Lene Frost Andersen

• Amberntsson, Anna; Paulsen, Mari Mohn; Bianchi, Marta Angela; Birgisdottir, Bryndis Eva; Biltoft-Jensen, Anja Pia & Konglevoll, Dina Moxness [Show all 9 contributors for this article] (2026). Exploring an energy-density adjustment to the Nutri-Score algorithm for general foods. European Journal of Nutrition. ISSN 1436-6207. 65(7). doi: 10.1007/s00394-026-04105-5. Full text in Research Archive Show summary

  Abstract Purpose: The Nutri-Score categorizes foods by nutritional value per 100 g or 100 ml, which may lead to poor discriminatory ability for products with low energy density and large portion sizes, like ready-to-eat meals. We hypothesized that adapting the Nutri-Score algorithm to account for variation in energy density could better capture nutritional quality, particularly in lower energy-dense foods like ready meals, without substantially affecting other food scores. The aim of this study was to perform a proof‑of‑concept evaluation of adapting the Nutri-Score algorithm for general foods to different levels of energy density. Methods: This study utilized the Norwegian food databases Tradesolution and Unil ( N  = 25,813) to compare the energy-adjusted algorithm with the Nutri-Score 2023. Results: The energy-adjusted Nutri-Score shifted food categorizations for 22% of products. Foods with low energy density, such as ready meals, showed increased scoring variation, indicating a more nuanced nutritional quality assessment, as intended. In these foods, we also saw a decline in favourable scores and an increase in unfavourable ones. However, high-energy-density food categories, like cakes and pastries, more often received more favourable scores. Also, the discriminatory ability between low-fat and full-fat products was reduced. Conclusion: While the energy-adjusted Nutri-Score improved scoring differentiation for certain low-energy-density foods, it showed unfavourable side-effects, indicating that overall, it is not superior to the Nutri-Score 2023. Nonetheless, adapting the algorithm to energy density offers potential for improved nutrient profiling methodologies in specific contexts. Further refinement of the weighting system could address observed weaknesses, optimizing this approach for broader application.

• Myhre, Jannicke Borch; Totland, Torunn Holm & Andersen, Lene Frost (2026). Validity of self-reported educational attainment collected as part of a telephone interview in a Norwegian dietary study. Journal of Public Health Research. ISSN 2279-9028. 15(3). doi: 10.1177/22799036261481566. Full text in Research Archive
• Amberntsson, Anna; Paulsen, Mari Mohn; Randby, Jorunn Sofie; Lund-Iversen, Kaja; Brantsæter, Anne Lise & Andersen, Lene Frost [Show all 7 contributors for this article] (2026). The potential of Nutri-Score to differentiate foods in regulating food marketing to children. European Journal of Nutrition. ISSN 1436-6207. 65(5). doi: 10.1007/s00394-026-04041-4. Full text in Research Archive Show summary

  Abstract Purpose: To evaluate the potential of Nutri-Score to identify foods unsuitable for marketing to children by assessing its agreement with two established nutrient profiling models: WHO-EURO 2023 and the Norwegian Regulation on Marketing (NORMA). Further, we explored the impact of additional criteria to improve agreement. Addition, we evaluated the agreement between a modified Nutri-Score, the «NewTools-score», and WHO-EURO 2023 and NORMA. Methods: Products from the Norwegian food composition table (N = 1,944) were used to explore scenarios for Nutri-Score (and NewTools-score) against WHO-EURO and NORMA. The scenarios were: 1) All products scoring C-E not permitted for marketing, 2) Same as scenario 1, but with additional criteria for trans fatty acids, non-sugar sweeteners (NSS), and added sugar for beverages. For NORMA, a third scenario was tested as an extension of scenario 2, additionally banning selected food categories from marketing. Agreement was assessed through cross classification. Results: Under scenario 1, 53% of products were classified as Nutri-Score C-E, and 47% and 23% not permitted for marketing under WHO-EURO and NORMA, respectively. Overall agreement between Nutri-Score C-E and WHO-EURO was 84%, and 66% with NORMA. However, Nutri-Score allowed some products within unhealthy food categories, e.g., ice creams with NSS. Applying additional criteria in scenarios 2 and 3 had important effects on banning such products. Results for the NewTools-score were almost identical. Conclusion: The Nutri-Score and the NewTools-score may be used for identifying a high proportion of products unsuitable for marketing to children. However, some additional criteria, including a complete ban from marketing in selected food categories, seems warranted to better protect children from exposure to marketing of unhealthy products.

• Amberntsson, Anna; Abel, Marianne Hope; Paulsen, Mari Mohn; Andersen, Lene Frost; Øyen, Jannike & Rosendahl-Riise, Hanne [Show all 7 contributors for this article] (2026). Diet quality and risk of using medication for hypertension up to 11 years after delivery: Testing the predictive validity of a proposed revision of the Nutri-Score and the current Nutri-Score in the NewTools project. British Journal of Nutrition. ISSN 0007-1145. doi: 10.1017/s0007114526107697. Full text in Research Archive Show summary

  The aim of this study was to investigate the predictive validity of a proposed revision of the Nutri-Score and the current Nutri-Score by investigating associations between the diet quality scores measured in mid-pregnancy and the risk of dispended prescription of medications for hypertension up to 11 years following delivery, and blood pressure mid-pregnancy. The study population (N=70,730) were participants in the Norwegian Mother, Father and Child Cohort Study. Food intake was assessed mid-pregnancy using a food frequency questionnaire. Nutritional scores for each food item were calculated based on content of energy, sugars, saturated fat, salt, fibre, protein, fruit, vegetables, and legumes. Diet quality scores were derived using energy-weighted means of nutritional scores. Anti-hypertensive medications were registered in the national prescription database. We estimated hazard ratios (HR) with 95% confidence intervals (95% CI) using Cox regression models. During a mean follow-up of 6 years, 4,736 (6.7%) women got dispended prescription of medications for hypertension. There was a non-linear association between diet quality and hypertension medication. Compared with the median diet quality score, poorer diet quality (90 th percentile of the score) was associated with higher risk of medications for hypertension (HR=1.08, 95% CI 1.02-1.14) and cross-sectional high diastolic blood pressure (odds ratio=1.18, 95% CI 1.03-1.32). Both diet quality scores yielded similar results overall. Poorer diet quality during pregnancy, assessed with a proposed version, and the current Nutri-Score, were associated with a higher risk of medications for hypertension, indicating its usefulness as a valuable tool for guiding consumers and improving public health.

• Severinsen, Frida; Varsi, Cecilie; Andersen, Lene Frost; Henriksen, Christine & Paulsen, Mari Mohn (2026). Implementation of Digital Seamless Nutrition Care throughout the Treatment Course for Patients with Head and Neck Cancer: A Process Evaluation. Current Developments in Nutrition (CDN). 10(4), p. 1–13. doi: 10.1016/j.cdnut.2026.107677. Full text in Research Archive Show summary

  Background Nutritional interventions may reduce the prevalence of malnutrition in patients with head and neck cancer; however, implementation often fails due to barriers at various levels. Process evaluations can provide an understanding of implementation outcomes, mechanisms of impact, and context and provide information about feasibility and acceptability. Objectives To perform a process evaluation of the Nutrition Throughout the Treatment Course (NUTREAT) intervention, including use of the MyFood app and web report. Specifically, we aimed to evaluate 1) the acceptability, adoption, appropriateness, feasibility, and fidelity of the intervention, 2) the implementation plan, and 3) patient adherence to the intervention. Methods A mixed methods approach was applied, including individual interviews, a focus group discussion, log data from electronic patient records (EPRs), an experience questionnaire, and information from the MyFood web report. Proctor’s implementation outcomes guided the development of the interview guide and analysis. Themes were deductively established using codebook thematic analysis. The implementation plan was evaluated through logs of completed activities. Log data from EPRs were collected to evaluate fidelity among healthcare professionals (HCPs), and information from the MyFood web report informed patient adherence to the intervention. Results Individual interviews were conducted with patients (n = 8), registered nurses (n = 3), and leaders (n = 2), and a focus group discussion was conducted with registered dietitians (n = 6). Patients, registered nurses, registered dietitians, and leaders found the intervention acceptable, appropriate, and feasible. Patient adherence was high, whereas fidelity among HCPs was low. Conclusions The NUTREAT intervention increased patients’ awareness of their own nutritional requirements and was considered helpful by HCPs in preparing for patient consultations. However, fidelity among HCPs was low. Future efforts should focus on identifying strategies to improve fidelity among HCPs and study the long-term sustainability of the intervention.

• Cabre, Hannah E; Marlatt, Kara L; Fernández-Verdejo, Rodrigo; Beyl, Robbie; Redman, Leanne M & Ainslie, Philip N [Show all 74 contributors for this article] (2026). Sex Differences in Measures of Energy Expenditure and Body Composition in Young, Middle-Aged, and Older Adults. Current Developments in Nutrition (CDN). 10(1). doi: 10.1016/j.cdnut.2025.107614. Full text in Research Archive Show summary

  Background Total daily energy expenditure (TDEE) is vital for energy balance and cardiometabolic health, yet its trajectory across the lifespan, particularly in females, remains poorly understood. Objectives We sought to examine the effects of aging and sex on body composition and TDEE. Methods In a cross-sectional analysis of data from research centers across 9 European Countries and the United States from the International Atomic Energy Agency database, TDEE and body composition measures of 2326 participants (1560W/766M; 50.7 ± 12 .6 y) were stratified across age groups: young (30–39 y; YOUNG), middle-aged (40–54 y; MID), and old (55–70 y; OLD). Doubly labeled water was used to estimate TDEE and fat-free mass (FFM). Fat mass (FM) was calculated as the difference between body mass and FFM, and %fat was ratio between FM and body mass as a percentage. Linear models were used for analysis. Results Females demonstrated greater FM and lower FFM with each age group, compared with males (P < 0.001). In females, OLD had lower absolute TDEE than YOUNG (−217 kcal/d, P < 0.001) and MID (−208 kcal/d, P < 0.001). Male absolute TDEE was lowered across all age groups (OLD compared with YOUNG: −334 kcal/d; OLD compared with MID: −210 kcal/d; MID compared with YOUNG: −124 kcal/d; P < 0.001). Adjusted TDEE was similar within age groups between females and males. Conclusions These results suggest that age influences changes in body composition and energy expenditure similarly between males and females. The most significant change in TDEE occurs as individuals transition from middle age to older adulthood. Females generally have a higher percentage of %fat and FM, along with lower FFM, compared with males across all age groups. These findings are important for understanding how aging affects metabolism and body composition, which could inform sex-specific health strategies and interventions.

• Kucuk, Bahar; Rylander, Charlotta; Carlsen, Monica Hauger; Lundblad, Marie Wasmuth; Andersen, Lene Frost & Skeie, Guri (2025). Environmental impact of food consumption and sociodemographic factors in Northern Norway through an intersectional lens: A cross-sectional study. BMC Public Health. 25, p. 1–15. doi: 10.1186/s12889-025-23899-3. Full text in Research Archive Show summary

  Abstract Background: Food systems contribute significantly to environmental degradation. The interplay of sociodemographic factors influences food choices and thus, the environmental impacts of diet. This study investigated the environmental impact of food consumption in Northern Norway, focusing on intersectional dynamics. Methods: A cross-sectional design was employed using data from the Tromsø Study. The diet was assessed using a food frequency questionnaire, and the environmental impacts of the diet were estimated for greenhouse gas emissions, water use, land use, acidification, and eutrophication using a Norwegian life cycle analysis food database. Multiple linear regression analyses were performed to examine the associations with sociodemographic variables using three-way interactions with sex, education, and income in an inter-categorical intersectionality framework. Pairwise contrasts were calculated to assess the mean differences between interacting groups. Results: The typical diet in Northern Norway substantially impacts the environment, with dairy products being the primary contributor. When controlling for energy intake, age was inversely linked to the environmental impact, whereas a higher body mass index corresponded to a greater environmental impact. No clear association with sex was observed, and the associations among environmental impact, education, and income varied. Including intersectional analyses did not significantly improve the explanatory power of the models. Although a few pairwise comparisons were statistically significant, the effect sizes were generally small. Conclusion: The study underscores the complex dynamics of dietary habits and sociodemographic factors in shaping the environmental impact of food consumption. The findings are important to develop approaches that balance sustainability perspectives and the diverse needs of the population in Northern Norway.

• Bjøntegaard, Marie Michaelsen; Paulsen, Mari Mohn; Oort, Bob Van & Andersen, Lene Frost (2025). Food procurement in upper secondary schools in a Norwegian county: nutritional quality and environmental impacts. Food & Nutrition Research (FNR). ISSN 1654-6628. 69, p. 1–11. doi: 10.29219/fnr.v69.12600. Full text in Research Archive Show summary

  Background: Public food procurement has the potential to play a significant role in transforming the food system. Objective: This study aimed to investigate the nutritional quality and environmental impacts of food procurement in public upper secondary schools within a large county in Norway. Design: A cross-sectional study with food procurement data from 35 upper secondary school canteens, analysed using a food-and-nutrient calculation system at the University of Oslo, which also includes a life cycle assessment (LCA) food database. Results: Food procurement amongst school canteens did not align with guidelines for food and meals in upper secondary schools and recommendations for nutritional considerations in public food procurement. There was considerable variability between the schools’ food procurement regarding nutritional quality and environmental impacts. However, on average, high levels of saturated fat and added sugar, as well as inadequate levels of folate, vitamin D, iron and iodine, were observed. Red meat and dairy products exhibited the most significant environmental impacts between the food groups. Discussion: Few studies have utilised food procurement data to evaluate nutritional quality and environmental impacts of school meals. Using food procurement instead of actual consumption data introduces some uncertainties, including limited knowledge about the amount of food waste, quantities actually consumed and demographics of the canteen users. Identifying key nutrients of concern can be invaluable in guiding meal planning and food procurement, especially in a school setting. Our environmental analysis supported current literature by illustrating the high impact of animal-based foods relative to plant-based foods. Conclusions: The present study found both nutritional and environmental limitations in food procurement in public upper secondary schools in a large Norwegian county. Encouraging procurement of plant-based proteins and sustainably sourced fish whilst reducing purchases of full-fat dairy products would better align with the guidelines for food and meals in schools and reduce the environmental impact. Moreover, significant variability in procurement practices that do not comply with the guidelines suggests a need for clearer guidance and follow-up.

• McGrosky, Amanda; Luke, Amy; Arab, Leonore; Bedu-Addo, Kweku; Bonomi, Alberto G. & Bovet, Pascal [Show all 98 contributors for this article] (2025). Energy expenditure and obesity across the economic spectrum. Proceedings of the National Academy of Sciences of the United States of America (PNAS). ISSN 0027-8424. 122(29). doi: 10.1073/pnas.2420902122. Full text in Research Archive Show summary

  Global economic development has been associated with an increased prevalence of obesity and related health problems. Increased caloric intake and reduced energy expenditure are both cited as development-related contributors to the obesity crisis, but their relative importance remains unresolved. Here, we examine energy expenditure and two measures of obesity (body fat percentage and body mass index, BMI) for 4,213 adults from 34 populations across six continents and a wide range of lifestyles and economies, including hunter-gatherer, pastoralist, farming, and industrialized populations. Economic development was positively associated with greater body mass, BMI, and body fat, but also with greater total, basal, and activity energy expenditure. Body size–adjusted total and basal energy expenditures both decreased approximately 6 to 11% with increasing economic development, but were highly variable among populations and did not correspond closely with lifestyle. Body size–adjusted total energy expenditure was negatively, but weakly, associated with measures of obesity, accounting for roughly one-tenth of the elevated body fat percentage and BMI associated with economic development. In contrast, estimated energy intake was greater in economically developed populations, and in populations with available data (n = 25), the percentage of ultraprocessed food in the diet was associated with body fat percentage, suggesting that dietary intake plays a far greater role than reduced energy expenditure in obesity related to economic development.

• Amberntsson, Anna; Heide, Emilie; Paulsen, Mari Mohn; Solberg, Siri Løvsjø; Løvhaug, Anne Lene & Andersen, Lene Frost [Show all 7 contributors for this article] (2025). The performance of Nutri-Score as a tool in guiding and evaluating nutritional quality of food procurements for high schools in Norway. Food & Nutrition Research (FNR). ISSN 1654-6628. 69. doi: 10.29219/fnr.v69.11483. Full text in Research Archive Show summary

  Background: The Norwegian Directorate of Health has issued school meal guidelines to advocate for the availability of healthy food options. However, awareness and adherence among school officials and canteen staff are low. Moreover, the broadly formulated guidelines complicate evaluation and selection of appropriate foods. Nutri-Score might be a potential tool for guiding and evaluating food procurements. Objective: We aimed to 1) examine agreement between the Nutri-Score and the school meal guidelines, 2) investigate the potential of using Nutri-Score to guide food procurements through proposing food-group-specific ranges, and 3) propose realistic goals for food purchases in value (money spent) for recommended and non-recommended foods based on Nutri-Score distribution in a sample of schools. Design: A list of all foods procured in all high school canteens in Viken County, Norway, from January 2021 to June 2023 was obtained. The Nutri-Score 2023 version was calculated on all products. Based on the school meal guidelines, foods had been classified into three categories by nutrition experts: foods recommended to be offered, foods recommended to be offered in limited amounts, and foods recommended not to be offered. Agreement and disagreement were assessed using boxplots and cross tables. Linear regression presented as scatter plots was used to investigate relevant goals for food purchases. Results: There was overall good agreement between the Nutri-Score and the Norwegian school meal guidelines. We propose that foods with Nutri-Score A and B can be recommended, but for some food groups, such as bread toppings, Nutri-Score C and D can also be recommended. A goal for food procurements could be minimum 65% of total value spent on products with Nutri-Score A or B and maximum 15% on products with Nutri-Score E (C-E for beverages). Conclusion: Nutri-Score could be an effective, complementary tool for guiding and evaluating food purchases in alignment with school meal guidelines

• Severinsen, Frida; Varsi, Cecilie; Andersen, Lene Frost; Henriksen, Christine & Paulsen, Mari Mohn (2025). Experiences with nutritional follow-up and barriers and opportunities of implementing digital seamless nutrition care in the head and neck cancer treatment course: a qualitative study from patient, family caregiver, and healthcare professional perspectives. BMC Health Services Research. 25(1). doi: 10.1186/s12913-025-13542-7. Full text in Research Archive Show summary

  Introduction Patients with head and neck cancer (HNC) are often malnourished. Despite evidence of beneficial effects of digital health interventions, challenges with implementation into clinical practice have been reported. Objective To investigate the implementation of a seamless nutrition care intervention into the HNC treatment course, this study aimed to (1) explore the experiences with current nutritional follow-up; and (2) identify potential barriers and opportunities associated with future implementation of the Nutrition Throughout the Treatment Course (NUTREAT) intervention. Methods This qualitative study involved semi-structured interviews with patients with HNC, family caregivers, and healthcare professionals (HCPs). The Consolidated Framework for Implementation Research (CFIR) guided the development of the interview guide and analysis. Inductive-deductive analyses were conducted. Results Interviews were conducted with patients (n = 7), family caregivers (n = 4), registered nurses (n = 5), and physicians (n = 2). Themes created to cover experiences with the current nutritional follow-up were: (1) Nutritional challenges; (2) Family caregiver support; and (3) Experience with current nutritional follow-up. Barriers and opportunities for implementing the NUTREAT intervention were analyzed within 20 constructs of CFIR. Patients were satisfied with nutritional follow-up, and spouses served as key emotional support, yet a need for closer monitoring post-treatment was identified. Exhaustion, advanced age, and dementia were potential barriers for implementing NUTREAT. Increased awareness of nutritional requirements for patients, and increased accessibility of dietary recordings for HCPs compared to current practices were opportunities. Conclusion Overall, patients and spouses were satisfied with the nutritional follow-up, though challenges were identified. The identified barriers and opportunities will inform the development of an implementation plan for an effectiveness- and implementation study.

