Food & Nutrition Research

Effects of ketogenic diet on weight loss parameters among obese or overweight patients with polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trails

Nan-nan Xing, Fang Ren, Hui Yang — Tue, 12 Mar 2024 00:00:00 -0700

Aim: To evaluate how effective a low carbohydrate ketogenic diet (KD) is for changing key physical measurements such as weight, waist circumference (WC), body mass index (BMI), and fat mass (FM) in women with polycystic ovary syndrome (PCOS) who were obese or overweight.

Methods: Several online databases, including PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science (WOS), were searched systematically to find relevant randomized controlled trials (RCTs) up until June 2023. The Q-test and I² statistics were used to assess the level of heterogeneity among the included studies. The data were then combined using either a fixed or random effects model and presented as a weighted mean difference (WMD) along with a 95% confidence interval (CI).

Results: Of the 682 citations, 11 RCTs were included. The pooled results showed a significant decrease in the WMD of weight levels [WMD = −9.13 kg; 95% CI, −11.88, −6.39, P < 0.001; I² = 87.23%] following KD. Moreover, KD significantly reduced BMI levels [WMD = −2.93 kg/m²; 95% CI, −3.65, −2.21, P < 0.001; I² = 78.81%] compared to the controls. Patients with PCOS received KD demonstrated significant decrease in WC [WMD = −7.62 cm; 95% CI, −10.73, −4.50, P < 0.001; I² = 89.17%] and FM [WMD = −5.32 kg; 95% CI, −7.29, −3.36, P < 0.001; I² = 83.97%].

Conclusion: KD was associated with lower weight loss (WL) parameters, including weight, BMI, WC, and FM, in obese or overweight women with PCOS, highlighting the significance of physicians and nurses in taking care of the nutritional needs of overweight/obese patients with PCOS.

Iodine status and determinants in adults in Norway – results from a population-based health examination survey (The HUNT Study)

Mon, 01 Apr 2024 02:05:00 -0700

Background: In Norway, there is a lack of knowledge about the iodine status in the general and older adult population, and there is no established national monitoring programme for iodine. Several studies have indicated that iodine deficiency is prevalent in subgroups of the population. Salt iodisation is currently being considered as a measure to increase the population iodine status. In this cross-sectional study, the aim was to evaluate iodine status and determinants in the adult and older adult population in Mid-Norway, before salt iodisation is likely to be initiated.

Methods: The study sample was a subsample of participants in the fourth wave of the population-based Trøndelag Health Study (HUNT4, 2017–2019) with available spot-urine samples. This subsample included participants with 25–64 years (n = 500) and 70–79 years (n = 250). The urine samples were analysed for iodine and creatinine. Information on the habitual intake of milk/yoghurt, fish, supplement use, use of thyroid medication and relevant background factors was collected through a general questionnaire. Multivariable quantile regression was used to model differences in the median urinary iodine concentration (UIC) by determinants. Estimates were weighted to match the age and sex distribution of the Norwegian population aged 25–79 years in 2019.

Results: Median UIC was 97 µg/L (95% confidence interval [CI]: 92, 103) indicating borderline iodine deficiency at a group level. The median UIC increased with age, and iodine status was insufficient in participants below age 55 years (median 92 µg/L [95% CI: 85, 99]). Important determinants of UIC were habitual milk/yoghurt intake, daily supplement use and current use of thyroid medication, but not intake of lean or fatty fish. Risk of mild-to-moderate iodine deficiency was seen in those with a low intake of milk/yoghurt, no supplement use and who did not use thyroid medication. No group was identified as being at risk of iodine excess.

Conclusion: Iodine status was adequate in older adults but mildly deficient in adults under 55 years. Milk intake, supplement use and use of thyroid medication are important determinants of iodine intake in Norway.

Defining malnutrition in persons with spinal cord injury – does the Global Criteria for Malnutrition work?

Mon, 25 Mar 2024 02:39:01 -0700

Background and aims: Physiologic and metabolic changes following spinal cord injury (SCI) lead to an increased risk of malnutrition. The Global Leadership Initiative on Malnutrition (GLIM) is a three-step approach to diagnose malnutrition: 1) screening; 2) phenotypic and etiological criteria; and 3) malnutrition severity. The main aim of this study was to assess malnutrition in patients with SCI, according to the GLIM criteria.

Methods: Patients with SCI (≥ 18 years) admitted to rehabilitation were included. Anthropometrics, food intake, and inflammation were assessed on admission. Fat-free mass index (FFMI) was estimated from bioimpedance analysis. Malnutrition was diagnosed by the GLIM criteria, using the Malnutrition Universal Screening Tool (MUST) as the first step screening tool. Sensitivity and specificity analyses were performed.

Results: In total, 66 patients were assessed (50 men) with a mean age of 51.4 (± 17.4) years and median time since injury was 37.5 (10–450) days. The mean body mass index was 24.7 (± 4.2) kg/m², and 1-month involuntary weight loss was 5.7 (± 4.4)%. FFMI for men was 17.3 (± 1.9) and for women 15.3 (± 1.6) kg/m². Forty-one patients (62%) were malnourished according to the GLIM criteria: 27 moderately and 14 severely malnourished. MUST was not able to detect malnutrition risk of nine patients, giving a moderate agreement (kappa 0.66), with a sensitivity of 0.78 and a specificity of 0.92 compared to the GLIM diagnosis.

Conclusions: In this cross-sectional study, 62% of subacute SCI patients were malnourished according to the GLIM criteria. The screening tool MUST showed moderate agreement with the GLIM criteria and did not detect risk of all patients with a malnutrition diagnosis. The clinical implications of these findings need further investigation.

Curcuma longa L. extract exhibits anti-inflammatory and cytoprotective functions in the articular cartilage of monoiodoacetate-injected rats

Tue, 19 Mar 2024 10:42:01 -0700

Background: Osteoarthritis (OA), the most prevalent form of arthritis, is a degenerative joint disease marked by the progressive deterioration of articular cartilage, leading to clinical manifestations such as joint pain.

Objective: This study investigated the effects of Curcuma longa L. extract (CL) containing curcumin, demethoxycurcumin, and bisdemethoxycurcumin on monosodium iodoacetate (MIA)-induced OA rats.

Design: Sprague–Dawley rats with MIA-induced OA received CL supplementation at doses of 5, 25, and 40 mg/kg body weight.

Results: CL extract administration suppressed mineralisation parameters and morphological modifications and decreased arachidonate5-lipoxygenase and leukotriene B4 levels in articular cartilage. Additionally, it decreased serum prostaglandin E2, NO, and glycosaminoglycanlevels as well as the protein expression of phosphorylated inhibitor kappa B-alpha, phosphorylated p65, cyclooxygenase-2, and inducible nitric oxide synthase in the cartilage of MIA-injected rats. Furthermore, it also reduced matrix metalloproteinases and elevated SMAD family member 3 phosphorylation, tissue inhibitor of metalloproteinases, aggrecan, collagen type I, and collagen type II levels in the articular cartilage of MIA-induced OA rats.

Conclusions: This study’s findings suggest that CL supplementation helps prevent OA development and is an effective therapy for OA.

