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Yes / Personalised nutrition (PN) may promote public health. PN involves dietary advice based on individual characteristics of end users and can for example be based on lifestyle, blood and/or DNA profiling. Currently, PN is not refunded by most health insurance or health care plans. Improved public health is contingent on individual consumers being willing to pay for the service. Methods: A survey with a representative sample from the general population was conducted in eight European countries (N = 8233). Participants reported their will- 25 ingness to pay (WTP) for PN based on lifestyle information, lifestyle and blood information, and lifestyle and DNA information. WTP was elicited by contingent valuation with the price of a standard, non-PN advice used as reference. Results: About 30% of participants reported being willing to pay more for PN than for non-PN advice. They were on average prepared to pay about 150% of the reference price of a standard, non-personalised advice, with some differences related to socio-demographic factors. Conclusion: There is a potential market for PN 30 compared to non-PN advice, particularly among men on higher incomes. These findings raise questions to what extent personalized nutrition can be left to the market or should be incorporated into public health programs / EC (FW7) funded Food4me project

Yes / There has been an increase in development of technologies that can deliver personalised dietary advice. Devising healthy, sustainable dietary plans will mean taking consideration of extrinsic factors such as individual social circumstances. The aim of this study was to identify societal groups more or less receptive to and likely to engage with digitally delivered personalised nutrition initiatives. Sample and Methods: Volunteers were recruited via a social research agency from within the UK. The resultant sample (N=1061) was 49% female, aged 18-65 years. Results: MANOVA (Tukey HSD applied) indicated that females and younger people (aged 18-29 years) had more favourable attitudes and were more likely to intend to adopt personalised nutrition. There were no differences in attitude toward or intention to adopt personalised nutrition between different education levels, income brackets or occupational groups. Conclusion: These results imply that females and younger people may be most likely to adopt personalised nutrition in the future. Initiatives to promote personalised nutrition should target males and older people.

<p>Weight loss and other nutritional problems are common in cancer patients. The problems are of importance for response to treatment and survival and the well-being of the patients.</p><p>Nutritional support can be carried out in different ways. The efforts considered in this thesis are; assessment of nutritional status to find the patients who are at risk to become or already are malnourished, assessment of dietary intake, dietary advice, information and support to the families, information and education to the caregivers, and supplementation with drugs that possibly could influence the weight development. The Swedish version of the Patient Generated Subjective Global assessment of nutritional status, PG-SGA, is useful in assessment of nutritional status in cancer patients. Dietary advice and support to patients and their families combined with information and education to the staff, at the hospital and in the home care, turned out to have a positive influence at the weight development and other parameters related to nutrition. The effects were seen in consecutive patients with small cell lung cancer in comparison with a historical control group, and in patients in a randomised trial. Fish oil and melatonin could stabilise weight development in patients with advanced gastrointestinal cancer, but had no marked influence on factors reflecting cachexia. Problems with nutrition in cancer patients are possible to recognise and various interventions may be beneficial.</p>

Weight loss and other nutritional problems are common in cancer patients. The problems are of importance for response to treatment and survival and the well-being of the patients. Nutritional support can be carried out in different ways. The efforts considered in this thesis are; assessment of nutritional status to find the patients who are at risk to become or already are malnourished, assessment of dietary intake, dietary advice, information and support to the families, information and education to the caregivers, and supplementation with drugs that possibly could influence the weight development. The Swedish version of the Patient Generated Subjective Global assessment of nutritional status, PG-SGA, is useful in assessment of nutritional status in cancer patients. Dietary advice and support to patients and their families combined with information and education to the staff, at the hospital and in the home care, turned out to have a positive influence at the weight development and other parameters related to nutrition. The effects were seen in consecutive patients with small cell lung cancer in comparison with a historical control group, and in patients in a randomised trial. Fish oil and melatonin could stabilise weight development in patients with advanced gastrointestinal cancer, but had no marked influence on factors reflecting cachexia. Problems with nutrition in cancer patients are possible to recognise and various interventions may be beneficial.

