This study is part of the Skills for life project, which aims to develop, test, and evaluate a practical university dietary life skills course to foster students’ food literacy and a healthy diet. The Developmental Origins of Health and Disease (DOHaD) framework emphasises the importance of preconception health (PCH), including dietary health, in shaping pregnancy outcomes and reducing the risk of chronic diseases. Approximately 70

Abstract BackgroundIn October 2022, the Nutrition Now (NN) e-learning resource was implemented within Maternal and Child Healthcare centers and Early Childhood Education and Care centers of a southern Norwegian municipality. The e-learning resource targets expectant parents, parents of children aged 0‐2 years, and Early Childhood Education and Care staff, aiming to promote healthy dietary behaviors during the first 1000 days of life. ObjectiveThis study aimed to explore parental perceptions related to the acceptability, appropriateness, feasibility, and reported use of the NN e-learning resource among parents. MethodsFrom October 2022 to May 2023, expecting parents and parents of children aged 0‐2 years were recruited from 2 Norwegian municipalities, one intervention group receiving access to the NN e-learning resource, and one control. Participants in the intervention group received a web-based follow-up questionnaire 7 months after gaining access to the NN e-learning resource. Data were analyzed using descriptive statistics. ResultsOf the 179 participants in the NN study intervention group, 48 completed the web-based follow-up questionnaire administered 7 months after enrollment. Parents rated the e-learning resource positively on items assessing whether they liked and appreciated the resource, perceived it as an appropriate source of information, and found it doable and easy to use. Most respondents reported visiting the resource (38/48, 79%), although only 21% (10/48) reported frequent visits. Less than half of the participants answering the web-based follow-up questionnaire reported having watched the theme films (20/48, 42%), the recipe films (17/48, 35%), or making food using recipes provided in the e-learning resource (20/48, 42%). ConclusionsParents rated the NN e-learning resource positively but reported limited use. These findings point to the need for strategies that enhance engagement with self-guided digital interventions among expectant parents and parents of young children. Future efforts should focus on identifying how to maximize potential adoption of the e-learning resource and evaluate its impact to promote healthy dietary behaviors during the first 1000 days of life.

Abstract Background Early Childhood Education and Care (ECEC) centers play an important role in fostering healthy dietary habits. The Nutrition Now project focusing on improving dietary habits during the first 1000 days of life. Central to the project is the implementation of an e-learning resource aimed at promoting feeding practices among staff and healthy dietary behaviours for children aged 0–3 years in ECEC. Implementing new interventions often presents challenges. This study explores ECEC staff views and experiences with selected strategies for implementing an e-learning resource in ECEC centers in a municipality in Southern Norway. Methods The study is a part of the Nutrition Now study, a hybrid type 1 non-randomized controlled trial. The implementation process followed the Dynamic Integrated Evaluation Model (DIEM). Implementation strategies were selected from the Expert Recommendations for Implementing Change (ERIC) project and included identify and prepare champions, conduct educational meetings, distribute educational materials, create a learning collaborative, and remind clinicians. ECEC teachers from participating ECEC centers in the intervention municipality were recruited as champions. Brief (5–7 min minutes), semi-structured phone interviews, covering key points, were conducted with the champions 8 times, evenly distributed over six months. The interviews were analysed using qualitative thematic analysis. Results In total, 29 of the invited ECEC centers (53%) participated, and 260 brief interviews (88%) were conducted with champions (n = 37). An evaluation of the feedback from the champions suggests that the five selected implementation strategies were acceptable. Five main themes were developed by qualitative analysis: 1) Being a champion resembles what I already do. 2) Educational meetings are fine but take time. I prefer when peers share experiences. 3) Newsletters were helpful and reminded me, but I do not always have enough time to read. 4) Evaluations have increased my awareness, and we do them informally and formally. 5) The regular phone calls reminded me I could receive support and express my opinion. Conclusion This study’s findings suggest that several implementation strategies are acceptable for stakeholders in an ECEC e-learning healthy eating intervention. However, time constraints among champions may hinder deep engagement. These results provide valuable insights into how the selected implementation strategies may function in practice and how they are perceived and experienced by the ECECs staff. Trial registration Trial registration on June 6, 2022: ISRCTN10694967.

