To verify the impact of flour fortification on anaemia in Brazilian children. The survey also investigated the role of Fe deficiency as a cause of anaemia and estimated the bioavailability of the Fe in the children's diet. This local study was complemented by a nationwide survey of the types of Fe compounds added to flour.

Series of population-based surveys conducted in 2004 (baseline study), 2005, 2006 and 2008.

Pelotas, Rio Grande do Sul, Brazil.

Children under 6 years of age residing in the urban area of the city of Pelotas, Southern Brazil (n 507 in 2004; n 960 in 2005; n 893 in 2006; n 799 in 2008). In 2008, a sub-sample of children (n 114) provided venous blood samples to measure body Fe reserve parameters (ferritin and transferrin saturation).

We found no impact of fortification, with an increase in anaemia prevalence among children under 24 months of age. Hb levels decreased by 0·9 g/dl in this age group between 2004 and 2008 (10·9 g/dl to 10·0 g/dl; P < 0·001). Roughly 50 % of cases of anaemia were estimated to be due to Fe deficiency. Half of the mills surveyed used reduced Fe to fortify wheat flour. Total Fe intake from all foodstuffs was adequate for 88·6 % of the children, but its bioavailability was only 5 %.

The low bioavailability of the Fe compounds added to flours, combined with the poor quality of children's diets, account for the lack of impact of mandatory fortification.

To estimate the frequency of anaemia in pregnant women before and after the fortification of flours with Fe.

Retrospective study developed from secondary data obtained from medical records.

Two health units in Rio de Janeiro, Brazil.

Socio-economic, demographic, obstetric and Hb concentration data were collected of 778 pregnant women attending prenatal care. Two study groups were created: the first referred to the period before fortification (G1, n 391), including women whose parturition happened before June 2004; and the second referred to the period after fortification (G2, n 387), including women whose last menstrual cycle happened after June 2005. The Hb cut-off point adopted for anaemia diagnosis was <11·0 g/dl.

In linear regression models, when Hb concentration was expressed as a dependent variable, women in G2 presented Hb concentration 0·26 g/dl and 0·36 g/dl higher during the second and third trimesters of pregnancy, respectively, compared with G1. In logistic regression models where the dependent variable was anaemia during the second and third trimesters, it was verified that being a member of G2 was a protective factor against anaemia in the third trimester. Regarding the presence of anaemia at any gestational moment, it was verified that being a member of G2 represented a protective factor against anaemia during pregnancy.

Results indicate the protective effect of the fortification of flours with Fe in the fight against gestational anaemia, contributing to prevention and control of this nutritional disorder among pregnant women.

To investigate the impact of fortification by comparing food records and selected biochemical indicators of nutritional status pre- and post-fortification.

Mean intake from 24 h recalls (n 142) was compared with the Estimated Average Requirement (EAR) to determine the proportion with inadequate intake. In a subsample (n 34), diet and serum retinol, folate, ferritin and Zn were compared pre- and post-fortification for fortified nutrients vitamin A, thiamin, riboflavin, niacin, folic acid, Fe and Zn.

South Africa.

Breast-feeding women (ninety-four HIV-infected, forty eight HIV-uninfected) measured at ∼6, 14, 24 weeks, and 9 and 12 months postpartum.

Pre-fortification, >80 % of women did not meet the EAR for vitamins A, C, D, thiamin, riboflavin, niacin, B6, B12 and folate and minerals Zn, iodine and Ca. Dietary intake post-fortification increased for all fortified nutrients. In post-fortification food records, >70 % did not meet the EAR for Zn and vitamins A, riboflavin and B6. Serum folate and Zn increased significantly post-fortification (P < 0·001 for both), with no change in ferritin and a reduction in retinol. Post-fortification marginal/deficient folate status was reduced (73·5 % pre v. 3·0 % post; P < 0·001), as was Zn deficiency (26·5 % pre v. 5·9 % post; P < 0·05). Pre- and post-fortification, >93 % were retinol replete. There was no change in Fe deficiency (16·7 % pre v. 19·4 % post; P = 0·728).

Micronutrient intake improved with fortification, but >70 % of lactating women did not meet the EAR for Zn, vitamins A, riboflavin and B6. Although 100 % exceeded the EAR for Fe after fortification, Fe status did not improve.

We assessed serum homocysteine (tHcy) and folate concentrations among US adolescents before and after fortification of cereal-grain products with folic acid, and associations with demographic, behavioural and physiological factors.

Observational study conducted among participants of a randomized trial.

The Child and Adolescent Trial for Cardiovascular Health (CATCH) study.

Adolescents (n 2445) in grades 8 (pre-fortification, mean age 14 years) and 12 (post-fortification, mean age 18 years).

