Conselho Nacional de Desenvolvimento Científico e Tecnológico / A tese descreve o consumo de alimentos marcadores da qualidade da dieta no Brasil e identifica os alimentos que mais contribuem com a ingestão de açúcar e sódio no país. Foram utilizados para este fim os dados do Sistema Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) realizado nos anos de 2007, 2008 e 2009 e os dados provenientes do primeiro Inquérito Nacional de Alimentação (INA) realizado nos anos de 2008-2009 no Brasil. Os resultados são apresentados na forma de quatro artigos. O primeiro artigo avaliou as questões marcadoras de consumo alimentar do Sistema VIGITEL e sua evolução temporal e inclui 135.249 indivíduos de 27 cidades brasileiras, entrevistados nos anos de 2007 2009. Para os demais artigos, utilizou-se os dados obtidos no INA, para descrever os alimentos mais consumidos no país segundo sexo, grupo etário, região e faixa de renda familiar per capita (artigo 2) e identificar os alimentos que mais contribuem para o consumo de sódio (artigo 3) e de açúcar na população brasileira (artigo 4). As análises do INA baseiam-se em informações do primeiro de dois dias não consecutivos de registro alimentar de 34.003 indivíduos com 10 anos ou mais de idade. Os resultados apresentados indicam que a alimentação dos brasileiros vem se caracterizando pela introdução de alimentos processados de alta densidade energética e bebidas com adição de açúcar, embora os hábitos tradicionais de alimentação, como o consumo de arroz e feijão, ainda sejam mantidos. Entre as bebidas açucaradas os refrigerantes aparecem como importante marcador da qualidade da dieta na população brasileira. Os dados do VIGITEL evidenciaram aumento no consumo deste item de 7% e dentre os itens avaliados no inquérito, foi o que mais discriminou o consumo alimentar na população. De acordo com os dados do INA, o refrigerante foi um dos itens mais consumidos pelos brasileiros, e constitui-se também como marcador do consumo de açúcar total, de adição e livre, juntamente com sucos, café e biscoitos doces. Adolescentes apresentaram o maior consumo de açúcar, comparados aos adultos e idosos e este resultado pode ser explicado pelo alto consumo de bebidas açucaradas e biscoitos doces observado nesta faixa etária. Quanto ao consumo de sódio, alimentos processados, como carne salgada, carnes processadas, queijos, biscoitos salgados, molhos e condimentos, sanduíches, pizzas e pães figuraram entre as principais fontes de sódio na dieta do brasileiro. Nossos achados reafirmam a importância de políticas de alimentação e nutrição, que estimulem o consumo de alimentos saudáveis, como frutas, verduras e grãos integrais, e a manutenção do consumo de alimentos básicos tradicionais, como o feijão. O sistema VIGITEL deve contemplar itens do consumo alimentar que possam ter impacto na redução das doenças crônicas não transmissíveis. / This dissertation aimed to describe the most consumed foods in the Brazilian diet according to gender, age, regions and per capita family income and to identify the main sources of sugar and sodium in the country using data from the 2007-2009 Telephone-based Risk Factor Surveillance System for Chronic Diseases (VIGITEL) and from the first Brazilian National Dietary Survey (NDS). The results are described in 4 articles. The first article aimed to evaluate markers of food intake of the telephone-based risk factor surveillance system for chronic diseases (VIGITEL) and the trend of these markers. A total of 135,249 subjects from 27 brazilian cities interviewed in the 2007 2009 surveys were evaluated. For the others articles, data from the 2008-2009 Brazilian NDS were used in order to describe the most consumed foods in the country according to gender, age, regions and per capita family income (article 1) and to identify the major food sources of dietary sodium (article 3) and free, added and total sugar in Brazil (article 4). The analysis was based on food intake data obtained on the first of two non-consecutive food records from 34,003 subjects over 10 years old. Brazilian population food intake has been characterized by the increase of the consumption of high energy-dense processed foods and sugar sweetened beverages, even though the intake of traditional foods, such as rice and beans, were still observed. Among the sugar sweetened beverages, the consumption of soft drinks can be considered as marker of quality of the diet in the Brazilian population. Data from the VIGITEL showed an increase of 7% in the