The transition from living at home to independent university life has been associated with deteriorated health outcomes, and many university students lack cooking skills. Life skills education promotes skills essential to mastering everyday challenges such as planning and preparing healthy meals. We developed a dietary life skills course to foster cooking skills and a healthy diet among university students. This paper describes the feasibility testing of this Skills for Life course. Skills for Life was feasibility tested as a pre-post intervention without a control group. The course comprised 10 weekly, practical lessons at a university teaching kitchen. Topics included among others: nutrition from a life course perspective and why diet matters, how to stock your kitchen, how to make the most of your student loan, and sustainable food and ‘food rescuing’. The emphasis was on how to plan and cook easy, cheap, healthy, tasty, and sustainable meals. The students were encouraged to engage with a course-specific website that included short video lectures, relevant literature, learning activities, recipes, and a podcast. An online survey including background information and a validated dietary screener (MyFoodMonth 1.1) was distributed pre- and post-course. Feasibility questionnaires were distributed after each of the 10 lessons and post-course. Progression criteria were set regarding acceptability (mean value ≥ 4 of 5), demand (30 or more sign up; 20 or more participate), implementation (10 lessons delivered), practicality (intervention delivered within normal working hours) and limited efficacy (no significant adverse effects on participants). All progression criteria were met. Sixty-nine students signed up, but the dropout rate was substantial. Twenty-eight students attended at least one lesson, and 14 students attended at least five of the 10 lessons. The overall attendance rate was 49

BackgroundIn response to the growing need for effective programmes to promote healthy eating habits among children in real-world settings, we conducted a qualitative study. Our aim was to explore the content-related needs of early childhood education and care (ECEC) staff regarding the core components of an upcoming digital "healthy eating" resource. This resource, designed for real-world implementation through the Nutrition Now project, seeks to enhance children's nutrition and health within ECEC settings.MethodsTwelve individual semi-structured interviews with ECEC staff in a Norwegian municipality were conducted. Subsequently, we conducted two focus group discussions, involving five participants, to encourage reflection on the preliminary findings from the individual interviews. Qualitative thematic analysis was conducted using Nvivo software. Data from the interviews and focus groups were transcribed verbatim and analysed thematically to identify and summarise staff's subjective experiences and reasoning.ResultsSix themes were identified for the development of the upcoming digital "healthy eating" resource: (1) A comprehensive recipe bank, and menu suggestions, (2) Tips for easy and quick cooking, simple hygiene and allergy management, (3) Age-appropriate food learning ideas, (4) Strategies for mealtime learning and engagement, (5) Alignment with the national ECEC curriculum, and (6) Parent-friendly access and content.ConclusionsThis research provides valuable guidance and informs the adaptation of an expert-led digital "healthy eating" intervention to better suit ECEC staff and the ECEC context, consequently enhancing its feasibility and effectiveness.Trial registrationThis study was not registered in a trial registry as it is not a clinical trial or intervention study but serves as a pilot for the Nutrition Now study, trial identifier ISRCTN10694967 (https//doi.org/10.1186/ISRCTN10694967), registration date 19/06/2022.

