Our latest publications

• Zadnik, V.; Konjević, A. Duratović; Jurtela, M.; Lokar, K.; Bric, N. & Zagar, T. [Show all 22 contributors for this article] (2026). Mapping population-based cancer registries in Europe: coverage, data availability, and capacity for real-world data generation. ESMO Real World Data and Digital Oncology. 14. doi: 10.1016/j.esmorw.2026.100785.
• 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
• Vandraas, Kathrine Flørenes; Andersen, Sarah Hjorth; Trewin-Nybråten, Cassia Bree; Andreassen, Bettina Kulle; Blix, Egil Støre & Naume, Bjørn [Show all 9 contributors for this article] (2026). Translating CLEOPATRA into routine practice: National treatment patterns and survival for patients with HER2-positive metastatic breast cancer. Breast. ISSN 0960-9776. 89. doi: 10.1016/j.breast.2026.104852. Full text in Research Archive Show summary

  Introduction Amplification of the epidermal growth factor receptor 2 (HER2) gene occurs in 15-20% of breast cancers and was historically associated with poor prognosis. The CLEOPATRA trial established pertuzumab added to trastuzumab and chemotherapy as standard of care for metastatic HER2-positive breast cancer, demonstrating a 15.7-month improvement in median overall survival (OS). Strict trial inclusion criteria may limit generalizability to clinical practice. Population-based data can assess whether these survival benefits translate to real-world outcomes. Methods Women diagnosed with HER2-positive metastatic breast cancer in 2012–2021 were identified through the Cancer Registry of Norway and linked to health and treatment databases. Patients were categorized by treatment regimen and year of treatment initiation: pre-CLEOPATRA (2012–2014; trastuzumab ± chemotherapy) and post-CLEOPATRA (2015–2021; trastuzumab + pertuzumab ± chemotherapy). OS was estimated using Kaplan–Meier and Cox regression adjusted for clinical, and socioeconomic factors. Outcomes were benchmarked against CLEOPATRA. Results The cohort comprised 329 women, 23% were aged ≥65 years. Seventy-eight patients (24%) received pre-CLEOPATRA regimens and 251 (76%) post-CLEOPATRA regimens; 59% met minimum one CLEOPATRA exclusion criterion. First-line dual HER2 blockade increased from 0% in 2012 to 75% in 2021. Median OS improved from 69 months to 96 months post-CLEOPATRA. Four-year OS increased from 59% to 65% (adjusted hazard ratio 0.77, 95% CI 0.53–1.12). Real-world OS was consistent with CLEOPATRA outcomes. Conclusions Nationwide real-world data demonstrate favorable survival outcomes following adoption of dual anti-HER2 therapy. While these findings are broadly consistent with the CLEOPATRA trial, the observational design does not allow direct assessment of equivalence between studies.

• Rinde, Ludvig Balteskard; Hopstock, Laila Arnesdatter; Lundblad, Marie Wasmuth; Rinde, Nikoline Balteskard; Brobak, Karl Marius & Norvik, Jon Viljar Porserud [Show all 13 contributors for this article] (2026). Higher habitual protein intake is not linked to decline of iohexol-measured GFR in adults ≥40 years. Clinical Kidney Journal (CKJ). ISSN 2048-8505. 19(8), p. 1–10. doi: 10.1093/ckj/sfag235. 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.

• Siwa, Maria; Banik, Anna; Cereijo, Luis; Herstad, Sondre Haugsbø; Lakerveld, Jeroen & Lien, Nanna [Show all 9 contributors for this article] (2026). Implementation Strategies Used in Effective Policies to Combat Obesity in Socioeconomically Disadvantaged Communities: Systematic Review. Obesity Reviews. ISSN 1467-7881. doi: 10.1111/obr.70183. Full text in Research Archive Show summary

  ABSTRACT Introduction The effectiveness of obesity prevention or obesity reduction policies is co‐determined by policy content, the implementation process, and contextual factors. This systematic review provides insight into implementation strategies used in whole‐of‐community obesity prevention policies aimed at changes in two types of outcomes: (1) a reduction in obesity/overweight prevalence, body mass index–related outcomes, and other weight‐related outcomes, or (2) a change in nutrition behaviors, physical activity, and sedentary behaviors or screen time. We specifically examined implementation strategies using the Expert Recommendations for Implementing Change (ERIC) framework, focusing on policies implemented in low socioeconomic status communities. Methods Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, eight databases were searched. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. The efficacy of implementation strategies was considered supported if at least 66% of the studies that applied respective strategies reported significant improvements for a given outcome type across at least three studies. Results A total of 29 original studies were included. Fifteen implementation strategies from the ERIC framework were consistently associated with favorable outcomes. These strategies included altering incentive structures, assessing community readiness, and using data warehousing techniques. Six additional non–ERIC strategies (e.g., cultural adaptation and grassroots mobilization) received support across different outcome domains. Most studies (72%) had a low risk of bias. Conclusion Findings may help prioritize implementation strategies that may drive the success of whole‐of‐community obesity policies targeting disadvantaged populations. The results suggest a need to expand existing implementation taxonomies to include community‐driven strategies.

• 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.

• Meshkovska, Biljana; Zolfaghari, Mahshid; Brandvik, Caroline Løvik; Klepp, Knut-Inge; Kopainsky, Birgit & Lie, Hanne Cathrine [Show all 7 contributors for this article] (2026). Adoption of the Norwegian School Fruit Program: A Qualitative Study on Barriers and Facilitators. Global Implementation Research and Applications. doi: 10.1007/s43477-026-00238-1. Full text in Research Archive Show summary

  The Norwegian School Fruit Program is financed by parents or local municipalities. The aim of this study was to explore contextual barriers and facilitators that influence the adoption of the program by schools using the Context and Implementation of Complex Interventions (CICI) framework. We conducted semi-structured interviews with 21 participants (mainly principals) from 20 lower secondary schools (classes 8–10). We analyzed the data using a deductive qualitative approach based on the CICI framework. We compared findings across schools offering the program (1) with no-parental-payment, (2) by parental subscription, and schools that (3) discontinued or (4) never offered the program. Economic costs were perceived as the main barrier to adoption across all schools. Although most schools recognized the need for such a program, some preferred to make their own arrangements. Except for schools offering the parental subscription option, many schools perceived asking parents to pay for the program as unfair, not in line with Norwegian values, and unlikely to allow the program to reach those who need it the most. Further barriers were the lack of legislation making the program obligatory and potential political changes causing uncertainty regarding the programme’s continuation from one year to the next. Social aspects of eating together were recognized as a facilitator. Food provision programs should be compatible with school priorities such as academic performance and mental health. Context and setting are dynamic and should be continuously evaluated to ensure they are in line with evolving school priorities and needs.

• Moshina, Nataliia; Gjesvik, Jonas; Castells, Xavier; Larsen, Marthe; Ursin, Giske & Hofvind, Solveig Sand-Hanssen (2026). Breast cancer mortality among women who have attended BreastScreen Norway, 1996-2023. Breast Cancer Research. ISSN 1465-5411. 28(1). doi: 10.1186/s13058-026-02244-5. Full text in Research Archive
• Bålsrud, Pia; Ulven, Stine Marie; Hjartåker, Anette; Ottestad, Inger Olaug; Retterstøl, Kjetil & Schwab, Ursula [Show all 9 contributors for this article] (2026). Association between dietary protein intake and frailty index among home-dwelling older adults; an 8-year follow-up study. The Journal of Nutrition, Health & Aging. ISSN 1279-7707. 30(6). doi: 10.1016/j.jnha.2026.100850. Full text in Research Archive
• 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.

• Pferdmenges, Larissa E.; Colombani, Paolo C.; Carlsen, Monica Hauger; Pajari, Anne Maria; Poulsen, Anders & Dias, M. Graça [Show all 12 contributors for this article] (2025). Toward harmonizing protein data in food composition databases: evaluating perspectives, methods and implications. Critical reviews in food science and nutrition. ISSN 1040-8398. 65(33), p. 8502–8515. doi: 10.1080/10408398.2025.2503461. Full text in Research Archive Show summary

  Protein content in foods has historically been estimated by multiplying measured nitrogen content with a universal nitrogen-to-protein conversion factor (NCF) of 6.25. Despite scientific consensus that this approach leads to systematic overestimations due to variations in amino acid composition and non-protein nitrogen (NPN) content, no universally accepted revision has been implemented. This review critically examines diverse perspectives on protein quantification and their implications for Food Composition Databases (FCDBs). A structured definition of protein for FCDBs is proposed, including amino acid residues, free amino acids and small peptides, while explicitly excluding NPN and prosthetic groups. Furthermore, analytical methods and NCF calculations are evaluated in order to provide more accurate assessments of protein content across a range of food matrices. The review highlights the importance of selecting food-specific NCFs to reduce overestimations, ensuring both scientific accuracy and practical feasibility. By addressing methodological shortcomings and proposing a refined protein quantification framework, this work aims to facilitate the transition toward more precise and harmonized protein values in FCDBs, benefiting nutritional research, dietary guidelines, and food labeling regulations.

• Botteri, Edoardo; Andersen, Sarah Hjorth; Conforti, Fabio; Bagnardi, Vincenzo; Andreassen, Bettina Kulle & Støer, Nathalie Charlotte [Show all 11 contributors for this article] (2025). Aprepitant use during chemotherapy and association with survival in women with early breast cancer. Journal of the National Cancer Institute. ISSN 0027-8874. 117(11), p. 2249–2258. doi: 10.1093/jnci/djaf178. Full text in Research Archive Show summary

  Background Preclinical studies have shown that aprepitant, an antiemetic used to prevent chemotherapy-induced nausea and vomiting, slows mammary tumor growth and progression. Here, we evaluated the association between aprepitant and survival in a large cohort of women with early breast cancer. Methods Using linked nationwide registry data, we identified 13 811 women diagnosed with early breast cancer between 2008 and 2020 in Norway, who received chemotherapy and antiemetics. Women were followed for metastasis and death from 1 year after diagnosis until the end of 2021. To evaluate the association between aprepitant use and distant disease-free survival (DDFS) and breast cancer-specific survival (BCSS), we used Cox regression models, controlling for tumor and patient characteristics, chemotherapy regimens, and use of other antiemetics. Results During chemotherapy, 7047 (51%) women were supplied with aprepitant. Overall, aprepitant use was associated with better DDFS (HRDDFS = 0.89; 95% CI = 0.79 to 1.00) and BCSS (HRBCSS = 0.83; 95% CI = 0.71 to 0.97). The survival advantage was specific to women with non-luminal breast cancer (HRDDFS = 0.69; 95% CI = 0.56 to 0.83; HRBCSS = 0.64; 95% CI = 0.51 to 0.81) and was strongest in women with triple negative breast cancer (TNBC) (HRDDFS = 0.66; 95% CI = 0.53 to 0.83; HRBCSS = 0.61; 95% CI = 0.47 to 0.80). In women with non-luminal breast cancer, longer durations of aprepitant use were associated with increasingly favorable survival outcomes (DDFS: Ptrend = .002; BCSS: Ptrend = .016). Supply of other antiemetics of different drug classes was not associated with survival. Conclusions Aprepitant use during chemotherapy treatment was associated with better prognosis for women with non-luminal early breast cancer, in particular TNBC. Long-term clinical trials are required to confirm these findings.