consumption of soft drinks, and this item was the one that discriminates food intake the most. According to the data from the 2008-2009 Brazilian NDS, soft drinks was one of most consumed food items, and could be also considered as a marker of total, added and free sugar intake, as well as, the intake of juices, cookies and coffee. Adolescents were the age group that presented the highest intake of total, added and free sugar. This result could be attributable to the largest intake of sugar sweetened beverage and cookies in this age group. Regarding sodium intake, processed foods, such as salty preserved meats, processed meats, cheeses, crackers, oils, spreads, sauces and condiments, sandwiches, pizzas, and breads were the main sources of dietary sodium in the Brazilian population diet. Our findings reinforce the importance of food and nutrition policies that encourage the intake of healthy food, such as fruits, vegetables, whole grains, and traditional foods, such as beans. VIGITEL system should include food items that may have impact in reducing the prevalence of chronic diseases.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A tese descreve o consumo de alimentos marcadores da qualidade da dieta no Brasil e identifica os alimentos que mais contribuem com a ingestão de açúcar e sódio no país. Foram utilizados para este fim os dados do Sistema Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) realizado nos anos de 2007, 2008 e 2009 e os dados provenientes do primeiro Inquérito Nacional de Alimentação (INA) realizado nos anos de 2008-2009 no Brasil. Os resultados são apresentados na forma de quatro artigos. O primeiro artigo avaliou as questões marcadoras de consumo alimentar do Sistema VIGITEL e sua evolução temporal e inclui 135.249 indivíduos de 27 cidades brasileiras, entrevistados nos anos de 2007 2009. Para os demais artigos, utilizou-se os dados obtidos no INA, para descrever os alimentos mais consumidos no país segundo sexo, grupo etário, região e faixa de renda familiar per capita (artigo 2) e identificar os alimentos que mais contribuem para o consumo de sódio (artigo 3) e de açúcar na população brasileira (artigo 4). As análises do INA baseiam-se em informações do primeiro de dois dias não consecutivos de registro alimentar de 34.003 indivíduos com 10 anos ou mais de idade. Os resultados apresentados indicam que a alimentação dos brasileiros vem se caracterizando pela introdução de alimentos processados de alta densidade energética e bebidas com adição de açúcar, embora os hábitos tradicionais de alimentação, como o consumo de arroz e feijão, ainda sejam mantidos. Entre as bebidas açucaradas os refrigerantes aparecem como importante marcador da qualidade da dieta na população brasileira. Os dados do VIGITEL evidenciaram aumento no consumo deste item de 7% e dentre os itens avaliados no inquérito, foi o que mais discriminou o consumo alimentar na população. De acordo com os dados do INA, o refrigerante foi um dos itens mais consumidos pelos brasileiros, e constitui-se também como marcador do consumo de açúcar total, de adição e livre, juntamente com sucos, café e biscoitos doces. Adolescentes apresentaram o maior consumo de açúcar, comparados aos adultos e idosos e este resultado pode ser explicado pelo alto consumo de bebidas açucaradas e biscoitos doces observado nesta faixa etária. Quanto ao consumo de sódio, alimentos processados, como carne salgada, carnes processadas, queijos, biscoitos salgados, molhos e condimentos, sanduíches, pizzas e pães figuraram entre as principais fontes de sódio na dieta do brasileiro. Nossos achados reafirmam a importância de políticas de alimentação e nutrição, que estimulem o consumo de alimentos saudáveis, como frutas, verduras e grãos integrais, e a manutenção do consumo de alimentos básicos tradicionais, como o feijão. O sistema VIGITEL deve contemplar itens do consumo alimentar que possam ter impacto na redução das doenças crônicas não transmissíveis. / This dissertation aimed to describe the most consumed foods in the Brazilian diet according to gender, age, regions and per capita family income and to identify the main sources of sugar and sodium in the country using data from the 2007-2009 Telephone-based Risk Factor Surveillance System for Chronic Diseases (VIGITEL) and from the first Brazilian National Dietary Survey (NDS). The results are described in 4 articles. The first article aimed to evaluate markers of food intake of the telephone-based risk factor surveillance system for chronic