BackgroundFew effective health interventions transition from smaller efficacy or effectiveness studies to real-world implementation at scale, representing a gap between evidence and practice. Recognising this, we have developed Nutrition Now – a tailored digital resource building on four efficacious dietary interventions, aiming to improve nutrition in the important first 1,000 days of life. Nutrition Now targets and guides expectant parents and parents of 0–2 year olds, serves as a reliable source of evidence-based information for midwives and public health nurses at maternal and child healthcare (MCH) centres, and offers pedagogical tools for early childhood education and care (ECEC) staff. The aim of this study is to implement Nutrition Now at scale and evaluate the impact of different sets of multifaceted implementation strategies on implementation outcomes.MethodsA quasi-experimental design with three study arms will be used, providing either low, medium or high implementation support, when rolled out in 50 municipalities in 2 counties in Norway. Nutrition Now will be implemented in MCH and ECEC settings and made available to expectant parents and parents of 0–2 year olds through social media and MCH. The implementation support builds on strategies described in the Expert Recommendations for Implementing Change (ERIC) implementation framework and is informed by dialogues with stakeholders. Impact of the different degree of implementation support will be assessed by examining reach, adoption, fidelity, and sustainability using usage data generated from the Nutrition Now resource, publicly available municipal data and qualitative interviews with MCH and ECEC staff.DiscussionNutrition Now Phase 2 will break new ground by scaling up successively delivered and complementary dietary interventions in the first 1,000 days of life in a real-life context. The project also seeks to identify what level of implementation support is most effective when implementing digital, scalable, evidence-based early-life nutrition interventions in community settings. The project will inform implementation research and provide knowledge about effective implementation strategies to be used in a national scale-up of Nutrition Now.Trial registrationThe study is registered prospectively (submitted 14/06/2022, registration date: 19/06/2022) in the International Standard Randomised Controlled Trial Number registry (ISRCTN): reg. Number: ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967.

BackgroundNutrition interventions targeting early childhood can be cost-effective and may provide lifelong, intergenerational benefits. From October 2022 to April 2023 the Nutrition Now (NN) e-learning resource was implemented within Early Childhood Education and Care centres and the Maternal and Child Healthcare Centre (MCHC) in a southern Norwegian municipality. As part of the NN project, the present study aims to explore the MCHC staff's experiences with implementing the NN resource, to gain insights into measures important to scale up digital early-life nutrition interventions.MethodsThree group interviews were conducted among public health nurses and midwives alongside one individual interview with the department leader of a MCHC in May 2023. An inductive thematic analysis, as described by Braun and Clarke, was conducted to generate the key themes and subthemes regarding the implementation process of NN within the MCHC.ResultsThree main themes were generated: [1] Important resource but not always utilized; [2] Parents are interested but had issues with access; and [3] Staff and stakeholder buy-in and commitment needed from the start. Overall, the staff viewed the NN resource as a potential tool for promoting diet-related topics and believed it could support the guidance they were already providing parents. However, few staff members fully familiarized themselves with the resource. While staff perceived parents as positive when informed about NN, they believed issues such as access challenges, competing platforms, and time constraints reduced parental engagement. Lastly, staff suggested improvements for NN's implementation, including enhanced training, better planning, assigning champions, and lowering the threshold for access.ConclusionThe findings of this study suggest that the real-world implementation of digital evidence-based health behaviour interventions is feasible but would be enhanced by employing strategies focusing on engagement and utilization.Trial registrationThe main study is registered in the ISRCTN registry with ID ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967. (Registration date: 19-06-2022).

Essential life skills related to food and meals have a potential triple dividend for children and adolescents, that is, short-term, medium-term and possible generational effects with regard to public health, sustainability and well-being of future citizens in local communities. While parents and childhood environments are a basis for learning about food and meals, systematic food education in the setting of primary and lower secondary schools may have a significant role that should be utilized more strongly, reaching and benefitting all pupils from a life course perspective. Through this article, we explore the current state of the art of the mandatory school subject Food and Health (FH) from the Nordic perspective. Our leading questions are: (1) What potential is currently utilized and which future potential does FH education have in primary and secondary schools in terms of food education for essential life skills and competencies, and (2) How can this untapped potential be better harnessed with a goal of facilitating better learning in FH? Drawing on data from Norway as a case study, supported by Swedish and Finnish data, we discuss the status, challenges and potential reformation of food education, focusing on FH. This includes perspectives on the prioritization of the FH subject and the organization of more systematic food education in schools, which might improve FH's status and significance. Combining theory-practice, creating room for discussion and focusing less on cooking-related activities may better facilitate learning in FH. Without proper FH, food education might be nonsystematic, thereby generating unequal outcomes for children and adolescents.

