Based on principles specified in the Swedish Code on health claims and experiences from handling of claims within the Code, priorities that may be useful when establishing a positive list of generic health claims and for responsible use of claims are suggested. One key factor highlighted is that claims should be relevant and meaningful for the consumer. To be useful in choosing a healthy diet, claims should primarily aim to stimulate an intake in agreement with official nutrition recommendations. Claims may thus be considered as relevant primarily for nutrients of which a considerable part of the population has an intake deviating from the recommendations. For vitamins and minerals, commonly involved in many functions in the body, it would be useful to prioritize claims referring to effects considered more important than others. Functions true for all essential nutrients, and/or affected by a large number of dietary factors, would be less relevant to claim for single vitamins and minerals. The relative importance of a specific vitamin or mineral, in relation to other nutrients potentially exerting similar effects, should also be considered. Based on these priorities, and on claims permitted or suggested as examples in the Code, a list of generic claims on vitamins, minerals, fatty acids, carbohydrates, dietary fibre, energy and wholegrain is suggested. Additional issues considered within the Code are also discussed.
Dear Colleagues Thanks for the interest in our article: Lack of nutritional and functional effects of nutritional supervision by nurses: a quasi-experimental study in geriatric patients 1. We agree with Frode Slinde and Ulla Svantesson that nutritional care is an interdisciplinary task. As we have described in the article, the geriatric context where the study was performed, had a highly interdisciplinary approach as we have described in another article 2. Both the intervention and the control unit used physiotherapists as part of the team. All team members used validated instruments for quality control, one of which was Barthel index. We find, that a test assessing functionality and independence of help from other persons, as Barthel Index does, also expresses quality of life. The nurses in our study were the staff group responsible for the care 24 hours around the clock, and thus very relevant to involve in the intervention. The dieticians were only available as experts when the patients needed specific diets. Whether or not the results had been different if we had used dieticians and physiotherapists as part of the specific intervention is, as Slinde and Svantesson points out, impossible to say. What we have done in our study is to examine what we could achieve when only one staff group was involved in the intervention superimposed on the interdisciplinary geriatric teamwork. We could not find any differences between the groups, however there could be numorus reasons other than the composition of the interdisciplinary team that could be responsible for that, for instance, that our patients on average had a good nutritional status.
Background: Reduced taste and smell, chewing problems and swallowing dysfunction are common amongelderly people and affect perception, food choice and the ability to eat.Objective: To study the preference for texture-modified carrot and meat products in elderly people aiming tomeet the needs of people with impaired chewing and/or swallowing.Design: Data were collected using questionnaires focusing on health, oral status and preference for theproducts. Altogether, 108 elderly people in ordinary housing (OH) and 50 living in special housing (SH) inMalmo¨ (SH-M) and Go¨teborg (SH-G) participated.Results: 19% had a body mass index ≤22, predominantly in SH (24%). Stroke was reported by 20% of thesubjects in SH. Among those with subjectively experienced difficulties in swallowing (12%), 58% reportedcoughing, 21% a gurgly voice in association with food intake and 50% obstruction during swallowing. Only20% with subjective swallowing difficulties had been specifically examined regarding this problem. All thetested products were easy to masticate and swallow. Compared with OH, people in SH-M found the meatproducts easier to masticate and swallow. Compared with OH, subjects in SH found the carrot products easierto masticateConclusions: There is a need to develop tasty texture-modified nutritious food products for people withmastication and/or swallowing problems. Possible factors for differences in preference between groups, in thisstudy OH and SH, may be related to health status in general and specifically mastication and swallowingfunctions.