• 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.

• Svendsen, Karianne; Nes, Lise Solberg; Leithe, Sigrid; Meland, Anders; Gjelsvik, Ylva Maria & Børøsund, Elin [Show all 17 contributors for this article] (2025). Testing two digital stress-management interventions in a randomized controlled trial of breast cancer patients. Scientific Reports. 15, p. 1–16. doi: 10.1038/s41598-025-22889-0. Full text in Research Archive Show summary

  Abstract The digital stress-management intervention StressProffen has been shown to be associated with improved well-being and quality of life for cancer survivors. In the Coping After Breast Cancer (CABC) trial, effects of 6 months’ access to modified versions of StressProffen, delivered through a digital download-only model, were examined. Women with breast cancer were invited to participate in the trial 6–9 months following diagnosis. Eligible participants were randomized to either: (1) digital cognitive behavioral therapy stress-management intervention (CBI), n  = 140, (2) digital mindfulness-based stress-management intervention (MBI), n  = 143, or (3) usual-care (control group), n  = 147. Primary outcome was change in perceived stress level (PSS-10), while secondary outcomes included changes in health-related quality of life (HRQoL), anxiety and depression, fatigue, mindfulness, sleep and coping. Perceived stress level at baseline was low for all groups. No statistically significant mean differences (MD) were detected between either of the intervention groups and the control group from baseline to 6-month follow-up for perceived stress level (MBI: MD -0.28 [95%CI: -1.75, 1.19], CBI: MD -0.42 [95%CI: -1.89, 1.06]), nor for the majority of the secondary outcomes. After 6 months of access, the CBI and MBI stress-management interventions did not yield significantly improved outcomes for women with breast cancer compared with usual-care controls. Further explorations of which interventions and delivery models may optimize use and effect, best timing for delivery, and individual preferences are needed. ClinicalTrials.gov identifier NCT04480203.

• Arnesen, Erik Kristoffer; Christensen, Jacob J.; Laake, Ida; Carlsen, Monica Hauger; Veierød, Marit Bragelien & Retterstøl, Kjetil (2025). Low-fat and whole milk consumption in relation to cardiovascular disease–related and all-cause mortality: a prospective cohort study in 3 Norwegian counties. American Journal of Clinical Nutrition. ISSN 0002-9165. 122(4), p. 1075–1085. doi: 10.1016/j.ajcnut.2025.07.035. Full text in Research Archive Show summary

  Background The impact of milk consumption on cardiovascular disease (CVD) risk or mortality is unclear, and specific comparisons between types of milk are scarce. Objectives We aimed to investigate the associations between milk consumption, measured in a large Norwegian cohort in 3 counties during 1974–1988, and CVD–related mortality and all-cause mortality and to compare the associations between whole (full-fat) and low-fat milk. Methods This population-based, prospective cohort study included adults invited to repeated health screenings in the Norwegian Counties Study (>80% attendance). Dietary intake was assessed from food frequency questionnaires at each screening in 1974–1988. Cox regression analysis was used to estimate hazard ratios (HRs) with 95% CIs for the associations between milk intake (assessed as cumulative mean intake from repeated questionnaires) and risk of death from all CVD, ischemic heart disease (IHD), acute myocardial infarction (AMI), and all causes. Results Among 73,860 participants included in this study (mean age: 41.2 years at baseline; 49% females), 26,393 deaths occurred (8590 from CVD, 4372 from IHD, and 3047 from AMI) during a median follow-up of 33 y. Comparing the highest with the lowest quintile of overall milk intake, the HR was 1.12 (95% CI: 1.03, 1.21) for CVD-related mortality and 1.22 (95% CI: 1.16, 1.28) for all-cause mortality. For whole milk, high compared with no intake was positively associated with CVD (HR: 1.07; 95% CI: 0.99, 1.16), IHD (HR: 1.13; 95% CI: 1.01, 1.27), and all-cause mortality (HR: 1.15; 95% CI: 1.10, 1.21). Compared with whole milk, low-fat milk intake was associated with lower CVD-related, IHD-related, AMI-related, and all-cause mortality. The associations were attenuated in analyses considering only baseline intakes. Conclusions In this cohort with high milk consumption, whole milk is associated with higher CVD and all-cause mortality, whereas low-fat milk is not. Low-fat milk may be associated with lower risks than whole milk.

• Trømborg, Åsne Skram; Vik, Jon Olav; Carlsen, Monica Hauger & Carlsen, Harald (2025). The prevalence and co-occurrence of emulsifiers, thickeners and stabilizers in food products on the Norwegian market. Food & Nutrition Research (FNR). ISSN 1654-6628. 69. doi: 10.29219/fnr.v69.12986. Full text in Research Archive Show summary

  Background: As the intake of food that has undergone substantial processing increases, the intake of common additives like Emulsifiers, Thickeners, and Stabilizers (ETSs) also increases. Several ETSs have drawn attention due to potential negative health effects. Objective: This study aimed to map the prevalence and co-occurrence patterns of ETSs across food products on the Norwegian market, examining their distribution across different food groups and products with varying nutritional profiles, including those classified as hyper-palatable. Design: Food product information, including ingredient lists and nutritional information, was obtained from two online databases used by major grocery chains, thus representative of the Norwegian market and analyzed for presence or absence of ETSs. Results: Thirty-two percent of food products contained at least one ETS, 60% of these contained more than one ETS, and many ETSs were found more frequently in combinations with others than individually. ETSs were present in a broad range of food products, with the highest percentage seen in the food groups Bakery, Cakes & Pastries, and Desserts & Ice cream. Mono- and diglycerides of fatty acids (E471) and diphosphates (E450) were the most used food additives. Fifty-eight percent of the food products analyzed were classified as hyper-palatable, though relationships with ETSs were variable across food groups. Conclusion: This is the first comprehensive analysis of its kind, providing a basemap for future research on the potential health effects of modern food products, particularly considering the limited understanding of how multiple ETSs may interact within biological systems.

• Vandraas, Kathrine Flørenes; Andersen, Sarah Hjorth; Trewin-Nybråten, Cassia Bree; Ursin, Giske; Botteri, Edoardo & Kulle, Bettina [Show all 10 contributors for this article] (2025). Anti‐Her2 therapy patterns in metastatic breast cancer—Real‐world data suggest undertreatment. International Journal of Cancer. ISSN 0020-7136. 158(3), p. 633–641. doi: 10.1002/ijc.70120. Full text in Research Archive Show summary

  Treatment efficacy of anti‐HER2 therapies for metastatic breast cancer (mBC) has been demonstrated in clinical trials, but real‐world data are lacking. In particular, it is unclear whether patients in clinical practice receive treatment as recommended. We took advantage of population‐based registries in Norway to assess anti‐HER2 therapy patterns in real‐world data, with specific attention to the treatment of vulnerable groups. We included 715 patients with HER2+ mBC diagnosed from 2012 to 2021. Median age was 60 years, 473 (66%) had relapsed from early‐stage BC, and 440 (62%) had hormone receptor positive (HR+) disease. Anti‐HER2 therapy patterns aligned with national recommendations. Median treatment duration for first line therapy was 7.2 months, where 261 patients (55%) used trastuzumab and pertuzumab (±chemotherapy), followed by monotherapy with trastuzumab (195 patients, 41%). Second line therapy was initiated by 206 patients (43%), with a median duration of 7 months, where trastuzumab emtansine was the most prevalent therapy, used by 84 patients (41%). Third line therapy was initiated in 119 patients (25%) and 55 patients (11%) proceeded to fourth line therapy. The 182 patients (28%) who did not receive any anti‐HER2 therapy were older (74 years vs. 55 years) and had more comorbidity compared to treated patients. Among patients ≤75 years and healthy, 15% did not receive anti‐HER2 therapy. Patient characteristics strongly influence anti‐HER2 treatment patterns, and although numerous treatment options are available, a substantial proportion of HER2+ mBC patients did not receive targeted therapy. Undertreatment may be present.

• 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.

• Moshina, Nataliia; Falk, Ragnhild Sørum; Botteri, Edoardo; Larsen, Marthe; Akslen, Lars Andreas & Ursin, Giske [Show all 8 contributors for this article] (2025). Long-term quality of life and quality adjusted life years after breast cancer: Impact of detection mode, tumor characteristics and treatment. Journal of Cancer Policy. 45. doi: 10.1016/j.jcpo.2025.100631. Full text in Research Archive
• 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.

• Teshale, Achamyeleh Birhanu; Htun, Htet Lin; Owen, Alice J; Baker, JR; Isaksen, Irja Minde & Freak-Poli, Rosanne (2025). Gender-Specific Population Attributable Fractions for Cardiovascular Disease and All-Cause Mortality Associated with Living Arrangement in Community-Dwelling Older People. Journal of General Internal Medicine (JGIM). ISSN 0884-8734. 40, p. 2613–2623. doi: 10.1007/s11606-025-09648-7. Full text in Research Archive Show summary

  Background Living alone poses significant cardiovascular disease (CVD) and mortality risks. The population attributable fraction (PAF) quantifies the proportion of disease burden attributable to a specific risk factor. This study aims to estimate the PAF for CVD and all-cause mortality related to living completely alone. Additionally, the study examined the PAFs associated with not living with a partner/spouse. Methods This study used longitudinal data from the Aspirin in Reducing Events in the Elderly (ASPREE) study and its sub-study, the ASPREE Longitudinal Study of Older Persons (ALSOP), which included 5853 men and 6998 women. The participants were community-dwelling healthy adults aged 70 + years without CVD, dementia, or significant physical disabilities. Adjusting for social determinants and traditional risk factors, the gender-specific PAFs of CVD and all-cause mortality attributable to living completely alone and not living with a partner/spouse were determined. Results Among women, 13.5% (95% CI: 6.3%, 22.4%) of CVD events could be attributed to living completely alone, and 14.1% (95% CI: 4.6%, 25.2%) to not living with a partner/spouse. For all-cause mortality in women, the corresponding PAFs were 9.8% (95% CI: 3.7%, 16.6%) and 12.3% (95% CI: 5.8%, 20.8%), respectively. In contrast, among men, only the PAF between not living with a partner/spouse and all-cause mortality reached statistical significance (PAF = 6.0%; 95% CI: 1.7%, 10.2%). The remaining PAF estimates for CVD events and all-cause mortality were not statistically significant. Conclusion The observed gender differences in CVD and all-cause mortality related to living alone highlight the need for tailored public health interventions to meet gender-specific needs for social connectedness.

