 16, no 6, p. 1109-1117Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine whether an association exists between different clusters of fruit- and vegetable-specific family-environmental factors and children's daily fruit and vegetable intake, and whether these associations differ between countries with different school lunch policies.

    DESIGN: Cross-sectional data from four European countries participating in the Pro Greens project in 2009. These countries have different school food policies: two serve free school lunches and two do not. Self-administered data were used. Food frequency questions served to assess fruit and vegetable intakes. The study assessed sixteen children-perceived family-environmental factors, which were clustered based on principal component analysis into five sum variables: fruit and vegetable encouragement; vegetable modelling, family routine and demand; fruit modelling; fruit and vegetable snacking practices; and fruit and vegetable allowing.

    SETTING: Schools in Finland, Germany, Sweden and the Netherlands.

    SUBJECTS: Schoolchildren aged 11 years (n 3317).

    RESULTS: Multilevel logistic regression analyses revealed positive associations between nearly all clustered family-environmental factors and daily fruit and vegetable intake. The study tested a moderation effect between family-environmental factors and school lunch policy. In five out of twenty models significant interactions occurred. In the stratified analyses, most of the associations between family-environmental factors and raw and cooked vegetable intake were stronger in Germany and the Netherlands, neither of which provided free school lunches.

    CONCLUSIONS: Children reporting more fruit- and vegetable-promoting family-environmental factors had a more frequent intake of fruits and vegetables; the associations were stronger for vegetable intakes in countries providing no free school lunches, suggesting that parental involvement is crucial when schools offer no vegetables.

  • 79.
    Ray, Carola
    et al.
    Folkhälsan Research Center, Paasikivenkatu 4, 00250 Helsinki, Finland; 2Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland.
    Roos, Eva
    Folkhälsan Research Center, Paasikivenkatu 4, 00250 Helsinki, Finland; 2Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland.
    Brug, Johannes
    EMGO Institute for Health and Care Research and Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
    Behrendt, Isabel
    Institute for Nutritional Sciences, Justus-Liebig-University of Giessen, Giessen, Germany.
    Ehrenblad, Bettina
    Unit for Public Health Nutrition, Department for Biosciences and Nutrition at Novum, Karolinska Institutet, Stockholm, Sweden.
    Yngve, Agneta
    Department of Health, Nutrition and Management, Oslo and Akershus University College, Lillestro¨m, Norway.
    te Velde, Saskia J.
    EMGO Institute for Health and Care Research and Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
    Role of free school lunch in the associations between family-environmental factors and children's fruit and vegetable intake in four European countries2013In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 16, no 6, p. 1109-1117Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:To determine whether an association exists between different clusters of fruit- and vegetable-specific family-environmental factors and children's daily fruit and vegetable intake, and whether these associations differ between countries with different school lunch policies.DESIGN:Cross-sectional data from four European countries participating in the Pro Greens project in 2009. These countries have different school food policies: two serve free school lunches and two do not. Self-administered data were used. Food frequency questions served to assess fruit and vegetable intakes. The study assessed sixteen children-perceived family-environmental factors, which were clustered based on principal component analysis into five sum variables: fruit and vegetable encouragement; vegetable modelling, family routine and demand; fruit modelling; fruit and vegetable snacking practices; and fruit and vegetable allowing.SETTING:Schools in Finland, Germany, Sweden and the Netherlands.SUBJECTS:Schoolchildren aged 11 years (n 3317).RESULTS:Multilevel logistic regression analyses revealed positive associations between nearly all clustered family-environmental factors and daily fruit and vegetable intake. The study tested a moderation effect between family-environmental factors and school lunch policy. In five out of twenty models significant interactions occurred. In the stratified analyses, most of the associations between family-environmental factors and raw and cooked vegetable intake were stronger in Germany and the Netherlands, neither of which provided free school lunches.CONCLUSIONS:Children reporting more fruit- and vegetable-promoting family-environmental factors had a more frequent intake of fruits and vegetables; the associations were stronger for vegetable intakes in countries providing no free school lunches, suggesting that parental involvement is crucial when schools offer no vegetables

  • 80.
    Roos, Eva
    et al.
    Folkhälsan Research Center, Paasikivenkatu Helsinki, Finland; Hjelt Institute, Department of Public Health, University of Helsinki, Finland .
    Pajunen, Tuuli
    Folkhälsan Research Center, Paasikivenkatu 4Helsinki, Finland .
    Ray, Carola
    Folkhälsan Research Center, Paasikivenkatu Helsinki, Finland; Hjelt Institute, Department of Public Health, University of Helsinki, Finland .
    Lynch, Christel
    Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Gudrun Kristiansdottir, Åsa
    Unit for Nutrition Research, School of Health Sciences, University of Iceland, Reykjavik, Iceland .
    Halldorsson, Thorhallur
    Unit for Nutrition Research, School of Health Sciences, University of Iceland, Reykjavik, Iceland .
    te Velde, Saskia
    EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands .
    Krawinkel, Michael
    Institute of Nutritional Sciences, Faculty of Agricultural Nutrition, Environmental Sciences and Home Economics, Justus-Liebig-University, Giessen, Germany .
    Behrendt, Isabel
    Institute of Nutritional Sciences, Faculty of Agricultural Nutrition, Environmental Sciences and Home Economics, Justus-Liebig-University, Giessen, Germany .
    Vaz de Almeida, Maria Daniel
    Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal .
    Franchini, Bela
    Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal .
    Papadaki, Angeliki
    Department of Social Medicine, Preventive Medicine and Nutrition Clinic, University of Crete, Heraklion, Crete, Greece; Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom .
    Moschandreas, Johanna
    Department of Social Medicine, Preventive Medicine and Nutrition Clinic, University of Crete, Heraklion, Crete, Greece.
    Thorsdottir, Inga
    Unit for Nutrition Research, School of Health Sciences, University of Iceland, Reykjavik, Iceland .
    Ribic, Cirila Hlastan
    National Education Institute of the Republic of Slovenia, Ljubljana, Slovenia .
    Petrova, Stefk
    National Center for Public Health Protection, Sofia, Bulgaria .
    Duleva, Vesselka
    National Center for Public Health Protection, Sofia, Bulgaria .
    Simcic, Irena
    National Education Institute of the Republic of Slovenia, Ljubljana, Slovenia .
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Does eating family meals and having the television on during dinner correlate with overweight?: a sub-study of the PRO GREENS project, looking at children from nine European countries2014In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 17, no 11, p. 2528-2536Article in journal (Refereed)
    Abstract [en]

    Objective: Family meals have been negatively associated with overweight in children, while television (TV) viewing during meals has been associated with a poorer diet. The aim of the present study was to assess the association of eating family breakfast and dinner, and having a TV on during dinner, with overweight in nine European countries and whether these associations differed between Northern and Southern & Eastern Europe.