diseases (VIGITEL) and the trend of these markers. A total of 135,249 subjects from 27 brazilian cities interviewed in the 2007 2009 surveys were evaluated. For the others articles, data from the 2008-2009 Brazilian NDS were used in order to describe the most consumed foods in the country according to gender, age, regions and per capita family income (article 1) and to identify the major food sources of dietary sodium (article 3) and free, added and total sugar in Brazil (article 4). The analysis was based on food intake data obtained on the first of two non-consecutive food records from 34,003 subjects over 10 years old. Brazilian population food intake has been characterized by the increase of the consumption of high energy-dense processed foods and sugar sweetened beverages, even though the intake of traditional foods, such as rice and beans, were still observed. Among the sugar sweetened beverages, the consumption of soft drinks can be considered as marker of quality of the diet in the Brazilian population. Data from the VIGITEL showed an increase of 7% in the consumption of soft drinks, and this item was the one that discriminates food intake the most. According to the data from the 2008-2009 Brazilian NDS, soft drinks was one of most consumed food items, and could be also considered as a marker of total, added and free sugar intake, as well as, the intake of juices, cookies and coffee. Adolescents were the age group that presented the highest intake of total, added and free sugar. This result could be attributable to the largest intake of sugar sweetened beverage and cookies in this age group. Regarding sodium intake, processed foods, such as salty preserved meats, processed meats, cheeses, crackers, oils, spreads, sauces and condiments, sandwiches, pizzas, and breads were the main sources of dietary sodium in the Brazilian population diet. Our findings reinforce the importance of food and nutrition policies that encourage the intake of healthy food, such as fruits, vegetables, whole grains, and traditional foods, such as beans. VIGITEL system should include food items that may have impact in reducing the prevalence of chronic diseases.

Rye bread has shown potential as a health-beneficial component in the diet, especially in relation to non-communicable diseases. To have a beneficial effect in reality, however, it also needs to be available, chosen and eaten. Less research has focused on rye bread from a consumer perspective. The main aim was to investigate consumption patterns, health-related and sensory qualities and consumer perceptions of bread, more specifically commercial rye bread. In Study I, secondary analysis was performed on bread consumption data from a national dietary survey (n=1,435, 18-80 years). In Study II, commercial rye breads (n=24) were characterized by sensory descriptive analysis; the in vitro measurement fluidity index (FI) was used to predict glycemic properties, and chemical acidity was measured. Study III was a consumer test (n=398, 18-80 years), where acceptance and perceptions of nine rye breads were investigated. Study IV was a web-based and postal sequential mixed-mode survey (n=1,134, 18-80 years) with open-ended items covering health-related perceptions of bread. Consumers with the lowest intake of whole grain and rye bread were from younger age groups, families with children and groups with lower educational levels. Health-related and sensory properties of commercial rye bread varied widely. The FI indicated more beneficial glycemic properties in half of the samples and this was associated with a chewy, dry texture and sour flavor. The younger consumer group (18-44 years) differed in their liking compared to the older group (45-80 years) and displayed a preference toward bread with less whole grain and rye, although different clusters were identified. Rye bread liking was associated with bread type consumed in childhood, food choice motives and educational level. Most (75%) knew of bread they considered healthy. Coarse, whole grain, fiber, sourdough and rye were perceived to be good for the stomach, bowel and, to have good satiation and glycemic properties. Few health claims have been authorized, making it challenging for consumers to identify bread with these properties. Front-of-package label indicating rye bread was sometimes found on breads with very little rye flour. Sensory attributes, foremost textural and flavor, e.g., sourness, correlated with beneficial FI values and could thereby help guide consumers.

Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / Esta tese é composta por quatro artigos que permitiram avaliar o impacto do consumo de alimentos fora do domicílio na dieta e no peso corporal da população brasileira. O primeiro artigo revisou de forma sistemática as evidências científicas da associação entre alimentação fora do domicílio e peso corporal com abordagem crítica dos artigos publicados na literatura. Foram avaliados 28 artigos e os resultados sugeriram uma associação positiva entre o consumo de alimentos fora do domicílio e o ganho de peso. A revisão mostrou que uma das limitações nessa área é a ausência de padronização nas definições e métodos de avaliação do consumo de alimentos fora do domicílio. Para o desenvolvimento dos demais artigos, utilizou-se dados do Inquérito Nacional de Alimentação (INA) do Brasil, uma subamostra da Pesquisa de Orçamentos Familiares (POF) 2008-2009, com o objetivo de caracterizar o consumo de alimentos fora do domicílio da população brasileira (artigo 2) e investigar a associação entre alimentação fora do domicílio e ingestão total de energia (artigo 3) e peso corporal (artigo 4). As análises foram realizadas com os dados de consumo de alimentos coletados por meio de registro alimentar de 34.003 indivíduos acima de 10 anos em dois dias não-consecutivos. Os registros incluíram descrição detalhada dos alimentos e quantidade consumida, tipo de preparação, horário e local de consumo (dentro ou fora do domicílio). Alimentação fora do domicílio foi definida como todo alimento adquirido e consumido fora de casa. O primeiro dia de registro foi utilizado nas análises, considerando o peso amostral específico do INA e o efeito do desenho amostral. O consumo de alimentos fora do domicílio no Brasil foi reportado por 40% dos entrevistados; diminuiu com a idade e aumentou com a renda em todas as regiões brasileiras; foi maior entre os homens e na área urbana. Os grupos de alimentos com maior percentual de consumo fora de casa foram bebidas alcoólicas, salgadinhos fritos e assados, pizza, refrigerantes e sanduíches. Entre indivíduos residentes nas áreas urbanas do Brasil (n=25.753), a média de energia proveniente dessa alimentação foi 337 kcal, representando 18% do consumo total de energia. Alimentação fora do domicílio foi positivamente associada ao consumo total de energia. Avaliando somente adultos entre 25 e 65 anos de idade das áreas urbanas (n=13.736) não foi encontrada associação entre o consumo de alimentos fora do domicílio e Índice de Massa Corporal (IMC). Indivíduos que consumiram alimentos fora do domicílio apresentaram menor ingestão de proteína; maior ingestão de gordura total, gordura saturada e açúcar livre; menor consumo de arroz, feijão e leite e maior consumo de salgadinhos fritos e assados, doces e açúcar, refrigerantes e bebidas alcoólicas do que não consumidores. Apesar da ausência de associação entre alimentação fora de casa e excesso de peso, o consumo de alimentos fora do domicílio influencia a qualidade da dieta dos indivíduos e em longo prazo pode ter um impacto no ganho de peso da população, portanto, deve ser considerado nas ações de saúde pública voltadas para a melhoria da alimentação dos brasileiros. / This thesis is composed by four articles that focused on the impact of food consumed away from home on the diet and body weight of the Brazilian population. The first article is a systematic review of the scientific evidence of the association between food away from home and body weight with a quality assessment of published articles in scientific literature. We evaluated 28 articles and results suggested a positive association between the consumption of food away from home and weight gain. The review showed that one of the limitations in this area is the lack of standard definition and methods to assess away-from-home eating. For the other articles, data from the Brazilian National Dietary Survey (NDS) conducted along with the Household Budget Survey (HBS) 2008-2009 were used to characterize the consumption of food away from home (article 2); to