• 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.

• Svendsen, Camilla; Andreassen, Monica; Bruzell, Ellen Merete; Denison, Eva Marie-Louise; Devold, Tove Gulbrandsen & Granum, Berit Brunstad [Show all 9 contributors for this article] (2025). Update of the scoping review of research on gastrointestinal effects of selected emulsifiers, stabilisers, and thickeners. VKM Report. 2025(2025: 03), p. 1–63. doi: https:/vkm.no/download/18.66c3e761195a46a3cfe39417/1742306403051/Rapport_Update%20of%20the%20scoping%20review%20of%20research%20on%20gastrointestinal%20effects%20of%20selected%20emulsifiers,%20stabilisers,%20and%20thickeners_Final%20(1).pdf. Full text in Research Archive Show summary

  In an updated scoping review of research on the effects of emulsifiers, stabilisers and thickeners on the gastrointestinal tract, VKM concludes that there are few studies in which the substance studied fulfills the criteria for being used as a food additive. None of the included studies were suitable for assessing long-term effects in humans, and the uncertainty related to the results and conclusions of the studies were high. Emulsifiers, stabilisers and thickeners (EST) Emulsifiers, stabilisers and thickeners are additives used in food to improve and preserve consistency. Emulsifiers are used to mix water and fats, thickeners are used to make food more viscous, and stabilisers can be used to prevent the precipitation. Substances that do not meet the criteria in the EU regulations for food additives, which are also followed in Norway, may have different biological properties than the approved additives. Studies of emulsifiers, stabilisers and thickeners that do not describe the substances in such a way that they unambiguously satisfied the criteria could, therefore, not be included in the overview. The emulsifiers, stabilisers and thickeners included in this scoping review were carrageenan (E 407), sodium carboxymethyl cellulose (E 466), sodium alginate (E 401), agar (E 406), processed Eucheuma seaweed (E 407a), guar gum (E 412), xanthan gum (E 415), and gellan gum (E 418). Few new studies were included in the updated scoping review In 2023, VKM mapped the research on what types of effects had been studied in the gastrointestinal tract in animals, humans or in organ models after exposure to the above-mentioned eight EST. VKM found that there was insufficient information about the substances in 214 studies, and therefore we could not assess whether the reported effects in these studies were due to the approved EST or to similar substances with other properties. "In this updated scoping review, VKM sent requests by email to the corresponding authors of the publications, whenever such contact information was available," says Trine Husøy, who was the chair of the project group. "Following receipt of the requested information, six of these studies were included. It was also confirmed that in some studies, the substance tested did not fulfill the criteria for use as food additives in Norway/EU. This shows the importance of including specific eligibility criteria also for the substances. The literature search was updated, but no new studies fulfilling all eligibility criteria were identified." Conclusion The conclusion in the present updated scoping review, after inclusion of six additional studies, remains the same as in the previous scoping review (VKM, 2023). The included studies on the effects of agar (E 406), sodium alginate (E 401), carrageenan (E 407), processed Eucheuma seaweed (E 407a), sodium carboxymethyl cellulose (E 466), guar gum (E 412) and xanthan gum (E 415) on the gastrointestinal tract were few, and in most of the studies the potential for systematic errors in the results or findings was high. None of the studies lasted long enough to evaluate long-term exposure in humans. Thus, the evidence base will be weak for assessment of risk for any negative effects on the gastrointestinal tract in humans. Share this page

• Zerouga, Insaf; Valeur, Jørgen; Sommer, Christine; Carlsen, Monica Hauger; Hagen, Milada & Høivik, Marte Lie [Show all 22 contributors for this article] (2025). Habitual Intake of Macronutrients and Fermentable Oligo-, Di-, Monosaccharides and Polyols is not associated with Irritable Bowel Syndrome-like Symptoms in Inflammatory Bowel Disease. Clinical Nutrition ESPEN. ISSN 2405-4577. 67, p. 105–113. doi: 10.1016/j.clnesp.2025.03.005. Full text in Research Archive
• Engstad, Martin Kvalvik; Seynnes, Olivier R.; Vesterhus, Ingvild; Hesseberg, Eirik; Fjeldberg, Ken & Carlsen, Monica Hauger [Show all 12 contributors for this article] (2025). Effect of Oral Contraceptive Use on Muscle Hypertrophy Following Strength Training. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 35(4). doi: 10.1111/sms.70052. Full text in Research Archive Show summary

  Oral contraceptives (OC) are widely used by women, while their interactions with strength training are yet to be resolved. This study investigated the effects of OC use on muscle hypertrophy and strength adaptation to heavy strength training in young adult women. Fifteen habitual OC users and 17 non-OC users (NOC) with regular menstrual cycles completed ~12 weeks of strength training, which spanned three menstrual cycles for the NOC group. All participants were young, healthy, and strength-untrained. Isometric knee-extensor strength, muscle cross-sectional area of the vastus lateralis (ultrasound imaging), and body composition (DXA) were used to evaluate training adaptations. Blood samples for estradiol and progesterone analyses, dietary registrations, and questionnaires assessing appetite, vitality, motivation, recovery status, and sleep duration were collected during the intervention period. Both groups experienced gains in lean mass and muscle strength. However, the OC group demonstrated a significantly larger increase in arm lean mass (5.5% ± 3.9% [mean ± standard deviation] vs. 2.9% ± 2.8%, p < 0.05) and vastus lateralis cross-sectional area (10.0% ± 4.1% vs. 5.3% ± 4.4%, p < 0.05) compared to the NOC group. Despite these differences, there was no significant group difference in lower body strength gains. Both groups reported similar levels of appetite, dietary intake, vitality, motivation to exercise, and perceived recovery throughout the study, although the OC group slept an average of 42 min longer per day. Our findings suggest that OC use potentiates muscle growth during strength training, although further research is needed to elucidate the underlying mechanisms and long-term effects.

• Kvåle, Rune; Ursin, Giske; Ekanger, Christian & Møller, Bjørn (2025). Considerable decline in prostate cancer mortality in Nordic countries after 2000. Acta Oncologica. ISSN 0284-186X. 64, p. 114–119. doi: 10.2340/1651-226X.2025.41334. Full text in Research Archive Show summary

  Background and purpose: In the late 1990s, the Nordic countries, with Norway at the top, were among the countries with the highest prostate cancer mortality in the world. We present updated mortality rates from the Nordic countries and discuss possible interpretations of changes in trends. Material and methods: Age-standardized rates for prostate-specific mortality in 1985–2022, estimated lifetime risk of death (0–84 years) and annual changes in mortality were obtained from the NORDCAN database. Joinpoint regression was used to evaluate trend changes for the period 1985–2022. For comparison, rates from other European countries from 2022 were retrieved from the GLOBOCAN database. Results: Between 1995–99 and 2018–22, mortality in men aged 40–84 years decreased from 38% in Denmark to 59% in Norway. By 2022 Norway had the second lowest mortality among the Nordic countries overall, and the lowest under 85 years. The life-time risk of dying from prostate cancer declined from 5.6–7.1% in 1995–99 to 3.1–4.2% in the last 5-year period. During the last years mortality has decreased most rapidly in Sweden (4.5% annually from 2016) and Norway (4.3% annually from 2014). The Nordic countries are no longer among the countries with the highest mortality in Europe. Interpretation: Mortality from prostate cancer has decreased significantly in the Nordic countries over the last decades. Possible explanatory factors are likely to include improvements in prostate cancer management strategies and treatment.

• Dahlgren, Monica Linnea; Berstad, Paula Marianna; Henriksen, Hege Berg; Blomhoff, Rune & Kværner, Ane Sørlie (2025). Characterization of Nova-classified foods in a large cohort of Norwegian colorectal cancer screening participants. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 23(1), p. 7–19. doi: 10.18261/ntfe.23.1.3. Full text in Research Archive Show summary

  Background: Epidemiological studies on Nova-classified ultra-processed foods (Nova 4) often rely on food frequency questionnaire (FFQ) data without specifying the foods that fall into this category. We aimed to provide a detailed characterization of Nova-classified food intake relevant to the Norwegian context. Method: We applied the Nova classification system on FFQ data obtained from a large sample of Norwegian colorectal cancer screening participants (the CRCbiome study). The contribution of each Nova category (1–4) to the total diet was assessed, identifying the main food and beverage contributors within each group, both by weight (g/day) and as percentage of total energy intake (E%). Results: Nova categories 1, 2, 3, and 4 contributed 1633, 4, 329 and 562 g/day, respectively, accounting for 31, 1, 18 and 50% of total E%. Bread was the largest contributor to Nova 4, providing 19 E%. Other significant contributors included desserts and sweets (5 E%), processed meat (4 E%), processed fish (2 E%), margarine (2 E%), and dairy products (1 E%). For Nova categories 1, 2, and 3, the main contributors were fruits (4 E%), oils (1 E%), and cheese (5 E%), respectively. Although men had a slightly higher intake of Nova category 4 foods than women (51 vs. 47 E%), the overall distribution and within-group contributors were largely similar between sexes. Conclusion: Using FFQ data, as much as half of the energy intake of the present population was derived from ultra-processed foods. Bread was the predominant contributor to ultra-processed foods, far surpassing the other items.