Nimbolide: promising agent for prevention and treatment of chronic diseases (recent update)

Mon, 18 Mar 2024 00:00:00 -0700

Background: Nimbolide, a bioactive compound derived from the neem tree, has garnered attention as a potential breakthrough in the prevention and treatment of chronic diseases. Recent updates in research highlight its multifaceted pharmacological properties, demonstrating anti-inflammatory, antioxidant, and anticancer effects. With a rich history in traditional medicine, nimbolide efficacy in addressing the molecular complexities of conditions such as cardiovascular diseases, diabetes, and cancer positions it as a promising candidate for further exploration. As studies progress, the recent update underscores the growing optimism surrounding nimbolide as a valuable tool in the ongoing pursuit of innovative therapeutic strategies for chronic diseases.

Methods: The comprehensive search of the literature was done until September 2020 on the MEDLINE, Embase, Scopus and Web of Knowledge databases.

Results: Most studies have shown the Nimbolide is one of the most potent limonoids derived from the flowers and leaves of neem (Azadirachta indica), which is widely used to treat a variety of human diseases. In chronic diseases, nimbolide reported to modulate the key signaling pathways, such as Mitogen-activated protein kinases (MAPKs), Wingless-related integration site-β (Wnt-β)/catenin, NF-κB, PI3K/AKT, and signaling molecules, such as transforming growth factor (TGF-β), Matrix metalloproteinases (MMPs), Vascular Endothelial Growth Factor (VEGF), inflammatory cytokines, and epithelial-mesenchymal transition (EMT) proteins. Nimbolide has anti-inflammatory, anti-microbial, and anti-cancer properties, which make it an intriguing compound for research. Nimbolide demonstrated therapeutic potential for osteoarthritis, rheumatoid arthritis, cardiovascular, inflammation and cancer.

Conclusion: The current review mainly focused on understanding the molecular mechanisms underlying the therapecutic effects of nimbolide in chronic diseases.

Extract mixture of plants (OXYLIA) inhibits fat accumulation by blocking FAS-related factors and promoting lipolysis via cAMP-dependent PKA activation

Tue, 12 Mar 2024 06:59:19 -0700

Background: Obesity is characterized by an imbalance between energy intake and expenditure, leading to the excessive accumulation of triglycerides in adipose tissue.

Objective: This study investigated the potential of Oxylia to prevent obesity in mice fed with a high-fat diet (HFD).

Design: C57BL/6J mice were fed with one of the following five diets – AIN93G normal diet (normal control), 60% (HFD; control), HFD containing metformin at 40 mg/kg body weight (b.w.) (Met; positive control), HFD containing Oxylia at 30 mg/kg b.w. (O30), or HFD containing Oxylia at 60 mg/kg b.w. (O60) – for 15 weeks.

Results: Mice under an HFD supplemented with Oxylia had decreased body weight gain, adipose tissue weight, and adipose tissue mass. In addition, triglyceride (TG), total cholesterol, and VLDL/LDL cholesterol levels were lower in the O60 groups than in the HFD-fed control group. Moreover, Oxylia supplementation decreased the expression of adipogenesis-related mRNAs and lipogenesis-related proteins while increasing the expression of lipolysis-related proteins in white adipose tissue and thermogenesis-related proteins in brown adipose tissue.

Conclusions: These findings suggest that Oxylia has potential as a functional food ingredient for the prevention and treatment of obesity and related metabolic disorders.

Transmission of food literacy to youth in Norwegian childcare institutions – a qualitative study

Marianne S. Morseth, Siyamali Gananathan, Sigrun Henjum, Laura Terragni — Fri, 26 Jan 2024 04:17:37 -0800

Background: Youth in childcare institutions may have lower levels of food literacy compared to other youth. Food literacy, indicating the ability to plan and prepare meals from scratch, is associated with consuming healthier diets.

Objective: The objective of this study was to explore how food literacy is transmitted to youth through involvement and participation in food-related activities in Norwegian childcare institutions.

Design: Data were collected through qualitative semi-structured interviews with 13 staff and 8 adolescents (>16 years of age) selected by convenient sampling in childcare institutions (n = 6) in South-East Norway.

Results: We found that the institutional context provided both opportunities and limitations for transmitting food literacy. The staff tended to prefer a soft approach to transmitting food literacy due to the youth being perceived as vulnerable and a focus on youth autonomy. The youth showed ambivalent interests in participating in food-related activities and wished for their need to decide how much to be involved to be respected. A firm approach was perceived to increase the risk of conflict.

Discussion: Our findings are best interpreted in light of a childcare institution being at the intersect between the homely and public spheres. There was ambivalence among staff between following institutional guidelines and caring for the different needs of residents. Food was often referred to as symbolizing something else in the relationship between staff and youth, such as care, structure, autonomy, and a normal family life.

Conclusion: Initiatives aiming at including food literacy in care relations in childcare institutions are recommended.

Ilex paraguariensis A.St.-Hil. improves lipid metabolism in high-fat diet-fed obese rats and suppresses intracellular lipid accumulation in 3T3-L1 adipocytes via the AMPK-dependent and insulin signaling pathways

Maya Kudo, Ming Gao, Misa Hayashi, Yukiko Kobayashi, Jinwei Yang, Tonghua Liu — Mon, 22 Jan 2024 13:27:04 -0800

Background: Obesity is closely associated with several chronic diseases, and adipose tissue plays a major role in modulating energy metabolism.

Objective: This study aimed to determine whether Mate, derived from I. paraguariensis A.St.-Hil., ameliorates lipid metabolism in 3T3-L1 adipocytes and high-fat diet (HFD)-fed obese Sprague-Dawley (SD) rats.

Design: 3T3-L1 adipocytes were cultured for 7 days, following which intracellular lipid accumulation and expression levels of lipid metabolism-related factors were examined. Dorsomorphin was used to investigate the potential pathways involved, particularly the adenosine monophosphate-activated protein kinase (AMPK)- dependent pathway. Mate was administered to rat HFD-fed obese SD models for 8 consecutive weeks. The expression of lipid metabolism-related factors in the organs and tissues collected from dissected SD rats was evaluated.

Results: Mate suppressed intracellular lipid accumulation in 3T3-L1 adipocytes, increased the protein and gene expression levels of AMPK, hormone sensitive lipase (HSL), calmodulin kinase kinase (CaMKK), liver kinase B1 (LKB1), protein kinase A (PKA), CCAAT/enhancer binding protein β (C/EBPβ), insulin receptor b (IRβ), and insulin receptor substrate 1 (IRS1) (Tyr465), and decreased those of sterol regulatory element binding protein 1C (Srebp1c), fatty acid synthase (FAS), peroxisome-activated receptor γ (PPARγ), and IRS1 (Ser1101). Furthermore, an AMPK inhibitor abolished the effects exerted by Mate on intracellular lipid accumulation and HSL and FAS expression levels. Mate treatment suppressed body weight gain and improved serum cholesterol levels in HFD-fed obese SD rats. Treatment with Mate increased the protein and gene expression levels of AMPK, PKA, Erk1/Erk2 (p44/p42), and uncoupling protein 1 and reduced those of mammalian target of rapamycin, S6 kinase, Srebp1c, ap2, FAS, Il6, Adiponectin, Leptin, and Fabp4 in rat HFD-fed obese SD models.

Discussion and conclusions: Mate suppressed intracellular lipid accumulation in 3T3-L1 adipocytes and improved lipid metabolism in the epididymal adipose tissue of HFD-fed obese SD rats via the activation of AMPK-dependent and insulin signaling pathways.