investigate the association between away-from-home food consumption and total energy intake (article 3), and body weight (article 4). Analyses were conducted with 34,003 individuals over 10 years old with data on food intake collected through food records in two non-consecutive days. The records included detailed description of the food and the amount consumed, type of preparation, and time and place of consumption (at home or away from home). Away-from-home food was defined as all foods purchased and consumed outside the home. The first day of record was used in the analyses, taking into account the sample weight of NDS and the sample design. The consumption of food away from home in Brazil was reported by 40% of the respondents; decreased with age and increased with income in all Brazilian regions; it was higher among men and in urban areas. The groups with the highest percentage of food consumption outside the home were alcoholic beverages, baked and deep-fried snacks, pizza, soft drinks and sandwiches. Among those living in urban areas (n=25,753), the mean energy intake from away-from-home food was 337 kcal, accounting for 18% of total energy intake. Food away from home was positively associated with total energy intake. Evaluating only adults between 25 and 65 years old in urban areas (n=13,736), we found no association between the consumption of food away from home and Body Mass Index (BMI). Individuals who consumed food away from home had a lower intake of protein, higher intake of total fat, saturated fat, and free sugar, low consumption of rice, beans and milk and higher consumption of baked and deep-fried snacks, sweets and sugar, soft drinks, and alcoholic beverages than non-consumers. Despite the lack of association between eating out and being overweight, the consumption of food away from home influences diet quality and in long-term it can have an impact on weight gain of the population. Therefore, it should be considered in public health strategies aiming at improving the diet of Brazilian population.

Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / Esta tese é composta por quatro artigos que permitiram avaliar o impacto do consumo de alimentos fora do domicílio na dieta e no peso corporal da população brasileira. O primeiro artigo revisou de forma sistemática as evidências científicas da associação entre alimentação fora do domicílio e peso corporal com abordagem crítica dos artigos publicados na literatura. Foram avaliados 28 artigos e os resultados sugeriram uma associação positiva entre o consumo de alimentos fora do domicílio e o ganho de peso. A revisão mostrou que uma das limitações nessa área é a ausência de padronização nas definições e métodos de avaliação do consumo de alimentos fora do domicílio. Para o desenvolvimento dos demais artigos, utilizou-se dados do Inquérito Nacional de Alimentação (INA) do Brasil, uma subamostra da Pesquisa de Orçamentos Familiares (POF) 2008-2009, com o objetivo de caracterizar o consumo de alimentos fora do domicílio da população brasileira (artigo 2) e investigar a associação entre alimentação fora do domicílio e ingestão total de energia (artigo 3) e peso corporal (artigo 4). As análises foram realizadas com os dados de consumo de alimentos coletados por meio de registro alimentar de 34.003 indivíduos acima de 10 anos em dois dias não-consecutivos. Os registros incluíram descrição detalhada dos alimentos e quantidade consumida, tipo de preparação, horário e local de consumo (dentro ou fora do domicílio). Alimentação fora do domicílio foi definida como todo alimento adquirido e consumido fora de casa. O primeiro dia de registro foi utilizado nas análises, considerando o peso amostral específico do INA e o efeito do desenho amostral. O consumo de alimentos fora do domicílio no Brasil foi reportado por 40% dos entrevistados; diminuiu com a idade e aumentou com a renda em todas as regiões brasileiras; foi maior entre os homens e na área urbana. Os grupos de alimentos com maior percentual de consumo fora de casa foram bebidas alcoólicas, salgadinhos fritos e