• Aguiar, Anaely; Rajah, Jefferson K.; Conway-Moore, Kaitlin; Savona, Natalie; Knai, Cécile & Vlad, Ioana [Show all 10 contributors for this article] (2025). Converging perspectives on the processes exacerbating adolescent obesity: An integrative systems approach. Social Science and Medicine. ISSN 0277-9536. 367. doi: 10.1016/j.socscimed.2025.117706. Full text in Research Archive Show summary

  Adolescent obesity is a complex public health challenge with steadily increasing and variable prevalence among countries. This paper synthesises the driving feedback mechanisms of adolescent obesity studied in the CO-CREATE project, furthering our understanding of the complexity of this issue. Using systems thinking principles and causal loop diagramming, we integrated the following knowledge and perspectives derived from diverse sources into a causal loop diagram (CLD): a systems map generated by adolescents through participatory modelling workshops, a comprehensive literature review, and input from subject-matter experts during validation workshops. We used a structured and iterative approach to include drivers and to identify feedback loops exacerbating adolescent obesity. The CLD identified 27 key feedback loops across four themes: twelve related to the commercial food environment, six to the physical activity environment, four to mental wellbeing and five to social norms. These loops indicate not only diet and physical activity as drivers of obesity but also stress and other emotional and social pressures. Recognising the imperative need to integrate the perspectives and experiences of adolescents into our analysis, this work advocates for the synthesis of experiential insights with empirical research. The integrated CLD can be used as a visual tool that fosters collaboration among stakeholders and engenders a more comprehensive and inclusive system understanding that can provide holistic intervention considerations to tackle adolescent obesity. Additionally, the CLD lays a foundation for subsequent quantitative modelling works to further address this issue and develop context-based approaches to prevention and evaluation of adolescent obesity.

• Meshkovska, Biljana; Moerman, Gerben; Baillergeau, Evelyne; Bröer, Christian; Lien, Nanna & Luszczynska, Aleksandra [Show all 9 contributors for this article] (2025). Voices of youth: youth participation in the CO-CREATE project. BMC Public Health. 25, p. 1–12. doi: 10.1186/s12889-025-23097-1. Full text in Research Archive Show summary

  Introduction Applying youth participatory action research (YPAR) has become common practice in public health. However, there are challenges in applying YPAR and there is a need for improving the process by learning from youth that has participated in such projects. This study explores youth involvement in the CO-CREATE project which focused on developing overweight and obesity prevention policies. Methods This is a qualitative study, based on three data sources: 1) fieldnotes taken by project staff during observation of youth (approximately 150 observations) 2) semi-structured interviews with project staff (n = 12) 3) direct feedback from participating youth through feedback forms (n = 51). Data was analyzed in NVivo, following the principles of reflexive thematic analysis. Results Five themes were generated which showcase youth involvement in CO-CREATE: 1) an inspired and engaged youth; 2) insights through respectful interactions; 3) a strength of voice and call to action; 4) challenges in understanding project and disengagement; and 5) interpersonal conflict and pressure to participate. Conclusion Taking the time to build trust and create a feeling of equality is important. It is also important to allow youth to take the lead when they wish so and have clear ideas of how to do so. Voices of rebelliousness can be a show of strength and help reach the goals of the project. Participation in CO-CREATE may have contributed toward individual empowerment of youth.

• Johansson, Anna L.V.; Skog, Anna; Johannessen, Tom Børge; Myklebust, Tor Åge; Kønig, Simon M. & Skovlund, Charlotte Wessel [Show all 19 contributors for this article] (2025). Changes in cancer incidence and stage during the COVID-19 pandemic in 2020–2021 in the Nordic countries. Acta Oncologica. ISSN 0284-186X. 64, p. 257–266. doi: 10.2340/1651-226X.2025.42079. Full text in Research Archive Show summary

  Background and purpose: The COVID-19 pandemic impacted substantially on cancer healthcare, including the temporary suspension of screening activities. We compared cancer incidence rates and stage during 2020–2021 to pre-pandemic rates in the Nordic countries. Material and methods: Using data from the national cancer registries in Denmark, Finland, Iceland, Norway, and Sweden, we estimated age-, sex-, and period-adjusted incidence rate ratios, expressed as relative percentage change (%) with 95% confidence intervals (CIs), comparing rates in 2020–2021 to those in 2017–2019 (pre-pandemic). Results: In 2020–2021, 340,675 cancer cases were diagnosed. The incidence rates declined during the first pandemic wave (Q2 2020), ranging from –21.7% [95% CI: –23.3%; –20.2%] (Sweden) to –7.9% [–17.7%; 3.0%] (Iceland). Incidence rates also declined in the second pandemic wave (Q1 2021), ranging from –8.6% [–10.2%; –6.9%] (Sweden) to –2.3% [–4.6%; 0.1%] (Norway), and in Sweden also by –3.1% [–4.8%; –1.3%] in the third pandemic wave (Q4 2021). Stage I breast cancer incidence declined during 2020 in Denmark/Norway/Sweden, with some catch-up in stage II incidence in 2021. Prostate cancer rates declined in Denmark/Finland/Norway/Sweden during 2020–2021, while melanoma rates declined in Finland in 2020. During 2020, colon cancer rates declined in Denmark and Iceland, while rectal cancer rates declined in Denmark, and lung and kidney cancer rates declined in Norway. Interpretation: During 2020–2021, cancer incidence rates declined across the Nordic countries with the largest declines in Sweden. During the third pandemic wave, the incidence rates were mostly similar to pre-pandemic rates. Changes in cancer stage may reflect reduced screening activities.

• 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.

• Tsuruda, Kaitlyn; Langseth, Hilde; Ursin, Giske; Hofvind, Solveig Sand-Hanssen & Fortner, Shannon Renee Turzanski (2024). Validity of self-reported number of pregnancies and maternal age at first birth among females attending organized mammographic screening. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948241281197. Full text in Research Archive Show summary

  Aims: Reproductive history conveys information about potential health risks later in adulthood. This study aimed to examine the validity of self-reported number of pregnancies and maternal age at first birth (AFB) among females attending BreastScreen Norway.<p> <p>Methods: Participants were identified through the Janus Serum Bank cohort in Norway and were eligible for this cross-sectional validation study if they participated in a health survey issued by BreastScreen Norway between 2006 and 2015. Retrospective self-reported survey information on number of pregnancies and AFB in years was validated against prospectively collected information from the Medical Birth Registry of Norway (MBRN) using the Spearman rank (rs) and intraclass correlation coefficients (ICC) with 95% confidence intervals (CI).<p> <p>Results: After exclusions, 51,598 subjects were included in the analysis on number of pregnancies and 46,919 in the analysis on AFB. On average, study subjects were 59–60 years old when completing the health survey and had become first-time mothers roughly 36 years earlier. Survey-based information about number of pregnancies was highly correlated and demonstrated high agreement with the registry data (rs=0.967, 95% CI 0.964–0.969; ICC=0.884, 95% CI 0.882–0.885). Survey-based information about AFB demonstrated even higher correlation and very high agreement with the registry data (rs=0.975, 95% CI 0.973–0.976; ICC=0.974, 95% CI 0.974–0.975).<p> <p>Conclusions: Retrospectively recalled survey-based information about number of pregnancies and AFB was highly accurate when validated against prospectively collected information in the MBRN. These survey-based data are valuable for future epidemiological research, and linkage to the MBRN may not be required when these data are available.

• Henriksen, Hege; Knudsen, Markus Dines; Hjartåker, Anette; Blomhoff, Rune & Carlsen, Monica Hauger (2024). Digital Food Frequency Questionnaire Assessing Adherence to the Norwegian Food-Based Dietary Guidelines and Other National Lifestyle Recommendations: Instrument Validation Study. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 26. doi: 10.2196/53442. Full text in Research Archive Show summary

  Background: Valid assessment tools are needed when investigating adherence to national dietary and lifestyle guidelines. Objective: The relative validity of the new digital food frequency questionnaire, the DIGIKOST-FFQ, against 7-day weighed food records and activity sensors was investigated. Methods: In total, 77 participants were included in the validation study and completed the DIGIKOST-FFQ and the weighed food record, and of these, 56 (73%) also used the activity sensors. The DIGIKOST-FFQ estimates the intake of foods according to the Norwegian food–based dietary guidelines (FBDGs) in addition to lifestyle factors. Results: At the group level, the DIGIKOST-FFQ showed good validity in estimating intakes according to the Norwegian FBDG. The median differences were small and well below portion sizes for all foods except “water” (median difference 230 g/day). The DIGIKOST-FFQ was able to rank individual intakes for all foods (r=0.2-0.7). However, ranking estimates of vegetable intakes should be interpreted with caution. Between 69% and 88% of the participants were classified into the same or adjacent quartile for foods and between 71% and 82% for different activity intensities. The Bland-Altman plots showed acceptable agreements between DIGIKOST-FFQ and the reference methods. The absolute amount of time in “moderate to vigorous intensity” was underestimated with the DIGIKOST-FFQ. However, estimated time in “moderate to vigorous intensity,” “vigorous intensity,” and “sedentary time” showed acceptable correlations and good agreement between the methods. The DIGIKOST-FFQ was able to identify adherence to the Norwegian FBDG and physical activity recommendations. Conclusions: The DIGIKOST-FFQ gave valid estimates of dietary intakes and was able to identify individuals with different degrees of adherence to the Norwegian FBDG and physical activity recommendations. Moderate physical activity was underreported, water was overreported, and vegetables showed poor correlation, which are important to consider when interpreting the data. Good agreement was observed between the methods in estimating dietary intakes and time in “moderate to vigorous physical activity,” “sedentary time,” and “sleep.”

• Ellingjord-Dale, Merete; Nygaard, Anders Benteson; Støer, Nathalie Charlotte; Bø, Ragnhild; Landrø, Nils Inge & Brunvoll, Sonja Hjellegjerde [Show all 14 contributors for this article] (2024). Temporal trajectories of long-COVID symptoms in adults with 22 months follow-up in a prospective cohort study in Norway. International Journal of Infectious Diseases. ISSN 1201-9712. 149, p. 1–8. doi: 10.1016/j.ijid.2024.107263. Full text in Research Archive Show summary

  Objectives There is a lack of large studies on long-COVID symptoms with symptoms measurements before the onset of COVID-19. Therefore, long-COVID is still poorly defined. Methods The Norwegian COVID-19 Cohort Study is a population-based, open cohort of adult participants (aged 18-96 years) from Norway. From March 27, 2020, participants were recruited through social media, invitations, and nationwide media coverage. Fourteen somatic and cognitive symptoms were assessed at baseline and four follow-ups for up to 22 months. SARS-CoV-2 test status was obtained from a mandatory national registry or from self-report. Results After follow-up, 15 737 participants had a SARS-CoV-2-positive test, 67 305 had a negative test, and 37 563 were still untested. Persistent symptoms reported more frequently by positive compared with negative participants one month after infection, were memory problems (3-6 months: adjusted odds ratio (aOR) = 6.8, CI = 5.7-8.1; >18 months: aOR = 9.4, CI = 4.1-22), and concentration problems (3-6 months: aOR = 4.1, CI = 3.5-4.7; >18 months: aOR = 4.4, CI = 2.0-9.7) as well fatigue, dyspnea, anosmia and dysgeusia. Conclusions COVID-19 was associated with cognitive symptoms, anosmia, dysgeusia, dyspnea, and fatigue as well as worsening of overall health up to 22 months after a SARS-CoV-2 test, even when correcting for symptoms before the onset of COVID-19.