    Design: Cross-sectional data. Schoolchildren reported family meals and TV viewing. BMI was based on parental reports on height and weight of their children. Cut-off points for overweight by the International Obesity Task Force were used. Logistic regressions were performed adjusted by age, gender and parental education.

    Setting: Schools in Northern European (Sweden, the Netherlands, Iceland, Ger- many and Finland) and Southern & Eastern European (Portugal, Greece, Bulgaria and Slovenia) countries, participating in the PRO GREENS project.

    Subjects: Children aged 10–12 years in (n 6316).

    Results: In the sample, 21 % of the children were overweight, from 35 % in Greece to 10 % in the Netherlands. Only a few associations were found between family meals and TV viewing during dinner with overweight in the nine countries. Northern European children, compared with other regions, were significantly more likely to be overweight if they had fewer family breakfasts and more often viewed TV during dinner.

    Conclusions: The associations between family meals and TV viewing during dinner with overweight were few and showed significance only in Northern Europe. Differences in foods consumed during family meals and in health-related lifestyles between Northern and Southern & Eastern Europe may explain these discrepancies.

  • 81.
    Rossen, Jenny
    et al.
    Sophiahemmet Univ, Stockholm, Sweden.;Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden..
    Buman, Matthew P.
    Arizona State Univ, Sch Nutr & Hlth Promot, Coll Hlth Solut, Phoenix, AZ USA..
    Johansson, Unn-Britt
    Sophiahemmet Univ, Stockholm, Sweden.;Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden..
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Sophiahemmet Univ, Stockholm, Sweden.
    Ainsworth, Barbara
    Arizona State Univ, Sch Nutr & Hlth Promot, Coll Hlth Solut, Phoenix, AZ USA..
    Brismar, Kerstin
    Karolinska Inst, Dept Mol Med & Surg, Karolinska Univ Hosp, Rolf Luft Res Ctr Diabet & Endocrinol, Stockholm, Sweden..
    Hagströmer, Maria
    Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Karolinska Univ Hosp, Allied Hlth Profess Funct, Funct Area Occupat Therapy & Physiotherapy, Stockholm, Sweden..
    Reallocating bouted sedentary time to non-bouted sedentary time, light activity and moderate-vigorous physical activity in adults with prediabetes and type 2 diabetes2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 7, article id e0181053Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate the potential associations of reallocating 30 minutes sedentary time in long bouts (>60 min) to sedentary time in non-bouts, light intensity physical activity (LPA) and moderate-to vigorous physical activity (MVPA) with cardiometabolic risk factors in a population diagnosed with prediabetes or type 2 diabetes.

    Methods: Participants diagnosed with prediabetes and type 2 diabetes (n = 124, 50% men, mean [SD] age = 63.8 [7.5] years) were recruited to the physical activity intervention Sophia Step Study. For this study baseline data was used with a cross-sectional design. Time spent in sedentary behaviors in bouts (>60 min) and non-bouts (accrued in <60 min bouts) and physical activity was measured using the ActiGraph GT1M. Associations of reallocating bouted sedentary time to non-bouted sedentary time, LPA and MVPA with cardiometabolic risk factors were examined using an isotemporal substitution framework with linear regression models.

    Results: Reallocating 30 minutes sedentary time in bouts to MVPA was associated with lower waist circumference (b = -4.30 95% CI:-7.23, -1.38 cm), lower BMI (b = -1.46 95% CI:-2.60, -0.33 kg/m(2)) and higher HDL cholesterol levels (b = 0.11 95% CI: 0.02, 0.21 kg/m(2). Similar associations were seen for reallocation of sedentary time in non-bouts to MVPA. Reallocating sedentary time in bouts to LPA was associated only with lower waist circumference.

    Conclusion: Reallocation of sedentary time in bouts as well as non-bouts to MVPA, but not to LPA, was beneficially associated with waist circumference, BMI and HDL cholesterol in individuals with prediabetes and type 2 diabetes. The results of this study confirm the importance of reallocation sedentary time to MVPA.