• Lengle, Julie Marie; Zhang, Chi; Frigessi, Arnoldo & Andersen, Lene Frost (2025). Nutritionally adequate, healthy, and climate-friendly diets following the Nordic Nutrition Recommendations 2023: an optimization study for Norway. Frontiers in Nutrition. 12, p. 1–16. doi: 10.3389/fnut.2025.1485287. Full text in Research Archive Show summary

  Background: Reducing red meat consumption is an effective tactic for decreasing environmental impact of diets while maintaining nutritional adequacy, healthiness, and overall consumer acceptability. Still, dietary change in favor of plant foods is a controversial climate mitigation measure, especially in the Nordic region where agri-food heritage is linked to ruminant husbandry. Objective: In this study we aimed to explore sustainable diets for the Norwegian context by (1) investigating the environmental impacts of nutritionally optimized diets following the Nordic Nutrition Recommendations 2023 (NNR2023), (2) estimating potential for environmental impact reduction across scenarios of meat and legume consumption, and (3) identifying nutritional challenges. Methods: Quadratic optimization was employed to minimize departure from the average observed Norwegian diet while meeting nutrient, health, and carbon footprint constraints. The diet of Norwegian adults was estimated based on results from the national dietary survey Norkost 3. Global warming potential (GWP), freshwater and marine eutrophication, terrestrial acidification, water use, and transformation and use of land were calculated using data from the Norwegian Life Cycle Assessment Food Database version 01. Diets were optimized to meet NNR2023 nutrition and health recommendations for nutrients and food groups. Optimizations were first run without constraints on GWP, for three diet scenarios: (1) nutrients and health-based targets for food amounts ( NNR2023 ), (2) nutrients and health-based targets for food amounts with ruminant meat ≥ observed intake (62 g/day) ( Ruminant ), and (3) nutrients and health-based targets for food amounts with legumes content ≥40 g/day (Legumes). Then, GWP constraints were applied in 5% increments until no solution was found. The optimal diet for each scenario was defined as the diet with the largest feasible reduction in GWP (NNR2023+/Ruminant+/Legumes+). Results: Optimizing the diet to meet nutrient and health constraints alone resulted in a modest decrease in GWP (NNR2023); retaining ruminant meat consumption (Ruminant) impeded the reduction (−9% vs. 0%). Diets following NNR2023 nutrient and health constraints alone were feasible up until a 30% reduction in GWP (NNR2023+). A 35% reduction in GWP was achieved when legumes were added to the diet (Legumes+), while diets retaining 62 g of ruminant meat were not identified beyond a 15% reduction in GWP (Ruminant+). Sodium and selenium were the strongest limiting constraints in all scenarios. Diets with a 40% reduction in GWP were identified when nutrient constraints were lowered from the Recommended Intake to the Average Requirement (NNR2023+/Legumes+). Reductions in GWP coincided with reductions in all measured environmental indicators except marine eutrophication. Conclusion: The NNR2023 guidelines outline diets that have generally lower environmental impacts than the average Norwegian diet, though outcomes depend on distribution of meat and legume consumption in the diet. Regardless of degree of environmental impact reduction, diets following NNR2023 guidelines will require significant dietary changes compared to observed intake, including an increase in consumption of fruits, vegetables, and grains, and a strong decrease in consumption of red meat, total meat, and discretionary foods. Preventing the model from removing any ruminant meat from the diet limited GWP reduction to 15% and induced considerable changes in intake of other food groups, especially a decrease in other types of meat.

• Amberntsson, Anna; Paulsen, Mari Mohn; Bianchi, Marta Angela; Birgisdottir, Bryndis Eva; Biltoft-Jensen, Anja Pia & Konglevoll, Dina Moxness [Show all 10 contributors for this article] (2025). Improvements to the Nutri-Score to address challenges identified in a Nordic setting. Food & Nutrition Research (FNR). ISSN 1654-6628. 69. doi: 10.29219/fnr.v69.10914. Full text in Research Archive Show summary

  Background: Front-of-pack nutrition labelling is an important policy tool for public health. The Nutri-Score classifies foods according to nutritional quality from A (high quality) to E (low quality). We have previously identified inconsistencies between Nutri-Score and the Norwegian food-based dietary guidelines. The objective was to propose revisions to the Nutri-Score 2023 algorithms and determine if the revised algorithms better align with the Nordic Nutrition Recommendations 2023 (NNR2023) and the Keyhole label. Methods: Items in the Norwegian pre-packed foods databases Tradesolution (n = 26,033) and Unil (n = 577) were classified using the Nutri-Score 2023 algorithms. To address carbohydrate quality, a penalty for low-fibre content was introduced, and the sugar scale compressed. The protein cap was removed for fish products to reward their nutritional quality. To improve the scoring of high-fat foods, the scale for saturated fat was extended, fat content determined the inclusion in the algorithm for fats, rather than food categories, and favourable fat quality in oils was rewarded through a fat quality component. Data from the databases guided the identification of specific thresholds. The distribution of Nutri-Score was calculated before and after applying the revisions. Results: In total, 5.5% of all products received a less favourable Nutri-Score with the revised carbohydrate quality components. Most refined pastas and flour shifted shifted from A to B or C, whilst whole grain pasta largely remained A. Sugar-rich breakfast cereals shifted from B to C or D. For fish, 11% (1% of all products) were moved from D or E to C or D. The variation in scores for cheese and creams increased. Around 5% of all products were affected by the revisions related to fat quality. Conclusions: The proposed revisions make the Nutri-Score more coherent with the NNR2023 and the Keyhole label. The proposed revisions also hold relevance for other European countries and should therefore be considered in the next revision of the Nutri-Score.

• Carlsen, Monica Hauger; Bjøntegaard, Marie Michaelsen; Oort, Bob van; Jafarzadeh, Sepideh; Mehta, Shraddha & Wright, Ellen Cecilie [Show all 7 contributors for this article] (2025). Environmental impact of Norwegian food and beverages: compilation of a life cycle assessment food database. Food & Nutrition Research (FNR). ISSN 1654-6628. 69, p. 10645–10645. doi: 10.29219/fnr.v69.10645. Full text in Research Archive Show summary

  Background: Food production contributes to greenhouse gas emissions and pollution. Climate and environmental impacts from food production vary across geographical areas. To estimate these impacts of food and diets, country-specific data are needed. Objective: This project aimed to compile an environmental impact food database, including the impact categories (ICs) global warming potential, soil acidification, freshwater and saltwater eutrophication, water use and land use, representative of the Norwegian diet. Design: The compilation was based on literature searches for original life cycle assessment (LCA) studies on foods, including domestic and imported foods, which constitute the habitual diet in Norway. Food items of importance in the average Norwegian diet were identified based on the national dietary survey Norkost 3. The study’s generic system boundaries included impacts from farm to fork: production, processing, packaging, transportation, storage and food preparation at home. Conversion factors for edible portions were applied when relevant. When LCA data of a certain food were missing, data from foods with similar cultivation conditions and nutritional composition were used as proxies. Data from other LCA food databases were also used if original LCA studies were not identified, or the LCA studies found were evaluated as being of poor quality. Results: The compiled database is tailored specifically for and covers main animal- and plant-based foods in the Norwegian diet. Discussion: Limitations of the compilation project include the fact that most LCA studies identified in the present project covered ICs up to the farm gate and used varying methodology. Also, proxy values were used when data for specific food items were missing. These methodological issues introduce variability and complicate direct comparisons. The strength of the present study is the thorough work in compiling and filling data gaps for the IC values of foods in the Norwegian diet. Conclusions: The Norwegian LCA food database enables simultaneous estimation of food and nutrient intakes and estimation of climate and environmental impacts of Norwegian diets.

• Yitayew, Teferi Mekonnen; Gebremariam, Mekdes; Andersen, Lene Frost; Lien, Nanna; Brantsæter, Anne Lise & Coutinho, Sílvia [Show all 8 contributors for this article] (2025). The impact of hypothetical early life interventions on rapid weight gain during infancy and body mass index at 5 and 8 years in Norway: The Norwegian Mother, Father, and Child Cohort Study (MoBa). Pediatric Obesity. ISSN 2047-6302. 20(6). doi: 10.1111/ijpo.70008. Full text in Research Archive Show summary

  Objectives: This study examined the impact of hypothetical interventions on (i) early life factors (prenatal and early postnatal) on rapid weight gain during infancy, and (ii) early life factors and child energy balance-related behaviours (EBRB) on children's body mass index (BMI)-for-age at 5 and 8 years. Methods: Data from the Norwegian Mother, Father, and Child Cohort Study included participants aged 2 (n = 48 109), 5 (n = 18 810) and 8 (n = 10 830) years. Early life intervention variables were maternal smoking during pregnancy, maternal weight before and during pregnancy, exclusive/partial breastfeeding for 6 months, and introduction of complementary food at 6 months. Child EBRB intervention variables for the 5-year outcome included screen time, fruit and vegetable intake, and sugar-sweetened soft drink intake assessed at 3 years. For the 8-year outcome, interventions included screen time, presence of a television in the child's bedroom, sleep hours and breakfast intake assessed at 5 years. The parametric g-formula was used for analysis. Results and Conclusions: The average population-level difference in rapid weight gain during infancy at 2 years under the intervention targeting the prenatal, early postnatal factors and these factors combined with 95% confidence intervals were −0.012 (−0.017, −0.007), −0.009 (−0.012, −0.005) and −0.020 (−0.025, −0.015), respectively. The average population-level differences in children's BMI-for-age z-score for interventions targeting early life factors, child EBRB and these factors combined were −0.225 (−0.244, −0.207), 0.02 (−0.021, 0.024) and −0.223 (−0.249, −0.196), respectively among 5-year-olds and −0.265 (−0.295, −0.236), −0.020 (−0.029, −0.011) and −0.285 (−0.315, −0.256), respectively among 8-year-olds. Our results suggested joint interventions on early life factors may reduce childhood BMI-for-age z-scores.

• Paulsen, Mari Mohn; Holm, Lisa Bucher; Amberntsson, Anna; Abel, Marianne Hope & Andersen, Lene Frost (2025). Evaluation of Nutri-Score and NewTools-score in a Norwegian setting using a reference standard based on nutrition experts’ ranking of foods’ healthiness. Food & Nutrition Research (FNR). ISSN 1654-6628. 69, p. 1–13. doi: 10.29219/fnr.v69.11444. Full text in Research Archive Show summary

  Background: The Nutri-Score is a color-coded front-of-pack nutrition label that classifies foods and beverages from A (higher nutritional quality) to E (lower nutritional quality). The NewTools-score is an adaptation of the Nutri-Score 2023-version, modified to better align with the Nordic Nutrition Recommendations. Validating nutrient profiling models in different countries is crucial for their reliability and effectiveness in promoting healthier food choices and combating non-communicable diseases. Objective: This study aimed to assess the convergent validity of the Nutri-Score and the NewTools-score by evaluating their agreement with a reference standard based on rankings of foods’ healthiness by Norwegian nutrition experts. Additionally, we examined the consistency among these experts in rating foods’ healthiness representative of the Norwegian diet. Design: Between August and December 2023, 29 nutrition experts completed a web-based questionnaire, scoring 100 foods on a scale from 1 (less healthy) to 6 (very healthy) based on the Norwegian food-based dietary guidelines. Agreement among experts was evaluated using descriptive statistics and Cronbach’s alpha. We calculated both Nutri-Score and NewTools-score for all 100 foods and assessed their agreement with the reference standard through cross-classification and score distribution analyses. Results: The nutrition experts exhibited high agreement in their healthiness ratings of foods representative of the Norwegian diet. The Nutri-Score 2023-version showed good agreement with the experts for most foods, although discrepancies were observed for wholegrain and refined grains, fat content in dairy products, certain fish products, and plant-based dairy and meat substitutes. The NewTools-score displayed overall better agreement with the reference standard for several foods and with fewer discrepancies. Conclusions: Norwegian nutrition experts showed high agreement in rating the healthiness of foods representative of the Norwegian diet. While the Nutri-Score 2023-version aligned well with experts’ ratings, the NewTools-score demonstrated better agreement than Nutri-Score in this Norwegian context, despite some remaining discrepancies.

• Kristiansen, Anne Lene; Myhre, Jannicke Borch; Øyri, Linn Kristin Lie; Holven, Kirsten Bjørklund & Andersen, Lene Frost (2025). Vitamin D status in Norwegian children and associations between child vitamin D status, dietary factors, and maternal vitamin D status. Food & Nutrition Research (FNR). ISSN 1654-6628. 69. doi: 10.29219/fnr.v69.10727. Full text in Research Archive Show summary

  Background and aims: There is limited data regarding the vitamin D status of infants and young children in Norway. We aimed to assess vitamin D status among Norwegian children at approximately 6 and 12 months of age and explore associations between child vitamin D status, dietary factors, and maternal vitamin D status. Methods: Mothers/parents completed a food frequency questionnaire for their 6/12-month-old child. Dried blood spot samples were collected from the mother and child. Results: The mean serum 25-hydroxyvitamin D (S-25(OH)D) concentration was 81 nmol/L (standard deviation [SD] 22 nmol/L) for 6-month-old children (n = 84) and 72 nmol/L (SD 22 nmol/L) for 12-month-old children (n = 56) (P = 0.03 for difference between age groups). In the younger and older age groups, 94 and 88% of the children, respectively, had a S-25(OH)D concentration ≥ 50 nmol/L. The mean dietary vitamin D intake was 12 μg/day for the 6-month-olds and 14 μg/day for the 12-month-olds. Adjusted linear regression models showed that for every μg/day increase in dietary vitamin D intake, serum 25(OH)D (nmol/L) increased by around one nmol/L for both age groups (P = 0.002 for the younger age group and P = 0.04 for the older age group). Use of vitamin D supplements was associated with higher S-25(OH)D concentrations in both age groups, while a higher S-25(OH)D concentration among formula users was found only in the youngest age group. Breastfeeding was not associated with S-25(OH)D concentration in either age group. Small positive correlations between child and maternal vitamin D status were observed for both the younger (r = 0.22) and the older (r = 0.28) age groups (P = 0.04 for both groups). Conclusion: While there was a wide range in S-25(OH)D concentrations among children, most were within the sufficient range. Adequate vitamin D intake should be encouraged both in the first and second year of life.

• Lara-Castor, Laura; O’Hearn, Meghan; Cudhea, Frederick; Miller, Victoria; Shi, Peilin & Zhang, Jianyi [Show all 336 contributors for this article] (2025). Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries. Nature Medicine. ISSN 1078-8956. 31(2), p. 552–564. doi: 10.1038/s41591-024-03345-4. Full text in Research Archive Show summary

  The consumption of sugar-sweetened beverages (SSBs) is associated with type 2 diabetes (T2D) and cardiovascular diseases (CVD). However, an updated and comprehensive assessment of the global burden attributable to SSBs remains scarce. Here we estimated SSB-attributable T2D and CVD burdens across 184 countries in 1990 and 2020 globally, regionally and nationally, incorporating data from the Global Dietary Database, jointly stratified by age, sex, educational attainment and urbanicity. In 2020, 2.2 million (95% uncertainty interval 2.0–2.3) new T2D cases and 1.2 million (95% uncertainty interval 1.1–1.3) new CVD cases were attributable to SSBs worldwide, representing 9.8% and 3.1%, respectively, of all incident cases. Globally, proportional SSB-attributable burdens were higher among men versus women, younger versus older adults, higher- versus lower-educated adults, and adults in urban versus rural areas. By world region, the highest SSB-attributable percentage burdens were in Latin America and the Caribbean (T2D: 24.4%; CVD: 11.3%) and sub-Saharan Africa (T2D: 21.5%; CVD: 10.5%). From 1990 to 2020, the largest proportional increases in SSB-attributable incident T2D and CVD cases were in sub-Saharan Africa (+8.8% and +4.4%, respectively). Our study highlights the countries and subpopulations most affected by cardiometabolic disease associated with SSB consumption, assisting in shaping effective policies and interventions to reduce these burdens globally.