• Andersen, Oddbjørn Klomsten; Gebremariam, Mekdes; Kaupang, Oda Bjørge; Lien, Nanna & Kolle, Elin (2024). Built for movement: Neighborhoods and adolescent physical activity behaviors, and the moderating role of socioeconomic position and gender. Health and Place. ISSN 1353-8292. 89. doi: 10.1016/j.healthplace.2024.103313. Full text in Research Archive Show summary

  This study examined whether the built environment was associated with physical activity among adolescents in Oslo, Norway, and the role of socioeconomic position and gender as potential moderators of this association. We used data from 897 adolescents who participated in the TACKLE cross-sectional study conducted in 2020. Built environment features (recreational facilities, parks, forest, public transport, traffic calming devices, and schools) were assessed objectively using Geographical Information Systems. Physical activity data included device-measured moderate-to-vigorous physical activity, total physical activity, and self-reported active transportation to school. Using general linear models and logistic regression, we found that most built environment features were unrelated to the participants’ device-measured physical activity. Longer distances to school and to traffic calming devices were associated with decreased likelihood of participants reporting active transportation to school. Our moderated regression analysis showed that adolescents with low socioeconomic backgrounds seemed less affected by longer distances to school compared with their high socioeconomic counterparts. Furthermore, boys appeared to be more sensitive to traffic safety relative to girls. Implementing traffic calming devices may enhance active transportation to school and improve traffic safety for Norwegian adolescents.

• Henjum, Sigrun; Rosendahl-Riise, Hanne; Morseth, Marianne S.; Hevrøy, Thyra Jensen; Hjartåker, Anette & Engebretsen, Ingunn Marie Stadskleiv [Show all 7 contributors for this article] (2024). Iodine nutrition in Community-dwelling Older Persons from Norway. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 22(4), p. 179–188. doi: 10.18261/ntfe.22.4.2. Full text in Research Archive Show summary

  Background: Older persons are vulnerable to malnutrition and inadequate micronutrient intake, including iodine deficiency. Objectives: To assess urinary iodine concentration (UIC) and dietary iodine intake in a group of community-dwelling older persons receiving home care services in Oslo. Method: One spot urine sample and two 24-hour dietary recalls were collected in 60 community-dwelling older persons (34 women and 26 men). UIC was analyzed by the Sandell-Kolthoff reaction and dietary iodine intake was calculated and compared to the provisional Average Requirement (AR). Multiple linear regression analyses were performed to find predictors for iodine intake. Results: The median UIC (p25-p75) was 102 (64–168) μg/L and dietary iodine intake was 104 (69–173) μg/day. In total, 58% had iodine intakes below provisional AR. The main source of iodine was milk and dairy products, accounting for 42% of total iodine intake. In multiple linear regression analyses, iodine supplement use and oral supplement use were largely associated with iodine intake, (β, 95 % CI): 132 (76, 187) and 92 (23, 187), respectively. Increasing number of meals (β, 95 % CI): 48 (9, 86) and older age 2 (0, 4) was also associated with iodine intake. Conclusions: Iodine status was found to be adequate at the group level, however, median iodine intake was below provisional AR. We found that the number of meals and total energy intake directly influenced iodine status. Most of the older persons consumed iodine-rich food items, thus the largest risk was not limited intake of iodine-rich food sources but limited energy intake.

• 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.

• Carlsen, Monica H.; Totland, Torunn Holm; Kumar, Radhika; Lensnes, Therese Margrethe Lysell; Sharma, Archana & Suntharalingam, A. Anita [Show all 9 contributors for this article] (2024). Evaluation of a digital FFQ using 24 h recalls as reference method, for assessment of habitual diet in women with South Asian origin in Norway. Public Health Nutrition (PHN). ISSN 1368-9800. 27(1). doi: 10.1017/S1368980024000302. Full text in Research Archive Show summary

  Objective: Dietary assessment tools should be designed for the target population. We developed an FFQ designed to assess diet in South Asian women in Norway. The study objective was to evaluate this FFQ using 24-h dietary recalls as reference method. Design: Approximately 3 weeks after the participants (n 40) had filled in the FFQ, the first of three non-consecutive 24-h dietary recalls was completed. The recalls were telephone-based, unannounced and performed by a trained dietitian, with 2–3 weeks between each interview. Setting: The DIASA 1 study, in Oslo, Norway. Participants: Women of South Asian ethnic origin participating in the DIASA 1 study were invited to participate in the evaluation study. Results: The WebFFQasia significantly overestimated the absolute intake of energy, protein, fat and carbohydrates compared with the 24-h dietary recalls. Absolute intakes of sugar, starch and fibre did not differ significantly between the methods. For energy percentages (E%), there were no significant differences, except for monounsaturated fat. Correlations were strong for E% from sugar and saturated fat and moderate for E% from fibre, carbohydrate, total fat and protein. Fourteen food groups out of twenty three were not significantly different compared with the reference method, and sixteen groups showed strong to moderate correlations. Conclusion: The WebFFQasia may be used to assess E% from habitual diet and can adequately estimate intakes and rank participants according to nutrient intake and main food categories at group level.

• Randby, Jorunn Sofie; Ogden, Terje & Lien, Nanna (2024). Implementation and effectiveness of a school-based intervention to increase adherence to national school meal guidelines: A non-randomised controlled trial. Public Health Nutrition (PHN). ISSN 1368-9800. 27. doi: 10.1017/S1368980023002938. Full text in Research Archive Show summary

  Objective: Implementation of school meal guidelines is often inadequate, and evidence for effective implementation strategies for school-based nutrition interventions is limited. The aim of the present study was to examine the implementation and effectiveness of a multi-strategy implementation intervention to increase adherence to the Norwegian national school meal guideline. Design: The study was a school-based hybrid implementation effectiveness trial with a pre–post non-equivalent control group design, testing three implementation strategies: internal facilitation, training and an educational meeting. Setting: Primary schools and after-school services in two counties in south-east Norway. Participants: School principals, after-school leaders and class teachers from thirty-three schools in the intervention county and principals and after-school leaders from thirty-four schools in a comparison county. Results: There was a significant difference of 4 percentage points in change scores between the intervention and the comparison groups at follow-up, after adjusting for baseline adherence (B = 0·04, se B = 0·01, t = 3·10, P = 0·003). The intervention effect was not associated with the school’s socio-economic profile. School-level fidelity was the implementation dimension that was most strongly correlated (rs = 0·48) with the change scores in the intervention group, indicating that principals’ support is important for gaining the largest intervention effects. Conclusions: A school-based intervention with low intensity, based on trained teachers as internal facilitators, can increase adherence to the national school meal guideline among Norwegian primary schools, irrespective of local socio-economic conditions. Implementation fidelity, at an organisational level, may be a useful predictor for intervention outcomes in schools.

• Arnesen, Erik Kristoffer; Laake, Ida; Carlsen, Monica Hauger; Veierød, Marit Bragelien & Retterstøl, Kjetil (2024). Potato Consumption and All-Cause and Cardiovascular Disease Mortality – A Long-Term Follow-Up of a Norwegian Cohort. Journal of Nutrition. ISSN 0022-3166. 154(7), p. 2226–2235. doi: 10.1016/j.tjnut.2024.05.011. Full text in Research Archive Show summary

  Background Potatoes are a staple food in many traditional cuisines, yet their impact on long-term risk of cardiovascular disease (CVD) and mortality is unclear, hampering evidence-based dietary guidelines. Objectives This study aimed to examine the association between potato consumption and all-cause and CVD-specific death over a substantial follow-up period within a cohort predominantly consuming boiled potatoes. Methods Adults from 3 Norwegian counties were invited to 3 health screenings in 1974–1988 (>80% attendance). Dietary data were collected using semiquantitative food frequency questionnaires at each screening to categorize weekly potato consumption (≤6, 7–13, or ≥14 potatoes/wk) and calculate daily cumulative mean intakes (grams/day). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression to estimate HRs and 95% CIs for the association between potato consumption and risk of death from all causes, CVD, ischemic heart disease (IHD), and acute myocardial infarction (AMI). Results Among 77,297 participants with a mean baseline age of 41.1 y (range: 18.0–63.9 y), we observed 27,848 deaths, including 9072 deaths due to CVD, over a median follow-up of 33.5 y. Participants who consumed ≥14 potatoes/wk had a lower risk of all-cause death compared with those consuming ≤6 potatoes/wk (HR: 0.88; 95% CI: 0.84, 0.93). Potato consumption was associated with a minor, inverse risk of death due to CVD, IHD, and AMI. In continuous analyses of cumulative intakes, each 100 g/d increment was associated with 4% lower risk of death from all causes (HR: 0.96; 95% CI: 0.94, 0.98), CVD (HR: 0.96; 95% CI: 0.93, 0.99), IHD (HR: 0.96; 95% CI: 0.91, 1.00), and AMI (HR: 0.96, 95% CI: 0.91, 1.01). Conclusions In this cohort with a generally high consumption of predominantly boiled potatoes, we find modest, inverse associations between potato consumption and death from all causes, CVD, and IHD.

• Baillergeau, Evelyne; Veltkamp, Gerlieke; Bröer, Christian; Helleve, Arnfinn; Kulis, Ewa & Lien, Nanna [Show all 12 contributors for this article] (2024). Democratising participatory health promotion: power and knowledge involved in engaging European adolescents in childhood obesity prevention. Health, Risk and Society. ISSN 1369-8575. 26(5-6), p. 201–221. doi: 10.1080/13698575.2024.2338120. Full text in Research Archive Show summary

  Public policy aimed at preventing undesired phenomena has increasingly sought to engage representatives of the target population. Little is known, however, about how power dynamics function to shape the processes and outcomes of risk governance engagement interventions. In order to study the ways in which, and the extent to which, power differentials can be reduced in participatory health promotion initiatives, we develop a conceptual framework synthetising theories of participatory action, phenomenology and governmentality. Based on the empirical research into youth participation in the EU project CO-CREATE, involving 15–19-year-old adolescents in five European countries (2019–2021), we show that diverse forms of knowledge may become available in engagement interventions. We analyse the use and relative inclusion and exclusion of these different forms of knowledge in terms of a three-level framework of different depths of democratisation in participatory health promotion: risk management, risk definition and risk negotiation. Advanced democratisation can only be achieved if risk negotiation is carried out in ways which embrace and encourage a range of different, and potentially conflicting forms of knowing.