The effect of the association between food budget and food quality on adherence to national guidelines in kindergartens, and the impact of budget limit on the food quality

Kristin Fjæra, Ratib Lekhal, Sølvi Helseth, Milada Hagen, Samira Lekhal — Thu, 11 Jan 2024 10:50:40 -0800

Background: In Norway, almost 97% of children attend kindergartens. Most of the daily food intake happens during the day in kindergartens, and the quality of food and meals being served is essential to promote healthy food habits. There is variation in the food that kindergartens provide, and kindergartens can ask for additional payment from parents to cover the food. There are no rules neither across kindergartens for the food offering nor how much additional payment kindergarten can request.

Objective: Our main objective is to investigate possible associations between the food budget and the quality of food offered in kindergartens. We specifically aimed to identify budget levels that were associated with better adherence to national guidelines, thereby the quality of the food provided, as recommended by the Norwegian Directorate of Health.

Design: A cross-sectional study design, based on kindergarten pedagogical leaders’ answers to a web-based questionnaire.

Settings: Private and public kindergartens across Norway are included in this present study.

Participants: A total of 324 kindergarten staff attending on behalf of kindergartens participated.

Results: The food budget thresholds over NOK 199 are associated with higher quality of served food, in adherence to national guidelines of food and meals (odds ratio 5.2, CI = [1.5, 16.5]), compared to thresholds under 199 NOK. However, increasing the monthly food budget per child to low (200–299 NOK), medium (300–399 NOK), high (400–499 NOK), or very high (>500 NOK) levels did not lead to an improvement in food quality.

Conclusion: The main results reveal that budget plays a limited role in the quality of food and meals served as long as it is above ‘very low’ (199 NOK) food budget threshold. We assume that other contextual factors can influence the quality of food and meals in a more prominent role.

The effect of extra virgin olive oil on HSP27 expression in the cerebral cortex of male Rattus norvegicus middle cerebral artery occlusion model

Mon, 08 Jan 2024 13:19:50 -0800

Background: Ischemic stroke produces oxidative stress in neurons and neuroglial, triggering a cellular response with HSP27 as one of the markers. Extra virgin olive oil (EVOO) is reported to act as a neuroprotection by inhibiting reactive oxygen species, which can modulate HSP27.

Objective: To analyze the potential neuroprotection of EVOO containing 7-g MUFA on the expression of HSP27 in the cerebral cortex of Rattus norvegicus Wistar strain middle cerebral artery occlusion (MCAO) model.

Design: MCAO-Rattus norvegicus Wistar male rodents (n = 32), randomly divided into negative control (sham), positive control (P0), MCAO added EVOO 0.5 mL/kg body weight (P1), and MCAO added EVOO 2 mL/kg body weight (P2); the experiment was conducted 14 days. The nuclei of neurons, glial, and expression of HSP27 on the cerebral cortex were analyzed using Image J software, data were compared between groups with a significance level of P < 0.05.

Results: There were significant differences in the neuron and glia nuclei numbers between groups (P = 0.01). There was also a significant difference in cerebral cortex HSP27 expression between groups (P = 0.006).

Conclusion: There was a significant down-regulated of HSP27 in the cerebral cortex of the male Rattus norvegicus Wistar strain MCAO model given EVOO with 7 g of MUFA content at a dose of 0.5–2 mL/kgBW.

Legumes and pulses - a scoping review for Nordic Nutrition Recommendations 2023

Liv Elin Torheim, Lars T. Fadnes — Tue, 26 Mar 2024 00:00:00 -0700

Consumption of legumes and pulses is associated with various health outcomes. Therefore, when updating the Nordic Nutrition Recommendations (NNR), summarizing the best available evidence on key health outcomes regarded as relevant for the Nordic and Baltics related to the consumption of legumes was essential. The aim of this scoping review was to evaluate the updated evidence on the effect of the consumption of legumes and pulses on various health outcomes, as well as their dose-response relationship in updated systematic reviews and meta-analyses. The scoping review is built on a de novo systematic review published in 2023 and additional searches on the consumption of legumes and pulses and its various health outcomes, including cardiovascular disease (CVD), cancer, type 2 diabetes, and obesity. Current available evidence shows that the consumption of legumes and pulses is associated with a lower risk of several cancers (evidence: low-moderate), and lower all-cause mortality (evidence: moderate). The associations with CVDs are neutral or inverse, with studies generally showing favourable changes in biomarkers for CVDs. Legume consumption is associated with a lower risk of obesity (evidence: low). For type 2 diabetes, no association was found with incidence, but trials on consumption of legumes and pulses and biomarkers generally indicated protective effects. Overall, the current evidence supports dietary recommendations to increase the consumption of legumes and pulses.

Fats and oils - a scoping review for Nordic Nutrition Recommendations 2023

Fredrik Rosqvist, Sari Niinistö — Fri, 09 Feb 2024 00:00:00 -0800

This scoping review for the Nordic Nutrition Recommendations 2023 summarizes the available evidence on fats and oils from a food level perspective. A literature search for systematic reviews (SRs) and meta-analyses was conducted in PubMed. There are few SRs and meta-analyses available that investigate the association between fats and oils (food level) and health outcomes; the majority report associations at the nutrient level (fatty acid classes). All identified SRs and meta-analyses were of low methodological quality, thus the findings and conclusions presented within this scoping review should be interpreted cautiously. Based on this limited evidence, the following results were indicated: the intake of olive oil may be associated with reduced risk of cardiovascular disease (CVD), type 2 diabetes (T2D), and total mortality in prospective cohort studies. The intake of butter was not associated with the risk of CVD but may be related to slightly lower risk of T2D and higher risk of total mortality in prospective cohort studies. For cancer, the evidence is sparse and primarily based on case-control studies. The intake of olive oil may be associated with reduced risk of cancer, whereas the intake of butter may be associated with increased risk of certain cancer types. Butter increases LDL-cholesterol when compared to virtually all other fats and oils. Palm oil may increase LDL-cholesterol when compared to oils rich in MUFA or PUFA but may not have any effect on glucose or insulin. Coconut oil may increase LDL-cholesterol when compared to other plant oils but may decrease LDL-cholesterol when compared to animal fats rich in SFA. Canola/rapeseed oil may decrease LDL-cholesterol compared to olive oil, sunflower oil and sources of SFA and may also reduce body weight compared to other oils. Olive oil may decrease some inflammation markers but may not have a differential effect on LDL-cholesterol compared to other fats and oils. The effect on risk markers likely differs depending on the type/version of oil, for example, due to the presence of polyphenols, phytosterols and other minor components. Taken together, based on the available evidence, oils rich in unsaturated fat (e.g. olive oil, canola oil) are to be preferred over oils and fats rich in saturated fat (e.g. butter, tropical oils).

Iron – a background article for the Nordic Nutrition Recommendations 2023

Magnus Domellöf, Agneta Sjöberg — Thu, 08 Feb 2024 00:00:00 -0800

Iron absorption from foods is generally lower than that of most other nutrients and is highly variable depending on individual iron status and iron bioavailability in the meal. Several large population groups in the Nordic and Baltic countries are at risk of iron deficiency, including infants, young children, menstruating females, pregnant women as well as vegetarians. Iron deficiency leads to anemia, fatigue, and limited capacity for physical activity. Of particular concern is that iron deficiency anemia in young children is associated with impaired neurodevelopment. A comprehensive literature search has been performed and summarized. New factorial calculations have been performed considering iron losses, iron absorption and iron requirements in various population groups. Recent data on iron intakes and the prevalence of iron deficiency in the Nordic countries are presented. Average requirements and tentative recommended intakes are presented for 12 different population groups. Pregnant women and those with high menstrual blood losses should consume iron-rich food and undergo screening for iron deficiency. Infants should consume iron-rich complementary foods and cow’s milk should be avoided as a drink before 12 months of age and limited to < 500 mL/day in toddlers. Vegetarians should consume a diet including wholegrains, legumes, seeds, and green vegetables together with iron absorption enhancers. There is no evidence that iron intake per se increases the risk of cancer or diabetes. Iron absorption from foods is generally lower than that of most other nutrients and can vary between <2 and 50% depending on individual iron status and iron bioavailability in the meal.