  • 82.
    Rossen, Jenny
    et al.
    Karolinska Inst, Stockholm, Sweden;Sophiahemmet Univ, Stockholm, Sweden.
    Hagströmer, Maria
    Karolinska Inst, Stockholm, Sweden.
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Brismar, Kerstin
    Karolinska Inst, Stockholm, Sweden.
    Johansson, Unn-Britt
    Sophiahemmet Univ, Stockholm, Sweden.
    Self-management of physical activity by the use of step registration in type 2 diabetes: Six months results of the RCT Sophia Step Study2018In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 15, no 10, p. S225-S225Article in journal (Other academic)
  • 83.
    Rossen, Jenny
    et al.
    Sophiahemmet university.
    Lööf, Helena
    Sophiahemmet university, Stockholm, Sweden.
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Hagströmer, Maria
    Karolinska Institutet, Strockholm, Sweden.
    Brismar, Kerstin
    Karolinska Institutet,Stockholm, Sweden.
    Johansson, Unn-Britt
    Sophiahemmet university, Stocklholm, Sweden.
    "This is why I'm doing a lot of exercise": a qualitative study of participant's experiences of the Sophia Step Study2018In: International Diabetes Nursing, ISSN 2057-3316, E-ISSN 2057-3324, article id http://www.tandfonline.com/doi/full/10.1080/20573316.2018.1437940Article in journal (Refereed)
  • 84.
    Rossen, Jenny
    et al.
    Sophiahemmets högskola.
    Lööf, Helena
    Sophiahemmets högskola.
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Hagströmer, Maria
    Karolinska Institutet.
    Brismar, Kerstin
    Karolinska Institutet.
    Johansson, Unn-Britt
    Sophiahemmets högskola.
    Using pedometers for self-management of physical activity. Participant's experiences from Sophia Step Study: A physical actvity promotion intervention in pre- and type 2 diabetics1917Conference paper (Refereed)
  • 85.
    Rossen, Jenny
    et al.
    Sophiahemmet University, Stockholm, Sweden; Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Hagströmer, Maria
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
    Brismar, Kerstin
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska University Hospital, Stockholm, Sweden.
    Ainsworth, Barbara E
    School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, United States.
    Iskull, Christina
    Sophiahemmet Hospital, Stockholm, Sweden.
    Möller, Peter
    Sophiahemmet Hospital, Stockholm, Sweden.
    Johansson, Unn-Britt
    Sophiahemmet University, Stockholm, Sweden; Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Physical activity promotion in the primary care setting in pre- and type 2 diabetes - the Sophia step study, an RCT2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 647Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Physical activity prevents or delays progression of impaired glucose tolerance in high-risk individuals. Physical activity promotion should serve as a basis in diabetes care. It is necessary to develop and evaluate health-promoting methods that are feasible as well as cost-effective within diabetes care. The aim of Sophia Step Study is to evaluate the impact of a multi-component and a single component physical activity intervention aiming at improving HbA1c (primary outcome) and other metabolic and cardiovascular risk factors, physical activity levels and overall health in patients with pre- and type 2 diabetes.

    METHODS/DESIGN: Sophia Step Study is a randomized controlled trial and participants are randomly assigned to either a multi-component intervention group (A), a pedometer group (B) or a control group (C). In total, 310 patients will be included and followed for 24 months. Group A participants are offered pedometers and a website to register steps, physical activity on prescription with yearly follow-ups, motivational interviewing (10 occasions) and group consultations (including walks, 12 occasions). Group B participants are offered pedometers and a website to register steps. Group C are offered usual care. The theoretical framework underpinning the interventions is the Health Belief Model, the Stages of Change Model, and the Social Cognitive Theory. Both the multi-component intervention (group A) and the pedometer intervention (group B) are using several techniques for behavior change such as self-monitoring, goal setting, feedback and relapse prevention. Measurements are made at week 0, 8, 12, 16, month 6, 9, 12, 18 and 24, including metabolic and cardiovascular biomarkers (HbA1c as primary health outcome), accelerometry and daily steps. Furthermore, questionnaires were used to evaluate dietary intake, physical activity, perceived ability to perform physical activity, perceived support for being active, quality of life, anxiety, depression, well-being, perceived treatment, perceived stress and diabetes self- efficacy.

    DISCUSSION: This study will show if a multi-component intervention using pedometers with group- and individual consultations is more effective than a single- component intervention using pedometers alone, in increasing physical activity and improving HbA1c, other metabolic and cardiovascular risk factors, physical activity levels and overall health in patients with pre- and type 2 diabetes.

    TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02374788 . Registered 28 January 2015.

  • 86.
    Sandvik, Camilla
    et al.
    Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo; Research Centre for Health Promotion, Department of Education and Health Promotion, Faculty of Psychology, University of Bergen, Bergen, Norway.
    De Bourdeaudhuij, Ilse
    Department of Movement and Sport Sciences, Ghent University, Ghent , Belgium.
    Due, Pernille
    Department of Social Medicine, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
    Brug, Johannes
    Department of Public Health, Erasmus University Medical Centre, Rotterdam , The Netherlands; f Community Nutrition Unit of Bilbao, Bilbao, Spain.
    Wind, Marianne
    Department of Public Health, Erasmus University Medical Centre, Rotterdam , The Netherlands; f Community Nutrition Unit of Bilbao, Bilbao, Spain.
    Bere, Elling
    Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo.
    Pérez-Rodrigo, Carmen
    Community Nutrition Unit of Bilbao, Bilbao, Spain.
    Wolf, Alexandra
    nstitute for Nutritional Sciences, University of Vienna, Vienna, Austria.
    Elmadfa, Ibrahim
    nstitute for Nutritional Sciences, University of Vienna, Vienna, Austria.
    Thórsdóttir, Inga
    Unit for Nutrition Research, Landspitali University Hospital, Reykjavik, Iceland; Department of Food Science, University of Iceland, Reykjavik, Iceland.
    Vaz de Almeida, Maria Daniel
    Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Biosciences, Karolinska Institute, Stockholm, Sweden .
    Klepp, Knut-Inge
    Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo.
    Personal, social and environmental factors regarding fruit and vegetable intake among schoolchildren in nine European countries2005In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 49, no 4, p. 255-266Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/AIMS: Children in Europe are consuming less fruit and vegetables than recommended. Knowledge about the potential determinants of fruit and vegetable intake is vital to understand discrepancies in intake and to guide interventions. The aim of the present study was to assess personal, social and environmental factors regarding fruit and vegetable intake among 11- to 12-year-old children in Europe.

    METHODS: A cross-sectional survey was undertaken, with nationally or regionally representative samples of in total 13,305 children (mean age 11.4 years) from nine European countries. Pupils in the classroom completed a self-administered questionnaire measuring fruit and vegetable intake and personal, social and environmental factors during one school lesson. Age-adjusted covariance analyses were carried out by gender, for the full sample and for each country separately. Proportions responding positively to the constructs are presented.

    RESULTS: Overall, European children held a positive attitude towards fruit and vegetable intake. For some constructs, large between-country differences were found. Children had a more positive attitude towards fruit than towards vegetables, and girls were on average more positive than boys. The children perceived their social environment as supportive towards fruit and vegetable intake. They reported good to very good availability of fruit and vegetables at home. However, availability at school and during leisure time activities seemed to be low, both for fruit and for vegetables.