• Medin, Anine Christine; Andersen, Lene Frost; Fadnes, Lars Thore; Lillegaard, Inger Therese Laugsand; Madsen, Lise & Mangschou, Bente [Show all 12 contributors for this article] (2024). Beregning og vurdering av i hvilken grad høringsutkast til nye kostråd vil dekke behov og anbefalinger for næringsstoffer. VKM Report. 2024(6), p. 1–79. Full text in Research Archive Show summary

  Vitenskapskomiteen for mat og miljø (VKM) har vurdert om Helsedirektoratets høringsutkast til nye kostråd fra 22. mars dekker næringsstoffanbefalingene for voksne, inkludert gravide og ammende.' Oppdraget er gitt av Helsedirektoratet, som en del av arbeidet med å revidere kostrådene, og VKMs beregninger og vurderinger er basert på høringsutkastet. VKMs rapport med resultatene fra oppdraget publiseres samtidig som kostrådene. VKMs rapport og konklusjonerne som presenteres gjelder høringsutkast til kostråd, slik de forelå 22. mars 2024. Basert på VKMs arbeid, har Helsedirektoratet valgt å justere enkelte av kostrådene, slik at kritiske næringsstoffer vil dekkes bedre i de endelige kostrådene som ble publiseres 15. august, parallelt med publisering av VKMs rapport. Hovedkonklusjon fra VKMs rapport: VKM konkluderer at et kosthold i tråd med høringsutkastet til nye kostråd sannsynligvis kan være tilstrekkelig for å dekke næringsstoffanbefalingene for de fleste vitaminer og mineraler for de fleste voksne, med noen unntak. Vurderingen omfatter to scenarioer – lavt og høyt – basert på utkast til kostrådene. Disse to scenarioene representerer henholdsvis de laveste og høyeste mengdene av matvaregruppene som omfattes av utkastet til kostrådene; lavt kostrådsscenario og høyt kostrådsscenario. VKM har kun beregnet næringsinnholdet for maten fra mengdene i utkast til kostråd, ikke for det totale kostholdet. –Vi har vurdert om næringsinnholdet dekkes hvis man følger de foreslåtte kostrådene, slik de forelå i mars. Vi konkluderer med at å følge disse sannsynligvis kan være tilstrekkelig for å dekke næringsstoffanbefalingene for de fleste vitaminer og mineraler for de fleste voksne, hvis man spiser et kosthold basert på de høyeste mengdene av matvaregruppene i kostrådsutkastet, sier faglig leder Anine Medin, som har ledet VKMs arbeid. VKMs resultater viser at innholdet av de fleste beregnede vitaminer og mineraler synes å være tilstrekkelig for kvinner og menn i alle aldere ved et kosthold i tråd med høyt kostrådsscenario. Innholdet av vitamin D, kalsium (kun unge voksne), jern (kun kvinner i fertil alder), sink (kun menn) og selen vil imidlertid sannsynligvis kunne være for lavt for en mindre andel kvinner og menn ved et kosthold som tilsvarer høyt scenario. Beregningene viser at i et kosthold i tråd med lavt kostrådsscenario, ligger innholdet av flere næringsstoffer lavere enn i høyt scenario. Innholdet av riboflavin, kalsium, jern (kun kvinner i fertil alder), sink, jod og selen vil sannsynligvis kunne være for lavt for en betydelig andel kvinner og menn ved et kosthold som tilsvarer lavt scenario. Videre vil innholdet av vitamin D, vitamin B6, folat, kalium, og jern (kun menn) kunne være for lavt for en mindre andel kvinner og menn. Gravide og ammende står i en særstilling, fordi de har høyere behov for næringsstoffer enn den øvrige befolkningen. Slik er beregningene og vurderingene gjort VKM har laget to kostrådsscenarioer basert på mengder av ulike matvaregrupper, som er gitt i høringsutkastet eller som tilleggsinformasjon fra Helsedirektoratet underveis i arbeidet med rapporten. Eksempelvis inneholder det lave scenarioet 500 gram frukt og grønnsaker, mens det høye scenarioet inneholder 800 gram. Det lave scenarioet inneholder ikke egg, ost eller rødt kjøtt, mens høyt scenario inneholder ett egg om dagen, to osteskiver om dagen og 350 gram rødt kjøtt i uken. Begge scenarioene inneholder eksempelvis også 90 gram fullkorn per dag. Valget av matvarer fra matvaregruppene som er inkludert i scenarioene er basert på ordlyden i kostrådene, samt innsikt fra nasjonale kostholdsundersøkelser. For å vurdere sannsynligheten til om disse scenariene inneholder tilstrekkelig med næringsstoffer, har VKM vurdert dem opp mot næringsstoffanbefalingene.

• Slaathaug, Christine; Paulsen, Mari Mohn; Jafarzadeh, Sepideh; Carlsen, Monica Hauger & Andersen, Lene Frost (2024). Nutritional quality and climate impact of Norwegian adults’ diet classified according to the NOVA system. Nutrition Journal. 23(1), p. 1–12. doi: 10.1186/s12937-024-01066-5. Full text in Research Archive Show summary

  Information about how ultra-processed foods (UPF) contribute to the intake of energy and nutrients and environmental impact is important for future food policies and dietary recommendations. This study assessed the contribution of the four NOVA food groups, including UPF, to energy intake, nutritional quality, and climate impact in Norwegian adults' diet. We used dietary data from 348 participants in the Norkost 4 pilot study, collected through two non-consecutive 24-h dietary recalls. Foods, beverages, and dietary supplements were classified using the NOVA system. The NOVA system has four groups; NOVA 1: Unprocessed or minimally processed foods, NOVA 2: Processed culinary ingredients, NOVA 3: Processed foods, and NOVA 4: UPF. UPF contributed to 48% of the total energy intake, NOVA 3 with 19%, and NOVA 1 with 28%. Within UPF, bread contributed the most to energy intake. Foods in NOVA 1 had the highest nutrient density (expressed as amount of nutrients provided per unit of energy) for protein, fiber, and several essential micronutrients. UPF had the highest nutrient density for added sugar, fats, and sodium. UPF contributed to 32% of total GWP from the diet, while NOVA 1 contributed to 38%. In conclusion, UPF contributed to about half of the energy intake of Norwegian adults, and had lower nutritional quality compared to NOVA 1. UPF also accounted for about one-third of the GWP from the total diet. These findings emphasize the importance of addressing the intake of UPF in dietary policies and recommendations to improve nutritional quality and reduce environmental impact.

• Lengle, Julie Marie; Bjøntegaard, Marie Michaelsen; Carlsen, Monica Hauger; Jafarzadeh, Sepideh & Andersen, Lene Frost (2024). Environmental impact of Norwegian self-selected diets: comparing current intake with national dietary guidelines and EAT-Lancet targets. Public Health Nutrition (PHN). ISSN 1368-9800. 27(1). doi: 10.1017/S1368980024000715. Full text in Research Archive Show summary

  Objectives: Dietary environmental impact in a Norwegian adult population was estimated for six environmental impact categories. Moreover, environmental benefits of scenario diets complying with the Norwegian Food-Based Dietary Guidelines (FBDG) and the EAT-Lancet reference diet were assessed. Design: The current diet of Norwegian adults was estimated according to 24-h dietary recall data from a national dietary surveillance survey (Norkost 3). Scenario diets were modelled to represent the Norwegian FBDG and the EAT-Lancet healthy reference diet. Dietary environmental impact in terms of global warming potential, freshwater and marine eutrophication, terrestrial acidification, water use and transformation and use of land was estimated for the current and scenario diets using environmental impact data representative of the Norwegian market. Significant associations between impact and gender/educational attainment were assessed at P < 0·05. Setting: Norway. Participants: Adults (n=1787) aged 18–70 years who participated in the Norkost 3 survey (2010–2011). Results: Environmental impact varied significantly by gender and educational attainment. The food groups contributing most to environmental impact of Norwegian diets were meat, dairy, beverages, grains and composite dishes. Compared with the current Norwegian diet, the FBDG scenario reduced impacts from 2 % (freshwater eutrophication) to 32 % (water use), while the EAT-Lancet scenario reduced impacts from 7 % (marine eutrophication) to 61 % (land use). The EAT-Lancet scenario resulted in 3–48 % larger reductions in impact than the FBDG scenario. Conclusions: The Norwegian FBDG, while not as environmentally friendly as the EAT-Lancet reference diet, can still be an important tool in lessening environmental burden of Norwegian diets.

• Lara-Castor, Laura; Micha, Renata; Cudhea, Frederick; Miller, Victoria; Shi, Peilin & Zhang, Jianyi [Show all 50 contributors for this article] (2024). Intake of sugar sweetened beverages among children and adolescents in 185 countries between 1990 and 2018: population based study. The BMJ. 386(8438). doi: 10.1136/bmj-2024-079234. Full text in Research Archive Show summary

  Objective To quantify global intakes of sugar sweetened beverages (SSBs) and trends over time among children and adolescents. Design Population based study. Setting Global Dietary Database. Population Children and adolescents aged 3-19 years in 185 countries between 1990 and 2018, jointly stratified at subnational level by age, sex, parental education, and rural or urban residence. Results In 2018, mean global SSB intake was 3.6 (standardized serving=248 g (8 oz)) servings/week (1.3 (95% uncertainly interval 1.0 to 1.9) in south Asia to 9.1 (8.3 to 10.1) in Latin America and the Caribbean). SSB intakes were higher in older versus younger children and adolescents, those resident in urban versus rural areas, and those of parents with higher versus lower education. Between 1990 and 2018, mean global SSB intakes increased by 0.68 servings/week (22.9%), with the largest increases in sub-Saharan Africa (2.17 servings/week; 106%). Of 185 countries included in the analysis, 56 (30.3%) had a mean SSB intake of ≥7 servings/week, representing 238 million children and adolescents, or 10.4% of the global population of young people. Conclusion This study found that intakes of SSBs among children and adolescents aged 3-19 years in 185 countries increased by 23% from 1990 to 2018, parallel to the rise in prevalence of obesity among this population globally. SSB intakes showed large heterogeneity among children and adolescents worldwide and by age, parental level of education, and urbanicity. This research should help to inform policies to reduce SSB intake among young people, particularly those with larger intakes across all education levels in urban and rural areas in Latin America and the Caribbean, and the growing problem of SSBs for public health in sub-Saharan Africa.

• Daas, Merel Celine; Gebremariam, Mekdes; Poelman, Maartje P.; Andersen, Lene Frost; Klepp, Knut Inge & Bjelland, Mona [Show all 7 contributors for this article] (2024). Mediators and Moderators of the Effects of a School-based Intervention on Adolescents' Fruit and Vegetable Consumption: The HEIA Study. Public Health Nutrition (PHN). ISSN 1368-9800. 27(1). doi: 10.1017/S1368980024000260. Full text in Research Archive Show summary

  Objective: To examine whether targeted determinants mediated the effects of the HEalth In Adolescents (HEIA) intervention on fruit and vegetable (FV) consumption and explore if these mediating effects were moderated by sex, parental education or weight status. Design: Cluster-randomised controlled trial. Setting: The HEIA study (2007–2009) was a Norwegian 20-month multi-component school-based intervention to promote healthy weight development. FV consumption and targeted determinants were self-reported at baseline, mid-way (8 months) and post-intervention (20 months). Participants: Adolescents (11–13-year-old) in twenty-five control schools (n 746) and twelve intervention schools (n 375). Results: At post-intervention, more adolescents in the intervention group compared with the control group had knowledge of the FV recommendations (OR: 1·4, 95 % CI 1·1, 1·9) and reported a decreased availability of vegetables at home (β: –0·1, 95 % CI –0·2, 0·0). Availability/accessibility of FV at home, availability of vegetables at dinner, taste preferences for different types of FV and knowledge of the FV recommendations were positively associated with the consumption of FV. However, none of the post-intervention determinants significantly mediated the intervention effects on FV consumption. Although no moderating influences by sex, parental education or weights status were observed on the mediating effects, exploratory analyses revealed significant moderations in the b-paths. Conclusions: Since none of the targeted determinants could explain the increase in FV consumption, it remains unclear why the intervention was effective. Reporting on a wide range of mediators and moderators in school-based interventions is needed to reveal the pathways through which intervention effects are achieved.

• Uchai, Shreeshti; Andersen, Lene Frost; Thoresen, Magne; Hopstock, Laila Arnesdatter & Hjartåker, Anette (2024). Does the association between adiposity measures and pre-frailty among older adults vary by social position? Findings from the Tromsø study 2015/2016. BMC Public Health. 24(1). doi: 10.1186/s12889-024-18939-3. Full text in Research Archive Show summary

  Introduction - Pre-frailty provides an ideal opportunity to prevent physical frailty and promote healthy ageing. Excess adiposity has been associated with an increased risk of pre-frailty, but limited studies have explored whether the association between adiposity measures and pre-frailty varies by social position.<p> <p>Methods - We used data from the seventh survey of the Tromsø Study (Tromsø7) conducted in 2015–2016. Our primary sample consisted of 2,945 women and 2,794 men aged ≥ 65 years. Pre-frailty was defined as the presence of one or two of the five frailty components: low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity. Adiposity was defined by body mass index (BMI), waist circumference (WC), fat mass index (FMI) and visceral adipose tissue (VAT) mass. Education and subjective social position were used as measures of social position. Poisson regression with robust variance was used to assess the association between adiposity measures and pre-frailty, and the interaction term between adiposity measures and social position measures were utilised to explore whether the association varied by social position.<p> <p>Results - In our sample, 28.7% of women and 25.5% of men were pre-frail. We found sub-multiplicative interaction of BMI-defined obesity with education in women and subjective social position in men with respect to development of pre-frailty. No other adiposity measures showed significant variation by education or subjective social position. Regardless of the levels of education or subjective social position, participants with excess adiposity (high BMI, high WC, high FMI and high VAT mass) had a higher risk of pre-frailty compared to those with low adiposity.<p> <p>Conclusion - We consistently observed that women and men with excess adiposity had a greater risk of pre-frailty than those with low adiposity, with only slight variation by social position. These results emphasize the importance of preventing excess adiposity to promote healthy ageing and prevent frailty among all older adults across social strata.

• Paulsen, Mari Mohn; Øvrebø, Bente; Løvhaug, Anne Lene; Lund-Iversen, Kaja; Andersen, Lene Frost & Helleve, Arnfinn [Show all 7 contributors for this article] (2024). Responses to the updated Nutri-Score algorithms in Norway: A qualitative study among food system actors in the NewTools-project. Food & Nutrition Research (FNR). ISSN 1654-6628. 68. doi: 10.29219/fnr.v68.10254. Full text in Research Archive Show summary

  Background: Nutri-Score is a front-of-pack label grading foods and beverages from A to E indicating nutri- tional quality based on the foods’ favorable and unfavorable components, and a contender in the ongoing debate on the possible implementation of a harmonized mandatory front-of-pack nutrition label in the European Union. NewTools is a research project on scoring systems for foods involving 28 partners represent- ing actors involved in the Norwegian food system. Objective: This study aimed to explore views reported by Norwegian food system actors on the advantages and disadvantages with the updated Nutri-Score algorithms for food and beverages (2022–2023). This included Nutri-Score’s performance in ranking foods according to the national food-based dietary guidelines and to the nutritional challenges in Norway. Design: A total of 28 project partners and 15 other food system stakeholders following the NewTools-project were invited to provide responses on the Nutri-Score algorithms and their application on foods and beverages in the Norwegian food composition table. Thirteen written responses were received and analyzed with quali- tative content analysis. Results: The responses to the updated Nutri-Score varied in content, reflecting mainly concerns. Examples of perceived concerns included excessive penalty of salt content; insufficient differentiation based on fat content in meat, sausages, cheese, and milk; and several unreasonable comparisons across food categories. They also expressed a concern that Nutri-Score may stimulate to increased food processing, and some reported inconsis- tencies between Nutri-Score’s classification of foods and national nutrition guidelines and policies. Discussion and conclusion: Several concerns with the updated Nutri-Score algorithms were raised, including the weighting of specific nutrients, unfair outcomes when comparing across food categories, and inconsis- tencies with established Norwegian nutrition guidelines and policies. The results should be interpreted with caution, as some perspectives from the Norwegian food system may be missing.

• Konglevoll, Dina Moxness; Andersen, Lene Frost; Thoresen, Magne; Totland, Torunn Holm; Hopstock, Laila Arnesdatter & Hjartåker, Anette [Show all 7 contributors for this article] (2024). Dietary trajectories over 21 years and frailty in Norwegian older adults: the Tromsø Study 1994–2016. European Journal of Nutrition. ISSN 1436-6207. 63, p. 2987–2998. doi: 10.1007/s00394-024-03482-z. Full text in Research Archive Show summary

  Purpose To investigate the association between five dietary trajectories over 21 years and frailty in Norwegian older adults.<p> <p>Methods This study used data from three surveys of the Tromsø Study. Diet was measured using food frequency questionnaires at baseline (Tromsø4, 1994–95), after 7 years (Tromsø5, 2001) and at the end of follow-up (Tromsø7, 2015–16). Survey-specific diet scores were constructed based on the Nordic Nutrition Recommendations 2023 and group-based trajectory modelling was used to derive dietary trajectories. At follow-up, frailty was assessed with a 41-item frailty index. Linear regression analysis was performed to assess the associations between dietary trajectories and frailty, adjusted for baseline variables. <p>Results Among the 715 participants, 55% were women, with an average age of 54 years at baseline and 74 years at followup. The dietary trajectories ‘moderately healthy’ and ‘healthy increase’ were associated with a lower frailty index score at follow-up (β = −0.02, 95% confidence interval (CI)=−0.04, −0.002, β = −0.03, 95% CI=−0.06, −0.007), compared with the ‘unhealthy’ trajectory. <p>Conclusion Our findings suggest that maintaining a moderately healthy to very healthy diet from mid-life into older age is associated with a lower risk of frailty and supports the promotion of a healthy diet from adulthood to facilitate healthy ageing.

• Varsi, Cecilie; Andersen, Lene Frost; Koksvik, Gunhild Tellebon; Severinsen, Frida & Paulsen, Mari Mohn (2023). Intervention-related, contextual and personal factors affecting the implementation of an evidence-based digital system for prevention and treatment of malnutrition in elderly institutionalized patients: a qualitative study. BMC Health Services Research. 23(1), p. 1–12. doi: 10.1186/s12913-023-09227-8. Full text in Research Archive Show summary

  Background: Malnutrition in elderly institutionalized patients is a significant challenge associated with adverse health outcomes. The ‘MyFood’ decision support system was designed to prevent and treat malnutrition and has previously been studied in a hospital setting. The aim of this study was to explore the experiences of nursing staff regarding the implementation of MyFood in settings treating elderly patients. Methods: The study was conducted in two settings treating elderly patients in Norway. Nursing staff received training in how to follow-up patients with MyFood. Qualitative interviews were conducted with 12 nursing staff. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data collection and the thematic data analysis. Results: The implementation of a digital decision support system to prevent and treat malnutrition into settings treating elderly patients was found to be affected by intervention-related, contextual, and personal factors. Although nursing staff experienced several advantages, the leadership engagement was low and hampered the implementation. Conclusion: Nursing staff experienced several advantages with implementing a digital decision support system for the prevention and treatment of malnutrition in institutionalized elderly patients, including quality improvements and time savings. The results indicate that the leadership engagement was weak and that some nursing staff experienced low self-efficacy in digital competence. Future improvements include increasing the level of training, using MyFood throughout the patient course and involving the patient’s next-of-kin.

• Yitayew, Teferi Mekonnen; Papadopoulou, Eleni Zoumpoulia; Lien, Nanna; Andersen, Lene Frost; Pinho, Maria Gabriela Matias & Havdal, Hanne Hennig [Show all 8 contributors for this article] (2023). Mediators of parental educational differences in the intake of carbonated sugar-sweetened soft drinks among adolescents, and the moderating role of neighbourhood income. Nutrition Journal. 22(1). doi: 10.1186/s12937-023-00872-7. Full text in Research Archive Show summary

  Background: Existing evidence suggests that the intake of sugar-sweetened beverages (SSB) among adolescents remains a public health concern and that socioeconomic differences in intake exist. Tackling these challenges requires identifying the factors associated with SSB intake and the mediators of socioeconomic differences in SSB intake among adolescents. Thus, this study aimed to explore (i) factors at different levels of the ecological model associated with the intake of carbonated soft drinks with added sugar (hereafter called soft drinks), (ii) mediators of the association between parental education and the intake of soft drinks(iii) whether neighbourhood income moderates the indirect effect of parental education on adolescents’ soft drink intake through potential mediators. Methods: Data from 826 7th graders in Oslo, Norway, who participated in the TACKLE cross-sectional study conducted in 2020 were used. The association between factors at the individual, interpersonal and neighbourhood food environment levels and the intake of soft drinks among adolescents was assessed, as well as the mediating roles of these factors for the differences in intake by parental education, using multiple logistic regression and mediation analysis, respectively. Moderated mediation analyses were used to explore whether an indirect effect of parental education on adolescents' soft drink intake through potential mediators varies across neighbourhood income areas. Results: Higher perceived accessibility of SSB at home, increased parental modelling for SSB intake, and increased frequency of food/drink purchased from the neighbourhood store were associated with a higher intake of soft drinks among adolescents and mediated the differences in intake by parental education. Neighbourhood food environment factors were neither statistically significantly associated with adolescents’ higher intake of soft drinks nor explained the differences in intake by parental education. Moderated mediation analysis showed that the mediating effect of perceived accessibility of SSB at home on the association between parental education and adolescent soft drink intake was stronger among those living in low neighbourhood income. Conclusions: Our study identified modifiable factors at the intrapersonal level (perceived accessibility of SSB at home and frequency of food/drink purchased from neighbourhood shops) and interpersonal levels (parental modelling for SSB intake) associated with a higher intake of soft drinks among adolescents and mediated the differences in the intake by parental education. The modifiable factors identified in this study could be targeted in public health initiatives among adolescents aimed at reducing the intake of soft drinks and the related differences by parental education.