assados, pizza, refrigerantes e sanduíches. Entre indivíduos residentes nas áreas urbanas do Brasil (n=25.753), a média de energia proveniente dessa alimentação foi 337 kcal, representando 18% do consumo total de energia. Alimentação fora do domicílio foi positivamente associada ao consumo total de energia. Avaliando somente adultos entre 25 e 65 anos de idade das áreas urbanas (n=13.736) não foi encontrada associação entre o consumo de alimentos fora do domicílio e Índice de Massa Corporal (IMC). Indivíduos que consumiram alimentos fora do domicílio apresentaram menor ingestão de proteína; maior ingestão de gordura total, gordura saturada e açúcar livre; menor consumo de arroz, feijão e leite e maior consumo de salgadinhos fritos e assados, doces e açúcar, refrigerantes e bebidas alcoólicas do que não consumidores. Apesar da ausência de associação entre alimentação fora de casa e excesso de peso, o consumo de alimentos fora do domicílio influencia a qualidade da dieta dos indivíduos e em longo prazo pode ter um impacto no ganho de peso da população, portanto, deve ser considerado nas ações de saúde pública voltadas para a melhoria da alimentação dos brasileiros. / This thesis is composed by four articles that focused on the impact of food consumed away from home on the diet and body weight of the Brazilian population. The first article is a systematic review of the scientific evidence of the association between food away from home and body weight with a quality assessment of published articles in scientific literature. We evaluated 28 articles and results suggested a positive association between the consumption of food away from home and weight gain. The review showed that one of the limitations in this area is the lack of standard definition and methods to assess away-from-home eating. For the other articles, data from the Brazilian National Dietary Survey (NDS) conducted along with the Household Budget Survey (HBS) 2008-2009 were used to characterize the consumption of food away from home (article 2); to investigate the association between away-from-home food consumption and total energy intake (article 3), and body weight (article 4). Analyses were conducted with 34,003 individuals over 10 years old with data on food intake collected through food records in two non-consecutive days. The records included detailed description of the food and the amount consumed, type of preparation, and time and place of consumption (at home or away from home). Away-from-home food was defined as all foods purchased and consumed outside the home. The first day of record was used in the analyses, taking into account the sample weight of NDS and the sample design. The consumption of food away from home in Brazil was reported by 40% of the respondents; decreased with age and increased with income in all Brazilian regions; it was higher among men and in urban areas. The groups with the highest percentage of food consumption outside the home were alcoholic beverages, baked and deep-fried snacks, pizza, soft drinks and sandwiches. Among those living in urban areas (n=25,753), the mean energy intake from away-from-home food was 337 kcal, accounting for 18% of total energy intake. Food away from home was positively associated with total energy intake. Evaluating only adults between 25 and 65 years old in urban areas (n=13,736), we found no association between the consumption of food away from home and Body Mass Index (BMI). Individuals who consumed food away from home had a lower intake of protein, higher intake of total fat, saturated fat, and free sugar, low consumption of rice, beans and milk and higher consumption of baked and deep-fried snacks, sweets and sugar, soft drinks, and alcoholic beverages than non-consumers. Despite the lack of association between eating out and being overweight, the consumption of food away from home influences diet quality and in long-term it can have an impact on weight gain of the population. Therefore, it should be considered in public health strategies aiming at improving the diet of Brazilian population.

