marimkri

• Amberntsson, Anna; Paulsen, Mari Mohn; Bianchi, Marta Angela; Birgisdottir, Bryndis Eva; Biltoft-Jensen, Anja Pia & Konglevoll, Dina Moxness [Vis alle 9 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Amberntsson, Anna; Paulsen, Mari Mohn; Randby, Jorunn Sofie; Lund-Iversen, Kaja; Brantsæter, Anne Lise & Andersen, Lene Frost [Vis alle 7 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

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

• Amberntsson, Anna; Abel, Marianne Hope; Paulsen, Mari Mohn; Andersen, Lene Frost; Øyen, Jannike & Rosendahl-Riise, Hanne [Vis alle 7 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

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

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

  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.

• Nassau, Femke van; Cillekens, Bart; Jelsma, Judith G M; Vis, Christiaan; Mokkink, Lidwine B & Treweek, Shaun [Vis alle 61 forfattere av denne artikkelen] (2025). CONsensus-based Process evaluation reporting guideline for public HEalth intervention Studies (CONPHES) conducted alongside an effectiveness trial: an e-Delphi study. BMJ Open. 15(12). doi: 10.1136/bmjopen-2024-093962. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Many researchers conduct a process evaluation alongside an effectiveness trial of a public health intervention to better understand mechanisms behind observed effects. Yet, there is no standardised, scientifically accepted guideline for reporting such process evaluations, which impedes interpretation and comparison of study results. The aim of this project was to develop a consensus-based and expert-based guideline for reporting process evaluations of public health interventions conducted alongside an effectiveness trial. Design and setting We conducted an e-Delphi study with a large panel of international experts. Participants Based on purposive sampling, we invited 137 international experts that had been involved in the design of process evaluations, researchers who published high-profile process evaluations or frameworks, editors of journals that publish process evaluations, and authors of other reporting guidelines. Results Based on a literature search, a first draft of the reporting guideline included 32 items, which was proposed to panel members during the first round. Of the invited 137 invited international experts, 73 (53%) participated in at least one round of the e-Delphi study. Participants rated the inclusion and comprehensibility of the proposed items on a 5-point Likert scale and provided comments and suggestions for relevance and definitions of the items. Adjustments to the items and descriptions were proposed to the e-Delphi panel until consensus of ≥67% for each individual item was reached. In total, 64 (88% of 73) completed round 2, and 55 (76% of 73) completed round 3. This resulted in 19 items that are included in the consensus-based process evaluation reporting guideline for public health intervention studies (CONPHES) guideline. The items cover a detailed description of the intervention that is evaluated, the implementation strategies applied, and underlying causal pathways, and the role of the delivery and support team. The guideline also requires describing the evaluation framework and how evaluation outcomes were assessed. Lastly, the guideline includes items on providing a detailed description of applied analyses (both quantitative and qualitative) and measures for assuring quality. The guideline is accompanied by an Explanation and Elaboration document, with a more detailed explanation of each item. Conclusions We expect that the CONPHES reporting guideline for process evaluations of public health interventions can improve the reporting of process evaluations of interventions aimed at promoting public health. This can potentially facilitate more effective translation of public health research into practice and contribute to improving both individual and population health outcomes.

• 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, s. 1–11. doi: 10.29219/fnr.v69.12600. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Amberntsson, Anna; Heide, Emilie; Paulsen, Mari Mohn; Solberg, Siri Løvsjø; Løvhaug, Anne Lene & Andersen, Lene Frost [Vis alle 7 forfattere av denne artikkelen] (2025). The performance of Nutri-Score as a tool in guiding and evaluating nutritional quality of food procurements for high schools in Norway. Food & Nutrition Research (FNR). ISSN 1654-6628. 69. doi: 10.29219/fnr.v69.11483. Fulltekst i vitenarkiv Vis sammendrag