• Bodin, Johanna Eva; Aakre, Inger; Alexander, Jan; Mangschou, Bente; Parr, Christine Louise & Andersen, Lene Frost [Show all 15 contributors for this article] (2023). Risk assessment of hyaluronic acid in food supplements. VKM Report. 13, p. 1–70. Full text in Research Archive Show summary

  Hyaluronic acid (HA) is a high-molecular-mass polysaccharide, that is endogenously produced and present in connective tissue, synovial fluid, intraoccular fluid, and skin. The basic unit of the HA polymer consists of D-glucuronic acid and N-acetyl-D-glucosamine. The Norwegian Food Safety Authority has requested VKM to evaluate the risk of adverse effects related to daily intake of food supplements with 150 mg, 120 mg, 64 mg, and 48 mg HA. Exposure from other sources of HA (food, cosmetics, and different medical applications) is not estimated.

• Øvrebø, Bente; Brantsæter, Anne Lise; Lund-Iversen, Kaja; Andersen, Lene Frost; Paulsen, Mari Mohn & Abel, Marianne Hope (2023). How does the updated Nutri-Score discriminate and classify the nutritional quality of foods in a Norwegian setting? International Journal of Behavioral Nutrition and Physical Activity. 20. doi: 10.1186/s12966-023-01525-y. Full text in Research Archive Show summary

  Background The Nutri-Score is a candidate for the harmonized mandatory front-of-pack nutrition label enabling consumers in the European Union to make healthier food choices. Nutri-Score classifies foods (including beverages) from A (high nutritional quality) to E (low nutritional quality) based on the foods’ qualifying and disqualifying components. We aimed to evaluate the updated Nutri-Score for foods (2022) and beverages (2023) in a Norwegian setting by exploring its ability to discriminate the nutritional quality of foods within categories. Additionally, we assessed Nutri-Scores’ ability to classify foods in accordance with the Norwegian food-based dietary guidelines (FBDGs). Methods The updated Nutri-Score was calculated for 1,782 foods in a Norwegian food database. The discriminatory ability of the updated Nutri-Score was considered by exploring the distribution of Nutri-Score within categories of foods using boxplots and frequency tables, and by examining which qualifying and disqualifying components that contributed most to the Nutri-Score class. Accordance with the Norwegian FBDGs was assessed by exploring Nutri-Score for foods specifically mentioned in the guidelines. Results Overall, the updated Nutri-Score seemed to discriminate the nutritional quality of foods within categories, in a Norwegian setting. The foods’ content of salt and the beverages’ content of sugar were components contributing the most to Nutri-Scores’ discriminatory ability. Furthermore, in most cases the updated Nutri-Score classified foods in accordance with the Norwegian FBDGs. However, there were minor inconsistencies in how Nutri-Score classified certain foods, such as the inabilities to discriminate between full-fat and low-fat/leaner cheeses, cremes and processed meats (sausages), and between whole grain and refined pasta/rice. Conclusions We observed an overall acceptable discriminatory performance of the updated Nutri-Score in a Norwegian setting and in most cases the updated Nutri-Score classified foods in accordance with the Norwegian FBDGs. However, minor inconsistencies were observed. Together with the FBDGs, the updated Nutri-Score could be a useful tool in guiding consumers towards healthier food choices in Norway, but consumer evaluations are warranted to fully assess the performance of the updated Nutri-Score in a Norwegian context.

• Paulsen, Mari Mohn; Myhre, Jannicke Borch; Totland, Torunn Holm & Andersen, Lene Frost (2023). Discretionary foods and drinks in Norwegian children and adolescents' diet: Data from the national dietary survey Ungkost 3. Public Health Nutrition (PHN). ISSN 1368-9800. 26(12), p. 2629–2640. doi: 10.1017/S1368980023001982. Full text in Research Archive Show summary

  Objective: This study aimed to identify the amount of discretionary foods and drinks consumed by Norwegian children and adolescents, describe how such products contribute to the intake of total energy and nutrients, and study the distribution in intake of discretionary foods and drinks across different meals. Secondly, the aim was to explore factors associated with those children and adolescents having the highest consumption of discretionary foods and drinks. Design: Secondary analysis of data from a national survey of dietary intake among Norwegian children and adolescents. Setting: Schools in fifty randomly selected municipalities in Norway. Participants: The study population included 636 pupils in 4th grade (9–11 years) and 687 pupils in 8th grade (12–14 years). Results: Discretionary foods and drinks contributed to about 20 % of the children and adolescents’ total energy intake. These products contributed to about two-thirds of the participants’ intake of added sugar, and limited amounts of dietary fibre, vitamins and minerals. The quartile which had the lowest proportion of their energy intake from discretionary foods and drinks seemed to have a higher intake of whole grains, and fish and seafood. Conclusions: Almost all 4th and 8th graders in Norway consumed discretionary foods and drinks, and these products contributed to a substantial proportion of the total energy intake and limited amounts of nutrients. Those children and adolescents consuming the least discretionary foods and drinks had a higher intake of whole grains, fish and seafood, indicating healthier and more sustainable food habits.

• Severinsen, Frida; Andersen, Lene Frost & Paulsen, Mari Mohn (2023). The Use of a Decision Support System (MyFood) to Assess Dietary Intake Among Free-Living Older Adults in Norway: Evaluation Study. JMIR mhealth and uhealth. 11. doi: 10.2196/45079. Full text in Research Archive Show summary

  Background The proportion of older adults in the world is constantly increasing, and malnutrition is a common challenge among the older adults aged ≥65 years. This poses a need for better tools to prevent, assess, and treat malnutrition among older adults. MyFood is a decision support system developed with the intention to prevent and treat malnutrition. Objective This study aimed to evaluate the ability of the MyFood app to estimate the intake of energy, protein, fluids, and food and beverage items among free-living older adults aged ≥65 years, primarily at an individual level and secondarily at a group level. In addition, the aim was to measure the experiences of free-living older adults using the app. Methods Participants were instructed to record their dietary intake in the MyFood app for 4 consecutive days. In addition, each participant completed two 24-hour recalls, which were used as a reference method to evaluate the dietary assessment function in the MyFood app. Differences in the estimations of energy, protein, fluid, and food groups were analyzed at both the individual and group levels, by comparing the recorded intake in MyFood with the 2 corresponding recalls and by comparing the mean of all 4 recording days with the mean of the 2 recalls, respectively. A short, study-specific questionnaire was used to measure the participants’ experiences with the app. Results This study included 35 free-living older adults residing in Norway. Approximately half of the participants had ≥80% agreement between MyFood and the 24-hour recalls for energy intake on both days. For protein and fluids, approximately 60% of the participants had ≥80% agreement on the first day of comparison. Dinner was the meal with the lowest agreement between the methods, at both the individual and group levels. MyFood tended to underestimate the intake of energy, protein, fluid, and food items at both the individual and group levels. The food groups that achieved the greatest agreement between the 2 methods were eggs, yogurt, self-composed dinner, and hot beverages. All participants found the app easy to use, and 74% (26/35) of the participants reported that the app was easy to navigate. Conclusions The results showed that the MyFood app tended to underestimate the participants’ dietary intake compared with the 24-hour recalls at both the individual and group levels. The app’s ability to estimate intake within food groups was greater for eggs, yogurt, and self-composed dinner than for spreads, mixed meals, vegetables, and snacks. The app was well accepted among the study participants and may be a useful tool among free-living older adults, given that the users are provided follow-up and support in how to record their dietary intake.

• Halsey, Lewis G.; Careau, Vincent; Ainslie, Philip N.; Alemán-Mateo, Heliodoro; Andersen, Lene Frost & Anderson, Liam J. [Show all 110 contributors for this article] (2023). Greater male variability in daily energy expenditure develops through puberty. Biology Letters. ISSN 1744-9561. 19(9). doi: 10.1098/rsbl.2023.0152. Full text in Research Archive Show summary

  There is considerably greater variation in metabolic rates between men than between women, in terms of basal, activity and total (daily) energy expenditure (EE). One possible explanation is that EE is associated with male sexual characteristics (which are known to vary more than other traits) such as musculature and athletic capacity. Such traits might be predicted to be most prominent during periods of adolescence and young adulthood, when sexual behaviour develops and peaks. We tested this hypothesis on a large dataset by comparing the amount of male variation and female variation in total EE, activity EE and basal EE, at different life stages, along with several morphological traits: height, fat free mass and fat mass. Total EE, and to some degree also activity EE, exhibit considerable greater male variation (GMV) in young adults, and then a decrease in the degree of GMV in progressively older individuals. Arguably, basal EE, and also morphometrics, do not exhibit this pattern. These findings suggest that single male sexual characteristics may not exhibit peak GMV in young adulthood, however total and perhaps also activity EE, associated with many morphological and physiological traits combined, do exhibit GMV most prominently during the reproductive life stages.

• Uchai, Shreeshti; Andersen, Lene Frost; Hopstock, Laila Arnesdatter & Hjartåker, Anette (2023). Body mass index, waist circumference and pre-frailty/frailty: the Tromsø study 1994−2016. BMJ Open. 13:e065707(2), p. 1–11. doi: 10.1136/bmjopen-2022-065707. Full text in Research Archive Show summary

  Objective This study investigated the association between obesity, assessed using body mass index (BMI) and waist circumference (WC), and pre-frailty/frailty among older adults over 21 years of follow-up. <p>Design Prospective cohort study. <p>Setting Population-based study among communitydwelling adults in Tromsø municipality, Norway. <p>Participants 2340women and 2169 men aged ≥45 years attending the Tromsø study in 1994–1995 (Tromsø4) and 2015–2016 (Tromsø7), with additional BMI and WC measurements in 2001 (Tromsø5) and 2007–2008 (Tromsø6). <p>Primary outcome measure Physical frailty was defined as the presence of three or more and pre-frailty as the presence of one to two of the five frailty components suggested by Fried et al: low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity. <p>Results Participants with baseline obesity (adjusted OR 2.41, 95% CI 1.93 to 3.02), assessed by BMI, were more likely to be pre-frail/frail than those with normal BMI. Participants with high (OR 2.14, 95%CI 1.59 to 2.87) or moderately high (OR 1.57, 95%CI 1.21 to 2.03) baseline WC were more likely to be pre-frail/frail than those with normal WC. Those at baseline with normal BMI but moderately high/high WC or overweight with normal WC had no significantly increased odds for pre-frailty/frailty. However, those with both obesity and moderately high/ high WC had increased odds of pre-frailty/frailty. Higher odds of pre-frailty/frailty were observed among those in ‘overweight to obesity’ or ‘increasing obesity’ trajectories than those with stable normal BMI. Compared with participants in a stable normal WC trajectory, those with high WC throughout follow-up were more likely to be prefrail/frail. <p>Conclusion Both general and abdominal obesity, especially over time during adulthood, is associated with an increased risk of pre-frailty/frailty in later years. Thus maintaining normal BMI and WC throughout adult life is important.

• Megen, Frida van; Fossli, Maria; Skodje, Gry Irene; Carlsen, Monica Hauger; Andersen, Lene Frost & Veierød, Marit Bragelien [Show all 8 contributors for this article] (2023). Nutritional assessment of women with celiac disease compared to the general population. Clinical Nutrition ESPEN. ISSN 2405-4577. 54, p. 251–257. doi: 10.1016/j.clnesp.2023.01.031. Full text in Research Archive Show summary

  Background & aims The nutritional quality of a gluten-free diet is debated because of the elimination of grains that are important sources of nutrients. The aim of this cross-sectional study was to perform a nutritional assessment in treated women with celiac disease and ongoing symptoms, and compare dietary intake with a healthy reference group (Norkost 3). Methods Celiac disease patients with biopsy confirmed mucosal healing, but persistent gastrointestinal symptoms, were included from an ongoing clinical trial. Nutritional assessment included anthropometrics, blood samples and dietary intake obtained by two 24 h recalls. Dietary intake in celiac women was compared with dietary intake in healthy women (Norkost 3). Two sample t-test was used for comparison of CeD and Norkost 3 women. Adjustment for age, BMI, education and smoking, by use of multiple linear regression analysis, did not change the results. Results In total, 59 women with celiac disease and 925 women that participated in Norkost 3 were included, with a mean age of 45 years in both groups. Women with celiac disease had a higher proportion of energy (E%) from fat (39 vs 34%, P < 0.001) and saturated fat (15 vs 13%, P = 0.01), a lower E% from protein (16 vs 18%, P = 0.01) and a lower intake of dietary fiber (19 vs 22 g, P = 0.002) compared to Norkost 3 women. Women with celiac disease had a lower intake of bread, fruit and milk, and a higher intake of cereals and cheese compared to Norkost 3 women. The average requirement was not met for several micronutrients, but blood analysis revealed few nutritional deficiencies: two women with insufficient vitamin D status and one with insufficient folic acid status. Conclusion The women with celiac disease had an unbalanced diet with a higher intake of total- and saturated fatty acids and a lower intake of fiber compared to the general population. These findings emphasizes the need for nutritional follow-up of celiac patients and development of nutrient dense gluten-free products.

• Kristiansen, Anne Lene; Myhre, Jannicke Borch; Paulsen, Mari Mohn; Totland, Torunn Holm; Lande, Britt & Andersen, Lene Frost (2023). Secular trends in infant feeding practices during the first year of life in Norway: Findings from 1998 to 2019 - the Spedkost surveys. British Journal of Nutrition. ISSN 0007-1145. 131(5), p. 851–859. doi: 10.1017/S0007114523002246. Full text in Research Archive Show summary

  The aims of the present study were to assess secular trends in breast-feeding and to explore associations between age at introduction of solid foods and breast-feeding duration. Data from three national dietary surveys in Norway were used, including infants born in 1998 (Spedkost 1, n 1537), 2006 (Spedkost 2, n 1490) and 2018 (Spedkost 3, n 1831). In all surveys, around 80 % of the infants were breastfed at 6 months of age. At 12 months of age, breast-feeding rate was 41 % in Spedkost 1, increasing to 48 % in Spedkost 2 and 51 % in Spedkost 3. Compared with earlier introduction, introduction of solid foods at ≥ 5 months of age was associated with a lower risk of breast-feeding cessation during the first year of life in the two most recent Spedkost surveys. In Spedkost 2, the adjusted hazard ratio for breast-feeding cessation during the first year of life for those introduced to solid foods at ≥ 5 months of age was 0·43 (95 % CI (0·31, 0·60)), P < 0·001, while the corresponding number in Spedkost 3 was 0·44 (95 % CI (0·29, 0·67)), P < 0·001. In conclusion, breast-feeding at infant age 12 months increased over time. Introduction of solid foods at ≥ 5 months of age was positively associated with breast-feeding duration in the two most recent Spedkost surveys. As breast-feeding contributes to numerous health benefits for infant and mother, and possibly improved dietary sustainability in infancy, findings point to the importance of continued protection, support and promotion of breast-feeding.

• Wright, Ellen Cecilie; Oort, Bob van; Bjøntegaard, Marie Michaelsen; Carlsen, Monica Hauger & Andersen, Lene Frost (2023). Environmental and nutritional assessment of young children’s diets in Norway: comparing the current diet with national dietary guidelines and the EAT-Lancet reference diet. European Journal of Nutrition. ISSN 1436-6207. 62, p. 3383–3396. doi: 10.1007/s00394-023-03243-4. Full text in Research Archive Show summary

  Purpose Introducing healthy and sustainable diets early in life can promote lifelong healthy dietary patterns with a low environmental impact. Therefore, we aimed to estimate the environmental and nutritional consequences of a dietary change for 2-year-old children in Norway towards healthier dietary patterns. Methods Environmental impacts of the current habitual diet among 2-year-olds (n = 1413) were estimated for six impact categories and compared with scenario diets based on the Norwegian food-based dietary guidelines (FBDG) and the EAT-Lancet Commission reference diet. Last, we evaluated the nutritional adequacy of the diets against the Norwegian nutrition recommendations for children aged 2–5 years. The current diet was assessed by an FFQ. Results Environmental impacts of the current habitual diet were up to two times higher than those of the scenario diets. Compared with the current diet, impacts from the FBDG scenario diet were reduced by 35% for water use and 18% for terrestrial acidification, whereas impacts from the EAT-Lancet scenario diet were reduced by 51% for water use, 57% for terrestrial acidification, 36% for global warming potential and 27% for freshwater eutrophication. Milk and dairy products were the main contributors to environmental impacts in both the current diet and the FBDG scenario diet. The scenario diets were nutritionally adequate and improved the dietary quality among Norwegian 2-year-olds. Conclusion Compared to current diets among young children, more plant-based dietary patterns in line with national FBDG or the EAT-Lancet Commission reference diet can improve the nutritional adequacy of diets and simultaneously reduce environmental impacts.

• Uchai, Shreeshti; Andersen, Lene Frost; Johansson, Jonas; Hopstock, Laila Arnesdatter & Hjartåker, Anette (2023). Dual-Energy X-Ray Absorptiometry Derived Adiposity Measures and Pre-Frailty/Frailty among Norwegian Adults: The Tromsø Study 2007–2015. The Journal of Nutrition, Health & Aging. ISSN 1279-7707. 27, p. 403–410. doi: 10.1007/s12603-023-1920-2. Full text in Research Archive Show summary

  Objectives Aging is associated with changes in body composition. Excess adiposity among older adults has been linked with metabolic syndromes and aggravated age-associated decline in physical functioning. Few longitudinal studies have explored the association between dual-energy X-ray absorptiometry (DXA)-derived total as well as central adiposity measures and frailty. We examined the association of DXA-derived total and central adiposity with pre-frailty/frailty among Norwegian adults after 8 years of follow-up. Design Prospective observational study. Setting Community-dwelling adults from Tromsø, Norway. Measurements Adiposity was defined by fat mass index (FMI) and visceral adipose tissue (VAT) mass assessed using DXA measures. Frailty status was assessed by low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity level. Pre-frail and frail participants at baseline were excluded. Sex-stratified multivariable logistic regression models were used to investigate the association. Results Participants comprised 234 women (mean age 68 years) and 146 men (mean age 69 years) attending the population-based Tromsø Study in 2007–2008 (Tromsø6) and 2015–2016 (Tromsø7). At the end of follow-up, 25.6% of the women and 27.4% of the men were pre-frail/frail. Compared with women in the lowest tertiles, those in the highest tertile of baseline FMI (odds ratio [OR] 4.42, 95% confidence interval [CI] 1.88–10.35) and VAT mass (OR 2.47, 95% CI 1.10–5.50), respectively had higher odds for pre-frailty/frailty at follow-up. Conclusion We found a higher likelihood of pre-frailty/frailty in later years among women with general and central adiposity in adulthood, highlighting the importance of preventing excess adiposity for healthy aging.