Potassium – a scoping review for Nordic Nutrition Recommendations 2023

Ulla Toft, Nanna Louise Riis, Antti Jula — Wed, 07 Feb 2024 00:00:00 -0800

Potassium (K) is an essential mineral that is necessary for normal cell and membrane function and for maintaining both fluid balance and acid-base balance. Potassium is furthermore very important for normal excitation, for example in nerves and muscle. It is widely available in several food products, with the most important dietary sources being potatoes, fruits, vegetables, cereal and cereal products, milk and dairy products, and meat and meat products. Potassium deficiency and toxicity is rare in healthy people, but dietary potassium is associated with other health outcomes. Results from observational studies have shown that a potassium intake above 3500 mg/day (90 mmol/day) is associated with a reduced risk of stroke. Similarly, intervention studies provide evidence that this level of potassium intake has a beneficial effect on blood pressure, particularly among persons with hypertension and in persons with a high sodium intake (>4 g/day, equivalent to >10 g salt/day).

Nuts and seeds – a scoping review for Nordic Nutrition Recommendations 2023

Lars T. Fadnes, Rajiv Balakrishna — Wed, 07 Feb 2024 00:00:00 -0800

Background: Nuts and seeds have been part of diets in most of the world for millenniums, and they have also been consumed in the Nordic and Baltic countries for centuries. Consumption of nuts and seeds is linked with various health outcomes. Therefore, when updating the Nordic Nutrition Recommendations (NNR), summarizing the best evidence on key health outcomes from the consumption of nuts and seeds is essential.

Objectives: This study aims to evaluate the updated evidence on the consumption of nuts and seeds and health outcomes regarded relevant for the Nordic and Baltic countries, as well as their dose-response relationship presented in updated systematic reviews and meta-analyses.

Method: The scoping review is built on a de novo systematic review and an umbrella review published in 2022 on the consumption of nuts and seeds and its various health outcomes, including cardiovascular disease and diabetes.

Results: Intake of nuts and seeds is associated with a lower risk of cardiovascular diseases, with evidence assessed as probable. This conclusion is mirrored by evidence from trials on biomarkers for chronic diseases. An intake of a serving of nuts of 28–30 g/day compared to not eating nuts is estimated to translate into approximately 20% relative reduction in the risks of cardiovascular disease and premature deaths. For cancers, consumption of a serving of nuts is inversely associated with cancer mortality. However, for type 2 diabetes, there are mixed and inconclusive results. Additionally, there are inverse associations between nut consumption and respiratory and infectious disease mortality. Allergies for nuts are seen among 1–2% of the population.

Conclusion: Overall, the current evidence supports dietary recommendations to increase nut consumption to a serving of nuts and seeds per day for people without allergies to these foods.

Meat and meat products – a scoping review for Nordic Nutrition Recommendations 2023

Jelena Meinilä, Jyrki K. Virtanen — Wed, 21 Feb 2024 00:00:00 -0800

Meat is not only a source of several nutrients but also a proposed risk factor for several non-communicable diseases. Here, we describe the totality of evidence for the role of meat intake for chronic disease outcomes, discuss potential mechanistic pathways, knowledge gaps, and limitations of the literature. Use of the scoping review is based on a de novo systematic review (SR) and meta-analysis on the association between poultry intake and cardiovascular disease (CVD) and type 2 diabetes (T2D), qualified SRs (as defined in the Nordic Nutrition Recommendations 2023 project) on meat intake and cancer by the World Cancer Research Fund (WCRF), the International Agency for Research on Cancer (IARC), and a systematic literature search of SRs and meta-analyses. The quality of the SRs was evaluated using a modified AMSTAR 2 tool, and the strength of evidence was evaluated based on a predefined criteria developed by the WCRF. The quality of the SRs was on average critically low. Our findings indicate that the evidence is too limited for conclusions for most of the chronic disease outcomes. However, findings from qualified SRs indicate strong evidence that processed meat increases the risk of colorectal cancer and probable evidence that red meat (unprocessed, processed, or both) increases the risk. The evidence suggests that both unprocessed red meat and processed meat (also including processed poultry meat) are probable risk factors for CVD mortality and stroke, and that total red meat and processed meat are risk factors for CHD. We found no sufficient evidence suggesting that unprocessed red meat, processed red meat, total red meat, or processed meat (including red and white meat) would be protective of any chronic disease. There was also no sufficient evidence to conclude on protective effect of poultry on any chronic diseases; effects on the risk of CVD, stroke, and T2D, to any direction, were regarded as unlikely.

Alcohol – a scoping review for Nordic Nutrition Recommendations 2023

Dag Steinar Thelle, Morten Grønbæk — Mon, 01 Apr 2024 00:00:00 -0700

The objective of this scoping review is to evaluate the updated evidence on the consumption of alcohol and health outcomes regarded as relevant for the Nordic and Baltic countries, including cardiovascular disease, cancer, and all-cause mortality. It is based on the previous Nordic Nutrition Recommendations of 2012 and relevant papers published until 31 May 2021. Current evidence from mainly observational epidemiological studies suggests that regular, moderate alcohol consumption may confer protective effects against myocardial infarction (MI) and type 2 diabetes. Mendelian randomization analyses do not fully support these findings, possibly because these analyses may fail to identify low alcohol intake. For several cancers, it is not possible to set any safe limit. All-cause mortality is not increased with light to moderate alcohol intake in middle-aged and older adults who do not engage in binge drinking. Total abstinence is associated with the lowest risk of mortality in young adults. Observational studies on alcohol consumption are hampered by a number of inherent methodological issues such as ascertainment of alcohol intake, selection of appropriate exposure groups, and insufficient control of confounding variables, colliders, and mediators. It should also be emphasized that there is a socio-economic contribution to the alcohol-health axis with a stronger detrimental effect of alcohol in the lower social classes. The above issues contribute to the complexity of unravelling the causal web between alcohol, mediators, confounders, and health outcome.

Dietary patterns – a scoping review for Nordic Nutrition Recommendations 2023

Henna Vepsäläinen, Jaana Lindström — Wed, 07 Feb 2024 04:37:27 -0800

In Press/Preprint
This article has been accepted for publication and undergone full peer review. It is currently undergoing copyediting and typesetting. Although final publication galleys will be added at a later stage, the article is fully citable using the DOI number.

Background: A dietary pattern can be defined as the quantities, proportions, variety, or combination of foods and drinks typically consumed. The dietary pattern approach aims to place the emphasis on the total diet as a long-term health determinant, instead of focusing on separate foods and nutrients, which may interact or confound each other.

Aim: This scoping review describes the totality of evidence for the role of dietary patterns for health-related outcomes as a basis for setting and updating food-based dietary guidelines in the Nordic Nutrition Recommendations 2023 (NNR2023).

Methods: We used evidence from ten qualified systematic reviews identified by the NNR2023 project. No additional literature search was conducted.