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

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

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

• Beichmann, Benedicte; Sollerud, Eli; Warmbrodt, Nicole Sonja; Ottestad, Inger; Paulsen, Mari Mohn & Henriksen, Christine [Vis alle 7 forfattere av denne artikkelen] (2025). Measured and predicted energy expenditure among patients with distal bowel cancer: Results from the GAIN-project. Clinical Nutrition. ISSN 0261-5614. 53, s. 88–98. doi: 10.1016/j.clnu.2025.08.022. Fulltekst i vitenarkiv
• Paulsen, Mari Mohn; Torcelino-Iszatt, Nina Louise; Sakhi, Amrit Kaur; Karimi, Mahin; Broadwell, Sharon Lynn & Papadopoulou, Eleni [Vis alle 11 forfattere av denne artikkelen] (2025). Environmental contaminants, heavy metals, and essential elements in Norwegian children and adolescents: Data from the Norwegian environmental biobank. Environment International. ISSN 0160-4120. 202, s. 1–15. doi: 10.1016/j.envint.2025.109633. Fulltekst i vitenarkiv
• Amberntsson, Anna; Paulsen, Mari Mohn; Bianchi, Marta Angela; Birgisdottir, Bryndis Eva; Biltoft-Jensen, Anja Pia & Konglevoll, Dina Moxness [Vis alle 10 forfattere av denne artikkelen] (2025). Improvements to the Nutri-Score to address challenges identified in a Nordic setting. Food & Nutrition Research (FNR). ISSN 1654-6628. 69. doi: 10.29219/fnr.v69.10914. Fulltekst i vitenarkiv Vis sammendrag

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

• 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, s. 1–13. doi: 10.29219/fnr.v69.11444. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Paulsen, Mari Mohn; Haug, Line Småstuen; Sakhi, Amrit Kaur; Thomsen, Cathrine & Brantsæter, Anne Lise (2025). Associations between dietary patterns and environmental contaminants in children from the Norwegian Environmental Biobank: A cross-sectional analysis. Environmental Research. ISSN 0013-9351. 280, s. 1–9. doi: 10.1016/j.envres.2025.121871. Fulltekst i vitenarkiv
• Meltzer, Helle Margrete; Abel, Marianne Hope; Knutsen, Helle Katrine; Amberntsson, Anna; Brantsæter, Anne Lise & Ljøsne, Isabelle Sylvie Budin [Vis alle 13 forfattere av denne artikkelen] (2024). What is a sustainable diet in the Norwegian context? Scandinavian Journal of Public Health. ISSN 1403-4948. 53(2), s. 195–206. doi: 10.1177/14034948241269763. Fulltekst i vitenarkiv
• Bakken, Line; Helland-Kigen, Kaja & Paulsen, Mari Mohn (2024). Barrierer og fasilitatorer for systematisk ernæringsarbeid i hjemmesykepleien i en stor kommune i Norge. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 22(3), s. 128–136. doi: 10.18261/ntfe.22.3.4. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Systematisk ernæringsarbeid for å forebygge og behandle underernæring i tråd med nasjonale føringer skal være en integrert del av helse- og omsorgstjenestene. Likevel har flere studier og tilsyn vist mangler i både kartlegging og behandling av underernæring i hjemmesykepleien. Hensikt: Å identifisere barrierer og fasilitatorer for systematisk ernæringsarbeid i hjemmesykepleien, samt undersøke deltakernes kjennskap til nasjonale og lokale retningslinjer. Metode: Det ble utført en kvalitativ studie blant fastleger, ledere og pleiepersonell i hjemmesykepleien i en stor kommune i Norge. Det ble brukt semistrukturerte individuelle intervjuer for å samle inn dataene. Materialet ble analysert deduktivt med tematisk analyse i henhold til Consolidated Framework for Implementation Research (CFIR). Resultater: Det var varierende kjennskap til retningslinjene og kommunens prosedyre blant pleiepersonell i hjemmesykepleien. De største identifiserte barrierene for systematisk ernæringsarbeid var manglende kunnskap og kompetanse, mangel på tid og manglende systematikk. De største identifiserte fasilitatorene var en felles oppfatning om at ernæringsarbeid er viktig, samt god ledelsesforankring. Konklusjon: Systematisk ernæringsarbeid ble utfordret av manglende kunnskap og kompetanse, samt manglende systematikk og tid. God ledelsesforankring ble identifisert som en viktig fasilitator, samt en forutsetning for å tilrettelegge for systematisk ernæringsarbeid.