    CONCLUSION: A large majority of the children reported positively to the personal and social factors regarding fruit and vegetable intake. As regards availability of fruit and vegetables at school and leisure time, and accessibility of fruit and vegetables at home, there is room for improvement.

  • 87.
    Sayyari, Ali-Akbar
    et al.
    Department of pediatric gastroenterology, hepatology and nutrition research center, Research Institute for Children's health, Mofid Children's Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran .
    Abdollahi, Zahra
    Department of Nutrition, Mofid Children's Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
    Ziaodini, Hassan
    Department of Health Psychology, Research Center of Education Ministry Studies, Tehran, Iran.
    Olang, Beheshteh
    Department of pediatric gastroenterology, hepatology and nutrition research center, Research Institute for Children's health, Mofid Children's Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Nutrition, Mofid Children's Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
    Fallah, Hossein
    Department of Nutrition, Mofid Children's Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
    Salehi, Forouzan
    Department of Nutrition, Mofid Children's Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
    Heidari-Beni, Motahar
    Department of Nutrition, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Ifahan University of Medical Sciences, Isfahan, Iran.
    Imanzadeh, Farid
    Department of pediatric gastroenterology, hepatology and nutrition research center, Research Institute for Children's health, Mofid Children's Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran .
    Abasalti, Zahra
    Department of Nutrition, Provincial Health Center, Mashad University of Medical Sciences, Mashad, Iran.
    Fouzoni, Fereshteh
    Department of Nutrition, Provincial Health Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
    Jafari, Sakineh
    Department of Nutrition, Provincial Health Center, Isfahan University of Medical Sciences, Isfahan, Iran.
    Lashkarlouki, Farhad
    Department of Nutrition, Provincial Health Center, Golestan University of Medical Sciences, Gorgan, Iran.
    Sahebdel, Mahnoush
    Department of Nutrition, Provincial Health Center, Jundishapur University of Medical Sciences, Ahvaz, Iran.
    Siadati, Arash
    Department of Nutrition, Provincial Health Center, Ardabil University of Medical Sciences, Ardabil, Iran.
    Aslani, Hamideh
    Department of Health Psychology, Research Center of Education Ministry Studies, Tehran, Iran.
    Hosseini, Mostafa
    Department of biostatistics, Tehran University of Medical Sciences, Tehran, Iran.
    Goodarzi, Azam
    Department of Health Psychology, Research Center of Education Ministry Studies, Tehran, Iran; Department of Health Education and Promotion, Tarbiat Modarres University, Tehran, Iran.
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Kelishadi, Roya
    Department of Pediatrics, Child Growth and Development Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
    Methodology of the Comprehensive Program on Prevention and Control of Overweight and Obesity in Iranian Children and Adolescents: The IRAN-Ending Childhood Obesity (IRAN-ECHO) Program2017In: International Journal of Preventive Medicine, ISSN 2008-7802, E-ISSN 2008-8213, Vol. 8, article id 107Article in journal (Refereed)
    Abstract [en]

    Background: The World Health Organization program on Ending Childhood Obesity (WHO-ECHO) has developed a comprehensive and integrated package of recommendations to address childhood obesity. The present study, entitled IRAN-ECHO, was designed and implemented in the framework of the WHO-ECHO program.

    Methods: The IRAN-ECHO program is implementing multicomponent interventions by considering life course dimensions. The program has two parts: a population approach and an individual approach. The population approach considers different periods in life, including prenatal, infancy, childhood, and adolescence, as well as family and society. The individual approach targets those children or adolescents with overweight or obesity; this part is conducted as a referral system that is now integrated in the current national health system. As part of the population approach, a quasi-experimental study was conducted in six provinces to compare the status before and after implementing parts of the interventions. By intersectoral collaboration with different organizations, multicomponent interventions are conducted for different age groups.

    Results: The IRAN-ECHO program is being conducted in six provinces, and will be considered in all provinces in the near future. Its main effects could be assessed in future years. Part of this program that was conducted as a quasi-experimental survey comprised 7149 students and showed that a high percentage of students had acceptable knowledge about adverse health effects of overweight and obesity. However, the knowledge about the low nutritional value of unhealthy snacks such as potato chips, puffs, industrial juices, and carbonated drinks was not appropriate. Many participants had the undesirable attitude of skipping one of the main meals when attempting to lose weight.

    Conclusions: The IRAN-ECHO program is presenting the feasibility of conducting the WHO-ECHO recommendations in Iran. The scope of potential policy recommendations to decrease childhood obesity is extensive and includes various elements. This program considers multisectoral interventions through population and individual approaches. The multicomponent interventions of this program address the obesogenic environment by considering the life course dimensions. It is expected that, by its life course interventions, it could help in primordial and primary prevention of noncommunicable diseases.

  • 88. Scander, Henrik
    et al.
    Monteagudo, Celia
    Nilsen, Bente
    Tellström, Richard
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Beverage consumption patterns and energy contribution from beverages per meal type: results from a national dietary survey in Sweden.2018In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 21, no 18, p. 3318-3327Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Many studies of food intake have been performed and published in Sweden, but to our knowledge no studies have extensively explored the beverage consumption of the Swedish adult population. The present study aimed to describe the beverage consumption and the contribution of beverage energy (including alcohol energy) to total energy intake according to gender, region of living, meal type and day for a Swedish adult population.

    DESIGN: National dietary survey Riksmaten (2010-2011), collected by the Swedish National Food Agency.

    SETTING: Sweden.

    SUBJECTS: A total of 1682 participants (57 % women) reported dietary intake data during four consecutive days, specified by portion size, meal, time point, day of the week and venue. Meals were categorized as breakfast, lunch, dinner and 'other'.ResultThe beverage reported to be consumed the most was water (ml/d), followed by coffee. Men had a higher consumption of juice, soft drinks, beer, spirits and low-alcohol beer, while the consumption of tea and water was higher for women. For both genders, milk contributed the most to beverage energy intake. Energy percentage from beverages was higher at lunch and dinner during weekends for both genders. Participants from the biggest cities in Sweden had a higher consumption of wine for both genders and tea for men than participants from other regions.