Bakgrund: Hjärtsvikt är den vanligaste orsaken till sjukhusinläggning hos äldre personer. Upp till 50 % av dessa patienter är felnärda. Detta kan delvis orsakas av de gastrointestinala symtom som sjukdomen ger såsom tidig mättnadskänsla, aptitlöshet och illamående. Syfte: Att ur patienters perspektiv belysa problematik med mat och kostråd vid kronisk hjärtsvikt. Metod: En litteraturstudie där tio kvalitativa eller kvantitativa vetenskapliga artiklar ingår. Resultat: Personer med hjärtsvikt förstod inte alltid att de hade en kronisk sjukdom och att detta skulle påverka deras matintag för resten av livet. Att följa en saltfattigkost kunde ge svårigheter i det dagliga livet. Maten kunde väcka både positiva och negativa känslor. De kunde känna sig begränsade i sociala situationer t ex. vid högtider eller restaurangbesök, då maten de blev bjudna på oftast innehöll för mycket salt. De flesta patienterna utvecklade strategier för att lättare följa kostråden. Diskussion: Patienter och anhöriga har ett stort informationsbehov om sjukdomen och dess påverkan i det dagliga livet. De kan behöva stöd och uppmuntran från omgivningen för att genomföra livsstilsförändringarna. Det är viktigt att förstår sambandet mellan saltrik mat och ökade symtom. Personcentrerad vård kan minska vårdtiden och förbättra eller bevara patienternas vardagliga resurser jämfört med traditionell vård samt minska återinläggningarna. / Background: Heart failure is the leading cause of hospitalization of older people. Up to 50% of these patients are malnourished. This may be partly caused by the gastrointestinal symptoms caused by the disease, as early satiety, loss of appetite and nausea. Aim: From patient’s perspective highlight problems with food and dietary advice in chronic heart failure. Method: A literature review where ten qualitative or quantitative scientific papers were included.  Results: People with heart failure did not always understand that they had a chronic illness and that this would affect their food intake for the rest of their lives. To follow a low salt diet could cause difficulties in the daily life. The food could give both positive and negative emotions. They could feel limited at social occasions, feasts or when visiting restaurants, when the food they were invited to often included too much salt. Many patients developed strategies to follow the dietary recommendations more easily. Discussion: Patients and their relatives have a great need for information about the disease and the impact in daily life. They may need support and encouragement from the environment to implement lifestyle changes. It is important to understand the relationship between salty food and increased symtoms. Person-centred care could reduce the length of stay and maintain or improve the patient´s daily resources and reduce re-admission.

Background One of the challenges to public health in Sweden is the consumption of excessive saturated fat and too little unsaturated fat. The National Board of Health and Welfare (NBHW), the Swedish National Food Agency (SNFA) and the health sector work together to tackle such challenges, through educating the public on healthy dietary habits. The SNFA provides guidelines for all nutritional information but some of the guidelines have often been questioned leading to uncertainty and differing attitudes towards the consumption of fat in particular. Aims The study’s aim was to compare healthcare professionals’ attitudes to dietary fat and fat consumption to those of non-health professionals. A further aim was to assess if the named two groups gave advice on dietary habits. Method An online questionnaire survey was carried out with the participation of 260 adults recruited through convenience sampling. The questionnaire comprised 13 questions and the data collected were compiled in Microsoft Excel then imported to IBM SPSS 20.0., for processing and analysis. Results were analyzed using chi-square tests with p&lt;0.05. Results A total of 73 healthcare professionals and 187 non-health professionals took part in the study.  Significantly more healthcare professionals than non-health professionals knew and were positive to established dietary advice regarding fat. There were however no differences between the two groups in the consumption of hard dietary fats. Both groups gave advice on dietary habits. Conclusions Healthcare professionals can be perceived as more knowledgeable than non-health professionals on fat consumption. The sharing of dietary advice by healthcare professionals may therefore lead to positive developments regarding those dietary guidelines that have often been questioned. This however requires that the healthcare professionals act professionally and separate what they do in private from what they advise their patients. / Bakgrund En av utmaningarna för folkhälsan i Sverige är konsumtion av för mycket mättat fett och för lite omättat fett.  