• Konglevoll, Dina Moxness; Andersen, Lene Frost; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Totland, Torunn Holm [Show all 8 contributors for this article] (2023). Fish intake and pre-frailty in Norwegian older adults - a prospective cohort study: the Tromsø Study 1994–2016. BMC Geriatrics. 23(1). doi: 10.1186/s12877-023-04081-z. Full text in Research Archive Show summary

  Background Pre-frailty is an intermediate, potentially reversible state before the onset of frailty. Healthy dietary choices may prevent pre-frailty. Fish is included in most healthy diets, but little is known about the association between long-term habitual fish intake and pre-frailty. We aimed to elucidate the longitudinal association between the frequency of fish intake and pre-frailty in a cohort of older adults in Norway.<p> <p>Methods 4350 participants (52% women,≥65 years at follow-up) were included in this prospective cohort study. Data was obtained from three waves of the population-based Tromsø Study in Norway; Tromsø4 (1994–1995), Tromsø6 (2007–2008) and Tromsø7 (follow-up, 2015–2016). Frailty status at follow-up was defined by a modifed version of Fried’s phenotype. Fish intake was self-reported in the three surveys and assessed as three levels of frequency of intake: low (0–3 times/month), medium (1–3 times/week) and high (≥4 times/week). The fsh–pre-frailty association was analysed using multivariable logistic regression in two ways; (1) frequency of intake of lean, fatty and total fish in Tromsø6 and pre-frailty at follow-up, and (2) patterns of total fsh intake across the three surveys and pre-frailty at follow-up. <p>Results At follow-up, 28% (n=1124) were pre-frail. Participants with a higher frequency of lean, fatty and total fish intake had 28% (odds ratio (OR)=0.72, 95% confidence interval (CI)=0.53, 0.97), 37% (OR=0.63, 95% CI=0.43, 0.91) and 31% (OR=0.69, 95% CI=0.52, 0.91) lower odds of pre-frailty 8 years later compared with those with a low intake, respectively. A pattern of stable high fish intake over 21 years was associated with 41% (OR=0.59, 95% CI=0.38, 0.91) lower odds of pre-frailty compared with a stable low intake. <p>Conclusions A higher frequency of intake of lean, fatty and total fish, and a pattern of consistent frequent fish intake over time, were associated with lower odds of pre-frailty in older community-dwelling Norwegian adults. These results emphasise the important role of fish in a healthy diet and that a frequent fish intake should be promoted to facilitate healthy ageing.

• AASHEIM, ERLEND T.; Bhopal, Anand; O’Brien, Karen; Lie, Anne Kveim; Nakstad, Espen Rostrup & Andersen, Lene Frost [Show all 9 contributors for this article] (2023). Climate change and health: a 2-week course for medical students to inspire change. The Lancet Planetary Health. 7. doi: 10.1016/S2542-5196(22)00304-7. Full text in Research Archive
• Henriksen, Hege Berg; Berg, Hedda Beate; Andersen, Lene Frost; Weedon-Fekjær, Harald & Blomhoff, Rune (2023). Development of the Norwegian diet index and the Norwegian lifestyle index and evaluation in a national survey. Food & Nutrition Research (FNR). ISSN 1654-6628. 67. doi: 10.29219/fnr.v67.9217. Full text in Research Archive Show summary

  Background: Dietary and lifestyle indices are composite tools that are used to estimate risk of health outcomes. Objective: We aimed to develop a diet and a lifestyle index assessing adherence to the national guidelines in Norway, and to investigate adherence in a nationwide survey of healthy subjects (Norkost3). Design: Cut-off values for the indices were based on the Norwegian food based dietary guidelines and national lifestyle guidelines. Adherence was evaluated in the Norkost3 (n = 1,787). Results: Twelve dietary components were included in the diet index 1) fruit and berries, 2) vegetables, 3) whole grains, 4) unsalted nuts, 5) fish, 6) low-fat dairy products, 7) margarine/oils, 8) red meat, 9) processed meat, 10) foods rich in sugar and fat, 11) drinks with added sugar, and 12) dietary supplements. Each of the components was assigned a value of 0, 0.5 or 1 corresponding to low, intermediate and high adherence, except for plant-based foods, which were assigned a value of 0, 1.5 or 3, providing a composite diet index ranging from 0 to 20 points. The five components in the lifestyle index (i.e. diet, body mass index (BMI), physical activity, tobacco and alcohol) was assigned a value of 0, 0.5 or 1, giving a final score ranging from zero to five points. In Norkost3, 49% (95% CI: 47, 52) of the participants had low adherence to the diet component, whereas only 2% (95% CI: 2, 3) achieved high adherence, although most of the subjects had high educational level. High adherence to the recommendations of BMI, tobacco and alcohol intake was observed in 50% (95% CI: 47, 52), 72% (95% CI: 70, 74) and 68% (95% CI: 66, 70) of the participants, respectively. Due to the lack of data on physical activity, adherence to this component in the lifestyle index is not presented in this study. Conclusion: The new diet and lifestyle indices assess adherence to the Norwegian food-based dietary guidelines (FBDGs) and other national lifestyle guidelines. In this study, half of the subjects had low diet and lifestyle index scores. There is a need to implement interventions to improve this by focusing on the specific lifestyle components with low adherence.

• Yamada, Yosuke; Zhang, Xueying; Henderson, Mary E T; Sagayama, Hiroyuki; Pontzer, Herman & Watanabe, Daiki [Show all 92 contributors for this article] (2022). Variation in human water turnover associated with environmental and lifestyle factors. Science. ISSN 0036-8075. 378(6622), p. 909–915. doi: 10.1126/science.abm8668. Full text in Research Archive Show summary

  Water is essential for survival, but one in three individuals worldwide (2.2 billion people) lacks access to safe drinking water. Water intake requirements largely reflect water turnover (WT), the water used by the body each day. We investigated the determinants of human WT in 5604 people from the ages of 8 days to 96 years from 23 countries using isotope-tracking (2H) methods. Age, body size, and composition were significantly associated with WT, as were physical activity, athletic status, pregnancy, socioeconomic status, and environmental characteristics (latitude, altitude, air temperature, and humidity). People who lived in countries with a low human development index (HDI) had higher WT than people in high-HDI countries. On the basis of this extensive dataset, we provide equations to predict human WT in relation to anthropometric, economic, and environmental factors.

• Andresen, Ellen Cecilie; Hjelkrem, Anne-Grete Roer; Bakken, Anne Kjersti & Andersen, Lene Frost (2022). Environmental Impact of Feeding with Infant Formula in Comparison with Breastfeeding. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(11). doi: 10.3390/ijerph19116397. Full text in Research Archive Show summary

  Young children have unique nutritional requirements, and breastfeeding is the best option to support healthy growth and development. Concerns have been raised around the increasing use of milk-based infant formulas in replacement of breastfeeding, in regards to health, social, economic and environmental factors. However, literature on the environmental impact of infant formula feeding and breastfeeding is scarce. In this study we estimated the environmental impact of four months exclusive feeding with infant formula compared to four months exclusive breastfeeding in a Norwegian setting. We used life-cycle assessment (LCA) methodology, including the impact categories global warming potential, terrestrial acidification, marine and freshwater eutrophication, and land use. We found that the environmental impact of four months exclusive feeding with infant formula was 35–72% higher than that of four months exclusive breastfeeding, depending on the impact category. For infant formula, cow milk was the main contributor to total score for all impact categories. The environmental impact of breastfeeding was dependant on the composition of the lactating mother’s diet. In conclusion, we found that breastfeeding has a lower environmental impact than feeding with infant formula. A limitation of the study is the use of secondary LCA data for raw ingredients and processes.

• Paulsen, Mari Mohn; Paur, Ingvild; Henriksen, Christine & Andersen, Lene Frost (2022). Low inter-rater reliability between nurses and researchers for the NRS-2002 screening tool for malnutrition in a hematological hospital ward. Clinical Nutrition ESPEN. ISSN 2405-4577. 51, p. 490–492. doi: 10.1016/j.clnesp.2022.06.107. Full text in Research Archive Show summary

  Background & aims NRS-2002 is one of the recommended tools to screen hospitalized patients for malnutrition. NRS-2002 is considered as valid and reliable, but little is known about the inter-rater reliability between different groups of healthcare professionals. The aim of this study was to test the inter-rater reliability of the NRS-2002 tool between department nurses and researchers. Methods Inter-rater reliability was measured between the NRS-2002 scores given by department nurses and researchers, using data from a randomized controlled trial (RCT) at a hematological department in a Norwegian hospital. Results The mean NRS-2002 score was significantly higher when using researchers' scores compared to the department nurses’ scores. The total agreement between the two groups of raters was 59%, kappa = 0.27. Conclusion The inter-rater reliability of the NRS-2002 scores given by nurses and researchers was low. More research is needed to study if this is applicable also to other patient groups and in other wards.

• Halsey, Lewis G.; Careau, Vincent; Pontzer, Herman; Ainslie, Philip N.; Andersen, Lene Frost & Anderson, Liam J. [Show all 83 contributors for this article] (2022). Variability in energy expenditure is much greater in males than females. Journal of Human Evolution. ISSN 0047-2484. 171. doi: 10.1016/j.jhevol.2022.103229. Full text in Research Archive Show summary

  In mammals, trait variation is often reported to be greater among males than females. However, to date, mainly only morphological traits have been studied. Energy expenditure represents the metabolic costs of multiple physical, physiological, and behavioral traits. Energy expenditure could exhibit particularly high greater male variation through a cumulative effect if those traits mostly exhibit greater male variation, or a lack of greater male variation if many of them do not. Sex differences in energy expenditure variation have been little explored. We analyzed a large database on energy expenditure in adult humans (1494 males and 3108 females) to investigate whether humans have evolved sex differences in the degree of interindividual variation in energy expenditure. We found that, even when statistically comparing males and females of the same age, height, and body composition, there is much more variation in total, activity, and basal energy expenditure among males. However, with aging, variation in total energy expenditure decreases, and because this happens more rapidly in males, the magnitude of greater male variation, though still large, is attenuated in older age groups. Considerably greater male variation in both total and activity energy expenditure could be explained by greater male variation in levels of daily activity. The considerably greater male variation in basal energy expenditure is remarkable and may be explained, at least in part, by greater male variation in the size of energy-demanding organs. If energy expenditure is a trait that is of indirect interest to females when choosing a sexual partner, this would suggest that energy expenditure is under sexual selection. However, we present a novel energetics model demonstrating that it is also possible that females have been under stabilizing selection pressure for an intermediate basal energy expenditure to maximize energy available for reproduction.

• Andersen, Lene Frost; Berstad, Paula; Bukhvalova, Barbara Alexandra; Carlsen, Monica Hauger; Dahl, Lisbeth Jane & Goksøyr, Anders [Show all 35 contributors for this article] (2022). Benefit and risk assessment of fish in the Norwegian diet - Scientific Opinion of the Steering Committee of the Norwegian Scientific Committee for Food and Environment. VKM Report. 2022(17). Full text in Research Archive Show summary

  In 2006, VKM published “A comprehensive assessment of fish and other seafood in the Norwegian diet”. The assessment supported the recommendation from Norwegian Health authorities to eat more fish both for dinner and on sandwiches. In an update of the assessment in 2014 VKM concluded that “the benefits from fish consumption clearly outweigh the negligible risk presented by current levels of contaminants and other undesirable substances in fish”. Because of new knowledge available, the Norwegian Food Safety Authority requested a new benefit and risk assessment of fish in the Norwegian diet in 2019. In the assignment, they asked VKM to answer the following questions:<p> <p>Which health consequences will it have for the Norwegian population if they:<uli> <li>Continue with the same fish consumption levels as of today</li> <li>Increase the consumption of fish to match the recommendations given by the Norwegian Directorate of Health</li> </uli>

• Yitayew, Teferi Mekonnen; Brantsæter, Anne Lise; Andersen, Lene Frost; Lien, Nanna; Arah, Onyebuchi A. & Gebremariam, Mekdes [Show all 7 contributors for this article] (2022). Mediators of differences by parental education in weight-related outcomes in childhood and adolescence in Norway. Scientific Reports. 12(1), p. 1–13. doi: 10.1038/s41598-022-09987-z. Full text in Research Archive Show summary

  Studies exploring mediators of socioeconomic inequalities in excess weight gain in early-life and subsequent overweight/obesity (OW/OB) among youth are limited. Thus, this study examined the mediating role of prenatal and early postnatal factors and child energy balance-related behaviours (EBRB) in the effects of parental education on (i) excess weight gain from birth to 2 years and (ii) OW/OB at 5, 8 and 14 years. The Norwegian Mother, Father and Child Cohort Study was used to include participants at the ages of 2 (n = 59,597), 5 (n = 27,134), 8 (n = 28,285) and 14 (n = 11,278) years. Causal mediation analyses using the inverse odds weighting approach were conducted. Children of low-educated parents had a higher conditional excess weight gain at 2 years compared to children of high-educated parents (total effect, RRTE = 1.06; 95% CI 1.01, 1.10). The joint mediation effects of the prenatal and early postnatal factors explained most of the total effect of low education on conditional excess weight gain at 2 years. Children of low-educated parents had a higher risk of OW/OB at 5, 8 and 14 years compared to children of high-educated parents. The mediators jointly explained 63.7%, 67% and 88.9% of the total effect of parental education on OW/OB among 5, 8 and 14 year-old-children, respectively. Of the total mediated effects at 5, 8 and 14 years, the prenatal and early postnatal mediators explained 59.2%, 61.7% and 73.7%, whereas the child EBRB explained 10.3%, 15.8.0%% and 34.8%. The mediators included were found to have a considerable mediating effect in the associations explored, in particular the prenatal and early postnatal factors. If truly causal, the findings could indicate potential targets for interventions to tackle socioeconomic inequalities in OW/OB from birth to adolescence.

• Konglevoll, Dina Moxness; Hjartåker, Anette; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Andersen, Lene Frost [Show all 7 contributors for this article] (2022). Protein Intake and the Risk of Pre-Frailty and Frailty in Norwegian Older Adults. The Tromsø Study 1994–2016. Journal of Frailty & Aging (JFA). ISSN 2260-1341. 11(3), p. 256–266. doi: 10.14283/jfa.2022.16. Full text in Research Archive Show summary

  Background Protein intake is suggested as an important dietary factor in the prevention of frailty, however, the influence of lifelong intake remains unclear. Objectives The present study investigated the relationship between daily protein intake and patterns of protein intake over 21 years and the risk of pre-frailty/frailty. Design Prospective cohort study. Setting The population-based Tromsø Study in Tromsø municipality, Norway. Participants In total, 1,906 women and 1,820 men aged ≥45 years in 1994 who participated in both Tromsø4 (1994–95) and Tromsø7 (2015–16). Measurements Frailty status in Tromsø7 was measured according to Fried’s phenotype, classifying participants as “robust” (frailty components present: 0), “pre-frail” (1–2) or “frail” (≥3). Daily intake of protein was estimated from self-reported habitual dietary intake using food frequency questionnaires and assessed as grams per kilogram bodyweight (g/kg BW) and per megajoule energy intake (g/MJ). The protein–frailty association was assessed via longitudinal and cross-sectional multivariable logistic regression analyses. Results The prevalence of pre-frailty and frailty in this study was 27% and 1.0%, respectively. Longitudinal analysis showed that the odds of pre-frailty/frailty decreased by 57% (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.31;0.58, p<0.001) with the increase in intake of one additional gram of dietary protein per kg BW. The results obtained from cross-sectional analysis were similar. Tracking analysis showed that, compared to a stable high intake of protein in g/kg BW over time, other patterns of protein intake increased the risk of pre-frailty/frailty. No associations were found between intake of protein in g/MJ and pre-frailty/frailty. Conclusions Intake of protein in g/kg BW both in mid-life and later in life was inversely associated with pre-frailty/frailty in older adults. This emphasizes the importance of an adequate protein intake to facilitate healthy ageing in Norwegian older adults.

• Rimbach, Rebecca; Yamada, Yosuke; Sagayama, Hiroyuki; Ainslie, Philip N.; Andersen, Lene Frost & Anderson, Liam J. [Show all 82 contributors for this article] (2022). Total energy expenditure is repeatable in adults but not associated with short-term changes in body composition. Nature Communications. 13(1). doi: 10.1038/s41467-021-27246-z. Full text in Research Archive Show summary

  Low total energy expenditure (TEE, MJ/d) has been a hypothesized risk factor for weight gain, but repeatability of TEE, a critical variable in longitudinal studies of energy balance, is understudied. We examine repeated doubly labeled water (DLW) measurements of TEE in 348 adults and 47 children from the IAEA DLW Database (mean ± SD time interval: 1.9 ± 2.9 y) to assess repeatability of TEE, and to examine if TEE adjusted for age, sex, fat-free mass, and fat mass is associated with changes in weight or body composition. Here, we report that repeatability of TEE is high for adults, but not children. Bivariate Bayesian mixed models show no among or within-individual correlation between body composition (fat mass or percentage) and unadjusted TEE in adults. For adults aged 20–60 y (N = 267; time interval: 7.4 ± 12.2 weeks), increases in adjusted TEE are associated with weight gain but not with changes in body composition; results are similar for subjects with intervals >4 weeks (N = 53; 29.1 ± 12.8 weeks). This suggests low TEE is not a risk factor for, and high TEE is not protective against, weight or body fat gain over the time intervals tested.