    CONCLUSIONS: A considerable part of total energy intake was contributed by beverages, especially for men. Beverages can contribute to a more enjoyable diet, but at the same time provide energy, sugar and alcohol in amounts that do not promote optimal health.

  • 89.
    Scander, Henrik
    et al.
    Örebro Univ, Sch Hospitality Culinary Arts & Meal Sci, Grythyttan, Sweden.
    Monteagudo Sanchez, Celia
    Univ Granada, Dept Nutr & Food Sci, Granada, Spain.
    Nilsen, Bente
    OsloMet Oslo Metropolian Univ, Dept Nursing & Hlth Promot, Oslo, Norway.
    Tellström, Richard
    Stockholm Univ, Dept Ethnol Hist Relig & Gender Studies, Stockholm, Sweden.
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Örebro Univ, Sch Hospitality Culinary Arts & Meal Sci, Grythyttan, Sweden.
    Food and beverage dinner combinations, patterns among Swedish adults2018In: International Journal of Gastronomy and Food Science, ISSN 1878-450X, E-ISSN 1878-4518, Vol. 14, p. 20-26Article in journal (Refereed)
    Abstract [en]

    Introduction: Since the taste preferences of food and beverage combinations are considered subjective properties and have been studied in several different ways, mainly within the field of sensory science, this study contributes to the field of food and beverage combination studies by using self-reported eating habits.

    Objective: This article explores the relationships between food and beverage combinations, recorded by a Swedish adult population.

    Method: Analyses were made using data from the national dietary survey, Riksmaten (2010–2011), performed by the Swedish National Food Agency. A total of 1753 Swedish adults (53% women) aged 18–80 contributed dietary intake data during four consecutive days. All dinner choices were categorized into beverage categories and food categories. Combinations between beverage and food categories were analyzed by using cross tabulation. Correlation coefficients for non-parametric variables were used to determine the association power. Predictive factors for more important beverage and food combinations were explored by logistic regression analysis.

    Results: Water was the most frequent choice in combination with all food categories. The results also showed that alcoholic beverages are present in two of the three strongest food and beverage correlations, the spirits drinks and white wine. The most important predictive factors were where the dinner took place for non-alcoholic combinations (OR: 4.33; 95% CI: 2.28–8.21) and age and employment for alcoholic combinations (OR > 2; p < 0.05).

    Conclusion: Our results show correlations in reported consumption of food and beverage, which explain the occurrences of specific patterns of combinations of food and beverage. More studies on choice of beverage are needed to describe the patterns of intake, in order to understand the mechanisms behind beverage choice, in different settings, cultural situations and lifestyle backgrounds. Combinations in everyday life are described here and these are not always so sophisticated, rather building on availability than on optimal taste combinations. Our findings can offer an understanding of some common every-day choices to culinary professionals, useful for their guidance of food and beverage pairing, to enhance restaurant experiences.

  • 90.
    Serra-Majem, L
    et al.
    Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain; Community Nutrition Research Centre, Science Park of the University of Barcelona, Barcelona, Spain.
    MacLean, D
    Department of Community Health and Epidemiology, Dalhovile University, Canada.
    Ribas, L
    Community Nutrition Research Centre, Science Park of the University of Barcelona, Barcelona, Spain.
    Brulé, D
    Bureau of Nutritional Sciences, Food Directorate, Ottawa, Canada.
    Sekula, W
    National Food and Nutrition Institute, Warsaw, Poland.
    Prattala, R
    National Public Health Institute, Helsinki, Finland.
    Garcia-Closas, R
    Community Nutrition Research Centre, Science Park of the University of Barcelona, Barcelona, Spain.
    Yngve, Agneta
    Preventive Nutrition Unit, Karolinska Institutet, Sweden.
    Lalonde, M
    Health Promotion and Programs Branch, Health Canada, Ottawa, Canada.
    Petrasovits, A
    Health Promotion and Programs Branch, Health Canada, Ottawa, Canada.
    Comparative analysis of nutrition data from national, household, and individual levels: results from a WHO-CINDI collaborative project in Canada, Finland, Poland, and Spain2003In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 57, no 1, p. 74-80Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVE: This project determined to what extent data on diet and nutrition, which were collected in a non-uniform manner, could be harmonised and pooled for international and national comparison.

    DESIGN: Direct comparisons of dietary data between studies were made using food balance sheets (FBS), household budget surveys (HBS), and individual dietary data (IDS); comparisons were also made within countries. Differences in study design and methodological approaches were taken into consideration. Data from research projects from the following four World Health Organisation (WHO) Countrywide Integrated Noncommunicable Disease Intervention (CINDI) countries were included-Canada, Finland, Poland, and Spain.

    MAIN RESULTS: FBS overestimated food consumption and nutrient intake compared to IDS. Results between HBS and IDS were quite similar, except for fish, meat, pulses and vegetables, which were underestimated by HBS, and sugar and honey and cereals, which were overestimated. Percentages of energy from fat, carbohydrates and proteins were higher when estimated from FBS, HBS, and IDS respectively.

    CONCLUSIONS: Results suggest that estimations from these three sources of dietary data are difficult to compare because they are measuring different levels of dietary information. The understanding of their relations may be important in formulating and evaluating a nutrition policy.

  • 91.
    Sjöström, M
    et al.
    Department of Social Medicine, University of Umeå, Sweden; Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden; Department for Physical Education and Health, University of Örebro, Sweden.
    Karlsson, A B
    Department of Social Medicine, University of Umeå, Sweden; Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Kaati, G
    Department of Social Medicine, University of Umeå, Sweden.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Green, L W
    Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
    Bygren, L O
    Department of Social Medicine, University of Umeå, Sweden.
    A four week residential program for primary health care patients to control obesity and related heart risk factors: effective application of principles of learning and lifestyle change1999In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 53, no Suppl 2, p. S72-77Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To test the short and long-term effectiveness of a four week residential program for primary health care patients to control obesity and related risk factors for cardio-vascular disease (CVD), especially blood pressure (BP).

    DESIGN: Prospective clinical study, with follow up after 1 and 5 y.