Socialstyrelsen, det svenska Livsmedelsverket (SLV) och hälsosektorn arbeta tillsammans för att hantera utmaningen genom att utbilda allmänheten om goda matvanor. SLV ger riktlinjer för all näringsinformation men vissa av dessa har ifrågasatts vilket leder till osäkerhet och varierande inställning till just fett och dess konsumtion. Syfte Studiens syfte var att studera attityder till fett och fettkonsumtion bland hälso- och sjukvårdspersonal och icke-vårdpersonal.  Ytterligare syfte var att se om de två grupperna gav råd om matvanor. Metod En webbaserad enkätundersökning genomfördes med deltagandet av 260 vuxna som rekryterades genom bekvämlighetsurval. Enkäten bestod av 13 frågor.  Data som samlades in sammanställdes i Microsoft Excel och fördes sedan över till IBM SPSS 20.0 för bearbetning och analys. Resultaten analyserades genom att använda chi-två test med p &lt; 0,05. Resultat Totalt deltog 73 hälso- och sjukvårdspersonal och 187 icke-vårdpersonal i studien. Betydligt fler hälso- och sjukvårdspersonal än icke-vårdpersonal visste om och var positiva till etablerade kostråd om fett. Det fanns dock inga skillnader mellan de två grupperna i konsumtionen av hårda fetter i kosten. Båda grupperna gav råd om matvanor. Slutsatser Hälso- och sjukvårdspersonal kan upplevas som mer kunniga än icke-vårdpersonal angående fettkonsumtion. Råden om matvanor från hälso- och sjukvårdspersonal kan därför leda till positiv utveckling när det gäller de kostråd som ofta ifrågasätts. Detta kräver dock att hälso- och sjukvårdspersonalen agerar professionellt och separerar vad de gör privat och råd de ger till patienter.

Abstrakt Bakgrund: Övervikt och fetma hos barn i världen såväl som i Sverige är ett växande problem och dubbelt så många barn lider av övervikt eller fetma idag jämfört med för 20 år sedan. Det är väl känt att övervikt och fetma kan leda till fysisk och psykisk ohälsa hos barnet. Studier visar att distriktssköterskan inom barnhälsovården möter vissa svårigheter i arbetet med att få familjen att nå en livsstilsförändring. För att få en ökad förståelse för distriktssköterskornas arbete är det intressant att undersöka vilka upplevelser de har av att förmedla information om kosthållning i samband med att barnet har övervikt eller fetma.  Syfte: Att beskriva distriktssköterskans erfarenheter av arbetet med familjen i samband med övervikt och fetma hos barnet inom barnhälsovården. Metod: Studien genomfördes med kvalitativ metod och induktiv ansats. En intervjustudie genomfördes med tio distriktssköterskor som var verksamma inom barnhälsovården. Materialet analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Studiens resultat presenterades i tre huvudkategorier och sju underkategorier. Huvudkategorierna var: Familjen som tillgång i mötet, Användning av resurser och Utmaningar i mötet.  Slutsats: Studien visar att distriktssköterskorna upplever att relationen till familjen är avgörande för att ett framgångsrikt möte ska kunna uppstå. Avsaknad av en god relation till familjen kan resultera i att ämnet är svårt för distriktssköterskan att ta upp, men gör det även svårare för familjen att få till en livsstilsförändring. / Abstract Background: The conditions of overweight and obesity among children around the world, as well as in Sweden, is a growing issue. Twice as many children today suffer from being overweight or obese compared to 20 years ago. It is well known that these conditions can lead to physical and mental illness. Studies show that the child health care nurse faces some challenges in getting the family to achieve a lifestyle change. In order to gain a better understanding of the child health care nurses work it is interesting to study their experiences of providing dietary and nutritional advice when the child is overweight or obese. This understanding could be used to establish improvements within child health care. Aim: The aim of this study is to describe the child health care nurses’ experiences of working with the family when the child is overweight or obese. Method: This study was conducted using a qualitative method with an inductive approach. Material was collected through ten interviews with child health care nurses. The analysis was carried out using a qualitative content analysis. Result: The result of the study was presented in three main categories and seven subcategories. The main categories were: The family as an asset in the meeting, Usage of resources, Challenges in the meeting.  Conclusions: The study found that the child health care nurses relationship with the family was the main success factor when it came to meeting with them. The lack of a well-established relationship could result in the subject being difficult to address and thus making it harder for the family to accomplish the required lifestyle changes.