• Vetlesen, Hanna Skorstad; Wik-Klokk, Merete; Wallace, Sean Ciaran; Rasmussen, Magnhild; Hjartåker, Anette & Nordstrøm, Marianne (2024). Nutritional status and dietary intake in children and adolescents with spinal muscular atrophy types II and III on treatment with nusinersen. Clinical Nutrition Open Science. 53, p. 57–67. doi: 10.1016/j.nutos.2023.12.005. Full text in Research Archive Show summary

  Background There are few assessments of nutritional care needs of children and adolescents with spinal muscular atrophy (SMA) after disease-modifying treatments became available. Aims To assess nutritional status, dietary intake and feeding difficulties in children and adolescents with SMA II and SMA III on treatment with nusinersen, and to explore possible associations between feeding difficulties and dietary intake. Methods Nutritional status was assessed by anthropometric measures and blood samples from annual follow-up appointments over a three-year period. Three 24-hour dietary recalls by phone were used to assess dietary intake. Feeding difficulties were assessed by the Egen Klassifikation- 2 scale. Results This study included 20 participants with SMA II with a median age of 7.0 (Q1 2.0; Q3 12.9) years and 20 participants with SMA III with a median age of 8.4 (Q1 4.3; Q3 12.2) years. Adequate intake of iron and vitamin D was dependent on use of supplementation. Iron deficiency was implied in 17.5 %, whereas vitamin D deficiency was documented in 5 % and vitamin D insufficiency in 37.5 % of the total SMA cohort. Growth failure with small mean decrease in height-for-age z-score over time was observed in both subgroups, however only significant in the SMA II group (P=0.02). Feeding difficulties were associated with reduced intake of protein -4.6 grams per day, 95 % CI [-7.3; -1.8], P=0.002. Conclusions Systematic monitoring of nutritional status continues to be important in pediatric patients with SMA II and SMA III on disease-modifying treatment. Attention in clinical care should be on prevention and treatment of nutritional deficits, with emphasis on iron and vitamin D status and adequate protein intake in persons with feeding difficulties.

• Busund, Marit Katinka; Ursin, Giske; Lund, Tore Eiliv; Chen, Sairah Lai Fa & Rylander, Karin Charlotta Maria (2024). Menopausal hormone therapy and incidence, mortality, and survival of breast cancer subtypes: a prospective cohort study. Breast Cancer Research. ISSN 1465-5411. 26(1). doi: 10.1186/s13058-024-01897-4. Full text in Research Archive Show summary

  Background Menopausal hormone therapy (MHT) is associated with an increased risk of postmenopausal breast cancer, predominantly the luminal A-like subtype. The impact of MHT on deaths from breast cancer subtypes is less understood. This study aimed to explore associations between MHT use and the incidence, mortality, and survival of intrinsic-like breast cancer subtypes.<p> <p>Methods Data from 160,881 participants with self-reported MHT use from the prospective Norwegian Women and Cancer Study were analyzed. Among them, 7,844 incident breast cancer cases, and 721 breast cancer-specifc deaths occurred. Cox proportional hazard regression was performed to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between MHT use and the incidence, mortality, and survival of breast cancer subtypes. <p>Results MHT use was associated with increased risk of overall, luminal A-like, and luminal B-like breast cancer, with respective HRs of 1.44 (95% CI 1.36–1.52), 1.41 (95% CI 1.31–1.52), and 1.23 (95% CI 1.09–1.40) among current estrogen-progestin therapy (EPT) users compared with never users. The risk increased by 4%, 4%, and 2% per year of EPT use for overall, luminal A-like, and luminal B-like breast cancers, respectively. MHT use was also associated with increased risk of overall and luminal A-like breast cancer mortality, with HRs 1.61% (95% CI 1.36–1.91) and 2.15% (95% CI 1.51–3.05) increased risk among current EPT users compared with non-users. Among patients with breast cancer, pre-diagnostic MHT use was not associated with worse survival from overall breast cancer but was inversely associated with survival from triple-negative breast cancer (TNBC; HR death 0.41; 95% CI 0.24–0.73 among current users). Results varied significantly according to tumor subtype (pheterogeneity=0.02). <p>Conclusions Our study suggests that MHT use increases the risk of incident and fatal overall and luminal A-like, and incident luminal B-like breast cancer but does not decrease overall survival among patients with breast cancer. Further research is needed to elucidate the mechanisms underlying MHT use and breast cancer lethality, and to explore whether MHT use among patients with TNBC is indeed free from harm.

• Knudsen, Markus Dines; Wang, Kai; Wang, Liang; Polychronidis, Georgios; Berstad, Paula Marianna & Hjartåker, Anette [Show all 10 contributors for this article] (2024). Colorectal Cancer Incidence and Mortality After Negative Colonoscopy Screening Results. JAMA Oncology. ISSN 2374-2437. 11(1), p. 46–54. doi: 10.1001/jamaoncol.2024.5227. Full text in Research Archive
• Holm, Ida Marie; Lorentzen, Sissi C. Stove; Carlsen, Monica Hauger; Valeur, Jørgen; Mellin-Olsen, Tonje & Dale, Hanna Fjeldheim (2024). Evaluation of dietary quality in patients with functional gastrointestinal symptoms: a Norwegian single centre study. Food & Nutrition Research (FNR). ISSN 1654-6628. 68. doi: 10.29219/fnr.v68.10692. Full text in Research Archive Show summary

  Background: Poor dietary quality has been described as a contributor to symptoms in subjects with functional gastrointestinal (GI) symptoms. Hitherto, the focus in dietary evaluation and treatment in this patient group has mainly been on avoiding individual nutrient deficiencies, and less attention has been given to the dietary pattern and the overall food quality. Hence, we aim to describe and evaluate the dietary quality in patients with functional GI symptoms. Methods: Patients with GI symptoms and a diagnosis of irritable bowel syndrome or inflammatory bowel disease in remission, consecutively referred to a clinical dietitian for nutritional guidance, were included. All participants completed a 7-day weighed food record. The intake of foods, energy, macro- and micronutrients was computed. Dietary quality was evaluated by intake frequencies based on a predefined food index, combined with assessing achievement of nutrient intake recommendations. Results: A total of 35 patients were included. Intake frequencies of red meat, cheese and sweets were high, whereas intake frequencies of green leafy vegetables, berries, nuts, whole grain and legumes were low. The total intake of vegetables, fruit, berries, fish and nuts was lower than current recommendations, and the intake corresponded to intake below recommendations for several micronutrients, including vitamins D, C and A; iodine; folate; potassium; and selenium. Conclusion: The group of patients with GI symptoms had overall inadequate dietary quality. Low intake of nutrient-dense food groups considered as beneficial for health corresponded with insufficient intake of several micronutrients. We recommend that dietary evaluation should focus on the intake of food groups, rather than nutrients, in the treatment of patients with functional GI symptoms, to ensure a better evaluation of dietary quality.

• Brandvik, Caroline Løvik; Meshkovska, Biljana; Schultz, Gry Irene Granli & Garnweidner-Holme, Lisa (2024). Implementing a nutrition education intervention in Eastern Norwegian Kindergartens: barriers and facilitators. BMC Nutrition. 10(1). doi: 10.1186/s40795-024-00908-z. Full text in Research Archive Show summary

  Background Implementations to improve healthy eating in kindergartens may play a pivotal role in shaping children’s dietary behaviors. There is limited research on the implementation and key implementation determinants (barriers and facilitators) of interventions in kindergarten settings. The aim of this study was to explore kindergarten staff members’ experiences with the implementation of a nutrition education intervention to identify implementation barriers and facilitators. Methods We interviewed 12 employees from five different kindergartens in an Eastern Norwegian municipality between 2019 until 2020. The individual interviews were guided by the consolidated framework for implementation research. The interviews were recorded, transcribed verbatim, and analyzed inductively, inspired by Braun and Clarke’s reflexive thematic analysis. Results Implementation facilitators were satisfactory planning and presentation execution, including tailoring to kindergarten and staff needs, food and meals being a kindergarten/staff priority, and confidence-building of staff. Barriers included unsatisfactory planning and presentation execution, the presentation as a one-time event, non-tailoring to kindergarten and staff needs, and kindergartens/staff not prioritizing food and meals. Conclusions When developing and implementing similar kindergarten interventions, the following should be considered: a participatory approach, active engagement of staff, the physical learning environment, and the frequency of opportunities to revisit topics.

• 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.

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• Hjartåker, Anette; Retterstøl, Kjetil; Müller, Hanne & Anderssen, Sigmund Alfred (2026). Grunnleggende ernæringslære. Gyldendal. ISBN 9788205614734. 485 p. Full text in Research Archive Show summary

  Boken legger særlig vekt på betydningen av samspillet mellom kosthold og fysisk aktivitet for god helse. Innholdet i denne fjerde utgaven er oppdatert i tråd med aktuell forskningslitteratur og nasjonale anbefalinger, og den er spesielt tilpasset norske forhold. Boken henvender seg til et bredt spekter av studenter ved universitets- og høyskoler, blant annet innenfor medisin, ernæring, idrettsfag og fysioterapi, i tillegg til andre fagområder som jobber med forebygging og folkehelse. Boken gir også et solid grunnlag for videre studier innenfor mer spesialiserte, tilgrensende områder som klinisk ernæring, samfunnsernæring og næringsmiddelteknologi.

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• Geleijnse, Gijs; Backes, Claudine; Chirlaque, Maria Dolores; Sloep, Matthijs; Navarro, Esteve Rodon & Šekerija, Mario [Show all 8 contributors for this article] (2026). Every cancer patient counts: strengthening European population-based cancer registries to improve cancer control. The Lancet Regional Health - Europe. 70. doi: 10.1016/j.lanepe.2026.101855.
• Dahlgren, Monica Linnea; Kværner, Ane Sørlie; Berstad, Paula Marianna; Hjartåker, Anette & Meshkovska, Biljana (2026). Acceptability of a digital diet- and lifestyle intervention in the Norwegian colorectal cancer screening program – A qualitative interview study. Full text in Research Archive
• Kværner, Ane Sørlie; Dahlgren, Monica Linnea; Berstad, Paula Marianna & Hjartåker, Anette (2026). The KoloPrev Study: A Randomized Controlled Trial of a Personalized Digital Diet and Lifestyle Intervention at Colorectal Cancer Screening. Full text in Research Archive Show summary

  Poster presentation

• 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.