• Slaathaug, Christine; Paulsen, Mari Mohn; Jafarzadeh, Sepideh; Carlsen, Monica Hauger & Andersen, Lene Frost (2024). Nutritional quality and climate impact of Norwegian adults’ diet classified according to the NOVA system. Nutrition Journal. 23(1), s. 1–12. doi: 10.1186/s12937-024-01066-5. Fulltekst i vitenarkiv Vis sammendrag

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

• Paulsen, Mari Mohn; Øvrebø, Bente; Løvhaug, Anne Lene; Lund-Iversen, Kaja; Andersen, Lene Frost & Helleve, Arnfinn [Vis alle 7 forfattere av denne artikkelen] (2024). Responses to the updated Nutri-Score algorithms in Norway: A qualitative study among food system actors in the NewTools-project. Food & Nutrition Research (FNR). ISSN 1654-6628. 68. doi: 10.29219/fnr.v68.10254. Fulltekst i vitenarkiv Vis sammendrag

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

• Meltzer, Helle Margrete; Abel, Marianne Hope; Knutsen, Helle Katrine; Amberntsson, Anna; Brantsæter, Anne Lise & Ljøsne, Isabelle Sylvie Budin [Vis alle 13 forfattere av denne artikkelen] (2024). Hva er et bærekraftig norsk kosthold? Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 22(2), s. 75–91. doi: 10.18261/ntfe.22.2. Fulltekst i vitenarkiv
• Beichmann, Benedicte; Henriksen, Christine; Paur, Ingvild & Paulsen, Mari Mohn (2024). Barriers and facilitators of improved nutritional support for patients newly diagnosed with cancer: a pre-implementation study. BMC Health Services Research. 24, s. 1–12. doi: 10.1186/s12913-024-11288-2. Fulltekst i vitenarkiv Vis sammendrag

  Background Disease-related malnutrition affects a significant number of patients with cancer and poses a major social problem worldwide. Despite both global and national guidelines to prevent and treat malnutrition, the prevalence is high, ranging from 20 to 70% in all patients with cancer. This study aimed to explore the current practice of nutritional support for patients with cancer at a large university hospital in Norway and to explore potential barriers and facilitators of the intervention in the Green Approach to Improved Nutritional support for patients with cancer (GAIN), prior to implementation in a clinical setting. Methods The study used individual interviews and a focus group discussion to collect data. Study participants included different healthcare professionals and patients with cancer treated at a nutrition outpatient clinic. The Consolidated Framework for Implementation Research (CFIR) was used to guide the thematic data analysis. Results Barriers connected to the current nutritional support were limited resources and undefined roles concerning responsibility for providing nutritional support among healthcare professionals. Facilitators included a desire for change regarding the current nutritional practice. The GAIN intervention was perceived as feasible for patients and healthcare professionals. Potential barriers included limited knowledge of technology, lack of motivation among patients, and a potential added burden experienced by the participating patients. Conclusions The identification of the potential barriers and facilitators of the current nutritional support to patients with cancer will be used to plan the implementation of improved nutritional support in a randomized controlled trial for patients with cancer prior to clinical implementation. The current findings may be of value to others trying to implement either or both nutritional support and digital application tools in a clinical healthcare setting. Trial registration The study was registered in the National Institutes of Health Clinical trials 08/09/22. The identification code is NCT05544318.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• Paulsen, Mari Mohn; Paur, Ingvild; Gjestland, Johanna; Henriksen, Christine; Varsi, Cecilie & Tangvik, Randi Julie [Vis alle 7 forfattere av denne artikkelen] (2020). Effects of using the MyFood decision support system on hospitalized patients' nutritional status and treatment: A randomized controlled trial. Clinical Nutrition. ISSN 0261-5614. 39(12), s. 3607–3617. doi: 10.1016/j.clnu.2020.03.012. Fulltekst i vitenarkiv Vis sammendrag