Background A well-balanced nutritious diet is important for the pregnant woman and the growing fetus, as well as for their future health. Poor nutrition results from both over-consumption of energy-rich foods which can lead to a higher weight gain than is healthy and under-nutrition of essential nutrients. Food intake is regulated in complex biological systems by many factors, where steroid hormone is one factor involved. The overall aim of this thesis is to describe dietary intake, vitamin D levels, dietary information and dietary changes, and to study the relation between allopregnanolone and weight gain during pregnancy and postpartum. Methods Study I was a qualitative study with focus group interviews with 23 pregnant women. The text was analysed with content analysis. Study II was a quantitative cross-sectional study conducted in early pregnancy (n=209) with a reference group (n=206). Self-reported dietary data from a questionnaire was analysed using descriptive comparative statistics and a cluster analysis model (Partial Least Squares modelling). Study III had a quantitative longitudinal design. Vitamin D concentrations were analysed in 184 women, collected on five occasions during pregnancy and postpartum. Descriptive comparative statistics and a linear mixed model were used. Study IV was a quantitative longitudinal study with 60 women. Concentrations of allopregnanolone were analysed in gestational week 12 and 35. Descriptive and comparative statistics as well as Spearman’s correlation (rho) were used to describe the relationship between weight gain and allopregnanolone concentrations.   Results The focus group interviews showed that women wanted to know more about different foods to reduce any risk for their child but the information about foods was partly up to themselves to find out. They expressedfeelingsof insecurityand guiltif they accidentallyate something“forbidden”. The recommendationswere followedas best as possiblealong withcommon sense todeal with dietchanges. The main themes were “Finding out by oneself”, “Getting professional advice when health problems occur”, “Being uncertain” and “Being responsible with a pinch of salt”. Some differences in the dietary patterns were found among the pregnant women compared to references, with less, vegetables (47 g/day), potatoes/rice/pasta (31 g/day), meat/fish (24 g/day) and intake of alcohol and tobacco/snuff but a higher intake of supplements. Bothpregnant women and referenceshad intakes offolatethrough diet45% (pregnant) and 22% (references) lower than current recommendations(500vs400g/day). Vitamin Dintake was34% lower than the recommendationsof 10mg/day. At least a third of the participants had insufficient plasma levels below 50 nmol/L of vitamin D. Season was a strong factor influencing the longitudinal pattern. Gestational week, season, total energy intake, dietary intake of vitamin D, and multivitamin supplementation over the previous 14 days were factors related to vitamin D levels. A correlation betweenallopregnanoloneconcentrations ingestationalweek 35and weight gainin weeks12–35was seen (p = 0.016). Therewas alsoa correlation betweenthe increase inallopregnanolone(weeks12–35) andweight gain(see above) (p = 0.028).   Conclusions Dietary recommendations were described as contradictory and confusing and the dietary advice felt inadequate. The women faced their diet changes and sought information on their own but would have wished for more extensive advice from the midwife. The intake of vitamins essential for pregnancy was lower than recommended, which is also confirmed by low plasma levels of vitamin D in at least one third of the pregnant women. Vitamin D levels peaked in late pregnancy. Aside from gestational week and season which were related to plasma levels, intake from foods and supplements also affected the levels. Reasons for weight gain are complex and depend on many factors. Allopregnanolone is a factor that was seen to relate to the weight gain of the studied pregnant women. / Bakgrund En välbalanserad näringsrik kost är viktig