• Lundblad, Marie Wasmuth; Johansson, Jonas; Jacobsen, Bjarne Koster; Grimsgaard, Sameline; Andersen, Lene Frost & Wilsgaard, Tom [Show all 7 contributors for this article] (2021). Secular and longitudinal trends in body composition: The Tromsø Study, 2001 to 2016. Obesity. ISSN 1930-7381. 29(11), p. 1939–1949. doi: 10.1002/oby.23267. Full text in Research Archive Show summary

  <p><i>Objective - </i>Overweight, defined as excessive fat mass, is a long-standing worldwide public health challenge. Traditional anthropometric measures used to identify overweight and obesity do not assess body composition. The aim of this study was to examine population trends in general and abdominal fat mass during the past two decades. <p><i>Methods - </i>This study included participants from one or more consecutive surveys of the population-based Tromsø Study, including Tromsø 5 (conducted in 2001, n = 1,662, age 40-84 years), Tromsø 6 (2007-2008, n = 901, age 40-88 years), and Tromsø 7 (2015-2016, n = 3,670, age 40-87 years), with total body dual-energy x-ray absorptiometry scans. Trends in total fat and visceral adipose tissue (VAT) were analyzed by generalized estimation equation models in strata of sex and age groups. <p><i>Results - </i>Total fat and VAT mass increased during 2001 to 2016, with a larger increase during 2007 to 2016 than from 2001 to 2007 and among the youngest age group (40-49 years), particularly in women. Women had higher total fat mass than men, whereas men had higher VAT mass than women. <p><i>Conclusions - </i>General and abdominal dual-energy x-ray absorptiometry-derived fat mass increased during the past two decades in this general population. Of particular concern is the more pronounced increase in the past decade and in the younger age groups.

• Careau, Vincent; Halsey, Lewis G.; Pontzer, Herman; Ainslie, Philip N.; Andersen, Lene F. & Anderson, Liam J. [Show all 84 contributors for this article] (2021). Energy compensation and adiposity in humans. Current Biology. ISSN 0960-9822. 31(20). doi: 10.1016/j.cub.2021.08.016. Full text in Research Archive Show summary

  Understanding the impacts of activity on energy balance is crucial. Increasing levels of activity may bring diminishing returns in energy expenditure because of compensatory responses in non-activity energy expenditures.1, 2, 3 This suggestion has profound implications for both the evolution of metabolism and human health. It implies that a long-term increase in activity does not directly translate into an increase in total energy expenditure (TEE) because other components of TEE may decrease in response—energy compensation. We used the largest dataset compiled on adult TEE and basal energy expenditure (BEE) (n = 1,754) of people living normal lives to find that energy compensation by a typical human averages 28% due to reduced BEE; this suggests that only 72% of the extra calories we burn from additional activity translates into extra calories burned that day. Moreover, the degree of energy compensation varied considerably between people of different body compositions. This association between compensation and adiposity could be due to among-individual differences in compensation: people who compensate more may be more likely to accumulate body fat. Alternatively, the process might occur within individuals: as we get fatter, our body might compensate more strongly for the calories burned during activity, making losing fat progressively more difficult. Determining the causality of the relationship between energy compensation and adiposity will be key to improving public health strategies regarding obesity.

• Kristiansen, Anne Lene; Himberg-Sundet, Anne; Bjelland, Mona; Lien, Nanna; Holst, Rene & Andersen, Lene Frost (2021). Exploring intervention components in association with changes in preschool children’s vegetable intake: the BRA-study. BMC Research Notes. 14(214), p. 1–6. doi: 10.1186/s13104-021-05629-1. Full text in Research Archive Show summary

  Objective: The present study aimed to explore kindergarten staffs’ perceived usefulness of intervention components in association with changes in children’s vegetable intake and vegetables served in the kindergarten. Assessment of the perceived usefulness of intervention components consisted of a paper-based questionnaire for the kindergarten staff assessing usefulness of posters, supplementary material and 1-day inspirational course. Children’s vegetable intake in the kindergarten was assessed by direct observation, while vegetables served was assessed by a 5-day weighted vegetable diary. Results: Seventy-three kindergartens in two counties in Norway participated (response rate 15%) and parental consent was obtained for 633 children 3–5 years of age at baseline (response rate 39%). Mixed effect models indicated a tendency that posters were associated with increased child vegetable intake (P = 0.062). Surprisingly, a low degree of perceived usefulness of supplementary material was associated with the largest increase in child vegetable intake (P = 0.020). No significant associations between perceived usefulness of intervention components and vegetables served in the kindergarten were found. This study indicated a tendency that posters were associated with increased child vegetable intake; however, this may also be due to synergies between multiple intervention components.

• Øyri, Linn Kristin Lie; Bogsrud, Martin Prøven; Kristiansen, Anne Lene; Myhre, Jannicke Borch; Astrup, Helene & Retterstøl, Kjetil [Show all 10 contributors for this article] (2021). Cholesterol at ages 6, 12 and 24 months: Tracking and associations with diet and maternal cholesterol in the Infant Cholesterol Study. Atherosclerosis. ISSN 0021-9150. 326, p. 11–16. doi: 10.1016/j.atherosclerosis.2021.04.017. Full text in Research Archive Show summary

  Background and aims: There are indications for tracking of circulating total cholesterol concentration (TC) from childhood to later in life. An increased lifelong TC exposure increases the risk of developing atherosclerosis, however little is known about the determinants of TC early in life. We aimed to describe TC in Norwegian offspring aged 6, 12 and 24 months, and to explore if maternal TC, breastfeeding and offspring diet are associated with offspring TC. Methods: In this cross-sectional study, mothers of offspring aged 6 (n = 629), 12 (n = 258) and 24 (n = 263) months completed a questionnaire of the offspring's diet and took home-based dried blood spot samples from themselves and their offspring. The mothers and offspring participating at age 12 months also participated at age 6 months of the offspring. Results: Offspring TC showed a wide range in all three age groups. Twenty one percent of the offspring had TC ≥ 5.1 mmol/l. There was significant tracking of offspring TC from 6 to 12 months of age (r = 0.42, p < 0.001). Maternal and offspring TC was positively associated in all age groups (0.20 ≤ β ≤ 0.40, p < 0.001 for all). Breastfeeding was positively associated with offspring TC at ages 6 and 12 months (0.05 ≤ β ≤ 0.26, 0.001 ≤ p ≤ 0.03), but not at age 24 months. Conclusions: The wide range in TC and probable tracking of TC from infancy to later in life highlights the importance of early identification of children with elevated TC who can benefit from preventive measures.

• Paulsen, Mari Mohn; Varsi, Cecilie & Andersen, Lene Frost (2021). Process evaluation of the implementation of a decision support system to prevent and treat disease-related malnutrition in a hospital setting. BMC Health Services Research. 21(1). doi: 10.1186/s12913-021-06236-3. Full text in Research Archive Show summary

  Background Malnutrition is present in 30% of hospitalized patients and has adverse outcomes for the patient and the healthcare system. The current practice for nutritional care is associated with many barriers. The MyFood decision support system was developed to prevent and treat malnutrition. Methods This paper reports on a process evaluation that was completed within an effectiveness trial. MyFood is a digital tool with an interface consisting of an app and a website. MyFood includes functions to record and evaluate dietary intake. It also provides reports to nurses, including tailored recommendations for nutritional treatment. We used an effectiveness-implementation hybrid design in a randomized controlled trial. The RE-AIM (Reach, Efficiency, Adoption, Implementation, Maintenance) framework was used to perform a process evaluation alongside the randomized controlled trial, using a combination of quantitative and qualitative methods. An implementation plan, including implementation strategies, was developed to plan and guide the study. Results Reach: In total, 88% of eligible patients consented to participate (n = 100). Adoption: Approximately 75% of the nurses signed up to use MyFood and 50% used the reports. Implementation: MyFood empowered the patients in their nutritional situation and acted as a motivation to eat to reach their nutritional target. The compliance of using MyFood was higher among the patients than the nurses. A barrier for use of MyFood among the nurses was different digital systems which were not integrated and the log-in procedure to the MyFood website. Despite limited use by some nurses, the majority of the nurses claimed that MyFood was useful, better than the current practice, and should be implemented in the healthcare system. Conclusions This study used a process evaluation to interpret the results of a randomized controlled trial more in-depth. The patients were highly compliant, however, the compliance was lower among the nurses. MyFood empowered the patients in their nutritional situation, the usability was considered as high, and the experiences and attitudes towards MyFood were primarily positive. Focus on strategies to improve the nurses’ compliance may in the future improve the MyFood system’s potential. Trial registration The trial was registered in ClinicalTrials.gov 26/01/2018 (NCT03412695).

• Carlsen, Monica Hauger; Andersen, Lene F. & Hjartåker, Anette (2021). Reproducibility and feasibility of an online self-administered food frequency questionnaire for use among adult norwegians. Food & Nutrition Research (FNR). ISSN 1654-6628. 65, p. 1–14. doi: 10.29219/FNR.V65.7561. Full text in Research Archive
• Carlsen, Monica Hauger; Andersen, Lene Frost & Hjartåker, Anette (2021). Reproducibility and feasibility of an online self-administered food frequency questionnaire for use among adult Norwegians. Food & Nutrition Research (FNR). ISSN 1654-6628. doi: 10.29219/fnr.v65.7561. Full text in Research Archive Show summary

  Background: New methods of dietary assessment are increasingly making use of online technologies. The development of a new online food frequency questionnaire warranted investigation of its feasibility and the reproducibility of its results. Objective: To investigate the feasibility and reproducibility of a newly developed online FFQ (WebFFQ). Design: The semiquantitative WebFFQ was designed to assess the habitual diet the previous year, with questions about frequency of intake and portion sizes. Estimations of portion sizes include both pictures and household measures, depending on the type of food in question. In two independent cross-sectional studies conducted in 2015 and 2016, adults were recruited by post following random selection from the general population. In the first study, participants (n = 229) filled in the WebFFQ and answered questions about its feasibility, and in two subsequent focus group meetings, participants (n = 9) discussed and gave feedback about the feasibility of the WebFFQ. In the second study, the WebFFQ’s reproducibility was assessed by asking participants (n = 164) to fill it in on two separate occasions, 12 weeks apart. Moreover, in the second study, participants were offered personal dietary feedback, a monetary gift certificate, or both, as incentives to complete the study. Results: In the feasibility study, evaluation form results showed that participants raised issues regarding the estimation of portion size and the intake of seasonal foods as being particularly challenging; furthermore, in the focus group discussions, personal feedback on diet was perceived to be a more motivating factor than monetary reward. In the reproducibility study, total food intake was lower in the second WebFFQ; however, 63% of the food groups were not significantly different from those in the first WebFFQ. Correlations of food intake ranged from 0.62 to 0.90, >86% of the participants were classified into the same or adjacent quartiles, and misclassification ranged from 0 to 3%. Average energy intake was 3.5% lower (p = 0.001), fiber showed the least difference at 1.6% (p = 0.007), and sugar intake differed the most at −6.8% (borderline significant, p = 0.08). Percentage energy obtained from macronutrients did not differ significantly between the first and second WebFFQs. Conclusion: Our results suggest that at group level, the WebFFQ showed good reproducibility for the estimations of intake of food groups, energy, and nutrients. The feasibility of the WebFFQ is good; however, revisions to further improve portion size estimations should be included in future versions. The WebFFQ is considered suitable for dietary assessments for healthy adults in the Norwegian population.

• Pontzer, Herman; Yamada, Yosuke; Sagayama, Hiroyuki; Ainslie, Philip N.; Andersen, Lene Frost & Anderson, Liam J. [Show all 82 contributors for this article] (2021). Daily energy expenditure through the human life course. Science. ISSN 0036-8075. 373(6556), p. 808–812. doi: 10.1126/science.abe5017. Full text in Research Archive Show summary

  Total daily energy expenditure (“total expenditure”) reflects daily energy needs and is a critical variable in human health and physiology, but its trajectory over the life course is poorly studied. We analyzed a large, diverse database of total expenditure measured by the doubly labeled water method for males and females aged 8 days to 95 years. Total expenditure increased with fat-free mass in a power-law manner, with four distinct life stages. Fat-free mass–adjusted expenditure accelerates rapidly in neonates to ~50% above adult values at ~1 year; declines slowly to adult levels by ~20 years; remains stable in adulthood (20 to 60 years), even during pregnancy; then declines in older adults. These changes shed light on human development and aging and should help shape nutrition and health strategies across the life span.

• Speakman, John R.; Yamada, Yosuke; Sagayama, Hiroyuki; Berman, Elena S.F.; Ainslie, Philip N. & Andersen, Lene Frost [Show all 87 contributors for this article] (2021). A standard calculation methodology for human doubly labeled water studies. Cell Reports Medicine. 2(2). doi: 10.1016/j.xcrm.2021.100203. Full text in Research Archive Show summary

  The doubly labeled water (DLW) method measures total energy expenditure (TEE) in free-living subjects. Several equations are used to convert isotopic data into TEE. Using the International Atomic Energy Agency (IAEA) DLW database (5,756 measurements of adults and children), we show considerable variability is introduced by different equations. The estimated rCO2 is sensitive to the dilution space ratio (DSR) of the two isotopes. Based on performance in validation studies, we propose a new equation based on a new estimate of the mean DSR. The DSR is lower at low body masses (<10 kg). Using data for 1,021 babies and infants, we show that the DSR varies non-linearly with body mass between 0 and 10 kg. Using this relationship to predict DSR from weight provides an equation for rCO2 over this size range that agrees well with indirect calorimetry (average difference 0.64%; SD = 12.2%). We propose adoption of these equations in future studies. Highlights • 5,756 doubly labeled water (DLW) measures highlight variation from calculation equation • We derive here new equations for calculating CO2 production when using DLW • These equations outperform previous equations in validation studies • We recommend these equations should be adopted in future studies using DLW in humans

• Westerterp, Klaas R.; Yamada, Yosuke; Sagayama, Hiroyuki; Ainslie, Philip N.; Andersen, Lene F. & Anderson, Liam J. [Show all 82 contributors for this article] (2021). Physical activity and fat-free mass during growth and in later life. American Journal of Clinical Nutrition. ISSN 0002-9165. 114(5), p. 1583–1589. doi: 10.1093/ajcn/nqab260. Full text in Research Archive Show summary

  Background: Physical activity may be a way to increase and maintain fat-free mass (FFM) in later life, similar to the prevention of fractures by increasing peak bone mass. Objectives: A study is presented of the association between FFM and physical activity in relation to age. Methods: In a cross-sectional study, FFM was analyzed in relation to physical activity in a large participant group as compiled in the International Atomic Energy Agency Doubly Labeled Water database. The database included 2000 participants, age 3–96 y, with measurements of total energy expenditure (TEE) and resting energy expenditure (REE) to allow calculation of physical activity level (PAL = TEE/REE), and calculation of FFM from isotope dilution. Results: PAL was a main determinant of body composition at all ages. Models with age, fat mass (FM), and PAL explained 76% and 85% of the variation in FFM in females and males < 18 y old, and 32% and 47% of the variation in FFM in females and males ≥ 18 y old, respectively. In participants < 18 y old, mean FM-adjusted FFM was 1.7 kg (95% CI: 0.1, 3.2 kg) and 3.4 kg (95% CI: 1.0, 5.6 kg) higher in a very active participant with PAL = 2.0 than in a sedentary participant with PAL = 1.5, for females and males, respectively. At age 18 y, height and FM–adjusted FFM was 3.6 kg (95% CI: 2.8, 4.4 kg) and 4.4 kg (95% CI: 3.2, 5.7 kg) higher, and at age 80 y 0.7 kg (95% CI: −0.2, 1.7 kg) and 1.0 kg (95% CI: −0.1, 2.1 kg) higher, in a participant with PAL = 2.0 than in a participant with PAL = 1.5, for females and males, respectively. Conclusions: If these associations are causal, they suggest physical activity is a major determinant of body composition as reflected in peak FFM, and that a physically active lifestyle can only partly protect against loss of FFM in aging adults.

• Lundblad, Marie Wasmuth; Jacobsen, Bjarne Koster; Johansson, Jonas; Grimsgaard, Sameline; Andersen, Lene Frost & Hopstock, Laila Arnesdatter (2021). Anthropometric measures are satisfactory substitutes for the DXA‐derived visceral adipose tissue in the association with cardiometabolic risk—The Tromsø Study 2015–2016. Obesity Science & Practice. 7(5), p. 525–534. doi: 10.1002/osp4.517. Full text in Research Archive Show summary

  Background - Body mass index (BMI) increases while cardiometabolic risk factors decrease in individuals in high-income countries. This paradoxical observation raises the question of whether current measures of overweight and obesity properly identify cardiometabolic risk.<p> <p>Methods - A total of 3675 participants (59% women) aged 40–84 years with whole-body dual-energy x-ray absorptiometry scans from the seventh survey of the Tromsø Study were included to examine the association between visceral adipose tissue (VAT) in grams and BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Further, their association with single cardiometabolic risk factors (blood pressure, triglycerides, total cholesterol, high-density lipoprotein [HDL] cholesterol, glycated hemoglobin, high-sensitivity C-reactive protein), modified single components from the ATP Ⅲ criteria for metabolic syndrome (hypertension, diabetes, high triglycerides, and low HDL cholesterol), and metabolic syndrome were examined.<p> <p>Results - VAT mass was strongly correlated with BMI (r ≥ 0.77), WC (r ≥ 0.80), WHR (r ≥ 0.58), and WHtR (r ≥ 0.78). WC was the strongest predictor for VAT (area under the curve: 0.90). Compared to anthropometric measures, the associations between VAT and metabolic syndrome as well as single components of metabolic syndrome were statistically significantly stronger, but the clinical differences were likely minor.<p> <p>Conclusion - Although VAT mass showed statistically stronger associations with cardiometabolic risk compared to traditional anthropometrics, the clinical importance was likely small. Simple, clinically available tools seem to satisfactory substitute for VAT to identify cardiometabolic risk.

• Borge, Tiril Cecilie; Biele, Guido Philipp Emmanuel; Papadopoulou, Eleni Zoumpoulia; Andersen, Lene Frost; Jacka, Felice & Eggesbø, Merete Åse [Show all 10 contributors for this article] (2021). The associations between maternal and child diet quality and child ADHD - findings from a large Norwegian pregnancy cohort study. BMC Psychiatry. 21, p. 1–14. doi: 10.1186/s12888-021-03130-4. Full text in Research Archive Show summary

  Background Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder. Effective long-term treatment options are limited, which warrants increased focus on potential modifiable risk factors. The aim of this study was to investigate associations between maternal diet quality during pregnancy and child diet quality and child ADHD symptoms and ADHD diagnosis. Methods This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa). We assessed maternal diet quality with the Prenatal Diet Quality Index (PDQI) and Ultra-Processed Food Index (UPFI) around mid-gestation, and child diet quality using the Diet Quality Index (CDQI) at 3 years. ADHD symptoms were assessed at child age 8 years using the Parent Rating Scale for Disruptive Behaviour Disorders. ADHD diagnoses were retrieved from the Norwegian Patient Registry. Results In total, 77,768 mother-child pairs were eligible for studying ADHD diagnoses and 37,787 for ADHD symptoms. Means (SD) for the PDQI, UPFI and CDQI were 83.1 (9.3), 31.8 (9.7) and 60.3 (10.6), respectively. Mean (SD) ADHD symptom score was 8.4 (7.1) and ADHD diagnosis prevalence was 2.9% (male to female ratio 2.6:1). For one SD increase in maternal diet index scores, we saw a change in mean (percent) ADHD symptom score of − 0.28 (− 3.3%) (CI: − 0.41, − 0.14 (− 4.8, − 1.6%)) for PDQI scores and 0.25 (+ 3.0%) (CI: 0.13, 0.38 (1.5, 4.5%)) for UPFI scores. A one SD increase in PDQI score was associated with a relative risk of ADHD diagnosis of 0.87 (CI: 0.79, 0.97). We found no reliable associations with either outcomes for the CDQI, and no reliable change in risk of ADHD diagnosis for the UPFI. Conclusions We provide evidence that overall maternal diet quality during pregnancy is associated with a small decrease in ADHD symptom score at 8 years and lower risk for ADHD diagnosis, with more robust findings for the latter outcome. Consumption of ultra-processed foods was only associated with increased ADHD symptom score of similar magnitude as for overall maternal diet quality, and we found no associations between child diet quality and either outcome. No causal inferences should be made based on these results, due to potential unmeasured confounding.