• Isaksen, Irja Minde; Skeie, Guri; Brustad, Magritt; Kværner, Ane Sørlie; Thoresen, Magne & Hjartåker, Anette (2026). Dietary protein source and colorectal cancer risk in a prospective cohort of Norwegian women: preliminary results. Full text in Research Archive
• Hovland, Ida Heir; Bang, Lasse; Herfindal, Anne Mari; Strømland, Stine Sofie; Bogetvedt, Tina & Jahanshahi, Armita [Show all 29 contributors for this article] (2026). The Norwegian Microbiota Study in Anorexia Nervosa (NORMA): Integrating a clinical trial with preclinical experiments–A study protocol. doi: 10.1371/journal.pone.0342275. Full text in Research Archive Show summary

  Background: Anorexia nervosa (AN) remains difficult to treat, partly due to co-occurring mental health challenges and gastrointestinal symptoms. Emerging research suggests that individuals with AN exhibit gut microbiota dysbiosis and dysregulation in the gut-brain axis (GBA). However, research examining the role of gut microbiota as a potential driver of AN-related pathologies remains limited. The Norwegian Microbiota Study in Anorexia Nervosa (NORMA) will therefore investigate gut microbiota and its interaction with the GBA in AN. Methods: NORMA is a collaboration between the Norwegian University of Life Sciences and seven Norwegian specialized eating disorder inpatient treatment units, consisting of three work packages (WP): a clinical observational trial (WP1), in vitro fermentation experiments (WP2), and animal experiments (WP3). In WP1, 90 patients with AN (age 16-50, BMI < 18.5) admitted for treatment and 90 healthy controls (HCs, age 16-50, BMI 18.5-27) will be recruited. Data on mental and physical health, dietary intake, and blood and fecal samples for biomarker and microbiota analyses will be collected at baseline, 6 and 12 weeks after start of treatment for AN patients and once for HCs. Outcomes will be compared between groups, and longitudinal effects of standard treatment examined within the AN group. In WP2, fecal microorganisms from patients and HCs will be grown in vitro to assess influence of prebiotics. In WP3, mice will receive fecal microbiota from AN and HC donors to determine if and how AN‑related microbiota affects AN‑relevant phenotypes. Conclusion: NORMA is pioneering in its integration of clinical, in vitro, and animal studies, providing the most comprehensive gut microbiota study of AN so far. By investigating the role of gut microbiota in AN and effects of standardized treatment on gut microbiota composition, this study aims to inform the development of innovative therapeutic strategies and ultimately improve treatment outcomes and life quality for individuals with AN. Trial registration: NORMA is a registered clinical trial: clinicaltrials.gov as NCT06144905.

• Carlsen, Harald; Bøhn, Siv Kjølsrud; Rosa, Sabina Leanti La; Trømborg, Åsne Skram; Westereng, Bjørge & Carlsen, Monica Hauger [Show all 7 contributors for this article] (2025). AdHealth- introduksjon av et nytt forskningsprosjekt. Full text in Research Archive Show summary

  Oppstartsmøte for partnere i AdHealth

• Birkeland, Signe; Trømborg, Åsne Skram; Boysen, Preben; Carlsen, Monica Hauger & Carlsen, Harald (2025). On barrier functions in the mouse intestine. Full text in Research Archive
• Carlsen, Harald; Trømborg, Åsne Skram & Carlsen, Monica Hauger (2025). Food thickeners and their relation to health – a closer look at the gut. Full text in Research Archive Show summary

  Gjennomgang av litteraturen vedrørende fortykningsstoffer og tarmhelse på NutriNORs sommerskole 2025

• 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.

• Husøy, Trine; Andreassen, Monica; Bruzell, Ellen Merete; Denison, Eva Marie-Louise; Devold, Tove Gulbrandsen & Granum, Berit [Show all 9 contributors for this article] (2025). Update of the scoping review of research on gastrointestinal effects of selected emulsifiers, stabilisers, and thickeners. Scientific opinion of the panel on food additives, flavourings, processing aids,materials in contact with food, and cosmetics. VKM Report. 2025(3), p. 1–63. doi: https:/vkm.no/risikovurderinger/allevurderinger/konsistensmidlerogtarmenoppdatering.4.a627a4c190302ffd8525e33.html. Full text in Research Archive Show summary

  Summary This scoping review was commissioned by the Norwegian Food Safety Authority. The aim was to update a previous scoping review of research literature on the effects of emulsifiers, stabilisers and thickeners (EST) on the gastrointestinal (GI) tract, specifically agar (E 406), sodium alginate (E 401), carrageenan (E 407), processed Eucheuma seaweed (E 407a), sodium carboxymethyl cellulose (E 466), gellan gum (E 418), guar gum (E 412), and xanthan gum (E 415). The effects could be beneficial, adverse or neutral. A scoping review contrasts with a safety evaluation that consists of assessment of biological and chemical properties, potential toxicity of any organ, and dietary exposure estimates. It does not report on measures of the strength of the relationship between EST exposures and effects on the GI tract. The literature search covered the period from March 1, 2023 (end of search of the previous review) to June 11, 2024. The search strategy and the eligibility criteria were the same in the previous and the updated scoping reviews. Fifteen studies fulfilling the eligibility criteria were identified in the previous scoping review (VKM, 2023). In addition, 214 studies fulfilled all eligibility criteria except the criterion that the substance tested must be in accordance with the regulations for food additives in the EU and Norway. The information about the substance tested in these studies was insufficient, and to obtain this information for the present update, the VKM sent requests by email to the corresponding authors of the publications, whenever such contact information was available. If delivery failed, an effort was made to identify a new email address to which the request was re-sent. Six additional studies from five publications were included following receipt of requested information. No studies were included from the updated literature search. Four of the included studies examined effects of sodium alginate (E 401) and guar gum (E 412) in humans and two other studies examined effects of guar gum (E 412) and carboxymethyl cellulose (E 466) in pigs. From both the previous scoping review (VKM, 2023) and the present update, 21 controlled studies fulfilling the eligibility criteria were identified: five studies in humans and 16 in animals. The dose ranges reported or estimated, across all ESTs in the human and animal studies (four different species), were 36-214 mg/kg bw per day and 51-6000 mg/kg bw per day, respectively. The study durations of the human controlled studies were between 1 day and 1 week, i.e. acute exposures only. Study durations were subchronic (exposure ≥13 weeks) in four of the animal experimental studies and subacute (≤12 weeks) in the remainder. The endpoints addressed in the human studies were: • Faecal weight and consistency • Gastric emptying (time and frequency) • Glucose and insulin homeostasis • Satiety and appetite The endpoints addressed in the animal studies were: 10 Update of the scoping review of research on gastrointestinal effects of selected EST • Changes in gut microbiota composition or number of bacteria • Enzymatic activity (digestive, microbial, cell proliferation, and inflammatory) • Intestinal utilisation and fermentation of nutrients • Macroscopic changes (stomach, small intestine, colon) • Microscopic changes (digestive tract) including inflammation • Mucosal weight, content (colon) • Presence of blood or mucus in faeces • Tumor promotion in cancer-induced mice (genetic or chemical) The risk of bias was assessed as high in the human studies and as high and moderate in the animal studies. High risk of bias means that there is high likelihood that the features of the study design or conduct of the study will give misleading results and thus, conclusions. Conclusion There were few eligible studies on the effects of agar (E 406), sodium alginate (E 401), carrageenan (E 407), processed Eucheuma seaweed (E 407a), sodium carboxymethyl cellulose (E 466), guar gum (E 412) and xanthan gum (E 415) on the gastrointestinal tract. In most of the studies the potential was high for systematic errors in the results or findings. None of the studies lasted long enough to evaluate long-term exposure in humans. Thus, the evidence base will be weak for assessment of the risk for negative effects on the gastrointestinal tract in humans. The conclusion in the present updated scoping review, after inclusion of six additional studies, remains the same as in the previous scoping review (VKM, 2023). Key words: Colon, mapping review, eligibility criteria, EU regulation, food a

• Skammelsrud, Thorbjørn Brun; Hjartåker, Anette; Klingberg, Sofia & Brekke, Hilde Kristin (2025). Breastfeeding duration and maternal weight change through adulthood in a population-based cohort study. Full text in Research Archive
• 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
• Bjøntegaard, Marie Michaelsen (2025). Endring og omstilling – er det mulig? 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
• Henjum, Sigrun; Torheim, Liv Elin; Løvhaug, Anne Lene; Lund-Iversen, Kaja; Eide, Wenche Barth & Lien, Nanna (2025). Mat og menneskerettigheter i ernæringsrelatert folkehelsearbeid. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 23(3), p. 191–199. Full text in Research Archive Show summary

  Hva retten til fullgod mat som menneskerettighet innebærer, har i stor grad blitt fortolket av norske akademikere innen samfunnsernæring og menneskerettighets-jus i nært samarbeid med internasjonale kollegaer og norske myndigheter. Arbeidet har til tider vært nært knyttet til utviklingen av sentrale dokumenter og prosesser i FN-systemet. Dette arbeidet danner grunnlaget for aktivitetene i Kompetansenettverket for mat og menneskerettigheter (KoMM). KoMM har som formål å bidra til økt kompetanse om hvordan ulike aktører kan bruke en menneskerettighetsbasert tilnærming i arbeid med mat, ernæring, matsikkerhet, og sunne og bærekraftige matsystemer for å oppfylle FNs bærekraftsmål – primært i Norge, men også gjennom at Norge opprettholder og viderefører sin aktivitet på de relevante globale arenaene.

• Skammelsrud, Thorbjørn Brun; Hjartåker, Anette; Klingberg, Sofia & Brekke, Hilde Kristin (2025). Sammenhengen mellom amming og vektutvikling gjennom livet blant mødre i "Kvinner og kreft"-studien. 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.

• Bøhn, Siv Kjølsrud (2025). Blåbær og andre antioksidanter. Full text in Research Archive
• Carlsen, Monica Hauger; Andreassen, Monica; Bernhard, Annette; Bruzell, Ellen; Devold, Tove Gulbrandsen & Lillegaard, Inger Therese Laugsand [Show all 9 contributors for this article] (2025). Nitrat og nitritt i mat og drikke. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. doi: 10.18261/ntfe.23.1.8. Full text in Research Archive
• Husøy, Trine; Andreassen, Monica; Bernhard, Annette; Bruzell, Ellen Merete; Carlsen, Monica Hauger & Denison, Eva Marie-Louise [Show all 11 contributors for this article] (2025). Part 2 of the risk assessment of nitrate, nitrite and nitrosamines in food: The protocol. VKM Bulletin. p. 1–45. Full text in Research Archive Show summary

  The Norwegian Scientific Committee for Food and Environment (VKM) shall assess whether exposure to nitrates and nitrites from food poses a health risk for one or more groups in the Norwegian population. The Norwegian Scientific Committee for Food and Environment (VKM) will calculate the intake of nitrate and nitrite from food for different groups in the population and assess whether this constitutes a health risk. This is a two-part task commissioned by the Norwegian Food Safety Authority. As the first step, VKM has created an overview of which food items contain these substances and how much nitrate and nitrite they contain. The second part of the task is underway, where VKM will estimate nitrate and nitrite intake among different demographic groups in Norway and conduct a risk assessment. Background There is no existing data on which food items in the Norwegian market contain nitrate and nitrite, nor on the amounts present. Furthermore, the intake of nitrate and nitrite among different population groups in Norway is not known. Nitrate and nitrite can occur naturally in food and may also be added as a preservative or plant extract. Preservatives E 249, E 250, E 251, and E 252 are used to delay bacterial growth, thereby increasing food shelf life. Nitrate and nitrite have been linked to both positive and negative health effects. Read more about part 1 here: Foods containing nitrate and nitrite - Vitenskapskomiteen for mat og miljø (...)