för den gravida kvinnan och det växande fostret, så även för deras framtida hälsa. En bristfällig kost kan utgöras av både överförbrukning av energirika livsmedel vilket kan leda till högre viktuppgång än vad som är hälsosamt och bristande intag av viktiga näringsämnen. Kostintag regleras av komplexa biologiska system där flera faktorer är inblandade däribland steroidhormonet allopregnanolon. Det övergripande syftet med denna avhandling är att under och efter graviditet beskriva kostintag, vitamin D-nivåer, kostinformation och kostförändringar och att studera allopregnanolons relation till viktökning. Metod Studie I var en kvalitativ studie med fokusgruppsintervjuer med 23 gravida kvinnor. Texten analyserades med innehållsanalys. Studie II var en kvantitativ tvärsnittsstudie som genomfördes i tidig graviditet (n = 209) och med en grupp icke-gravida kvinnor (kontrollgrupp) (n=206). Självrapporterade kostdata från ett frågeformulär analyserades med beskrivande, jämförande statistik och en klusteranalysmodell (Partial Least Squares modellering). Studie III hade en kvantitativ longitudinell design. Vitamin D-koncentrationer analyserades hos 184 kvinnor, vid fem tillfällen under graviditeten och efter förlossningen. Beskrivande, jämförande statistik och en linjär mixad regressionsmodell användes. Studie IV var en kvantitativ longitudinell studie med 60 kvinnor. Koncentrationerna av allopregnanolon analyserades vid graviditetsvecka 12 och 35. Beskrivande och jämförande statistik samt Spearman’s korrelation användes för att beskriva samband mellan viktökning och koncentrationer av allopregnanolon. Resultat Intervjuerna i studie I visade att kvinnor ville veta mer om olika typer av mat för att minska en eventuell risk för sina barn men kostinformation var delvis upp till dem själva att ta reda på. De VIII uttryckte känslor av osäkerhet och skuld om de råkat äta något ”förbjudet”. Rekommendationerna följdes så väl som möjligt, tillsammans med sunt förnuft för att hantera kostförändringar. Huvudteman var ”Söka information på egen hand”, ”Få professionell rådgivning när problem uppstår”, ”Känna sig osäker” och ”Ta ansvar med en nypa salt”. I studie II kunde man se vissa skillnader i kostmönster bland de gravida kvinnorna jämfört med kontrollgruppen: mindre intag av grönsaker (47 g/dag), potatis/ris/pasta (31 g/dag), kött/fisk (24 g/dag) och alkohol och tobak/snus och ett högre intag av kosttillskott. Både gravida kvinnor och kontrollgruppen hade lägre intag av folsyra via kosten med 45 % (gravida) och 22 % (kontrollgruppen) än de gällande rekommendationer som är (500 resp 400 g/dag). I studie III såg man att inta et av vitamin D var 34 % lägre än rekommendationen på 10 µg/dag. Minst en tredjedel av deltagarna hade otillräckliga plasma nivåer av vitamin D, under 50 nmol/L. Årstid var en stark faktor som påverkar det longitudinella mönstret. Graviditetsvecka, säsong, totala energiintaget, intaget av vitamin D och multivitamintillskott under de senaste 14 dagarna var faktorer som relaterade till Dvitaminnivåer. I studie IV sågs ett samband mellan allopregnanolon-koncentrationer vid graviditetsvecka 35 och viktökning från vecka 12 till 35 (p = 0,016). Det sågs också ett samband mellan ökningen av allopregnanolon (vecka 12–35) och viktökningen (se ovan) (p = 0,028). Slutsatser Kostrekommendationer beskrevs som motsägelsefulla och förvirrande och kostråden de fick uppfattades som otillräckliga. Kvinnorna tog itu med sina kostförändringar och sökte information på egen hand men hade önskat mer omfattande råd från barnmorskan. Intaget av vitaminer viktiga för graviditeten var lägre än rekommendationerna, vilket också bekräftas av låga plasmanivåer av D-vitamin hos cirka en tredjedel av de gravida kvinnorna. D-vitaminnivåerna nådde en topp i slutet av graviditeten. Graviditetsvecka och säsong på året påverkade D vitaminnivåer, så även intag via mat och kosttillskott. Orsakertill viktökning är komplexa och beror på många faktorer. Allopregnanolon är en faktor som sågs relatera till viktökningen hos de undersökta gravida kvinnorna.