• Kristiansen, Anne Lene; Medin, Anine Christine; Bjelland, Mona; Himberg-Sundet, Anne; Lien, Nanna & Holst, René [Show all 7 contributors for this article] (2020). Long-term effects of a cluster randomized controlled kindergarten-based intervention trial on vegetable intake among Norwegian 3-5-year-olds: the BRA-study. BMC Research Notes. 13. doi: 10.1186/s13104-020-4892-x. Full text in Research Archive Show summary

  OBJECTIVE: To report on long-term effects of a cluster randomized controlled kindergarten-based intervention trial, which aimed to increase vegetable intake among Norwegian preschool children (3-5 years at baseline). The effects of the intervention at follow-up 1 (immediately post-intervention) have previously been published. This paper presents the effects of the intervention from baseline to follow-up 2 (12 months post-intervention). RESULTS: Parental consents were obtained for 633 out of 1631 eligible children (response rate 38.8%). The effects of the intervention from baseline to follow-up 2 were assessed by mixed-model analyses taking the clustering effect of kindergartens into account. Children's vegetable intake was reported by the parents at baseline (spring 2015), at follow-up 1 (spring 2016) and at follow-up 2 (spring 2017). No significant long-term effects in child vegetable intake were found. A mean difference of - 0.1 times per day (95% CI - 0.5, 0.2) (P = 0.44) was found for the daily frequency of vegetable intake. A mean difference of - 0.2 different kinds of vegetables eaten over a month (95% CI - 1.0, 0.7) (P = 0.70) was found and for daily amount of vegetables a mean difference of - 15.0 g vegetables (95% CI - 38.0, 8.0) (P = 0.19) was found. Trial registration International Standard Randomised Controlled Trials ISRCTN51962956 (http://www.isrctn.com/ISRCTN51962956). Registered 21 June 2016 (retrospectively registered).

• Medin, Anine Christine; Carlsen, Monica Hauger & Andersen, Lene Frost (2020). Iodine intake among children and adolescents in Norway: Estimates from the national dietary survey Ungkost 3 (2015-2016). Journal of Trace Elements in Medicine and Biology. ISSN 0946-672X. doi: 10.1016/j.jtemb.2019.126427. Full text in Research Archive Show summary

  Abstract BACKGROUND: Iodine is crucial for normal growth and neurodevelopment. Before 1950, goitre caused by iodine deficiency was widespread in Norway, but decreased significantly after mandatory fortification of animal fodder. Recent dietary changes in milk consumption and fish intake may again have increased the risk of inadequate intakes in some population groups in Norway. The situation for children and adolescents is unclear, and data from nationally representative studies are highly needed. We aimed to describe the iodine intake in Norwegian children and adolescents and estimate the proportion of individuals with an increased risk of suboptimal, adequate and excessive usual iodine intake. In addition, we aimed to investigate whether individuals' characteristics were associated with iodine intake, and to identify the major iodine contributing foods in the diet of this population. METHODS: Data from 1722 individuals (4-, 9- and 13-year-olds) from a national dietary survey in Norway from 2015-2016 was used. Both descriptive and inferential statistics were conducted. Usual iodine intakes were estimated, stratified by age group and sex and compared to dietary reference intake cut-offs. Linear regression models were used to assess the association between iodine intake and participants' characteristics. The contribution of iodine from different foods was described for all and across different participant groups. RESULTS: We estimated that the proportion of participants with an increased risk of a suboptimal usual intake of iodine varied from 3-36%. A significant increased risk was observed for older children and girls compared to younger children and boys. Excessive usual intakes were not observed in any age group. Iodine intake was associated with sex, maternal educational level and area of residence. A lower intake was observed for girls and those with a mother with a low educational level. Moreover, those living in the western part and Mid-Norway had statistically significantly higher intakes compared to those living in the capital city and surroundings. Milk, milk products, cheese, fish and shellfish were the main contributors to iodine intake. Supplements contributed with very little of the total iodine intake. CONCLUSIONS: We have shown that the estimated risk of suboptimal usual iodine intakes among children and adolescents in Norway varies according to age, sex, maternal educational level and area of residence. Those with a limited intake of the main dietary contributors to iodine intake may be at risk, and adolescent girls seem to be especially vulnerable.

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• Andersen, Lene Frost; Lillegaard, Inger Therese L.; Mangschou, Bente; Medin, Anine; Aakre, Inger & Dalen, Knut Tomas [Show all 12 contributors for this article] (2026). Vurdering av inntaket av vitaminer og mineraler i Norge sammenlignet med inntaksdata fra EFSA. VKM Bulletin. 2026(1), p. 1–65. Full text in Research Archive Show summary

  Vitenskapskomiteen for mat og miljø (VKM) har undersøkt hvordan nordmenns inntak av vitaminer og mineraler skiller seg fra resten av Europa. Vi konkluderer med at det er viktig å ta høyde for norske data når man fastsetter nye maksimumsgrenser.

• Bjøntegaard, Marie Michaelsen & Andersen, Lene Frost (2026). Mapping study: Healthy, sustainable and resilient public plates. Full text in Research Archive Show summary

  Formålet med denne studien var å kartlegge prosjekter og initiativer som jobber for å oppnå sunnere og mer bærekraftig offentlig innkjøp av mat i Norge, samt prosjekter med fokus på å styrke lokal og nasjonal matberedskap. Det ble utført et litteratursøk med fokus på grålitteratur. Videre ble relevante personer invitert til å fylle ut et digitalt spørreskjema. Kartleggingen identifiserte 107 prosjekter og initiativer. Prosjektene fokuserte hovedsakelig på innkjøp av bærekraftig mat, der innkjøp av lokalmat var høyest prioritert, etterfulgt av aspekter som økologi, matsvinn og klimavennlig mat. Innkjøp av både sunn og bærekraftig mat ble i mindre grad prioritert (~31% av prosjekter), mens kun 2% av prosjektene jobbet for sunnere innkjøp.

• Meltzer, Helle Margrete; Meyer, Haakon Eduard; Andersen, Lene Frost; Torheim, Liv Elin & Klepp, Knut-Inge (2025). Oppdatert: Fra hypotese til kostråd – veier, snarveier og blindveier. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 23(2), p. 79–89. doi: 10.18261/ntfe.23.2.4. Full text in Research Archive Show summary

  Få fagfelt får mer medieoppmerksomhet enn kosthold og ernæring, og få fagfelt har flere selvoppnevnte eksperter. Mange blir forvirret i jungelen av kostråd, som via media kan virke vidt forskjellige. I pressen blir gjerne resultater fra enkeltstudier slått stort opp uten å bli vurdert i lys av øvrig kunnskap innen faget. Nye hypoteser kan begeistre både leg og lærd, men veien er som regel lang frem til en veldokumentert konklusjon og offisielle råd til befolkningen. Et funn må alltid vurderes mot den totale kunnskapen innen emnet før konklusjoner kan trekkes. Det har vært arbeidet både nasjonalt og internasjonalt for å finne frem til en felles forståelse av hvilke minstekrav man bør ha til dokumentasjon før kostråd gis. I denne artikkelen beskrives generelle trekk i prosessen som fører frem til offisielle kostråd i Norge.

• Konglevoll, Dina Moxness; Andersen, Lene Frost; Thoresen, Magne; Totland, Torunn Holm; Hopstock, Laila Arnesdatter & Hjartåker, Anette [Show all 7 contributors for this article] (2025). Dietary trajectories over 21 years and frailty in Norwegian older adults. doi: 10.1007/s00394-024-03482-z. Full text in Research Archive Show summary

  This study investigated the association between dietary trajectories over two decades and frailty in older adults in the large Norwegian population-based study, the Tromsø Study. We found that there was an association between maintaining a moderately healthy to very healthy diet through adulthood and lower frailty in older age.

• Andersen, Lene Frost (2025). Innsikter fra forskning på kommuner: Barrierer og muligheter for bedre matinnkjøp v/ Lene Frost Andersen, Universitetet i Oslo. Full text in Research Archive
• Andersen, Lene Frost (2025). Hvordan kan vi få et mer bærekraftig matsystem? Full text in Research Archive
• Andersen, Lene Frost & Bjøntegaard, Marie Michaelsen (2025). Offentlig matinnkjøp – hvordan kan det gjøres mer sunt og bærekraftig? Full text in Research Archive
• Andersen, Lene Frost; Abel, Marianne Hope; Olsen, Hanne Fjerdingby; Torre, Sissel; Svensson, Hanna & Morseth, Marianne S. [Show all 8 contributors for this article] (2025). Hvis forskningsresultatene fikk bestemme. doi: https:/xp.cicero.oslo.no/no/api/_/attachment/inline/c9d460a0-63fe-4393-b9a9-906a1e27a2d2:90e2cfab4eb58e8cdb9a51dd23c9fcc8e5a8a0fb/Hvis%20forskningsresultatene%20fikk%20bestemme.pdf. Full text in Research Archive
• Andersen, Lene Frost; Lillegaard, Inger Therese Laugsand; Mangschou, Bente; Medin, Anine Christine; Aakre, Inger & Dalen, Knut Tomas [Show all 12 contributors for this article] (2025). New update of a fortification model. VKM Bulletin. VKM Bulletin 2025: 13(Bulletin 2025: 13), p. 1–34. Full text in Research Archive Show summary

  VKM has calculated the intakes of vitamins and minerals and compared them with the tolerable upper intake levels (UL) in a model for assessing the fortification of food and drink. Fortification means adding vitamins and minerals. The intake calculations cover all age groups. The model has been updated with data from a new dietary survey for adults, and with new tolerable upper intake levels from EFSA for several of the vitamins and minerals. Some of the data entered into the model has been taken from Danish dietary surveys, as there is no Norwegian data available. For most nutrients, it is the amount that can be added for 1- and 2-year-olds that regulates the fortification. The model was established in 2006, and has been updated in 2009, 2013 and 2021. The model does not include the risk of low intake of nutrients. The work has been commissioned by the Norwegian Food Safety Authority, which will use the results from the model as part of the basis for assessing applications for food fortification.

• Schultz, Gry Irene Granli; Parr, Christine Louise; Trosvik, Pål; Yazdankhah, Siamak Pour; Andersen, Lene Frost & Dalen, Knut Tomas [Show all 14 contributors for this article] (2025). Health risk assessment of Bifidobacterium breve M-16V in infant formula. VKM Bulletin. 2025(VKM Bulletin 2025: 09), p. 1–115. Full text in Research Archive Show summary

  VKM has not identified any short-term negative health effects from consuming infant formula with Bifidobacterium breve M-16V. However, there is uncertainty and limited research on possible long-term effects. There is also little research conducted independently of the manufacturers. The Norwegian Food Safety Authority has asked VKM to assess whether there may be health risks associated with giving infants (up to 12 months) infant formula supplemented with a specific probiotic bacterium (Bifidobacterium breve M-16V). "Probiotics" generally refers to health products containing live microorganisms, usually bacteria. Currently, some infant formulas outside Norway are supplemented with freeze-dried probiotic bacteria. The bacterium Bifidobacterium breve M-16V (B. breve M-16V) in given concentrations is considered safe in the USA and EU for use in food, but this status is regularly reviewed in the EU and may change if negative health effects are discovered. In infants, the intestinal microbiota (composition of microorganisms) and immune system are not fully developed, and it is uncertain whether the addition of high doses of probiotic bacteria during infancy may have unintended long-term effects. Background for the risk assessment A company has applied to the Norwegian Food Safety Authority to market two specific infant formulas in Norway: one peptide-based and another amino acid-based. The products are intended for infants having allergies and are regulated as foods for special medical purposes. Both products are supplemented with the probiotic bacterium B. breve M-16V. The Norwegian Food Safety Authority has asked VKM to assess whether there may be health risks associated with giving infants these products specifically, and infant formula supplemented with B. breve M-16V in general. VKM’s methodology A multidisciplinary project group appointed by VKM has reviewed documentation from the company. The group has also conducted a systematic literature review of health effects reported in studies where infants received infant formula supplemented with B. breve M-16V and calculated the possible intake of infant formula and B. breve M-16V among Norwegian infants. VKM has only assessed the risk of negative health effects based on the assignment and according to guidelines for probiotics in food, not as a medicinal product. The assessment has been approved by a multidisciplinary approval group, also appointed by VKM. Findings VKM has not found any unwanted properties of B. breve M-16V based on reported laboratory studies and animal experiments. VKM has also not found negative health effects in 13 clinical studies involving a total of 1580 children, of whom 836 received infant formula supplemented with B. breve M-16V (test) and the rest received infant formula without B. breve M-16V (control). The studies lasted from 6 weeks to 12 months (median 16 weeks). VKM found no consistent differences between test and control groups in reported side effects, children's growth, or symptoms from the gastrointestinal tract, skin, or respiratory system as long as the studies were ongoing (short-term). VKM has found only two studies of long-term effects in children one year (development of asthma symptoms) or 3-5 years (neurocognitive outcomes) after they received infant formula with B. breve M-16V. This is too little to draw conclusions about long-term effects.

• Lara-Castor, Laura; O’Hearn, Meghan; Cudhea, Frederick; Miller, Victoria; Shi, Peilin & Zhang, Jianyi [Show all 336 contributors for this article] (2025). Author Correction: Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries (Nature Medicine, (2025), 10.1038/s41591-024-03345-4). Nature Medicine. ISSN 1078-8956. doi: 10.1038/s41591-025-03524-x. Full text in Research Archive
• Andersen, Lene Frost & Carlsen, Monica Hauger (2024). Local vs global impact data in life cycle assessment food databases – does it matter? Full text in Research Archive
• Andersen, Lene Frost (2024). A sustainable diet in a Nordic setting. Full text in Research Archive
• Steffensen, Inger-Lise Karin; Bodin, Johanna Eva; Dalen, Knut Tomas; Mangschou, Bente; Aakre, Inger & Andersen, Lene Frost [Show all 13 contributors for this article] (2024). Risk assessment of quercetin dihydrate and rutin in food supplements – “Other substances”. VKM Bulletin. 2024(9), p. 1–149. Full text in Research Archive Show summary

  Det er trygt å bruke flavonoidene quercetin eller rutin i bestemte i kosttilskudd, ifølge Vitenskapskomiteen for mat og miljø (VKM). Det er hovedbudskapet i en risikovurdering utført på oppdrag fra Mattilsynet. I rapporten ble det konkludert at det er trygt å bruke quercetin eller rutin i kosttilskudd i daglige doser på 5 mg rutin for barn fra fireårsalderen, daglige doser på 25 mg rutin for voksne og 500 mg quercetin dihydrat for voksne i hvert fall opp til tre måneder. VKM har vurdert risiko for helseskadelige effekter ved daglig inntak av kosttilskudd med 25 mg rutin eller 500 mg quercetin dihydrat for voksne fra 18 år og eldre, og 5 mg rutin for barn fra fireårsalderen. Quercetin og rutin er flavonoider. Disse finnes naturlig i planter og inngår i kosten, særlig i frukt, grønnsaker og te. Mange flavonoider fra mat og drikke tas i liten grad opp i kroppen. Risikovurderingen er basert på informasjon fra en systematisk kunnskapsoppsummering av 23 randomiserte kontrollerte studier (studier hvor man undersøker effekten av en behandling ved å fordele deltagere tilfeldig i behandlings- og kontrollgruppe(r). Disse studiene omfattet voksne mennesker. I tillegg er det brukt kunnskap om hvordan stoffene håndteres i kroppen og noen dyrestudier i vurderingen. Studiene hadde undersøkt, men funnet få, og lite alvorlige, skadelige helseeffekter. Den lengste studien varte i 10 måneder. Konklusjonen for barna er basert på studiene av voksne og én studie spesifikk av barn. På grunn av mangel på tilstrekkelige data om gravide kvinner og fostre, og mangel på data om ammende kvinner og deres spedbarn, samt om barn generelt, er det ikke kjent om disse gruppene potensielt kan være mer sårbare for disse stoffene enn voksne. Studiene i mennesker undersøkte hovedsakelig positive effekter av quercetin og rutin for en rekke ulike tilstander og sykdommer. Mulige helseskadelige effekter ble dokumentert og undersøkt i varierende grad, og svært få og lite alvorlige skadelige effekter ble observert. Resultatene understøttes også av dyrestudiene. Ettersom de fleste studiene med quercetin og rutin ikke undersøkte bruk av stoffene i mer enn tre måneder, er lengre tids inntak mer usikkert, selv om noen få studier heller ikke fant skadelige effekter etter bruk i seks til ti måneder, sier Inger-Lise Steffensen, faglig leder av arbeidet. VKM har ikke beregnet bidrag fra andre kilder til rutin eller quercetin som mat, og har heller ikke vurdert bruk av stoffene til behandling av ulike tilstander og sykdommer. Noe data kan tyde på at personer med kronisk nyresykdom eller østrogen-avhengig kreft kanskje kan være sårbare for skadelige effekter av quercetin. Studier i mennesker og dyr har vist at quercetin kan påvirke opptaket av ulike medikamenter i kroppen, og kan påvirke enzymer som omdanner medikamenter. Om quercetin og rutin Quercetin og rutin inngår i gruppen “andre stoffer”. Dette er stoffer med ernæringsmessig eller fysiologisk effekt, og som ikke er vitaminer eller mineraler. Risikovurderingen er godkjent av VKMs faggruppe for ernæring, dietetiske produkter, ny mat og allergi.

• Amberntsson, Anna; Paulsen, Mari Mohn; Bianchi, Marta Angela; Birgisdottir, Bryndis Eva; Biltoft-Jensen, Anja & Konglevoll, Dina Moxness [Show all 10 contributors for this article] (2024). Enhancing Nutri-Score’s discrimination between whole grain and refined grain products – insights from the NewTools project. Full text in Research Archive
• Knutsen, Helle Katrine; Kvalem, Helen Engelstad; Mangschou, Bente; Parr, Christine Louise & Andersen, Lene Frost (2024). Kronikk: Skremmer folk unødig med fiskeråd. Full text in Research Archive Show summary

  Skal folk følge kostråd fra to leger som advarer mot fisk ved å vise til enkeltartikler og egne forskningsfunn? Eller skal folk heller stole på store, systematiske kunnskapsoppsummeringer av helseeffektene av fiskekonsum? Svaret bør være åpenbart. Les hele kronikken hos VKM: https://www.vkm.no/vkm/omvkm/nyheter/vkmnyheter/kronikkskremmerfolkunodigmedfiskerad.5.1db70e49192711fbd2b46e51.html Til orientering: De fleste artiklene vi refererer til har vært publisert i Nettavisen og Amedias kanaler. VKM ønsket derfor denne kronikken publisert hos dem. Nettavisen/Norsk debatt ønsket en forenklet og kortere versjon, den ble publisert i deres kanaler 10. oktober.