While primary and lower secondary school students in Norway have a relatively healthy diet, there are some weaknesses. Not all students eat breakfast at home/school or lunch at school. The school is an important arena for universal food and meal efforts targeting all students, which is important for their learning in the short and long term. Through a narrative/traditional review, this article investigates the research question: What impact do food and meals have on learning in primary and lower secondary schools? We focus on how food and meals affect concentration, school performance/results and social learning. Systematic reviews show that breakfast is important for short-term concentration and school results. Likewise, school lunch is associated with improved dietary quality, school attendance and academic achievement. School meals also impact social learning, e.g. eating routines, communication/friendship and broader societal issues of identity and connection to the community. Possibilities for promoting these outcomes in the Norwegian school system are presented, focusing on current curricula and policy documents. There is potential to strengthen the focus on food and meals, as well as the connection between food and learning in schools.

Over the course of 1st to 10th grade, every school student will consume nearly 2,000 lunches, and how schools plan this meal can be of great importance to the students. This chapter addresses various factors related to planning and providing the daily lunch meal in Norwegian school with the research question: Which promotive and inhibitive framework factors influence the implementation of school lunch in Norwegian primary and lower secondary school? Physical factors such as kitchen equipment, kitchens and dining rooms are important for the success of food and meals in school, depending on the type of school meal provision plan. Resource factors, such as staffing, and organizational factors are also important, as well as pedagogical and student factors. This chapter discusses promotive and inhibitive framework factors for the implementation of school lunches at Norwegian primary and lower secondary schools, primarily via the national professional guidelines for food and meals in schools. Today’s practice is also reviewed, and knowledge gaps as well as opportunities for new thinking and practical examples from the Norwegian context are presented.

Disappointingly few efficacious health interventions are successfully scaled up and implemented in real world settings. This represents an evidence-to-practice gap, with loss of opportunity to improve practice. Aiming to improve nutrition in the first 1000 days of life, we have combined four efficacious dietary interventions into a single adapted digital resource (Nutrition Now) for implementation in a Norwegian community setting. Nutrition Now targets pregnant women and parents of 0–2-year-olds with messages focusing on healthy dietary behaviours. Early childhood education and care (ECEC) staff are provided with pedagogical tools addressing healthy food exposure and child food acceptance. Objectives: a) evaluate the effectiveness of provision of the Nutrition Now resource on child diet and diet-related outcomes, with special attention to the influence of socio-economic position, b) gather information on the effectiveness of the implementation process to inform forthcoming scale-up and c) perform trial- and model-based economic evaluations. This is a hybrid type 1 implementation study, focusing on evaluation of effectiveness. A quasi-experimental design with pre- and post-tests, where one municipality gets access to the resource (n~800), while a matched non-equivalent control municipality (n~800) does not, will be used. Effectiveness will be assessed by examining e.g., diet outcomes, developmental outcomes, and feeding practices. The resource will be implemented in ECEC settings and made available to pregnant women and parents through the Norwegian system of maternal and child health (MCH) care. The implementation process includes iterative adjustments and implementation strategies from the implementation framework Expert Recommendations for Implementing Change (ERIC) informed by dialogues with stakeholders. Implementation outcomes (e.g., acceptability and adoption) will be assessed through questionnaires and interviews with parents, ECEC and MCH staff, with particular attention to ethnic diverse groups. Both within-trial and modelling-based economic evaluation will be performed. Nutrition Now will bridge the existing evidence-to-practice gap through rigorous scientific effectiveness evaluation of municipal scale up and inform subsequent county scale up. The study is the first to implement efficacious nutrition interventions in early life with potential for health improvement using technology to maximise the reach and impact of both parental and MCH dietary guidance and ECEC practice. Clinical Trial Registration https://www.isrctn.com/ , identified ISRCTN10694967.