Background: Undernutrition affects recovery from disease and regaining functional abilities; however, it frequently occurs in elderly hospitalized patients. Objective: To study whether identification of geriatric patients at nutritional risk followed by individualized nursing care could improve their nutritional and activities of daily living (ADL) status. Design: The design was quasi-experimental. In total, 345 rehabilitation patients (aged 8497 years, 72% women) were allocated, according to bed availability, to either an intervention or a control ward. Nurses on the intervention ward attended a short class on nutrition and were supervised in nutritional care by trained nurses. In the intervention unit, the nursing staff identified patients at risk of undernutrition through systematic assessment of risk factors, e.g. body mass index (BMI) B24 kg m_2, and treated them according to individual care plans. On the control ward routine nutritional care was offered. Functional status was assessed by the Barthel ADL index. Results: Mean BMI was 2495 on both wards. Fifty-five per cent of the patients had BMI B24. On average, patients were weight stable from admission to discharge, irrespective of allocation. No difference was found in ADL status as a result of the intervention. However, patients who gained weight improved more in ADL status than patients who remained stable or lost weight. Conclusions: In this geriatric setting standard care and care by trained and supervised nurses were equally effective in maintaining weight stability and functionality in rehabilitation patients with a mean BMI of 24. Weight increase was associated with improved functionality. Keywords: ADL; elderly; hospitalized; undernutrition; weight gain
Background A satisfactory nutritional status, as a result of optimal food intake, before conception and during pregnancy, is important for a successful pregnancy. Objective To evaluate the energy and nutrient intake before conception and at mid-gestation in a group of pregnant women (n=50) in relation to the Nordic Nutrition Recommendations (NNR). Design Pre-pregnant diet was studied by an 84-item food-frequency questionnaire and mid-gestational diet by repeated 24 h dietary recalls. Results Average requirements (AR) were met for all nutrients except for selenium intake before pregnancy. Absolute intakes were below recommended intake (RI) according to NNR for folate, vitamin D, selenium, vitamin E and iron both before and at mid-gestation. However, intakes were still above the lower intake levels (LI) defined by NNR for almost all women. Twenty-three women were below LI for selenium before pregnancy and five for each of vitamin D and selenium at mid-gestation. When expressed as nutrient densities (amount of nutrient per energy unit), intakes were below NNR for folate, vitamin D and selenium before pregnancy, and for folate, vitamin D and iron at mid-gestation. Intakes were adjusted for underreporting, estimated to 20% as revealed after comparing energy intake/basal metabolic rate with grouped physical activity level values. Conclusions The reported food intake satisfied the recommended level of intake according to AR, but when using RI for planning a diet as a reference, folate, vitamin D, selenium and iron intake were insufficient. Most striking were the low levels of folate and vitamin D intake both before pregnancy and at mid-gestation.
The area of health claims has been unregulated in Europe until recently.A new regulation on nutrition and health claims made on foods came into force on 19 January 2007.The Regulation has been eagerly awaited by all parties involved.The Regulation includes 37 whereas clauses, 29 Articles and an annex for nutrition claims and conditions applying to them.In practice, three main types of health claim are included in the Regulation, as referred to in Articles 13 and 14.The type of the scientific evidence is described slightly differently for Article 13.1 and Article 13.5: ''generally accepted scientific evidence'' and ''newly developed scientific evidence'', respectively, although the scientific status of evidence shall be the same for all kinds of claims.So far, there are four types of guidance for applying the Regulation.The wording of health claims is an essential issue in the Regulation, as well as the concept of nutrient profiles.In the Regulation there are three issues of special interest, when compared to the Swedish Food Sector's Code of Practice, i.e. concerns about ''other substances'', ''food supplements'' and ''the average consumer''.The Regulation will be evaluated in 2013, reporting the impact of this Regulation on dietary choices and the potential impact on obesity and noncommunicable diseases.
Constipation is a common problem and its prevalence increases with age. Severe constipation requires treatment with laxatives, but nutritional therapy, especially increased dietary fibre intake, is recommended primarily for the prevention and treatment of mild constipation. One alternative may be the use of oligosaccharides, which act as soluble fibre and have a bifidogenic effect. Galacto-oligosaccharides (GOS) resembling oligosaccharides occurring naturally in human milk can be produced from lactose. Several clinical studies reviewed in this paper have shown that the use of GOS (5–15g per day) may relieve the symptoms of constipation in adults and elderly people. In infants, the supplementation of formula with a mixture of GOS and fructo-oligosaccharides can modulate bowel function and stool characters in the same direction as does breast-feeding. Gastrointestinal symptoms may occur as side-effects of oligosaccharides, but 12g GOS per day or less is usually well tolerated.