    SETTING: Vindeln Patient Education Centre, Vindeln, and Department of Social Medicine, University of Umea, Sweden.

    SUBJECTS: Approximately 2500 individuals, with two or more of the traditional risk factors for CVD, participated in the program. This report describes a subsample of 100 consecutive patients, 52+/-9 y, 53 men, with obesity and/or high BP. Intervention: Four week residential program with lectures and group discussions as well as practical sessions in smaller groups (meal preparations, physical exercise, etc). The patients were followed-up medically in their home area.

    OUTCOME MEASURES: Weight and blood pressure.

    RESULTS: Dramatic reductions of weight and, especially, of blood pressure (BP) occurred during the residential weeks, and the reductions were pronounced also after 1 y. After 5 y, the total mean weight among men with initial BMI > or = 30 kg/m2 was still 5 kg lower, and diastolic and systolic BP among those with hypertension was 15 and 20 mm Hg lower, respectively, than before the program.

    CONCLUSIONS: The full-time participation in the residential program and the enrollment and commitment of the patients may explain the clinical outcome. A level of predisposition greater than that required of most weight- and BP-control programs was confirmed and a great preventive or therapeutic potential was indicated. The study illustrates an effective application of the Precede-Proceed model of health promotion planning.

  • 92.
    Sjöström, Michael
    et al.
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Ekelund, Ulf
    Örebro University, Department of Health Sciences.
    Environmental planning and public health nutrition: interventions in Nordic communities2001In: Physical activity: a part of healthy eating? : report from a Nordic Seminar, Lahti, Finland, February 2000 / [ed] Mikael Fogelholm, København, 2001, p. 117-124Conference paper (Refereed)
  • 93.
    Sjöström, Michael
    et al.
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Ekelund, Ulf
    Örebro University, Department of Health Sciences.
    Environmental planning and public health nutrition: interventions in Nordic communities2001In: Physical activity: a part of healthy eating? : report from a Nordic Seminar, Lahti, Finland, February 2000 / [ed] Mikael Fogelholm, København, 2001, p. 117-124Conference paper (Refereed)
  • 94. Sjöström, Michael
    et al.
    Yngve, Agneta
    Poortvliet, Eric
    Ekelund, Ulf
    Örebro universitet, Hälsoakademin.
    Hurtig-Wennlöf, Anita
    Örebro universitet, Institutionen för klinisk medicin.
    Nilsson, Andreas
    RISPA.
    Hagströmer, Maria
    Adolescent nutrition: a multidimensional challenge2003In: Modern aspects of nutrition: present knowledge and future perspectives / [ed] I. Elmadfa, E. Anklam, J. König, 2003, p. 253-254Conference paper (Refereed)
  • 95.
    Sjöström, Michael
    et al.
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge; Department of Physical Education and Health, University of Örebro, Örebro, Sweden.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge.
    Poortvliet, Eric
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge.
    Warm, Daniel
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge; nstitute of Human Nutrition, University of Southampton, Southampton, UK.
    Ekelund, Ulf
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge; Department of Physical Education and Health, University of Örebro, Örebro, Sweden.
    Diet and physical activity - interactions for health: public health nutrition in the European perspective1999In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 2, no 3A, p. 453-459Article in journal (Refereed)
    Abstract [en]

    For the majority of European adults, who neither smoke nor drink excessively, the most significant controllable risk factors affecting their long-term health are what they eat, and how physically active they are.

    Scientists are supposed to clarify to policy makers and health professionals the usefulness of their health messages. However, to be able to do that, a more detailed understanding is needed of the basic mechanisms behind the effects on health of diet and physical activity and, especially, the two in combination. Further, better methods for assessment of nutrition and physical activity in the population have to be developed, and more and better baseline data have to be collected. Increased and more efficient interventions are then needed. People trained and competent in the new discipline of Public Health Nutrition are required.

    Through the stimulating support that the European Commission, as well as other national and international partners, are presently giving to the development of Public Health Nutrition across Europe, we can hope for an increased mobility, networking and understanding between European nutrition and physical activity professionals. This will most likely result in greater and better policy making, strategy development, implementation and evaluation. We now have a great possibility to develop the integrated field of preventive nutrition and health enhancing physical activity.

  • 96. Soroush, A
    et al.
    Der Ananian, C
    Ainsworth, BE
    Belyea, M
    Poortvliet, E
    Swan, PD
    Walker, J
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Effects of a 6-Month Walking Study on Blood Pressure and Cardiorespiratory Fitness in U.S. and Swedish Adults: ASUKI Step Study2013In: Asian journal of Sports Medicine, ISSN 2008-000X, E-ISSN 2008-7209, Vol. 4, no 2, p. 114-124Article in journal (Refereed)
    Abstract [en]

    PURPOSE:The aim of this study was to assess the effects of a six-month pedometer-based workplace intervention on changes in resting blood pressure (BP) and cardiorespiratory fitness (CRF).METHODS:A subsample of ASUKI Step participants (n= 355) were randomly selected to have changes in their BP and CRF monitored during the intervention. Pedometers were used to monitor steps taken with a goal of walking more than 10,000 steps/day. Systolic and diastolic BP were taken using an Omron automated BP cuff. Estimated VO2 max was obtained using the Åstrand-Rhyming cycle ergometer test. A multi-level growth modeling approach, and a mixed model ANOVA were used to predict changes in systolic and diastolic BP, and estimated VO2 max over time by steps, age, gender, and university site.RESULTS:Steps/day averaged 12,256 (SD = 3,180) during month 1 and steadily decreased to month 6. There were significant linear and quadratic trends in systolic and diastolic BP over time. Age was positively related to initial starting values for systolic and diastolic BP, and approached significance for systolic BP changes over time. Steps/day approached significance for linear changes in systolic BP. There was a significant difference between ASU and KI participants' estimated VO2 max. There was a significant change over time in the estimated VO2 max. The number of steps taken was significantly related to changes in estimated VO2 max over time.CONCLUSIONS:The results of the present study indicate that healthy individuals who took part in a pedometer intervention improved several cardiovascular disease risk factors.