We eat foods not nutrients. What is more, we eat them in combinations. Consequently, capturing our complex food habits is likely an advantage in nutrition research. The overall aim of this doctoral thesis was therefore to investigate dietary patterns in the Swedish population –nutrient intakes, nutritional biomarkers and health aspects. Prostate cancer is the most common cancer among men in the developed world. However, the impact of dietary factors on disease risk is largely unknown. In Study I we investigated the association between a Mediterranean- and a Low-carbohydrate-high-protein dietary pattern and prostate cancer risk, in a cohort of elderly Swedish men. The latter (but not the former) was associated, inversely, with prostate cancer risk when taking validity in food records into account. Diet is one of our main exposure routes to environmental contaminants. Hence, such exposure could act as a mediating factor in the relation between diet and health. In Study II we investigated the association between; a Mediterranean- and a Low-carbohydrate-high-protein dietary pattern, as well as the official dietary recommendations, and circulating levels of environmental contaminants, in an elderly Swedish population. The first two patterns were positively related to levels of both persistent organic pollutants and heavy metals, whilst the dietary recommendations were inversely associated to dioxin and lead. Finally, although dietary patterns are likely to influence health, little is known about current dietary patterns in Sweden. In Study III we used a data-reduction method to identify dietary patterns in a nationwide sample of the Swedish population. Two major patterns were derived; a Healthy pattern of foods generally considered healthy (e.g. vegetables, fruits, fish and vegetable-oils) and a Swedish traditional pattern (with e.g. meats, potatoes, sauces, non-Keyhole milk-products, sweet-bakery products and margarine). Derived patterns were associated to population characteristics and the Healthy dietary pattern was inversely associated to anthropometric variables in Study IV. Dietary characteristics of the patterns were well reflected in correlations to nutrient intake and (to a lesser extent) in nutritional biomarkers. In conclusion dietary patterns for overall health should be considered, as well as other lifestyle-factors, when interpreting results in nutrition epidemiology and establishing dietary recommendations.

Formålet med undersøgelsen var at finde ud af, hvorvidt gravide kvinder på Færøerne fik en kost, som er i overensstemmelse med rekommandationer der foreligger gravide. 148 kvinder deltog i undersøgelsen, hvor der blev gennemført tre 24 h recall og seks selvregistreringer, samt et food frequency qeistionnaire omhandlende de sidste 12 måneder. Resultatet af den samlede energi, energifordeling, A-, C-, D- og E-vitaminer, og folsyre, jern og calcium er sammenlignet med de rekommandationer der foreligger for gravide i de nordiske lande, specielt Danmark, idet Færøerne følger de danske anbefalinger. Det gennemsnitlige energiindtag var 10,0 MJ, som i gennemsnit fordelte sig i henhold til kostanbefalingerne med 15% proteiner, 52% kulhydrater og 33% fedt. Kostfiberindtaget var lavere end anbefalet, 17,4 gram per dag. Mættede og monoumættede fedtsyrer fulgte anbefalingerne, men indtaget af polyumættede fedtsyrer var lavt, 3,6%. Indtaget af n-3 fedtsyrer var 0,6%, som er lavere end anbefalet. Indtaget at C-vitaminer og calcium var tilstrækkeligt gennem kosten. Indtaget af de andre vitaminer og mineraler var mindre end anbefalingerne. 85% tager vitamintilskud og 64% tager jerntilskud. Indtaget af fisk var 280 gram per uge, kornprodukter 323 gram per dag, kød 193 gram per dag, sødesager 128 gram per dag, frugt og grønt 193 gram per dag, frugt juice 98 gram per dag. Resultatet fra denne opgave kan sætte større fokus på kost og graviditet, samt at der er et behov for en større og mere indgående kostundersøgelse blandt den generelle befolkning, hvis resultater kan bruges i sundhedsfremmende arbejde. / The purpose of this project was to find out whether pregnant women in the Faroe Islands had a dietary intake, which were in accordance with recommendations for pregnant women. 148 women participated in the survey, which involved three 24 hour recall and six days diary, and a food frequency questionnaire for the last 12 months. The results of total energy, the energy distribution of protein, carbohydrate and fat and the micronutrients vitamin-A, -C, -D, -E, folic acid, iron and calcium are compared with recommendations for pregnant women in the Nordic countries, especially from Denmark because the Faroe Islands follow the Danish recommendations. In average the total energy consumption per day was 10,0 MJ, and the distribution was 15% protein, 52% carbohydrates and 33% fat. Dietary fibre intake was 17,4 gram per day, which is lower than recommended. The intake of saturated and monounsaturated fatty acids followed the recommendations whereas the intake of polyunsaturated fatty acids and n-3 fatty acids was lower then recommended, 3,6% and 0,6%. Supply of vitamin-C and calcium through the food was sufficient, whereas the supply of the other micronutrients was too low compare to recommendations. 