Feeding practices in early childhood education and care (ECEC) settings are important for the development of healthy eating habits early in life. However, there is limited research on feeding practices among ECEC staff working with infants and toddlers, and how these practices relate to staff education. This study assessed the feeding practices, level of food neophobia, and participation in shared meals among ECEC staff, and examined whether there were differences in feeding practices related to education and shared meals. Furthermore, we explored the association between food neophobia levels among ECEC staff and their respective feeding practices in ECEC. In total, 130 ECEC teachers and other staff from two Norwegian ECEC trials completed a questionnaire about feeding practices and level of food neophobia. Our results showed that ECEC staff commonly used modelling and encouraging balance and variety feeding practices, but used food as a reward and emotion regulation less often. These practices differed by staff educational level, favoring highly educated staff. We found that more than half of ECEC staff ate lunch together with the children every day, and those who did so used positive feeding practices (encouraging balance and variety and modelling) more than those who did not eat with children; however, they also used restriction for health more often. Higher scores on food neophobia were associated with less use of emotion regulation and restriction for health when adjusted for relevant variables. In conclusion, our results show there is potential to improve feeding practices in ECEC, especially focusing on ECEC staff with low education. Suggested ways forward are updating guidelines to cover feeding practices and working on implementing these guidelines.

Background Understanding the associations between health behaviors and which subgroups are at risk of developing health risk behaviors is vital knowledge to develop effective public health interventions to reduce the high prevalence of non-communicable diseases (NCDs). The objective of the study was to assess the association between physical activity, diet, tobacco use, and alcohol consumption and sociodemographic determinants (sex and education), and to examine clustering patterns of these health behaviors. Method Data was collected from an online self-reported questionnaire from the Norwegian public health survey conducted in 2019. The study sample consisted of 28,047 adults (≥ 18 years old) from Agder county in Southern Norway. Chi-square tests and logistic regression analysis were used to determine the association between sex and education according to physical activity, diet, tobacco use and alcohol consumption. Linear regression was used to examine the association between educational level and number of health risk behaviors, and cluster analysis were performed to determine cluster patterns. Results Females were more likely than men to meet the national public health recommendations for diet (p < 0.001), tobacco use (p < 0.01), and alcohol consumption (p < 0.001). High education was associated with meeting the recommendations for each of the four health behaviors and with a lower risk of having three or four health risk behaviors simultaneously. Furthermore, clustering of health risk behaviors was observed in five of the sixteen health behavior patterns. Conclusion Our findings show a higher risk of having multiple health risk behaviors for males and individuals with low education, and these subgroup findings could inform public health policy and be target goals in future public health interventions. Clustering patterns were observed in over 30% of the health behavior patterns. More research is needed on the causal relationship between health behaviors and socioeconomic factors, and the association between clustering and health outcomes to design effective interventions in the future.

Objective Universities have a role in educating and empowering students to become healthy and literate citizens of the 21st century society. The aim of this study was to explore university students' perceptions regarding the relevance and utility of a planned dietary life skills course. Design Qualitative design including focus group discussions. Setting A Norwegian university with participating undergraduate students from seven different disciplines. Method Data collection included 13 semi-structured focus group discussions involving 57 university students (35 women and 22 men aged 18-38 years). The focus group discussions were recorded and transcribed verbatim. To ensure in-depth knowledge of the research participants' thoughts and reflections, thematic analysis strategy was undertaken by a team of researchers. Results When presented to the idea of a dietary life skills course as a university course, the students were mostly positive regarding its relevance and utility, however both motivators and barriers for attending were put forward. Some mentioned potential academic course benefits, such as enhanced CV, and a few mentioned potential societal benefits such as a healthy population and sustainable food consumption. Several motivators for attending the course were launched, such as increased knowledge and cooking skills, having dinner and expanded network. The students wanted to learn about food, nutrients and health, and how to cook simple, affordable, healthy and sustainable meals. Potential barriers for attending were mostly related to practicalities, such as potential lack of alignment with ordinary study programme or too demanding lectures. Conclusion Most students acknowledged the value of a dietary life skills course and thought that such a course could benefit their personal life. This encourages the offering of such courses at university level, tailored to consider both motivators and barriers for attending.