Results: Strong or moderate evidence linked dietary patterns high in vegetables, fruits, whole grains, fish, low-fat dairy, and legumes and low in red and processed meats, sugar-sweetened beverages, sugary foods, and refined grains with beneficial health outcomes, such as reduced risk of cardiovascular disease, type 2 diabetes, obesity, cancer, bone health, and premature death. We also found limited evidence suggesting a relationship with the described dietary patterns in childhood and decreased risk of obesity and hypertension later in life. Most studies have been conducted among adult populations, and thus, there is a need for studies in certain subgroups, such as children and adolescents as well as the elderly.

Fish – a scoping review for Nordic Nutrition Recommendations 2023

Johanna E. Torfadóttir, Stine M. Ulven — Tue, 05 Mar 2024 00:00:00 -0800

The aim of this scoping review was to conduct evidence-based documentation between fish intake and health outcomes for food-based dietary guidelines (FBDGs) in the Nordic Nutrition Recommendations (NNR) 2023. For most health outcomes, the evidence for fish oil and n-3 long chain (LC) polyunsaturated fatty acids (PUFA) supplementation was included when examining evidence between fish intake and health. In this review, conclusions from qualified systematic reviews (qSR) approved by NNR2023 are included. In addition, conclusions of a de novo systematic reviews on the topic of n-3 LC-PUFA, asthma, and allergy are included. Finally, a systematic literature search was performed limited to systematic reviews and meta-analysis published between 2011 and September 2021. In total, 21 papers from the systematic literature search, four qSR, and eight reports were included addressing the association between fish intake, fish oil, and n-3 LC-PUFA supplementation on several health outcomes. These included cardiovascular disease (CVD), type 2 diabetes, cancers (colorectal, breast, and prostate), metabolic syndrome, obesity, mortality, cognition and mental health, pregnancy-related outcomes (preterm birth and birth weight), and outcomes specific for children (neurodevelopment, and risk of food allergies, and asthma). In addition, intermediate risk factors such as blood lipids, glucose, C-reactive protein, and blood pressure were reviewed. Based on current evidence, fish consumption can have beneficial effects to prevent coronary heart disease (CHD) and stroke incidence, and lower mortality from CVD, CHD, myocardial infarction (MI), and stroke, as well as total mortality risk. In addition, fish consumption is beneficial for preventing cognitive decline in adults (e.g. dementia and Alzheimer’s disease). Fish intake may also prevent metabolic syndrome, supported by an observed association between fish intake and reduction in plasma triglycerides and increase in high-density lipoprotein (HDL) cholesterol levels. Data from fish oil and n-3 LC-PUFA supplementation studies supports the conclusions on the effects of fish consumption on most of the health outcomes.

Meal patterns, including intermittent fasting – a scoping review for Nordic Nutrition Recommendations 2023

Mette Svendsen, Heléne Bertéus Forslund — Tue, 06 Feb 2024 07:00:19 -0800

Introduction: ‘Meal patterns’ refers to eating frequency, snacking, regularity, and timing. Here also including intermittent fasting. The effect of meal patterns on health is inconsistent and when updating the Nordic Nutrition Recommendations 2023 (NNR2023), summarizing the evidence is important.

Aims: To describe the evidence for the role of meal patterns on bodyweight, body composition, and cardiovascular risk factors (i.e. blood pressure and lipid- and glukose metabolism) in healthy people living with normal weight, overweight, or obesity in all age groups.

Methods: An initial search in PubMed found 481 reviews, of which 104 were identified based on titles. Of these, 47 were excluded based on title and abstracts. Of the remaining 57 reviews, 16 were included reporting search terms and inclusion/exclusion criteria. In addition, 8 reviews from reference list or known by authors were included. In total, 24 reviews were relevant. Cochrane Library was searched with no results.

Results: All reviews were rated low or critically low (AMSTAR 2). No consistent findings on eating frequency and body weight or composition were found in children/adolescents or adults. In snacking, mixed results were found, although among adults, some consistent results showed positive associations between snacking and body weight. In regularity, breakfast skipping showed mixed results in children/adolescents on body weight and composition. Among adults, randomized controlled trials on breakfast skipping showed a minor impact on improved weight loss. In prospective studies on timing, lower energy intake during late afternoon/evening was related to less body weight. Intermittent fasting reduced body weight but was not superior to continuous energy restrictions. Cardiovascular risk factors were assessed in a minority of the reviews, and despite some beneficial effects, the evidence was limited.

Conclusion: Given the overall low to critically low quality of the reviews, the evidence is limited and inconclusive. No consistent results providing evidence for setting recommendations for meal patterns were shown. In this regard, meal patterns may vary within the context of an energy balanced and nutritionally adequate diet.

Eggs – a scoping review for Nordic Nutrition Recommendations 2023

Jyrki K. Virtanen, Susanna C. Larsson — Tue, 06 Feb 2024 04:52:00 -0800

Cardiovascular diseases (CVD), type 2 diabetes (T2D), and cancer are a significant public health burden in the Nordic and Baltic countries. High intake of eggs, mainly due to its high cholesterol content, has been suggested to have adverse health effects. The purpose of this scoping review is to describe the evidence related to the impact of egg intake on health. A literature search identified 38 systematic reviews and meta-analyses on egg consumption in relation to health outcomes published between 2011 and 30 April 2022. Overall, current evidence from systematic reviews of randomized clinical trials indicates that higher egg intake may increase serum total cholesterol concentration and the ratio of low-density lipoprotein to high-density lipoprotein cholesterol, but with substantial heterogeneity in the response. However, recent evidence from observational studies does not provide strong support for a detrimental role of moderate egg consumption (up to one egg/day) on the risk of CVD, especially in the European studies. The overall evidence from observational studies indicates that egg consumption is not associated with increased risk of mortality or T2D in European study populations. There is also little support for a role of egg consumption in cancer development, although a weak association with higher risk of certain cancers has been found in some studies, mainly case–control studies. Again, no associations with cancer risk have been observed in European studies. Systematic reviews and meta-analyses of egg consumption in relation to other health-related outcomes are scarce. There are also limited data available on the associations between the consumption of more than one egg/day and risk of diseases. Based on the available evidence, one egg/day is unlikely to adversely affect overall disease risk.

Fruit juice – a scoping review for Nordic Nutrition Recommendations 2023

Magdalena Rosell, Christine Delisle Nyström — Tue, 06 Feb 2024 04:42:38 -0800

Fruit juice has a similar nutrient content as whole fruit and may in this respect be part of a healthy diet. However, a lower amount or lack of fibre and a higher concentration of sugars and energy could also contribute to less satiation and increase the risk of excess energy intake. The aim of this scoping review is to describe the overall evidence for the role of fruit juice as a basis for setting and updating food-based dietary guidelines in the Nordic Nutrition Recommendations 2023. PubMed was searched for systematic reviews and meta-analyses and evidence was extracted on relevant health outcomes. Current available evidence indicates that low to moderate consumption of fruit juice is not associated with an apparent risk of chronic diseases and may have protective effects on cardiovascular disease. The association between the intake of fruit juice and weight gain remains unclear and might be of concern for some groups of people. Overall, the evidence regarding health effects of fruit juice is limited.