• Paulsen, Mari Mohn; Øvrebø, Bente; Brantsæter, Anne Lise; Lund-Iversen, Kaja; Andersen, Lene Frost & Løvhaug, Anne Lene [Show all 8 contributors for this article] (2024). Nutri-Score: Identified strengths and weaknesses in a Norwegian context. Full text in Research Archive
• Bjøntegaard, Marie Michaelsen; Paulsen, Mari Mohn; Oort, Bob van & Andersen, Lene Frost (2024). Food procurement in Norwegian upper secondary schools: Nutritional quality and environmental impact. Full text in Research Archive
• Bjøntegaard, Marie Michaelsen; Paulsen, Mari Mohn; Oort, Bob van & Andersen, Lene Frost (2024). Food procurement in Norwegian upper secondary schools: Nutritional quality and environmental impact. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 22(5). doi: 10.18261/ntfe. Full text in Research Archive Show summary

  Background and objectives: Public procurement may accelerate the transition to a more sustainable food system by stimulating access to, and demand for, healthy foods with a lower impact on climate and the environment. Currently, there is limited information about the potential use of public procurement as a tool for healthier and more sustainable diets. First, this study aimed to investigate the nutritional quality and environmental impact of food procurement among upper secondary schools in former Viken County in Norway. Second, we aimed to examine the nutritional and environmental impacts of changes in food procurement after one year of intervention for healthier and more sustainable school canteens, organised by former Viken County in collaboration with the guidance service “Matvalget”. Methods: The main sample included procurement data for a fiscal quarter from 38 upper secondary schools, including data from 36 and 17 schools in 2022 and in 2023, respectively. The subsample analysis included baseline and follow-up data after one year of intervention, for 8 schools that participated in the intervention and 7 control schools without intervention. After extensive data processing, data was imported to the nutritional calculation system Kostberegningssystemet (KBS, version AE-22) at the University of Oslo. KBS enables estimation of nutritional content and environmental impact of the procurement data, including greenhouse gas emissions, eutrophication of freshwater and marine waters, soil acidification, land- and water use. Results: Preliminary results for the main sample show that soft drinks contributed to the largest share (in grams) of the procurement, followed by milk (including flavoured milk), fresh/frozen vegetables, and bread. The preliminary subsample analysis found a lower share of soft drinks, and increased shares of milk, white unprocessed meat and vegetable oils in the intervention schools compared to control schools. Further results from the analysis will be available in spring 2024. Discussion: The preliminary subsample analysis suggests nutritional improvements in the procurement pattern for intervention schools, however further investigation is required to conclude. Public procurement data from electronic invoices require extensive data processing before analysis to be utilized as a tool for healthier and sustainable diets and there is a need to standardize input to increase usability of the data.

• Konglevoll, Dina Moxness; Hjartåker, Anette; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Andersen, Lene Frost [Show all 7 contributors for this article] (2023). Proteininntak og skrøpelighet hos eldre deltagere i Tromsøundersøkelsen (1994–2016). Full text in Research Archive
• Konglevoll, Dina Moxness; Andersen, Lene Frost; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Totland, Torunn Holm [Show all 8 contributors for this article] (2023). Fish intake and pre-frailty in Norwegian older adults. A prospective cohort: the Tromsø Study 1994-2016. Full text in Research Archive
• Konglevoll, Dina Moxness; Andersen, Lene Frost; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Totland, Torunn Holm [Show all 8 contributors for this article] (2023). Fish intake and pre-frailty in Norwegian older adults. A prospective cohort: the Tromsø Study 1994-2016. Full text in Research Archive
• Konglevoll, Dina Moxness; Andersen, Lene Frost; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Totland, Torunn Holm [Show all 8 contributors for this article] (2023). Fish intake and pre-frailty in Norwegian older adults. A prospective cohort study: the Tromsø Study 1994-2016. Full text in Research Archive
• Konglevoll, Dina Moxness; Andersen, Lene Frost; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Totland, Torunn Holm [Show all 8 contributors for this article] (2023). Fiskeinntak of pre-skrøpelighet hos eldre deltagere i Tromsøundersøkelsen: et prospektivt studie (1994-2016). Full text in Research Archive
• Uchai, Shreeshti; Andersen, Lene Frost; Johansson, Jonas Lars; Hopstock, Laila Arnesdatter & Hjartåker, Anette (2023). Dual-Energy X-Ray Absorptiometry Derived Adiposity Measures and Pre-Frailty/Frailty among Norwegian Adults: The Tromsø Study 2007–2015. Full text in Research Archive
• Uchai, Shreeshti; Andersen, Lene Frost; Johansson, Jonas Lars; Hopstock, Laila Arnesdatter & Hjartåker, Anette (2023). Dual-Energy X-Ray Absorptiometry Derived Adiposity Measures and Pre-Frailty/Frailty among Norwegian Adults: The Tromsø Study 2007–2015. Full text in Research Archive
• Øvrebø, Bente; Abel, Marianne Hope; Brantsæter, Anne Lise & Andersen, Lene Frost (2023). Evaluation of the updated Nutri-Score algorithm in a Norwegian setting. Full text in Research Archive
• Bjøntegaard, Marie Michaelsen; Carlsen, Monica Hauger; Wright, Ellen Cecilie & Andersen, Lene Frost (2023). Poster Throne Holst Symposium 2023: Compilation of an environmental LCA food database. Full text in Research Archive
• Konglevoll, Dina Moxness; Hjartåker, Anette; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Andersen, Lene Frost [Show all 7 contributors for this article] (2022). Protein intake and the risk of pre-frailty/frailty in Norwegian older adults. The Tromsø Study 1994-2016. Full text in Research Archive
• Konglevoll, Dina Moxness; Hjartåker, Anette; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Andersen, Lene Frost [Show all 7 contributors for this article] (2022). Protein intake and the risk of pre-frailty/frailty in Norwegian older adults. The Tromsø Study 1994-2016. Full text in Research Archive
• Konglevoll, Dina Moxness; Hjartåker, Anette; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Andersen, Lene Frost [Show all 7 contributors for this article] (2022). Protein intake and the risk of pre-frailty/frailty in Norwegian older adults. The Tromsø Study 1994-2016. Full text in Research Archive
• Konglevoll, Dina Moxness; Hjartåker, Anette; Hopstock, Laila Arnesdatter; Strand, Bjørn Heine; Thoresen, Magne & Andersen, Lene Frost [Show all 7 contributors for this article] (2022). Protein intake and the risk of pre-frailty/frailty in Norwegian older adults. The Tromsø Study 1994-2016. Full text in Research Archive
• Uchai, Shreeshti; Andersen, Lene Frost; Hopstock, Laila Arnesdatter & Hjartåker, Anette (2022). Body Mass Index and Waist Circumference as predictors of Pre-frailty/frailty among older adults (Poster). Full text in Research Archive
• Øvrebø, Bente; Lund-Iversen, Kaja; Brantsæter, Anne Lise; Andersen, Lene Frost & Abel, Marianne Hope (2022). Ernæringsprofiler – estimerer matvarers ernæringsmessige kvalitet. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 20(4), p. 39–46. doi: 10.18261/ntfe.20.4.5. Full text in Research Archive
• Lengle, Julie Marie & Andersen, Lene Frost (2026). Healthy and environmentally sustainable diets for Norway: current patterns and future scenarios. The NOR-Eden Project. Universitetet i Oslo. ISSN 9788234809033. Full text in Research Archive Show summary

  Current food systems fail to deliver good health and are major drivers of environmental change. The aim of this thesis was to address key questions about the health and environmental implications of implementing the Nordic Nutrition Recommendations 2023 (NNR2023) and other dietary frameworks, including the Norwegian Food-Based Dietary Guidelines (FBDGs, 2012) and the EAT-Lancet Planetary Health Diet (PHD), under Norwegian conditions. The work uses detailed intake data from the national Norkost 3 (2010–2011) and Norkost 4 (2022–2023) dietary surveys of adults and older adults, linked to life cycle assessment data for six environmental indicators (e.g. greenhouse gas emissions, land use, eutrophication). We quantified the environmental impact of Norwegian adult diets across six indicators, assessed adequacy of utilizable protein in diets with higher plant protein shares, and applied constrained optimization to model culturally relevant diets that meet NNR2023 while reducing environmental pressures. Current Norwegian diets have high environmental footprints, largely driven by ruminant meat and dairy. Total protein intake is almost twice estimated requirements, and two thirds of protein comes from animal sources. Our analyses show that protein intake can be reduced and partially shifted from animal to plant sources without compromising adequacy for most adults, though some older women remain more vulnerable. FBDG aligned diets reduce environmental impacts, but more plant forward patterns and optimized NNR2023 consistent diets achieve considerably larger reductions, at the cost of marked changes in food choice. The findings highlight national FBDGs as a central tool to meet public health and environmental goals. However, the thesis work also underscores that achieving material dietary changes will require strong policy action and structural changes in food culture, particularly around ruminant meat, high fat dairy and the very low intake of legumes and other plant proteins.

• Lie, Anne Helene Kveim; Eriksen, Sara Soraya Aemsangthum; Sharma, Ritika; Asdal, Karoline; Tran, Elisabeth & Vereide, Ragnhild [Show all 11 contributors for this article] (2022). Klima og bærekraft i helseutdanningene. Universitetet i Oslo. Full text in Research Archive
• Astrup, Helene; Myhre, Jannicke Borch; Andersen, Lene Frost; Kristiansen, Anne Lene & Lund-Blix, Nicolai Andre (2020). Småbarnskost 3. Landsomfattende undersøkelse av kostholdet blant 2-åringer i Norge. Folkehelseinstituttet. ISSN 9788284061009. Full text in Research Archive Show summary

  Småbarnskost 3 er den tredje landsomfattende kartleggingen av kostholdet blant 2-åringer i Norge. I februar 2019 ble 3000 mødre til barn født i februar 2017 invitert til å fylle ut et spørreskjema om kostholdet til barnet ved 2 års alder. Spørreskjemaet var tilgjengelig både som et elektronisk spørreskjema og et papirspørreskjema. Deltakelsesprosenten i Småbarnskost 3 var 47 %. Mødrenes gjennomsnittsalder var 33 år og de fleste mødrene (67 %) hadde høyere utdanning. Da barnet var 2 år hadde de fleste mødrene (63 %) inntektsgivende arbeid på heltid og de fleste barna (94 %) gikk i barnehage. Resultatene fra Småbarnskost 3 viser en rekke positive trekk ved kostholdet til 2-åringer. Barna hadde et kosthold som i stor grad var i tråd med anbefalingene og inkluderte grovt brød, grøt og andre kornvarer, frukt, bær og grønnsaker, kjøtt og fisk, yoghurt og melk. Inntaket av næringsstoffer var også i stor grad i tråd med anbefalingene, med unntak av inntaket av mettet fett som i gjennomsnitt lå over anbefalt nivå og inntaket av jern som lå under anbefalt nivå for jenter. Tilskudd av vitamin D var nødvendig for å komme på nivå med anbefalt inntak av vitamin D. De viktigste resultatene fra undersøkelsen er summert opp i punktene under: • I andre leveår var andelen som ble ammet 34 % ved 13 måneders alder, 24 % ved 15 måneder, 16 % ved 18 måneder og 8 % ved 2 års alder. • 79 % av barna fikk grøt og gjennomsnittlig inntak av grøt var 87 g/dag. Hjemmelaget grøt ble gitt til 68 % og industrifremstilt grøt ble gitt til 29 % av barna. • Tilnærmet alle barna fikk brød, og gjennomsnittlig inntak var 113 g/dag. Grovt brød og ekstra grovt brød var de mest brukte brødtypene. De mest brukte påleggstypene var hvitost/smøreost og leverpostei. • Tilnærmet alle barna fikk grønnsaker og frukt og bær daglig eller ukentlig. Totalt gjennomsnittlig inntak av grønnsaker var 80 g/dag, og det var gulrot og tomat som var mest spist. Gjennomsnittlig inntak av frukt og bær var 181 g/dag, hvorav frisk frukt utgjorde 109 g/dag, mens industrifremstilte fruktmoser bidro med 35 gram frukt og bær per dag. • Gjennomsnittlig inntak av potet var 16 g/dag. • Gjennomsnittlig inntak av fisk og fiskeprodukter var 33 g/dag. Inntaket av kjøtt og kjøttprodukter var 35 g/dag. Rødt kjøtt utgjorde 83 % og hvitt kjøtt utgjorde 17 % av det totale kjøttinntaket. • Gjennomsnittlig inntak av kumelk som drikke var i underkant av 3 dl/dag. De fleste drakk lettmelk med 1 % fett (60 %) og lettmelk med 0,5 % fett (tilsatt vitamin D)(46 %). • De fleste barna (92 %) fikk yoghurt daglig eller ukentlig. Gjennomsnittlig inntak var 102 g/dag, og det meste av inntaket var fruktyoghurt. • Alle barna fikk vann, og gjennomsnittlig inntak var i underkant av 5 dl/dag. • 53 % av barna fikk juice daglig eller ukentlig, og gjennomsnittsinntaket var 29 g/dag. • 48 % av barna fikk søte drikker som saft, brus og nektar med sukker, og gjennomsnittlig inntak var i underkant av en halv desiliter per dag (40 g/dag). • 54 % av barna fikk vitamin D-tilskudd eller annet kosttilskudd, hvorav 30 % fikk tran og 16 % fikk vitamin D-dråper. • Gjennomsnittlig inntak av vitaminer og mineraler var på nivå med eller høyere enn anbefalt, med unntak av jern, som var litt under anbefalingen for jenter. Tran/vitamin D-dråper eller annet tilskudd med vitamin D var nødvendig for å komme på nivå med anbefalt daglig inntak av vitamin D. • Inntaket av vitamin A var over anbefalt daglig inntak, og den viktigste kilden var leverpostei. • Kosttilskudd (tran og vitamin D-dråper) var den viktigste kilden til vitamin D. Matvaregruppen smør, margarin og olje bidro også vesentlig til vitamin D. • De viktigste kildene til jern var brød, grøt og kjøtt/kjøttprodukter. • De viktigste kildene til jod var matvaregruppene melk og yoghurt og fisk og fiskeprodukter. • Gjennomsnittlig andel energi fra de ulike energigivende næringsstoffene (karbohydrat, protein og fett) var innenfor anbefalingene, med unntak av mettet fett som bidro med 12,8 energiprosent (E%) og dermed lå over anbefalt inntak (< 10 E%). 85 % av barna fikk mer mettet fett i kosten enn anbefalt. Hovedkildene til mettet fett var matvaregruppene smør, margarin og olje, melk og yoghurt, ost og kjøtt/kjøttprodukter. • Gjennomsnittlig andel energi fra tilsatt sukker var på 4,6 E% og innenfor anbefalingen (< 10 E%). 4 % av barna hadde et inntak ≥ 10 E%. Hovedkildene til tilsatt sukker var søte drikker og yoghurt. • Det var ingen store forskjeller i inntak av matvarer og næringsstoffer mellom gutter og jenter, men gutter hadde et høyere inntak av enkelte matvarer som for eksempel grøt og brød og et noe høyere inntak av enkelte næringsstoffer som for eksempel karbohydrat og jern. Sammenligningen av resultatene fra Småbarnskost 3 (2019) med resultatene fra den forrige landsomfattende kostholdsundersøkelsen blant 2 år gamle barn (Småbarnskost 2, 2007) tyder på at det har det skjedd flere endringer i kostholdet til 2-åringer i løpet av denne 12-årsperioden. Selv om samme metode (matvarefrekvensspørreskjema) ble benyttet i de to undersøkelsene, må endringene over tid vurderes med forbehold siden spørreskjemaet har blitt noe endret, samt at svarprosenten var lavere i Småbarnskost 3 sammenlignet med Småbarnskost 2 (47 % i 2019 vs. 56 % i 2007). Siden forrige undersøkelse har andelen barn som blir ammet i andre leveår økt. Det har vært en reduksjon i inntak av søte drikker (40 g/dag i 2019 vs. 60 g/dag i 2007), og en økning i inntak av vann (475 g/dag i 2019 vs. 307 g/dag i 2007). Inntaket av grønnsaker har økt (71 g/dag i 2019 vs. 54 g/dag i 2007), samtidig som inntaket av potet har gått ned (13 g/dag i 2019 vs. 26 g/dag i 2007). Totalt inntak av frukt og bær har økt (181 g/dag i 2019 vs. 152 g/dag i 2007), men inntaket av frisk frukt har gått ned, samtidig som inntaket av fruktmoser, og da særlig industrifremstilte fruktmoser, har økt. Inntaket av grøt har økt (87 g/dag i 2019 vs. 58 g/dag i 2007), og da særlig inntaket av hjemmelaget grøt, samtidig som inntaket av brød har blitt noe redusert (113 g/dag i 2019 vs. 131 g/dag i 2007). Selv om det totale inntaket av brød har gått ned, er inntaket av grovt brød høyere i 2019 sammenlignet med 2007. Inntaket av yoghurt har også økt siden 2007 (102 g/dag i 2019 vs. 71 g/dag i 2007). Inntaket av kumelk som drikke har blitt noe redusert (286 g/dag i 2019 vs. 309 g/dag i 2007), og da særlig inntaket av lettmelk med 1 % fett, samtidig som inntaket av lettmelk med vitamin D har økt siden 2007. Det har også vært en økning i andel brukere av helmelk og smør/Bremykt siden forrige undersøkelse i 2007. Gjennomsnittlig andel energi fra tilsatt sukker var lavere i 2019 (4,6 E%) sammenlignet med i 2007 (6,7 E%), og andelen som var innenfor anbefalingen for tilsatt sukker (< 10 E%) var høyere (96 % i 2019 vs. 84 % i 2007). Inntaket av mettet fett blant 2 år gamle barn synes ikke å ha endret seg siden 2007. Flere av barna fikk vitamin D-dråper i 2019 (16 %) sammenlignet med i 2007 (4 %), samtidig som andelen som fikk tran har blitt noe redusert, fra 38 % i 2007 til 30 % i 2019. Det var også en vesentlig reduksjon i andel som svarte at de unngikk å gi enkelte matvarer til barnet fordi de var redd barnet kunne reagere med allergi/intoleranse (15 % i 2019 vs. 27 % i 2007), og denne reduksjonen kunne tilskrives en vesentlig reduksjon i andelen som svarte at de unngikk å gi nøtter til barnet.

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