  Background & aims Compliance to guidelines for disease-related malnutrition is documented as poor. The practice of using paper-based dietary recording forms with manual calculation of the patient's nutritional intake is considered cumbersome, time-consuming and unfeasible among the nurses and does often not lead to appropriate nutritional treatment. We developed the digital decision support system MyFood to deliver a solution to these challenges. MyFood is comprised of an app for patients and a website for nurses and includes functions for dietary recording, evaluation of intake compared to requirements, and a report to nurses including tailored recommendations for nutritional treatment and a nutritional care plan for documentation. The study aimed to investigate the effects of using the MyFood decision support system during hospital stay on adult patients' nutritional status, treatment and hospital length of stay. The main outcome measure was weight change. Methods The study was a parallel-arm randomized controlled trial. Patients who were allocated to the intervention group used the MyFood app during their hospital stay and the nurses were encouraged to use the MyFood system. Patients who were allocated to the control group received routine care. Results We randomly assigned 100 patients (51.9 ± 14 y) to the intervention group (n = 49) and the control group (n = 51) between August 2018 and February 2019. Losses to follow-up were n = 5 in the intervention group and n = 1 in the control group. No difference was found between the two groups with regard to weight change. Malnutrition risk at discharge was present in 77% of the patients in the intervention group and 94% in the control group (p = 0.019). Nutritional treatment was documented for 81% of the patients in the intervention group and 57% in the control group (p = 0.011). A nutritional care plan was created for 70% of the intervention patients compared to 16% of the control patients (p < 0.001). Conclusions The intervention had no effect on weight change during hospital stay. A higher proportion of the patients in the control group was malnourished or at risk of malnutrition at hospital discharge compared to the patients in the intervention group. The documentation of nutritional intake, treatment and nutritional care plans was higher for the patients using the MyFood system compared to the control group. This trial was registered at clinicaltrials.gov (NCT03412695).

• Paulsen, Mari Mohn; Varsi, Cecilie; Paur, Ingvild; Tangvik, Randi Julie & Andersen, Lene Frost (2019). Barriers and Facilitators for Implementing a Decision Support System to Prevent and Treat Disease-Related Malnutrition in a Hospital Setting: Qualitative Study. JMIR Formative Research. 3(2), s. 1–15. doi: 10.2196/11890. Fulltekst i vitenarkiv Vis sammendrag