Cereals and cereal products – a scoping review for Nordic Nutrition Recommendations 2023

Guri Skeie, Lars T. Fadnes — Wed, 14 Feb 2024 00:00:00 -0800

Cereals and cereal products have traditionally been staple foods in many countries including in the Nordics and Baltics. Cereals can be consumed with their entire grain kernel and are then referred to as whole grains or can be consumed after removal of the bran or germ and are then referred to as refined grains. The terms cereals and grains are often used interchangeably. In this scoping review, we examine the associations between intake of cereals and cereal products and major health outcomes to contribute to up-to-date food-based dietary guidelines for the Nordic and Baltic countries in the Nordic Nutrition Recommendations 2023 project. Five qualified systematic reviews that covered non-communicable diseases, mortality, and risk factors were identified, and a supplementary literature search was performed in the MEDLINE and Cochrane databases for more recent studies and other endpoints. Compared to other high-income countries, the Nordic populations have a high consumption of whole grain foods. In some of the countries, rye constitutes a substantial fraction of the cereal consumption. However, few studies are available for specific cereals, and most of the research has been performed in predominantly wheat-consuming populations. The evidence suggests clear dose–response associations between a high intake of whole grains and lower risks of cardiovascular disease, colorectal cancer, type 2 diabetes, and premature mortality. The lowest risks of morbidity and mortality were observed for 3–7 servings of whole grains per day, equivalent of 90–210 g/day (fresh weight or ready-to-eat whole grain products, such as oatmeal or whole grain rye bread). Evidence from randomized trials indicates that a high intake of whole grains is beneficial for reducing weight gain. There is less evidence for refined grains, but the available evidence does not seem to indicate similar beneficial associations as for whole grains. It is suggested that replacing refined grains with whole grains would improve several important health outcomes. Cereals are plant foods that can be grown in most of the Nordic and Baltic regions.

Sweets and other sugary foods – a scoping review for Nordic Nutrition Recommendations 2023

Henna Vepsäläinen, Emily Sonestedt — Tue, 06 Feb 2024 06:01:59 -0800

In Press
This article has been accepted for publication and undergone full peer review. It has gone through copyediting and typesetting but not yet final proofreading. Although final publication galleys will be added at a later stage, this article is fully citable using the DOI number.

Background: Sweets, chocolate, and sweet bakery products are generally high in energy and added sugar, whereas the levels of essential nutrients and fibre are low. According to sales statistics, the consumption of sweets and chocolate is high in the Nordic and Baltic countries. Objective: This scoping review describes the totality of evidence for the role of sweets and other sugary foods for health-related outcomes as a basis for setting and updating food-based dietary guidelines in the Nordic Nutrition Recommendations 2023 (NNR2023) project. Design: We conducted a literature search to identify systematic reviews published between 2011 and 2021. The literature search resulted in 756 papers, of which 12 were included in this scoping review as sources of evidence. We also used evidence from the European Food Safety Authority’s (EFSA) scientific opinion on tolerable upper intake level for dietary sugars published in 2022. Results: Most of the papers included from the search focused on chocolate or cocoa, which are rich in flavonoids. We found some evidence linking chocolate consumption with lower blood pressure, lower risk of type 2 diabetes, and improved insulin markers, but the evidence was ranked low or very low. The search did not identify systematic reviews investigating the associations between other sugary food consumption and health outcomes. In the EFSA review, conclusions were not drawn for other sugar sources than sugar-sweetened beverages. However, for fasting glucose, total cholesterol, HDL-cholesterol, fasting triglycerides, and uric acid, there was a statistically significant effect of high sugar intake from solid foods compared to low sugar intake. Conclusion: Because sweets, chocolate, and other sugary foods are high in energy and added sugar, and low in essential nutrients and fibers, it is reasonable to limit their consumption, which is reported high in the Nordic countries.

Milk and dairy products – a scoping review for Nordic Nutrition Recommendations 2023

Kirsten Holven, Emily Sonestedt — Tue, 06 Feb 2024 06:05:44 -0800

Introduction: Milk and dairy products are major sources of protein, calcium, and other micronutrients. Milk and dairy products contribute with approximately half of the total intake of saturated fat. Saturated fat is an important determinant of plasma total and low density lipoprotein (LDL)-cholesterol levels, and a causal relationship between high LDL-cholesterol and atherosclerotic cardiovascular disease has consistently been documented. Aim: The aim of this scoping review is to describe the evidence for the role of milk and dairy products for health-related outcomes as a basis for setting and updating food-based dietary guidelines. Methods: Two qualified systematic reviews were included (World Cancer Research Fund and a systematic review for the US Dietary Guidelines Advisory Committee 2020). In addition, systematic reviews published between January 2011 and January 2022 were considered, screened (555 records) and evaluated (159 records) for this review. Results: The systematic reviews suggest that milk or dairy consumption is not associated with increased risk of cardiovascular disease and dyslipidaemia. Current evidence suggests an inverse association with some cardiometabolic risk factors, such as total and low density lipoprotein (LDL) cholesterol, especially regarding fermented dairy products (i.e. yogurt and cheese). There was evidence of an association between intake of dairy products and reduced risk of colorectal cancer. An inverse association with intake of dairy and type 2 diabetes or markers of impaired glucose homeostasis were reported for some studies specifically for low-fat dairy, yogurt, and cheese. Conclusion: Most studies suggest that intake of milk or dairy is not associated with increased risk of cardiovascular risk and some suggestions of inverse association, especially with low-fat products and fermented dairy products, were found with respect to cardiovascular disease, type 2 diabetes, and colorectal cancer. Milk or dairy products are important dietary sources of calcium and iodine, and are fully compatible with a healthy dietary pattern.

Beverages – a scoping review for Nordic Nutrition Recommendations 2023

Emily Sonestedt, Marko Lukic — Tue, 02 Apr 2024 00:00:00 -0700

Background: Coffee, tea, sugar-sweetened beverages (SSBs), and low- and no-calorie sweetened beverages (LNCSBs) are generally frequently consumed in the Nordic and Baltic countries. These beverages have also been related to potential health effects. This scoping review describes the evidence for the role of coffee, tea, SSBs, and LNCSBs for health-related outcomes as a basis for setting and updating food-based dietary guidelines. We used evidence from several qualified systematic reviews (i.e. World Cancer Research Fund, US Dietary Guidelines Advisory Committee, European Food Safety Authority, and World Health Organization) and performed a search for additional systematic reviews. The evidence suggests that moderate coffee and tea consumption do not have long-term adverse health effects. The long-term favorable effects of coffee consumption are related to reduced risk of endometrial and liver cancer, type 2 diabetes, and cardiovascular deaths. However, results from randomized controlled trials (RCTs) suggest that coffee brews that are rich in diterpenes, such as boiled coffee, increase serum cholesterol concentrations. High caffeine intake in pregnancy is associated with higher risk of pregnancy loss, preterm birth, and low birth weight. High consumption of SSBs has been associated with increased risk of obesity, type 2 diabetes, hypertension, and cardiovascular disease, based on data from RCTs and prospective cohort studies. The consumption of LNCSBs may result in a small reduction in body weight in adults, likely mediated through the effect of reduced energy intake, but has neutral effects on other cardiometabolic risk markers using evidence from RCTs. However, evidence from observational studies indicates increased risk of cardiometabolic diseases among high LNCSB consumers. In conclusion, current evidence suggests that moderate coffee and tea consumption have no long-term adverse health effects. The evidence of beneficial effects of coffee consumption on liver and endometrial cancer risk, and some cardiovascular outcomes, comes from observational studies. High consumption of boiled coffee should be avoided due to negative effect on lipid profile. Pregnant women should not exceed the recommended daily dose of caffeine intake of 200 mg set by the European Food Safety Authority as a safe level for the fetus. High consumption of SSBs has consistently been associated with adverse health effects, which is mainly due to excess energy intake, and should be limited. The conflicting results from RCTs and observational studies regarding LNCSBs may be due to revere causation and should be explored further.