Nutrition recommendations and their implementation N utrition recommendations are Á and should be Á under continuous debate.New findings challenge old concepts.The media have a preference for news, and rightly so.The increasing interest in diet and health issues among lay people merges with a continuously increasing importance for universities and individual scientists to be visible in the media.Thus, there are many reasons for the often contradictory messages on nutrition and health provided to the general public, leaving the impression of frequent rapid and drastic changes in the science base behind the nutrition recommendations, and therefore requests for changes in these recommendations.In this context it is important to consider the fact that official nutrition recommendations have been quite stable during the almost 40 years that have passed since the first recommendations appeared.The Scandinavian countries issued such recommendations in the late 1960s.At that time, there was already evidence that reduction in fat intake, particularly saturated fat, would help to decrease risk factors for cardiovascular disease.Developments within the field of dietary fibre in the 1970s and 1980s provided a basis for recommendations regarding intake.The 10 energy per cent limit of added sugars was included in the Nordic recommendations from the beginning.There is, in general, very strong agreement between the most recent Nordic recommendations (NNR 2004) and recommendations in other countries and internationally, e.g. as expressed in the WHO TRS 916 report from 2003 and recent recommendations issued by the Institute of Medicine/Food and Nutrition Board in the USA.An overview of the scientific basis of current nutrition recommendations was given at a recent symposium in Uppsala, reported in this issue, as a basis for examples and discussions on how to implement these recommendations in practice.Food-based simple messages were highlighted as important and found to be similar in the different Nordic countries in many respects.
Based on principles specified in the Swedish Code on health claims and experiences from handling of claims within the Code, priorities that may be useful when establishing a positive list of generic health claims and for responsible use of claims are suggested.One key factor highlighted is that claims should be relevant and meaningful for the consumer.To be useful in choosing a healthy diet, claims should primarily aim to stimulate an intake in agreement with official nutrition recommendations.Claims may thus be considered as relevant primarily for nutrients of which a considerable part of the population has an intake deviating from the recommendations.For vitamins and minerals, commonly involved in many functions in the body, it would be useful to prioritize claims referring to effects considered more important than others.Functions true for all essential nutrients, and/or affected by a large number of dietary factors, would be less relevant to claim for single vitamins and minerals.The relative importance of a specific vitamin or mineral, in relation to other nutrients potentially exerting similar effects, should also be considered.Based on these priorities, and on claims permitted or suggested as examples in the Code, a list of generic claims on vitamins, minerals, fatty acids, carbohydrates, dietary fibre, energy and wholegrain is suggested.Additional issues considered within the Code are also discussed.
Dear Reader, This is the last issue of the Scandinavian Journal of Food and Nutrition, No 4/2007, concluding volume 51. The journal started as “Naringsforskning” in Swedish (i.e. Nutrition Research) in 1957 with the aim of informing Swedish and Nordic readers about progress in nutritional sciences. It was directed to professionals working with nutrition such as dieticians, nutritionists, medical doctors and nurses, teachers of home economics, and not the least the Swedish food industry that was keen on applying new results for nutritional improvements of their products. In 1961, the Swedish Nutrition Foundation was established and took over the journal as one way of realising its overall aim to promote nutrition research and its practical implications. The Swedish language was kept, occasionally with articles in the Danish and Norwegian languages and the aim was to satisfy the broad spectrum of readers with different kinds of articles, reviews, summaries and debate in the broad area of nutrition. From 1992 the name of the journal was changed to Scandinavian Journal of Nutrition/Naringsforskning with the ambition to increase the number of subscribers and readers both within and outside the Nordic countries. Members of the Swedish Society of Nutrition were an important part of the readers who got a discounted subscription included in their membership fee. Similar but discounted subscriptions were offered to societies in the other Nordic countries, and at times the journal had Scandinavian News from Denmark, Finland, Iceland and Norway in each issue. The journal was made more consistently bilingual, i.e. English and Scandinavian languages. Original articles in English were welcomed and appeared more and more. The journal was produced in the offices of the Swedish Nutrition Foundation. From 2002 a contract was signed with a well-reputed publisher of scientific journals, Taylor&Francis, now Informa Healthcare/Taylor&Francis, with the title “Scandinavian Journal of Nutrition”, and the journal was published consistently in the English language. The aim was to increase the attractiveness of publishing original articles as well as reviews in the journal and to increase the number of international subscribers through efficient marketing activities. However, neither of these expectations was realised, also not after broadening of the scope and change of name to Scandinavian Journal of Food and Nutrition from 2006. The journal has been indexed in several databases, CAB Abstracts; Elsevier Bibliographic Databases; EMBASE (Excerpta Medica); Food Science and Technology Abstracts (FSTA); and SWEMED. However, applications to be indexed in Index Medicus/PubMed have failed so far. This fact and the absence of an official impact factor, are major and increasingly important obstacles in attracting good original articles, particularly from the biomedical area. With this background it was decided to discontinue the Scandinavian Journal of Food and Nutrition in its present form, volume 51 being the closing volume. From 2008, the Scandinavian Journal of Food and Nutrition will be continued in two separate forms: One purely scientific open access journal named Food & Nutrition Research (see adjacent advert), and a new information journal in Swedish, with certain articles in other Scandinavian languages, named Nordisk Nutrition (Nordic Nutrition).