  • 97. Soroush, A
    et al.
    Der Ananian, C
    Ainsworth, BE
    Belyea, M
    Poortvliet, E
    Swan, PD
    Walker, J
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Effects of a 6-Month Walking Study on Blood Pressure and Cardiorespiratory Fitness in U.S. and Swedish Adults: ASUKI Step Study2013In: Asian journal of Sports Medicine, ISSN 2008-000X, E-ISSN 2008-7209, Vol. 4, no 2, p. 114-124Article in journal (Refereed)
    Abstract [en]

    PURPOSE:The aim of this study was to assess the effects of a six-month pedometer-based workplace intervention on changes in resting blood pressure (BP) and cardiorespiratory fitness (CRF).METHODS:A subsample of ASUKI Step participants (n= 355) were randomly selected to have changes in their BP and CRF monitored during the intervention. Pedometers were used to monitor steps taken with a goal of walking more than 10,000 steps/day. Systolic and diastolic BP were taken using an Omron automated BP cuff. Estimated VO2 max was obtained using the Åstrand-Rhyming cycle ergometer test. A multi-level growth modeling approach, and a mixed model ANOVA were used to predict changes in systolic and diastolic BP, and estimated VO2 max over time by steps, age, gender, and university site.RESULTS:Steps/day averaged 12,256 (SD = 3,180) during month 1 and steadily decreased to month 6. There were significant linear and quadratic trends in systolic and diastolic BP over time. Age was positively related to initial starting values for systolic and diastolic BP, and approached significance for systolic BP changes over time. Steps/day approached significance for linear changes in systolic BP. There was a significant difference between ASU and KI participants' estimated VO2 max. There was a significant change over time in the estimated VO2 max. The number of steps taken was significantly related to changes in estimated VO2 max over time.CONCLUSIONS:The results of the present study indicate that healthy individuals who took part in a pedometer intervention improved several cardiovascular disease risk factors.

  • 98.
    Spinelli, Angela
    et al.
    Istituto Superiore di Sanita, National Centre for Disease Prevention and Health Promotion, Rome, Italy.
    Buoncristiano, Marta
    WHO European Office for the Prevention and Control of the NCDs, Moscow, Russian Federation.
    Kovacs, Viktoria Anna
    National Institute of Pharmacy and Nutrition, DG of Food and Nutrition Science, Budapest, Hungary.
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Spiroski, Igor
    Institute of Public Health of the Republic of Macedonia, Skopje, North Macedonia.
    Obreja, Galina
    State University of Medicine and Pharmacy, Chisinau, Moldova.
    Starc, Gregor
    Faculty of sport, University of Ljubljana, Ljubljana, Slovenia.
    Pérez, Napoleón
    Spanish observatory of nutrition and study of obesity, Madrid, Spain.
    Rito, Ana Isabel
    National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal.
    Kunešová, Marie
    Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic.
    Sant'Angelo, Victoria Farrugia
    Primary Health Care, Floriana, Malta.
    Meisfjord, Jørgen
    Departmnet of Health and Inequality, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
    Bergh, Ingunn Holden
    Department of Child HEalth and Development, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
    Kelleher, Cecily
    University College Dublin, Dublin, Ireland.
    Yardim, Nazan
    Turkish Ministry of Health, Ankara, Turkey.
    Pudule, Iveta
    Centre for Disease Prevention and Control, Riga, Latvia.
    Petrauskiene, Ausra
    Department of preventive medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Duleva, Vesselka
    National Center of Public Health and Analyses, Sofia, Bulgaria.
    Sjöberg, Agneta
    Department of food and nutrition and sport science, University of Gothenburg, Gothenburg, Sweden.
    Gualtieri, Andrea
    Social Security Institute San Marino, San Marino..
    Hassapidou, Maria
    Department of Nutriiton and Dietetics, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece.
    Hyska, Jolanda
    Institute of Public Health, Tirana, Albania.
    Burazeri, Genc
    Institute of Public Health, Tirana, Albania.
    Petrescu, Constanta Huidumac
    National Institute of public health, Bucharest, Romania.
    Heinen, Mirjam
    University College Dublin, Dublin, Ireland.
    Takacs, Hajnalka
    Semmelweis University, Karoly Racz School of PhD Studies, Budapest, Hungary.
    Zamrazilová, Hana
    Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic.
    Bosi, Tulay Bagci
    Public Health Department, Hacettepe University, Ankara, Turkey.
    Sacchini, Elena
    Health Authority San Marino, San Marino.
    Pagkalos, Ioannis
    Department of Nutriiton and Dietetics, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece.
    Cucu, Alexandra
    Institute of Public Health, Tirana, Albania.
    Nardone, Paola
    Istituto Superiore di Anita National Centre of Disease Prevention and Health Promotion, Rome, Italy.
    Gately, Paul
    Centre for Pplied Obesity Research, Leeds Beckett University, Leeds, United Kingdom.
    Williams, Julianne
    WHO European Office for the Prevention and Control of the NCDs, Moscow, Russian Federation.
    Breda, João
    WHO European Office for the Prevention and Control of the NCDs, Moscow, Russian Federation.
    Prevalence of Severe Obesity among Primary School Children in 21 European Countries2019In: Obesity Facts, ISSN 1662-4025, E-ISSN 1662-4033, Vol. 12, no 2, p. 244-258Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established more than 10 years ago to estimate prevalence and monitor changes in overweight and obesity in children aged 6-9 years. Since then, there have been five rounds of data collection in more than 40 countries involving more than half a million children. To date, no comparative studies with data on severe childhood obesity from European countries have been published.

    OBJECTIVES: The aim of this work was to present the prevalence of severe obesity in school-aged children from 21 countries participating in COSI.

    METHOD: The data are from cross-sectional studies in 21 European WHO member states that took part in the first three COSI rounds of data collection (2007/2008, 2009/2010, 2012/2013). School-aged children were measured using standardized instruments and methodology. Children were classified as severely obese using the definitions provided by WHO and the International Obesity Task Force (IOTF). Analyses overtime, by child's age and mother's educational level, were performed in a select group of countries.