85% of the women took vitamin supplements and 64% took iron supplements. Intake of fish was 280 gram per week, cereal products 323 gram per day, meat 139 gram per day, sweets 128 gram per day, fruit and vegetables 193 gram per day, fruit juice 98 gram per day. The results from this project can put a focus on the connection between diet and pregnancy as well as there is a need for a detailed dietary survey among the general population, where the results can used in further health promotion / <p>ISBN 91-7997-141-5</p>

Cardiovascular diseases are the leading cause of death in most industrialised countries and in developing countries the trend in cardiovascular-related deaths is increasing. World-wide, type 2 diabetes mellitus (T2DM) is an emerging cause of disability and premature death. Both these conditions are closely associated with the consumption of energy-dense foods and food products that are poor in nutrients, as well as with a sedentary lifestyle. Pharmacological and surgical interventions can improve the outcome and delay the progression of the disease, but in terms of population-level prevention there is no substitute for the adoption of a healthy lifestyle. SETTING The underlying studies were conducted in Västerbotten (the VIP study), and in Norrbotten and Västerbotten combined (the MONICA Project). Norrbotten andVästerbotten are the two northernmost counties in Sweden. Since the mid-1980sthe prevalence of cardiovascular disease has decreased and diabetes rates haveremained stable in this region, despite of an unbroken trend of increasing body weight. OBJECTIVE The aim of this thesis is to describe changes in reported dietary habits, estimatetheir relative importance as risk factors for diabetes and cardiovascular disease, and finally to identify lifestyle components as potential targets for intervention. RESULTS The first paper describes changes in self-reported food consumption between 1986 and 1999. During this period, the population in question switched from products with high saturated fatty acid content (e.g. milk containing 3% fat, butter) to foods containing less saturated fat (e.g. milk containing 1.5% fat, vegetable oil, low-fat margarine); pasta and rice were consumed more often, and potatoes were consumed less. Convenience foods (e.g. hamburgers, snacks, sweets) became more popular, whilst traditional dishes (e.g. potato dumplings, black pudding, blöta) decreased in popularity. Fruit and vegetable intake remained low. In paper two we study the effects of these changes in food intake on the risk of developing T2DM using body fat distribution as an early indicator. Increased consumption of convenience foods was associated with unfavourable changes (smaller hip circumference and larger waist circumference), whereas the increased consumption of vegetable oil and pasta was associated with low-risk fat distribution. In the third paper we report studies on the association between fat consumption and T2DM. We used the pattern of fatty acids in the membranes of red blood cells as a marker of fat intake. In addition to confirming earlier findings (markers of the intake of saturated fat are associated with increased risk of T2DM and markers of unsaturated fat are associated with reduced T2DM risk), we also identified associations between two markers of milk-derived saturated fat intake and enterolactone, a biomarker of dietary fibre intake, and the risk of developing myocardial infarction. Our results indicate that moderately high levels of enterolactone intake in men are associated with lower risk of experiencing myocardial infarction. Manuscript 5 ranks education level, physical activity, smoking status, and self-reported intake of dietary fibre and fatty acids according to their effects on body fat distribution. Increased levels of physical activity, a higher education level and a reduced intake of saturated fat from meat were ranked as the most strongly associated factors in both men and women. Increased intake of dietary fibre from grains in women, and increased intake of dietary fibre from fruits and vegetables in men, was also inversely associated with average waist circumference. CONCLUSION Both questionnaire-based and biological markers of the risk of developing diabetes or cardiovascular disease have been identified. Based on available population level measurements, reduced consumption of convenience foods, increased consumption of whole-grain products, fruits and vegetables, vegetable oil and pasta as well as increased physical activity are potential goals for interventions in northern Sweden.