Oxidative stress is believed to be one of the major factors behind several acute and chronic diseases, and may also be associated with ageing. Excess formation of free radicals in miscellaneous body environment may originate from endogenous response to cell injury, but also from exposure to a number of exogenous toxins. When the antioxidant defence system is overwhelmed, this leads to cell damage. However, the measurement of free radicals or their endproducts is tricky, since these compounds are reactive and short lived, and have diverse characteristics. Specific evidence for the involvement of free radicals in pathological situations has been difficult to obtain, partly owing to shortcomings in earlier described methods for the measurement of oxidative stress. Isoprostanes, which are prostaglandin-like bioactive compounds synthesized in vivo from oxidation of arachidonic acid, independently of cyclooxygenases, are involved in many human diseases, and their measurement therefore offers a way to assess oxidative stress. Elevated levels of F2-isoprostanes have also been seen in the normal human pregnancy, but their physiological role has not yet been defined. Large amounts of bioactive F2-isoprostanes are excreted in the urine in normal basal situations, with a wide interindividual variation. Their exact role in the regulation of normal physiological functions, however, needs to be explored further. Current understanding suggests that measurement of F2-isoprostanes in body fluids provides a reliable analytical tool to study oxidative stress-related diseases and experimental inflammatory conditions, and also in the evaluation of various dietary antioxidants, as well as drugs with radical-scavenging properties. However, assessment of isoprostanes in plasma or urine does not necessarily reflect any specific tissue damage, nor does it provide information on the oxidation of lipids other than arachidonic acid.
Dear Sir In a recent issue of the Journal, Poulsen et al. 1 studied the effects of individualized nursing care in elderly hospitalized patients. The setting was a geriatric rehabilitation clinic and the authors used a quasi-experimental design using one intervention unit and one control unit. The intervention consisted of intensified focus by nurses on nutrition. As it is stated in the article, “the authors did not have access to dietitians in this study”, neither is the term physiotherapy or physiotherapist mentioned. The main result in the study was that the two units did not differ in maintaining weight stability and functionality. However, the authors report that body weight increase was associated with functionality assessed by the Barthel index. Whether or not the results would had been different if dietitians and physiotherapists had been used as part of the intervention is impossible to say. But in future rehabilitation studies, it is our recommendation that a focus on teamwork, where different professions co-operate with a common goal, should be applied. In a recent study by Hojgaard Rasmussen et al. 2, a method for implementation of nutritional therapy in hospitals was presented and examined. They showed that one of the reasons for a successful implementation of nutritional therapy was a participating dietitian, with a clearly defined role, as part of the nutrition team in the unit. In patients with chronic obstructive pulmonary disease (COPD), it has been shown that a combination of nutritional support and exercise as an anabolic stimulus appears to be the best approach to obtain marked functional improvement 3. To ensure proper exercise, a physiotherapist should be involved. Further, in our opinion, functional improvement should preferably be assessed using standardized tests of muscle function, in addition to different form of indexes. In COPD patients 4, we have shown that body composition, expressed as fat-free mass index, is a better predictor of survival than body mass index (i.e. body weight and height). This is probably also the case for elderly hospitalized patients without COPD, and a measure of body composition as an outcome measure would show the effects of multidisciplinary interventions more clearly than measuring only body weight. In the future, we hope to see a multidisciplinary approach to rehabilitation and a more focused use of outcome measures. This would increase the evidence base for rehabilitation and also improve the between-disciplines understanding of each specialist's knowledge in the care of patients, and last but not least, give each patient a better chance of improving his or her muscle function and quality of life.