  Background: Disease-related malnutrition is a challenge among hospitalized patients. Despite guidelines and recommendations for prevention and treatment, the condition continues to be prevalent. The MyFood system is a recently developed decision support system to prevent and treat disease-related malnutrition. Objective: To investigate the possible implementation of the MyFood system in clinical practice, the aims of the study were (1) to identify current practice, routines, barriers, and facilitators of nutritional care; (2) to identify potential barriers and facilitators for the use of MyFood; and (3) to identify the key aspects of an implementation plan. Methods: A qualitative study was performed among nurses, physicians, registered dietitians, and middle managers in 2 departments in a university hospital in Norway. Focus group discussions and semistructured interviews were used to collect data. The Consolidated Framework for Implementation Research (CFIR) was used to create the interview guide and analyze the results. The transcripts were analyzed using a thematic analysis. Results: A total of 27 health care professionals participated in the interviews and focus groups, including nurses (n=20), physicians (n=2), registered dietitians (n=2), and middle managers (n=3). The data were analyzed within 22 of the 39 CFIR constructs. Using the 5 CFIR domains as themes, we obtained the following results: (1) Intervention characteristics: MyFood was perceived to have a relative advantage of being more trustworthy, systematic, and motivational and providing increased awareness of nutritional treatment compared with the current practice. Its lack of communication with the existing digital systems was perceived as a potential barrier; (2) Outer settings: patients from different cultural backgrounds with language barriers and of older age were potential barriers for the use of the MyFood system; (3) Inner settings: no culture for specific routines or systems related to nutritional care existed in the departments. However, tension for change regarding screening for malnutrition risk, monitoring and nutritional treatment was highlighted in all categories of interviewees; (4) Characteristics of the individuals: positive attitudes toward MyFood were present among the majority of the interviewees, and they expressed self-efficacy toward the perceived use of MyFood; (5) Process: providing sufficient information to everyone in the department was highlighted as key to the success of the implementation. The involvement of opinion leaders, implementation leaders, and champions was also suggested for the implementation plan. Conclusions: This study identified several challenges in the nutritional care of hospitalized patients at risk of malnutrition and deviations from recommendations and guidelines. The MyFood system was perceived as being more precise, trustworthy, and motivational than the current practice. However, several potential barriers were identified. The assessment of the current situation and the identification of perceived barriers and facilitators will be used in planning an implementation and effect study, including the creation of an implementation plan.

• Paulsen, Mari Mohn; Hagen, Martina Lovise Lindhart; Frøyen, Marte Hesvik; Foss-Pedersen, Rikke Julie; Bergsager, Dagfinn & Tangvik, Randi Julie [Vis alle 7 forfattere av denne artikkelen] (2018). A Dietary Assessment App for Hospitalized Patients at Nutritional Risk: Development and Evaluation of the MyFood App. JMIR mhealth and uhealth. 6(9). doi: 10.2196/mhealth.9953. Fulltekst i vitenarkiv Vis sammendrag

  Background: Disease-related malnutrition is a common challenge among hospitalized patients. There seems to be a lack of an effective system to follow-up nutritional monitoring and treatment of patients at nutritional risk after risk assessment. We identify a need for a more standardized system to prevent and treat disease-related malnutrition. Objective: We aimed to develop a dietary assessment app for tablets for use in a hospital setting and to evaluate the app’s ability to measure individual intake of energy, protein, liquid, and food and beverage items among hospitalized patients for two days. We also aimed to measure patients’ experiences using the app. Methods: We have developed the MyFood app, which consists of three modules: 1) collection of information about the patient, 2) dietary assessment function, and 3) evaluation of recorded intake compared to individual needs. We used observations from digital photography of the meals, combined with partial weighing of the meal components, as a reference method to evaluate the app’s dietary assessment system for two days. Differences in the intake estimations of energy, protein, liquid, and food and beverage items between MyFood and the photograph method were analyzed on both group and individual level. Results: Thirty-two patients hospitalized at Oslo University Hospital were included in the study. The data collection period ran from March to May 2017. About half of the patients had ≥90% agreement between MyFood and the photograph method for energy, protein, and liquid intake on both recording days. Dinner was the meal with the lowest percent agreement between methods. MyFood overestimated patients’ intake of bread and cereals and underestimated fruit consumption. Agreement between methods increased from day 1 to day 2 for bread and cereals, spreads, egg, yogurt, soup, hot dishes, and desserts. Ninety percent of participants reported that MyFood was easy to use, and 97% found the app easy to navigate. Conclusions: We developed the MyFood app as a tool to monitor dietary intake among hospitalized patients at nutritional risk. The recorded intake of energy, protein, and liquid using MyFood showed good agreement with the photograph method for the majority of participants. The app’s ability to estimate intake within food groups was good, except for bread and cereals which were overestimated and fruits which were underestimated. The app was well accepted among study participants and has the potential to be a dietary assessment tool for use among patients in clinical practice.