This study examines Adizes’s management model implemented in student enterprise teams among undergraduate students at the University of Agder, Norway, exploring factors that affect the collaborative process. As Adizes’s model claims four team roles (integrator, administrator, producer, entrepreneur) are required for effective and targeted collaboration, the researchers hypothesized that student enterprises with four roles present would collaborate better than teams with fewer roles present. Prior to commencing the student enterprise, each student categorized themselves according to these four roles. Eleven student enterprise teams were interviewed regarding their collaborative process. The four roles were represented to different extent in each team. Students reported collaborative benefits when having all four roles represented in the group. Most students ranked collaboration and ownership to business idea high and reported fruitful team discussions with only a few teams experiencing conflicts. Due to limited variance, further research is needed to investigate the hypothesis.

This article discusses social aspects of school lunches in Norway. How do 11-year-old students experience and perceive their packed lunches and lunch breaks and to what extent is the lunch break a space for children's sociality or an area for teachers' governmentality? The study is based on 25 focus group discussions and drawing and writing assignments with 165 participants. A large proportion of the students expressed that they appreciated their packed lunches because they could decide for themselves what and how much to eat. Additionally, shortage of time and disturbance and noise in the classroom could ruin a good meal. The main issue that the students raised in relation to our question of sociality was with whom they could sit and eat their packed lunches. This finding underlines the importance of considering the emotional dimensions of eating and that commensal eating is not dependent on sharing the same food. The children experienced that the lunch break was governed by an adult agenda in which they had limited opportunities to create their own spaces.

Background: It studies on the factors that affect the stability of fatty acid profiles from human blood specimens are generally performed by evaluating the effect of a single factor on an individual fatty acid and excluding a considerable amount of data from the total fatty acid profiles. Methods: The stability of fatty acids from plasma, serum and red blood cells (RBC) was evaluated in terms of time, temperature, antioxidant and thawing. The fatty acids were methylated and analyzed by gas chromatography. The large volume of data is evaluated simultaneously and automatically by observing an Excel-based colour scale that indicates whether the fatty acid profiles have changed significantly as a result of the storage time (0-52 weeks), temperature (-20 degrees C/ -80 degrees C), butylated hydroxytoluene (BHT) antioxidant (presence/absence) or thawing (single/multiple). Results: Fatty acids from plasma were stable at both temperatures (-20 degrees C/ -80 degrees C) regardless of BHT. Fatty acids from serum without BHT degrades faster at -80 degrees C than -20 degrees C and fatty acids from RBC without BHT degrades faster at -20 degrees C than -80 degrees C. Addition of BHT inhibits this effect in serum and RBC. Multiple thawing of RBC without BHT demonstrated that polyunsaturated fatty acids were generally more susceptible for changes at -80 degrees C than at -20 degrees C while BHT prevents partially this effect. Conclusions: This study draws attention to the importance of pre-analytical considerations when storing blood samples in biobanks and the need of careful judgments when analyzing fatty acids profiles.

BACKGROUND:Seafood intake is associated with beneficial effects for human health. Seafood provides a number of nutrients beyond the traditionally known long chain marine n-3 fatty acids EPA, DPA and DHA, such as protein, vitamin D, iodine, selenium and vitamin B12. Valid assessment of dietary seafood and n-3 supplement intakes are becoming increasingly crucial when giving recommendations to populations as seafood consumption is regarded as an important part of a healthy and balanced diet.METHODS:The aim was to validate a short FFQ developed for assessment of dietary intake of seafood and n-3 supplements using the biomarkers marine n-3 fatty acids in erythrocytes and 25(OH)D in serum.RESULTS:Fifty-three healthy Norwegians aged 30-64 years with a mean BMI of 25 kg/m2 were compliant with the study protocol. 70% reported eating seafood for dinner one to two times per week, and 45% reported to eat seafood as spread, in salads or as snack meal three to five times or more per week. The FFQ correlated significantly with both the levels of marine n-3 fatty acids (r=0.73, p<0.0001) and with 25(OH)D (r=0.37, p<0.01). Mean level of marine n-3 and of 25(OH)D were 232±65 μg/g erythrocytes and 73±33 nmol/L serum, respectively.CONCLUSION:The present short FFQ predicted strongly the levels of marine n-3 fatty acids in erythrocytes, and predicted fairly good the level of serum 25(OH)D and may therefore be a valid method for assessment of seafood and n-3 supplements intake among adults.