The new European Union (EU) regulation on nutrition and health claims came into force on 19 January 2007.This means that the same rules for use of such claims in advertisements, labelling and presentation of foods, including food supplements, will now be implemented throughout the EU.Some countries have had Codes of Practices allowing certain health claims.Experiences from such Codes, such as in Sweden since 1990, will be useful in implementing the new regulation.When used in a responsible way according to the regulation, health claims may be important in driving product development and assisting consumers in making healthy choices.
Background: Duchenne muscular dystrophy (DMD) is a disease characterized by progressive loss of functional muscle mass followed by changes in body composition.Objective: This study aimed to describe and evaluate bioimpedance parameters in boys with DMD.Design: This cross-sectional, descriptive study investigated children and adolescents diagnosed with DMD.Age, weight, height, resistance, and reactance data were collected.Phase angle and bioelectrical impedance vector analysis were calculated based on resistance and reactance values.Results: We analyzed 43 boys aged between 2.7 and 19.8 years.Low-phase angle values were observed during the investigation of bioimpedance parameters.Bioelectrical impedance vector analysis showed that approximately 87% of the subjects presented vectors outside the tolerance ellipses, and only one patient presented vectors located within the 50% tolerance ellipse, indicating normally hydrated and a good body cell mass.Compared with the reference population, boys with DMD had lower levels of body cell mass.Conclusion: Based on the evidence, compared with the reference population, patients with DMD had lower levels of body cell mass.This evidence points to bioimpedance parameters as useful tools for the nutritional evaluation and clinical management of patients with DMD.
European Regulation (EC) No. 1924/2006 on nutrition and health claims made on foods came into force in early 2007. This means that, after many years of discussion, it is now possible to use health claims on foods in all European Union (EU) countries. The main reasons for EU regulation in this area are consumer protection and protection of data behind innovative food products. Free movement of products without hindrance from differences in national legislation is another important aspect. The Regulation has been awaited for many years, by the industry as well as by consumer organizations. In the Regulation, provision is made even for the most controversial type of claims in relation to medicinal products legislation, i.e. disease risk reduction claims.
Background: Micronutrient malnutrition has many adverse effects on human health, not all of which may beclinically evident.Objective: To explore linkages between subclinical health complaints and micronutrient status inlactovegetarian Indian adults.Design: Health was assessed in 502 lactovegetarian adults (275 men, 227 women, aged 30.6±9 years) using astructured questionnaire for existing complaints with severity of symptoms on a four-point scale andmorbidity over the preceding month. Subjects were categorized as having no complaints (NC), or complaintsof mild (MI) or moderate (MD) degree, using cluster analysis. Diet was recorded by a semi-quantitative foodfrequency questionnaire and nutrient intakes were computed using standard databases. Levels ofhaemoglobin, vitamin C, retinol, ceruloplasmin, riboflavin (EGRAC), folic acid, vitamin B12 and erythrocytemembrane zinc (RBCMZn) in blood were estimated.Results: Health complaints of a mild and moderate degree were observed in 30.5% and 24.7% of the subjects,respectively. Average dietary intakes of β-carotene, riboflavin, iron and zinc were observed to be only abouthalf of the recommended dietary intakes. There was a decreasing trend in micronutrient intakes from NC toMD. Intakes of iron, zinc, niacin and thiamin of men from the MI group tended to be lower than in the NCgroup (p<0.1). . Men from the MD group had significantly lower intakes of calcium, zinc and riboflavin thanthose from the NC group (p<0.05). . The intakes of these nutrients in women from NC, MI and MD were notsignificantly different. Multinomial logistic regression of health status revealed that plasma vitamin C andRBCMZn were negatively associated with MD and RBCMZn with MI.Conclusions: The study indicates a need to increase micronutrient intakes of vegetarian populations, especiallyregarding vitamin C and zinc for maintenance of health.