• Totland, Torunn Holm; Knudsen, Markus Dines; Paulsen, Mari Mohn; Bjelland, Mona; Veer, Pieter van`t & Brug, Johannes [Vis alle 8 forfattere av denne artikkelen] (2017). Correlates of irregular family meal patterns among 11-year-old children from the Pro Children study. Food & Nutrition Research (FNR). ISSN 1654-6628. 61(1). doi: 10.1080/16546628.2017.1339554. Fulltekst i vitenarkiv Vis sammendrag

  Background: The importance of family meals to the consumption of healthful food choices has been stated in recent reviews. However, little information is available on barriers that interfere with regular family meal patterns during childhood. Objective: Describe family meal patterns among 11-year-old children across Europe and identify correlates of irregular family breakfast and dinner consumption. Design: Cross-sectional survey involving samples of 13,305 children from nine European countries in 2003. Results: The proportions of children who regularly ate family breakfast and dinner were 62% and 90%, respectively. Correlates of irregular family breakfasts and dinners were less vegetable consumption, and irregular family breakfasts were associated with more television viewing. Social differences in the consumption of family breakfasts were observed. Discussion: Strengths of this study are the large sample size and validated research method. Limitations are the cross-sectional design and self-reported data. Conclusion: The majority of 11-year-old children regularly ate breakfast and dinner with their families. More television viewing and less vegetable consumption were associated with irregular family breakfasts and dinners, respectively. Social differences were observed in the regularity of family breakfasts. Promoting family meals across social class may lead to healthier eating and activity habits, sustainable at the population level.

• Paulsen, Mari Mohn; Myhre, Jannicke Borch & Andersen, Lene Frost (2016). Beverage consumption patterns among Norwegian adults. Nutrients. 8(9). doi: 10.3390/nu8090561. Fulltekst i vitenarkiv Vis sammendrag

  Beverages may be important contributors for energy intake and dietary quality. The purpose of the study was to investigate how beverage consumption varies between different meals (breakfast, lunch, dinner, supper/evening meal, snacks) and between weekdays and weekend-days in Norwegian adults. A cross-sectional dietary survey was conducted among Norwegian adults (n = 1787) in 2010–2011. Two telephone-administered 24 h recalls were used for dietary data collection. Breakfast was the most important meal for milk and juice consumption, dinner for sugar-sweetened beverages and wine, and snacks for water, coffee, artificially sweetened beverages, and beer. Consumption of sugar-sweetened and artificially sweetened beverages did not differ between weekdays and weekend-days among consumers. The average intake of wine and beer (men only) was higher on weekend-days. Higher age was positively associated with wine consumption and negatively associated with consumption of water, sugar-sweetened, and artificially sweetened beverages. Higher education was associated with consumption of water, beer, and wine, whereas lower education was associated with sugar-sweetened beverage consumption. Beverage consumption patterns among Norwegian adults vary between different meal types and in subgroups of the population. Alcohol consumption was higher on weekend-days. Knowledge regarding beverage consumption patterns in the population should be considered when revising dietary guidelines in the future. View Full-Text