    RESULTS: A total of 636,933 children were included in the analysis (323,648 boys and 313,285 girls). The prevalence of severe obesity varied greatly among countries, with higher values in Southern Europe. According to the WHO definition, severe obesity ranged from 1.0% in Swedish and Moldovan children (95% CI 0.7-1.3 and 0.7-1.5, respectively) to 5.5% (95% CI 4.9-6.1) in Maltese children. The prevalence was generally higher among boys compared to girls. The IOTF cut-offs lead to lower estimates, but confirm the differences among countries, and were more similar for both boys and girls. In many countries 1 in 4 obese children were severely obese. Applying the estimates of prevalence based on the WHO definition to the whole population of children aged 6-9 years in each country, around 398,000 children would be expected to be severely obese in the 21 European countries. The trend between 2007 and 2013 and the analysis by child's age did not show a clear pattern. Severe obesity was more common among children whose mother's educational level was lower.

    CONCLUSIONS: Severe obesity is a serious public health issue which affects a large number of children in Europe. Because of the impact on educational, health, social care, and economic systems, obesity needs to be addressed via a range of approaches from early prevention of overweight and obesity to treatment of those who need it.

  • 99.
    Villa, Inga
    et al.
    Department of Public Health, University of Tartu, Tartu, Estonia; Estonian Centre of Behavioural & Health Sciences, Estonia.
    Yngve, Agneta
    Department of Biosciences and Nutrition at Novum, Karolinska Institutet, Stockholm, Sweden.
    Poortvliet, Eric
    Department of Biosciences and Nutrition at Novum, Karolinska Institutet, Stockholm, Sweden.
    Grjibovski, Andrej
    Department of Biosciences and Nutrition at Novum, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
    Liiv, Krystiine
    National Institute for Health Development, Tallinn, Estonia.
    Sjöström, Michael
    Department of Biosciences and Nutrition at Novum, Karolinska Institutet, Stockholm, Sweden.
    Harro, Maarike
    Estonian Centre of Behavioural & Health Sciences, Estonia; National Institute for Health Development, Tallinn, Estonia.
    Dietary intake among under-, normal- and overweight 9- and 15-year-old Estonian and Swedish schoolchildren.2007In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 10, no 3, p. 311-322Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To determine the differences in macronutrient and food group contribution to total food and energy intakes between Estonian and Swedish under-, normal- and overweight schoolchildren, and to estimate the association between diet and body mass index (BMI).

    DESIGN: Cross-sectional comparison between Estonian and Swedish children and adolescents of different BMI groups.

    SETTING: Twenty-five schools from one region in Estonia and 42 in two regions of central Sweden.

    SUBJECTS: In total 2308 participants (1176 from Estonia and 1132 from Sweden), including 1141 children with a mean age of 9.6 +/- 0.5 years and 1167 adolescents with a mean age of 15.5 +/- 0.6 years.

    RESULTS: Overweight was more prevalent among younger girls in Sweden (17.0 vs. 8.9%) and underweight among girls of both age groups in Estonia (7.9 vs. 3.5% in younger and 10.5 vs. 5.1% in older age group of girls). Compared with that of normal- and underweight peers, the diet of overweight Estonian children contained more energy as fat (36.8 vs. 31.7%) but less as carbohydrates, and they consumed more milk and meat products. Absolute BMI of Estonian participants was associated positively with energy consumption from eggs and negatively with energy consumption from sweets and sugar. Swedish overweight adolescents tended to consume more energy from protein and milk products. Risk of being overweight was positively associated with total energy intake and energy from fish or meat products. In both countries the association of overweight and biological factors (pubertal maturation, parental BMI) was stronger than with diet.

    CONCLUSION: The finding that differences in dietary intake between under-, normal- and overweight schoolchildren are country-specific suggests that local dietary habits should be considered in intervention projects addressing overweight.

  • 100.
    Walker, Jenelle R
    et al.
    College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.
    Soroush, Ali
    Department of Sports Medicine and Rehabilitation, Imam Reza Hospital, Kermanshah University of Medical Sciences (KUMS), Kermanshah, IR Iran.
    Ainsworth, Barbara E
    School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA.
    Belyea, Michael
    College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.
    Swan, Pamela D
    School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    U.S. Cohort differences in body composition outcomes of a 6-month pedometer-based physical activity intervention: the ASUKI step study2014In: Asian journal of Sports Medicine, ISSN 2008-000X, E-ISSN 2008-7209, Vol. 5, no 4, article id e25748Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Regular physical activity (PA) enhances health and is an important factor in disease prevention and longevity. The 2008 U.S. Physical Activity Guidelines recommends that all healthy adults attain at least 150 minutes per week of moderate intensity aerobic PA (e.g., brisk walking) to maintain and promote PA.

    OBJECTIVES: This study determined the effects of a 6-month pedometer-based worksite walking intervention with participants focusing on a goal of achieving 10,000 steps per day, on body composition in adults with a wide range of body mass index (BMI) values and compares the changes with outcomes of similar studies.

    MATERIALS AND METHODS: The design was a single group, quasi-experimental study. All participants received a pedometer and were asked to register the daily number of steps. Men and women (n = 142; age = 41 ± 11.5 years; BMI = 27.2 ± 7.25 kg.m(-2)) received body composition measures at 1, 3, and 6 months. A multilevel growth modeling approach was used to explore change over time and to predict change by steps, age, gender, and fat category categorized as normal and overweight/obese.

    RESULTS: Significant individual differences in linear slopes and change over time were observed for waist circumference (WC) (-3.0 cm) only in unconditional model (t = -0.67, P = 0.02).

    CONCLUSIONS: A 3.0 cm loss in WC shows that a 10,000 step per day walking program has the potential to influence changes in body composition measures that are correlated with adverse health outcomes. While significant changes did occur there are some limitations. The analysis did not consider the data regarding completing of 10,000 steps per day and other potential factors that could influence the results. Compliance to the walking dose and initial physical activity and body composition levels are important to consider when studying body composition changes in such programs.

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