Background: Propionic and butyric acids are important nutrients for the mucosal cells and may therefore increase the nutritional status and reduce the permeability of the colonic mucosa. These acids have also been suggested to counteract diseases in the colon, e.g. ulcerative colitis and colon cancer. Different substrates lead to different amounts and patterns of carboxylic acids (CAs). Objective: To study the effect of probiotics on CA formation in the hindgut of rats given inulin. Design: The rats were given inulin, marketed as highly soluble by the producer, together with the probiotic bacteria Bifidobacterium lactis (Bb-12), Lactobacillus salivarius (UCC500) or Lactobacillus rhamnosus (GG), or a mixture of all three. Results: Rats fed inulin only had comparatively high proportions of propionic and butyric acids throughout the hindgut. When diets were supplemented with Bb-12 and UCC500, the caecal pool of CAs increased compared with inulin only. In the caecum the proportion of butyric acid generally decreased when the rats were fed probiotics. In the distal colon the proportion of propionic and butyric acid was lower, while that of lactic acid was generally higher. The caecal pH in rats fed GG and Bb-12 was lower than expected from the concentration of CAs. Further, rats fed GG had the lowest weight gain and highest caecal tissue weight. Conclusions: It is possible to modify the formation of CAs by combining inulin with probiotics. Different probiotics had different effects. Keywords: Bifidobacterium lactis (Bb-12); carboxylic acids; inulin; Lactobacillus rhamnosus (GG); Lactobacillus salivarius (UCC500); prebiotics
Background: Leafy vegetables are good sources of folates and food shops nowadays offer an increasing number of lettuce varieties. Objective: To obtain data on the folate content and forms in common lettuce varieties and spinach sold in the Nordic countries, and to investigate effects of different storage conditions and preparations in the consumer's home or at lunchtime restaurants. Design: Folate was analysed in eight different lettuce varieties and spinach using a validated high-performance liquid chromatographic method and the detected forms of folates were confirmed by a mass spectrometric detector [liquid chromatography-mass spectrometry (LC-MS)] following heat extraction, deconjugation with rat serum and purification by solid-phase extraction. Results: Folate content, expressed in folic acid equivalents, in the lettuce samples varied six-fold, from 30 to 198µg 100 g-1 on a fresh weight basis. The folate content was decreased by 14% after storage at 48°C f or 8 days and by 2-40% after storage at 22°C for 2-4 h, depending on whether samples were stored as whole leaves, or small torn or cut pieces. LC-MS confirmed the identity of the folate forms: H4folate, 5-CH3- H4folate, 5-HCO-H4folate and 10-HCO-H4folate. Conclusion: The considerable variation in folate content between varieties of lettuce in this pilot study, with one variety reaching the level found in spinach, indicates the potential to increase folate intake considerably by choosing folate-rich varieties of lettuce and storing at low temperatures. Keywords: folate analysis; folate retention; HPLC, LC-MS; leafy vegetables; storage
Background: Low vitamin D status is associated with reduced muscle strength, but the benefit of vitamin D supplementation is not clear.Objective: To study whether a daily supplement of vitamin D could improve grip strength.Design: A subtrial of a double-blinded, controlled trial studying the effect of vitamin D on the incidence of hip fractures and other osteoporosis fractures in a frail nursing home population. Sixty nursing home residents in 14 nursing homes in the Oslo area were given 5 ml ordinary cod liver oil daily containing 10 µg vitamin D3 (vitamin D group) or 5 ml cod liver oil where vitamin D was removed (control group). Grip strength was measured at baseline and after 1 year with supplementation.Results: Grip strength did not improve in the vitamin D group (0.4 kg increase) compared with the control group (1.6 kg increase) after 1 year vitamin D supplementation (p=0.22). Serum 25(OH)D was estimated to increase by 21.1 nmol l-1 (p=0.002) in the intervention group compared with the control group.Conclusion: A group given a daily supplement of 10 µg vitamin D3 in cod liver oil did not improve grip strength compared with a group not receiving vitamin D from cod liver oil.