Se alle arbeider i NVA

• Amberntsson, Anna; Paulsen, Mari Mohn; Bianchi, Marta Angela; Birgisdottir, Bryndis Eva; Biltoft-Jensen, Anja & Konglevoll, Dina Moxness [Vis alle 10 forfattere av denne artikkelen] (2024). Enhancing Nutri-Score’s discrimination between whole grain and refined grain products – insights from the NewTools project. Fulltekst i vitenarkiv
• Paulsen, Mari Mohn; Thomsen, Cathrine; Brantsæter, Anne Lise; Granum, Berit Brunstad & Haug, Line Småstuen (2024). Norske barn har mange miljøgifter i kroppen og kosthold er en sentral bidragsyter. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 22(1), s. 37–40. doi: 10.18261/ntfe.22.1.8. Fulltekst i vitenarkiv
• Paulsen, Mari Mohn; Thomsen, Cathrine; Brantsæter, Anne Lise; Granum, Berit & Haug, Line Småstuen (2024). Norwegian children have many environmental contaminants in their bodies and diet is an important source. Fulltekst i vitenarkiv
• Wilhelmsen, Silje Elden; Andersen, Astrid Riseth; Brekke, Hilde Kristin & Paulsen, Mari Mohn (2024). E-læring om sykdomsrelatert underernæring for å gi studenter mengde- og ferdighetstrening i forebygging og behandling. Fulltekst i vitenarkiv
• Paulsen, Mari Mohn; Øvrebø, Bente; Brantsæter, Anne Lise; Lund-Iversen, Kaja; Andersen, Lene Frost & Løvhaug, Anne Lene [Vis alle 8 forfattere av denne artikkelen] (2024). Nutri-Score: Identified strengths and weaknesses in a Norwegian context. Fulltekst i vitenarkiv
• Bjøntegaard, Marie Michaelsen; Paulsen, Mari Mohn; Oort, Bob van & Andersen, Lene Frost (2024). Food procurement in Norwegian upper secondary schools: Nutritional quality and environmental impact. Fulltekst i vitenarkiv
• Bjøntegaard, Marie Michaelsen; Paulsen, Mari Mohn; Oort, Bob van & Andersen, Lene Frost (2024). Food procurement in Norwegian upper secondary schools: Nutritional quality and environmental impact. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. 22(5). doi: 10.18261/ntfe. Fulltekst i vitenarkiv Vis sammendrag

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

• Paulsen, Mari Mohn; Paur, Ingvild; Tangvik, Randi Julie & Andersen, Lene Frost (2019). MinMat, et digitalt verktøy for oppfølging av underernærte pasienter. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. doi: 10.18261/ntfe.17.4.7. Fulltekst i vitenarkiv
• Abel, Marianne Hope; Paulsen, Mari Mohn & Brantsæter, Anne Lise (2025). Evaluering av Intensjonsavtalen for et sunnere kosthold 2016-2025. Folkehelseinstituttet. ISSN 9788284065250. doi: https:/www.fhi.no/contentassets/3249cb84f18c4b0db7f7d33753668aa7/evaluering-av-intensjonsavtalen-for-et-sunnere-kosthold-2025.pdf. Fulltekst i vitenarkiv Vis sammendrag

  • Intensjonsavtalen for et sunnere kosthold er en samarbeidsavtale mellom helsemyndighetene og matbransjen med mål om å gjøre det enklere for forbrukerne å ta sunnere valg i tråd med de norske kostrådene. • Det er satt konkrete mål for å redusere inntaket av salt, tilsatt sukker og mettet fett, og for å øke inntaket av frukt og bær, grønnsaker, grove kornprodukter, fisk og sjømat. Det jobbes med ulike aktiviteter, blant annet reformulering av produkter og økt salg av nøkkelhullsmerkede produkter. • I løpet av avtaleperioden (2016-2025) har det vært lite eller ingen endring i engrosforbruket1 av tilsatt sukker og mettet fett, men saltinnholdet har blitt gradvis redusert i noen varegrupper som er viktige kilder til salt i kostholdet. • Matvarer som vi anbefales å spise mer av, frukt, bær, grønnsaker, grove kornprodukter, fisk og sjømat, har hatt en negativ utvikling med redusert engrosforbruk over avtaleperioden. • Målet som var satt for salg av produkter med nøkkelhullsmerket innen 2025 ble oppnådd i 2023. I 2023 utgjorde nøkkelhullsproduktene 22,9 % av salget (i verdi) innen varegrupper som er omfattet av nøkkelhullsordningen. • Flere parallelle faktorer kan bidra til å forklare trendene i matvareforbruket, blant annet at det har vært en høyere prisstigning på sunnere matvarer sammenlignet med mindre sunne varer. I tillegg har matsvinnet blitt redusert i samme periode. Evalueringen kan derfor ikke si noe sikkert om effektene av Intensjonsavtalen. • Intensjonsavtalen har mange positive aktiviteter og skaper en viktig arena for dialog og samhandling. I en eventuell videreføring av avtalen foreslår vi noen endringer i mål for avtalen. Dette kan gjøre det lettere å måle innsatsen og oppnå ønsket effekt på kostholdet til befolkningen.