Environmental sustainability of food production and consumption in the Nordic and Baltic region - a scoping review for Nordic Nutrition Recommendations 2023

Tue, 06 Feb 2024 03:20:07 -0800

This scoping review examines environmental impacts related to food production and consumption in Nordic and Baltic countries. The overarching advice to all Nordic and Baltic countries, in line with the current body of scientific literature, is to shift to a more plant based dietary pattern and avoid food waste. Taking into account current consumption patterns, there is a high potential and necessity to shift food consumption across the countries to minimize its environmental impact. More specifically, a substantial reduction in meat and dairy consumption and increased consumption of legumes/pulses, whole grains, vegetables, fruits, nuts and seeds is suggested as a priority intervention. Reducing the environmental impacts of seafoods is also key and suggestions include a shift to seafoods with lower environmental impacts such as seaweed and bivalves. As part of the suggested transition to a more plant-based diet, the scope for increasing the provision of plant-based foods through increasing the cultivation of legumes/pulses, vegetables and grains and through feed-to-food shifts within the region should be explored.

Infant feeding—a scoping review for Nordic Nutrition Recommendations 2023

Agneta Hörnell, Hanna Lagström — Mon, 05 Feb 2024 07:56:57 -0800

The 2012 edition of the Nordic Nutrition Recommendations (NNR) included recommendations on breastfeeding, based on the most recent guidelines and recommendations from major national food and health authorities and organizations, systematic reviews, and some original research. For NNR 2023, the scope has been expanded and also includes formula feeding and the introduction of solid food. The main focus in this scoping review is on infants aged 0–12 months but also considers parts both before and beyond the first year, as the concept of ‘the first 1000 days’ emphasizes the importance of factors during pregnancy and the first 2 years of life for immediate and later health: physical as well as emotional and mental health. Breastmilk is the natural and sustainable way to feed an infant during the first months of life. Numerous studies have indicated immediate as well as long-term beneficial effects of breastfeeding on health for both the infant and the breastfeeding mother, and from a public health perspective, it is therefore important to protect, support, and promote breastfeeding. For full-term, normal weight infants, breastmilk is sufficient as the only form of nutrition for the first 6 months, except for vitamin D that needs to be given as supplement. The World Health Organization (WHO) and several other authoritative bodies therefore recommend exclusive breastfeeding during the first 6 months. Starting solids at about 6 months is necessary for both nutritional and developmental reasons. According to the European Food Safety Authority (EFSA) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), solid foods are safe to give from 4 months although exclusive breastfeeding until 6 months is the desirable goal. Breastfeeding can continue together with complementary foods as long as it is mutually desired by the mother and child. If breastfeeding is not enough or for some reason discontinued before the infant is 4 months of age, the infant should be fed infant formula, and, when possible, breastfeeding should be continued alongside the formula feeding. If the infant is 4 months or older, starting with solids together with continued breastfeeding and/or formula feeding is an option. Infant formulas have been developed for infants who are not breastfed or do not get enough breastmilk. Home-made formula should not be given.

Social and economic dimensions of food sustainability – a background paper for the Nordic Nutrition Recommendations

Peter Jackson, Lotte Holm — Mon, 05 Feb 2024 00:00:00 -0800

This review seeks to demonstrate how the social and economic dimensions of sustainability need to be considered alongside its environmental dimensions. This is particularly important when, as in the case of the Nordic Nutrition Recommendations (NNRs), policymakers are attempting to address the twin goals of health and sustainability. For a policy that might make good sense when seen in purely environmental terms, it might not prove sustainable in social and economic terms – if it is too costly, it exacerbates existing inequalities or has detrimental effects on public health. There are some ‘win-wins’ in the field of health and sustainability policy. However, difficult choices between competing policy options will occur, similar to those facing ordinary consumers in their everyday lives. Being clear about the way food is framed as an issue and how different framings shape policy outcomes is a useful way forward in addressing the inevitable trade-offs and compromises between competing objectives.

An overview of approaches for assessing the environmental sustainability of diets – a scoping review for Nordic Nutrition Recommendations 2023

Thu, 01 Feb 2024 04:46:52 -0800

Assessing the environmental impacts of food, food systems and diets is highly complex due to the multitude of processes involved, the uncertainty in assessment models, the variability in production systems and the large range of products available. No single assessment method alone can provide a complete evidence base. The increasing number of Life Cycle Assessment and food system analyses, and more recently the integration of planetary boundaries offer insights from which we can draw some robust high-level conclusions, whilst recognising there is a need for more detailed analysis to capture the inherent nuances of more location and context-specific situations.
Despite the complexity of assessing the environmental sustainability of food, diets and food systems, there are a number of key considerations that could be used to guide this process, and in doing so, they help to increase utility of the outcomes and limit unintended adverse consequences. We identified five key considerations that can be applied (consider the thresholds, consider the system, consider the variables, consider the context and consider the spillover) to ensure assessments are comprehensive.

Challenges and opportunities when moving food production and consumption toward sustainable diets in the Nordics: a scoping review for Nordic Nutrition Recommendations 2023

Mon, 15 Apr 2024 00:00:00 -0700

The terms ‘Nordic countries’ or ‘The Nordics’ include the five countries Denmark, Finland, Island, Norway, and Sweden. This review includes evaluation of the Nordic countries against Food and Agricultural Organisation (FAO)/World Health Organizations’ (WHO) guiding principles for healthy, sustainable diets with respect to environmental impact (principles #9 – #13) and sociocultural aspects (principles #14 – #16). A food systems perspective is taken to summarize and discuss the most important challenges and opportunities for achieving sustainable diets. Food system, food security, self-sufficiency, and resilience perspectives are applied. The information can underpin decisions when developing and implementing Food Based Dietary Guidelines (FBDG) in the Nordics.

None of the Nordic countries are on track to reach the 2030 UN climate and biodiversity goals. We describe how food production, processing, and consumption contribute to these and other environmental challenges, and what kinds of dietary changes/transitions consistent with these goals are required.

A major challenge is the high production and consumption of meat and too low consumption of fish, vegetables, and fruits. Meat production is a major source of emissions and, together with farmed fish, heavily dependent on imported feed ingredients, leaving a large land-use and water footprint in exporting countries while domestic land resources are not used optimally. Dietary patterns have changed drastically over the past 50 years, and in large parts of the population, meat consumption has doubled since the 1970s, rendering historic food culture less useful as a basis for present-day recommendations. The Nordics have Europe’s lowest use of antibiotics in animal and fish production and have made some progress in reducing food waste along the food chain. A major opportunity is better alignment of food production and consumption based on local or regional production potentials, in conjunction with better and more constructive integration with the global food system while integrating novel technologies to reduce emissions and resource use.