• 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
• Hovland, Ida Heir; Bang, Lasse; Herfindal, Anne Mari; Strømland, Stine Sofie; Spernes, Tina & Jahanshahi, Armita [Show all 28 contributors for this article] (2024). The NORMA study - Gut microbiota alterations in anorexia nervosa - paving the way for personalized prebiotic treatment strategies. Presented by Siv Kjølsrud Bøhn. Full text in Research Archive Show summary

  Background & aim: Treatment of anorexia nervosa (AN) usually combines nutritional treatment with various types of psychotherapeutic approaches. The treatment is however complicated and only 50 percent of patients get satisfactory outcomes. In the NORMA-study the role of the gut microbiota for key features of AN is investigated and it is investigated whether the gut microbiota normalizes during treatment. The study also aims at developing strategies to improve treatment outcomes through microbiota manipulation. Method: The clinical trial is conducted as a longitudinal, multicenter study consisting of a clinical trial, a laboratory study and an animal study. In the clinical trial we will recruit a total of 90 patients with AN and 90 healthy controls (HC). Participants will complete self-reported questionnaires on mental and physical health, dietary intake and provide blood and fecal samples at three timepoints to analyze microbiota composition, specific blood biomarkers and nutrient intake associated to AN. Fecal microbial transplantation from humans to mice will be performed to investigate the impact of the microbiota on weight development, anxiety and obsessive-compulsive disorder (OCD)-like behavior. Prebiotics (carbohydrate types) will then be screened for their potential to normalize the anorexia associated microbiota using both in ex vivo and in vivo studies. Conclusion: The NORMA-study is the largest longitudinal microbiota study in AN ever conducted and will provide valuable insight into the role of the gut microbiota in AN and lay foundations for innovative treatment strategies that potentially can improve treatment outcomes and quality of life for patients.

• 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
• Lengle, Julie Marie (2024). Norsk kosthold optimalisert i henhold til Nordic Nutrition Recommendations 2023 og miljømessig bærekraft. Full text in Research Archive
• Lengle, Julie Marie (2024). Optimizing Norwegian diets to meet the Nordic Nutrition Recommendations 2023 and reduce environmental impacts. Full text in Research Archive
• Amberntsson, Anna (2024). The New Tools project - Developing tools for food system transformation, including food summary scores for nutrition and sustainability. Full text in Research Archive
• 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
• Klepp, Knut Inge (2024). Developing tools for food system transformaiton, including food summary scores for nutrition and sustainability - The NewTools project. Full text in Research Archive
• Carlsen, Monica Hauger (2024). Begrepet ultraprosessert mat og dets utfordringer i et kostholdsmetodologisk perspektiv. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 22(4), p. 233–236. doi: 10.18261/ntfe.22.4.10. Full text in Research Archive
• Hovland, Ida Heir (2024). Samarbeidsmøte og veiledning NORMA. Full text in Research Archive
• Hovland, Ida Heir (2024). Foredrag og veiledning NORMA-studien. Full text in Research Archive
• Hovland, Ida Heir (2024). Digitalt foredrag NORMA-studien. Full text in Research Archive
• Hovland, Ida Heir; Bøhn, Siv Kjølsrud; Bang, Lasse & Rø, Øyvind (2024). Gut microbiota alterations in Anorexia Nervosa and associations with gastrointestinal complaints and diet: The NORwegian study of gut Microbiota in Anorexia Nervosa (NORMA). Full text in Research Archive
• Hovland, Ida Heir (2024). Samarbeidsmøte og veiledning om NORMA-studien. Full text in Research Archive
• Hovland, Ida Heir (2024). Foredrag om tarmflora og anoreksi. Full text in Research Archive
• Hovland, Ida Heir (2024). Digital undervisning om NORMA-studien. Full text in Research Archive
• Abel, Marianne Hope & Amberntsson, Anna (2024). Evaluation of the revised Nutri-Score from a Norwegian perspective - Results from the NewTools project. Full text in Research Archive
• Lund-Iversen, Kaja; Løvhaug, Anne Lene; Helleve, Arnfinn; Meltzer, Helle Margrete; Abel, Marianne Hope & Olsen, Hanne Fjerdingby [Show all 9 contributors for this article] (2024). Engagement and involvement of partners in a collaborative research project for a sustainable food system – experiences from NewTools. Full text in Research Archive
• Andreassen, Monica; Carlsen, Monica Hauger; Bruzell, Ellen Merete; Denison, Eva Marie-Louise; Devold, Tove Gulbrandsen & Granum, Berit Brunstad [Show all 12 contributors for this article] (2024). Mapping of dietary sources of nitrates and nitrites. VKM Bulletin. VKM Bulletin 2024: 27, p. 1–53. Full text in Research Archive Show summary

  Vitenskapskomiteen for mat og miljø (VKM) skal beregne hvor mye nitrat og nitritt ulike grupper i befolkningen får i seg fra maten, og vurdere om dette utgjør en helserisiko. VKM har i første omgang laget en oversikt over hvilke matvarer som inneholder disse stoffene, og hvor mye nitritt og nitrat som finnes i disse matvarene. Det finnes ingen oversikt over hvilke matvarer på det norske markedet som inneholder nitrat og nitritt og hvor mye de inneholder, og det er heller ikke kjent hvor mye nitrat og nitritt ulike befolkningsgrupper i Norge får i seg fra kosten. Nitrat og nitritt kan forkomme naturlig i en matvare, og stoffene kan være tilsatt som konserveringsmiddel eller som planteekstrakt. Konserveringsmidlene E249, E 250, E 251 og E 252 brukes for å bremse vekst av bakterier, og øker dermed matens holdbarhet. Nitrat og nitritt knyttes både til både positive og negative helseeffekter. Om oppdraget VKM fikk i oppdrag å lage en oversikt over hvilke matvarer på det norske markedet som inneholder nitrat og nitritt, og i hvilke mengder stoffene forekommer. Vi fant at produkter fra de fleste matvaregrupper inneholder nitrat og nitritt, enten hver for seg eller samtidig. Stoffene finnes i ulike drikkevarer, fisk, frukt, grønnsaker, belgvekster, poteter, kjøtt, korn og kornprodukter, melk og melkeprodukter, salt og krydder, smør, margarin og oljer, samt i spedbarnsmat og sammensatte retter. Det er store forskjeller i mengden nitrat og nitritt som er funnet i de ulike matvaregruppene. Oversikten viser også i hvilke matvaregrupper vi ikke fant informasjon om nitrat- og nitrittinnhold. Dette er første del i et todelt oppdrag fra Mattilsynet. I neste omgang skal VKM beregne hvor mye nitrat og nitritt ulike grupper i den norske befolkningen får i seg fra maten, og foreta en risikovurdering av dette. Dette arbeidet startes i januar 2025. Oversikten er godkjent av VKMs faggruppe for tilsetningsstoffer, aroma, matemballasje og kosmetikk.

• Strømland, Stine Sofie; Aspholm, Trude; Fjørtoft, Jenny; Brønner, Charlotte Utheim; Stolt, Emma & Snipen, Lars-Gustav [Show all 12 contributors for this article] (2024). Effects of sulfur amino acid restriction on gut microbiota and inflammation in people with overweight and obesity: an 8-week randomized controlled dietary intervention study. 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.

• Carlsen, Harald; Carlsen, Monica Hauger; Trømborg, Åsne Skram & Teistung, Linnestad, Maren (2024). Mapping the occurrence of 11 common hydrocolloids in the Norwegian diet using the Norkost4 pilot study. Norges miljø- og biovitenskapelige universitet (NMBU). Full text in Research Archive Show summary

  Background: New ways of processing food were introduced during the 20th century. This has resulted in a diet where minimally processed foods increasingly have been replaced by products with a higher degree of processing. Highly processed food, often referred to as ultra-processed food (UPF), has been associated with obesity and other chronic diseases. Several aspects of highly processed food products have been suggested as causative in increased risk of chronic diseases, one of which involves hydrocolloids, through their interactions with the gut microbiota. These are food additives exclusively found in highly processed food. In Norway, there is growing concern over using hydrocolloids in foods due to their potential negative impact on intestinal health. Aims: The overall aim was to map the intake of foods with 11 common hydrocolloids in study participants of the pilot study of the national dietary survey Norkost4 and assess whether the intake of foods with hydrocolloids varied between sex and age. Methods: Dietary data from the Norkost4 pilot study collected through two non-consecutive 24-hour recall interviews were used. The foods and beverages were classified according to the NOVA classification by a former master’s student at the University of Oslo, and only foods classified as UPF were used in the present master thesis. These foods and beverages were assigned with global trade item numbers (GTINs) to be able to identify these in the VetDuAt.no product database, for the subsequent extraction of data on hydrocolloid content from the product declaration, using an application programming interface (API). Data was further analyzed in RStudio. Results: Virtually all participants consumed hydrocolloids daily, of whom 70% consumed between three to seven different hydrocolloids, and the remaining 30% consumed more than seven or fewer than three. Guar gum (E412) and xanthan gum (E415) were found to be the most frequently used hydrocolloids in foods and beverages, and the most consumed by 82% and 75% of the study participants respectively. The average intake of foods with hydrocolloids ranged from about two to 50 grams per person daily. Significant differences (p<0.05) in the intake of foods with hydrocolloids were found between sex (E401, E406, E407, E412, and E440) and age groups (E406, E407, E410, and E440). Conclusion: The 11 selected hydrocolloids were frequently consumed by the study participants and guar gum and xanthan gum were the most frequently consumed. Findings from the current study indicate that hydrocolloids are consumed daily in the Norwegian population, providing a basis for further investigation to elucidate possible long term health effects in humans.

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