• Paulsen, Mari Mohn; Thomsen, Cathrine; Brantsæter, Anne Lise; Granum, Berit Brunstad & Haug, Line Småstuen (2023). Miljøgifter i norske barn. Resultater fra Miljøbiobanken. Folkehelseinstituttet. Område for klima og miljø. ISSN 9788284063904. Fulltekst i vitenarkiv Vis sammendrag

  Miljøgifter er uønskede stoffer fra luft, mat, vann og forbrukerprodukter som kan være skadelige for helsa vår. Vi utsettes daglig for miljøgifter og andre uønskede stoffer, (heretter omtalt som miljøgifter), og slike stoffer er en trussel mot nålevende og kommende generasjoners helse. Det er derfor et stort behov for å overvåke befolkningens eksponering for miljøgifter, identifisere kilder og kunne følge endringer i nivå over tid. Human miljøbiobank Norge (Miljøbiobanken) ble opprettet for å overvåke nivåer av miljøgifter i befolkningen over tid og undersøke hvordan disse stoffene påvirker helsa vår. I denne rapporten presenteres nivåene av miljøgifter i urin- og blodprøver fra 669 barn i alderen 7-14 år i Miljøbiobanken, som er et underutvalg av Den norske mor, far og barnundersøkelsen (MoBa). I tillegg presenteres informasjon om barnas kosthold, bruk av kosmetikk og kroppspleieprodukter, samt faktorer i deres bomiljø som potensielt kan påvirke eksponeringen for miljøgifter. De viktigste funnene i rapporten er: • En lang rekke miljøgifter ble funnet i prøvene fra de fleste barna. • Barna i undersøkelsen var i alderen 7-14 år og bosatt forskjellige steder i Norge. • Nivåene av de fleste miljøgiftene var stort sett tilsvarende de som er funnet i andre sammenlignbare europeiske undersøkelser, med noen unntak. • Barna i undersøkelsen hadde et kosthold som er i tråd med Helsedirektoratets kostråd på flere områder, men inntaket av grønnsaker, frukt og bær var vesentlig lavere enn det som anbefales. • Nesten alle barna i undersøkelsen hadde nivåer av Bisfenol A i urin som var høyere enn det som European Food Safety Authority (EFSA) anser som trygt. • I underkant av 30% av barna hadde høyere blodnivåer av per- og polyfluor alkylstoffer (PFAS) enn det som EFSA anser som trygt. • Det er viktig med jevnlig overvåkning av nivået av miljøgifter i befolkningen og Miljøbiobanken er et sentralt bidrag til kunnskap om hva vi utsettes for.

• Paulsen, Mari Mohn; Myhre, Jannicke Borch; Andersen, Lene Frost & Kristiansen, Anne Lene (2020). Spedkost 3. Landsomfattende undersøkelse av kostholdet blant spedbarn i Norge, 12 måneder. Folkehelseinstituttet. ISSN 9788284060996. Fulltekst i vitenarkiv
• Hansen, Lisa Brooke; Myhre, Jannicke Borch; Johansen, Anne Marte Wetting; Paulsen, Mari Mohn & Andersen, Lene Frost (2015). UNGKOST 3. Landsomfattende kostholdsundersøkelse blant elever i 4. -og 8. klasse i Norge, 2015. Folkehelseinstituttet. Fulltekst i vitenarkiv
• Paulsen, Mari Mohn; Høvding, Benedicte Olsen; Kristiansen, Anne Lene & Andersen, Lene Frost (2012). Måltider, fysisk aktivitet og miljørettet helsevern i barnehagen. En undersøkelse blant styrere og pedagogiske ledere. Helsedirektoratet. Fulltekst i vitenarkiv

Se alle arbeider i NVA