Sodium – a systematic review for Nordic Nutrition Recommendations 2023

Antti Jula — Wed, 31 Jan 2024 12:25:29 -0800

Blood pressure (BP) rises along with increasing sodium intake from early childhood to late adulthood, and leads to hypertension among most men and women living in Nordic and Baltic countries. Elevated BP is the leading global risk factor for premature deaths and disability-adjusted life-years. A reduction in sodium intake is essential in the prevention of hypertension in individuals, in the lowering of BP levels, in the treatment of hypertensive individuals, and in decreasing risks associated with elevated BP. There is a progressive linear dose-response relationship between sodium intake and BP beginning from a sodium intake of less than 0.8 g/day. Sodium reduction decreases BP linearly by a dose-response manner down to a sodium intake level of less than 2 g/day. Randomised intervention studies with a duration of at least 4 weeks confirm the efficiency and safety of reducing blood sodium intake to a level of less than 2 g/day. Results from prospective cohort studies show that higher sodium intake is positively associated with an increased risk of stroke and cardiovascular events and mortality among the general adult population, and the associations are linear in studies using proper sodium assessment methods. Analyses assessing sodium intake using at least two 24-h urine samples have shown a linear positive relationship between sodium intake and the risk of a cardiovascular event or death. Based on an overall evaluation of the available data, a limitation of the sodium intake to 2.0 g/day is suggested for adults. The optimal sodium intake level would be probably about 1.5 g/day. Sodium intake recommended for children can be extrapolated from the recommended sodium intake for adults. According to national dietary surveys, the average sodium intakes in Nordic countries range in adult men from 3.6 to 4.4 g/day and in adult women from 2.6. to 3.2 g/day, and in Baltic countries in men from 2.6 to 5.1 g/day and in women from 1.8 to 3.6 g/day.

Potatoes – a scoping review for Nordic Nutrition Recommendations 2023

Magdalena Rosell, Christine Delisle Nyström — Mon, 29 Jan 2024 13:24:08 -0800

Potatoes comprise a common staple food in the Nordic and Baltic countries and contribute to the diet with vitamins, minerals, dietary fibre and phytochemicals. However, potatoes may also be consumed in processed forms with added fat and salt, which raises concerns about possible adverse health effects. The aim of this scoping review is to describe the overall evidence for the role of potatoes as a basis for setting and updating food-based dietary guidelines in the Nordic Nutrition Recommendations 2023. PubMed was searched for systematic reviews and meta-analyses, and evidence was extracted on relevant health outcomes. Current available evidence indicates that moderate consumption of potatoes is not associated with a substantial risk of chronic diseases, and that they may be part of a healthy diet. However, the health effects vary greatly depending on cooking methods, and studies indicate that the intake of French fries/fried potatoes should be limited. Overall, the evidence regarding health effects of potatoes is very limited, and possible associations need to be further investigated.

Vegetables, fruits, and berries – a scoping review for Nordic Nutrition Recommendations 2023

Magdalena Rosell, Lars T. Fadnes — Fri, 26 Jan 2024 04:31:24 -0800

Vegetables, fruits, and berries comprise a large variety of foods and are recognised to play an important role in preventing chronic diseases. Many observational studies have been published during the last decade, and the aim of this scoping review is to describe the overall evidence for the role of vegetables, fruits, and berries for health-related outcomes as a basis for setting and updating food-based dietary guidelines. A scoping review was conducted according to the protocol developed within the Nordic Nutrition Recommendations 2023 project. Current available evidence strengthens the role of consuming vegetables, fruits, and berries in preventing chronic diseases. The most robust evidence is found for cancer in the gastric system and lung cancer, cardiovascular disease, and all-cause mortality. Steeper risk reductions are generally seen at the lower intake ranges, but further reductions have been seen for higher intakes for cardiovascular disease. Weaker associations are seen for type 2 diabetes. There is evidence that suggests a beneficial role also for outcomes such as osteoporosis, depression, cognitive disorders, and frailty in the elderly. The observed associations are supported by several mechanisms, indicting causal effects. Some subgroups of vegetables, fruits, and berries may have greater benefits than other subgroups, supporting a recommendation to consume a variety of these foods.

Manganese – a scoping review for Nordic Nutrition Recommendations 2023

Maria Kippler, Agneta Oskarsson — Tue, 16 Jan 2024 01:41:32 -0800

Manganese is an essential trace element that is required for multiple enzymes in the human body. The general population is mainly exposed to manganese via food intake, in particular plant foods. In areas with elevated concentrations of manganese in groundwater, drinking water can also be an important source of exposure. The gastrointestinal absorption of manganese is below 10%, and it appears to be influenced by the amount of manganese in the diet and by the nutritional status of the individual, especially the iron status. In blood, most of the manganese is found in the cellular fractions. Manganese is primarily eliminated via the bile followed by excretion via faeces. To date, no specific biomarkers of manganese intake have been identified. The dietary intake of manganese in the Nordic countries has been reported to be within the range that has been reported for other European countries (2–6 mg/day). Since manganese is found in nutritionally adequate amounts in food, deficiency is not of public health concern. On the other hand, there is emerging epidemiological evidence that various suggested manganese biomarkers may be negatively associated with children’s neurodevelopment. However, the limited number of prospective studies, the lack of appropriate exposure biomarkers, and validated neurodevelopmental outcomes render data uncertain and inconclusive. In 2013, the European Food Safety Authority considered the evidence to be insufficient to derive an average requirement or a population reference intake, and instead an adequate intake for adults was set at 3.0 mg/day.

Biotin: a scoping review for Nordic Nutrition Recommendations 2023

Beate Stokke Solvik, Tor A. Strand — Tue, 16 Jan 2024 01:51:21 -0800

Biotin is a water-soluble B-vitamin with key roles in metabolism and are found in most foods at low concentrations. Symptomatic biotin deficiency is rare, and few studies have investigated biotin requirements in relation to health outcomes. Data to support the setting of dietary reference values for biotin are limited.

Fat and fatty acids – a scoping review for Nordic Nutrition Recommendations 2023

Kjetil Retterstøl, Fredrik Rosqvist — Fri, 12 Jan 2024 06:16:28 -0800

Two de novo NNR2022 systematic reviews (SRs) as well as 21 qualified SRs (qSRs) were available. A literature search yielded an additional ~70 SRs, meta-analyses and biomarker papers. Diets lower in total fat are associated with reductions in body weight and blood pressure compared with diets higher in total fat in adults. Partial replacement of saturated fatty acid (SFA) with n-6 polyunsaturated fatty acid (PUFA) improves blood lipid profile, decreases the risk of cardiovascular disease (CVD), improves glucose-insulin homeostasis and may decrease the risk of total mortality. Long-chain n-3 PUFAs (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) decrease triglycerides and are associated with lower risk of CVD. Dietary PUFAs, both n-3 and n-6, may be associated with reduced risk of type 2 diabetes (T2D). There is inconclusive evidence to suggest that the type of dietary fat is associated with blood pressure, risk of hypertension or musculoskeletal health. Higher intake of total PUFA is associated with lower mortality from any cancer. Long-chain n-3 PUFA is associated with reduced risk of breast cancer, whereas biomarker levels of n-6 PUFA are associated with lower risk of any cancer. Intake of long-chain n-3 PUFA during pregnancy increases length of gestation and child birth weight and reduces the risk of preterm delivery, but there is inconclusive evidence to suggest that it may influence child neurodevelopment, growth or development of allergic disease. In studies with higher versus lower dietary cholesterol intake levels, total blood cholesterol increased or were unaffected by the dietary cholesterol, resulting in inconclusive results. Trans fatty acid (TFA), regardless of source, impairs blood lipid profile compared to unsaturated fat. In observational studies, TFA is positively associated with CVD and total mortality but whether associations differ by source is inconclusive. Ruminant TFA, as well as biomarker levels of odd-chain fatty acids, might be associated with lower risk of T2D.