Average serum concentrations of tHcy, folate and vitamin B6 increased by 17 %, 16 % and 14 %, respectively, while serum concentrations of vitamin B12 decreased by 11 % post-fortification. Folic acid fortification provided, on average, an additional intake of 118 μg folate/d. Male sex (P < 0·0001) and white race (P = 0·0008) were associated with significantly greater increases in tHcy concentration, while increases in BMI (P = 0·006) and serum folate concentration (P < 0·0001) were associated with significant decreases in tHcy concentration. Female sex (P < 0·0001), non-smoking (P < 0·0001), use of multivitamins (P < 0·0001) and higher dietary intake of folate (P = 0·001) were associated with significantly greater increases in serum folate concentrations. From grade 8 to grade 12, the upward age trend in serum tHcy concentration was uninterrupted in its course (P > 0·50); whereas serum folic acid concentration showed a downward trend that incurred a discrete jump upward (17 % higher; P < 0·0001) with fortification. These trends differed significantly for males v. females (P < 0·001 for interaction).

Fortification had a significant impact on improving folate status but not serum tHcy concentrations among US adolescents.

To assess classical and non-classical metabolic risk biomarkers in prepubertal children with different levels of cardiorespiratory fitness (CRF).

CRF was assessed by the 20 m shuttle run test. To estimate physical activity, participants were observed while engaged in an after-school programme. Additionally, a short test based on a validated questionnaire was used to obtain information about physical activity practice and sedentary habits. Anthropometric parameters, blood pressure, and classical and non-traditional metabolic risk biomarkers – plasma lipid profile, glucose and insulin, homeostasis model assessment–insulin resistance index (HOMA-IR), plasma uric acid, transaminases and C-reactive protein (CRP) – were measured.

The study was conducted in local elementary schools in Córdoba, Spain.

One hundred and forty-one healthy children (eighty-eight boys, fifty-three girls) aged 7–12 years, in Tanner stage I, were recruited. They were divided into two groups after they performed the 20 m shuttle run test: equal or higher cardiovascular fitness (EHCF) group and low cardiovascular fitness (LCF) group.

The LCF group displayed significantly higher TAG (P = 0·004) and lower HDL cholesterol levels (P = 0·001), as well as significantly lower values for the non-traditional lipid marker apo-A1 (P = 0·001) compared with the EHCF group. The LCF children displayed higher plasma glucose (P = 0·003) and insulin levels, higher HOMA-IR scores (P < 0·001) and higher plasma uric acid and CRP levels (P < 0·05). After adjustment for BMI, age and sex, no statistically significant differences were found between groups for the biomarkers analysed.

The study provides new information to understand the role not only of weight status but also of the level of CRF on the metabolic health profile of prepubertal children.

Middle Eastern and North African countries are undergoing nutrition transition, a transition which is associated with an increased burden of non-communicable diseases. This necessitates the evaluation of dietary patterns in these regions. The present study aimed to assess changes in dietary patterns in Middle Eastern and North African countries between 1961 and 2007.

Availability of energy and fifteen main food items during 1961–2007 was examined using FAO food balance sheets from the FAOSTAT database.

Fifteen countries including nine in the Middle East and six in North Africa were selected and the average availability of total energy and different food items in these regions were compared.

Over the 47 years studied, energy and food availability (apart from animal fats and alcoholic beverages) has increased in the Middle East and North Africa. In both regions the proportion of energy derived from meat and vegetable oils has increased significantly while that from cereals decreased significantly. In addition, the proportion of energy from milk and dairy products and vegetables has shown an ascending trend in North Africa while the proportion of energy from fruits has shown a descending trend in the Middle East.

The study results reveal an unfavourable trend towards a Westernized diet in the Middle East and, to a certain extent, in North Africa. Tailored nutritional education encouraging healthy eating for prevention of the burden of chronic diseases in these countries seems essential.

Few data exist looking at vitamin D status and bone health in school-aged boys and girls from Saudi Arabia. The present study aimed to determine the extent of poor vitamin D status in school boys and girls aged 6–18 years and to examine if there was any difference in status with age, physical activity and veiling and concomitant effects on bone.

Cross-sectional study.

Jeddah, Kingdom of Saudi Arabia.

A total of 150 boys (7–16 years) and 150 girls (6–18 years) from local schools were divided into age categories: 6–9 years (elementary school); 10–12 years (secondary school); 13–14 years (middle years); 15–18 years (high school).

Vitamin D status was significantly lower in girls than boys in all age groups (P < 0·01), with the 15–18-year-old girls having the lowest level (22·0 (sd 9·4) nmol/l) in comparison to the 15–18-year-old boys (39·3 (sd 14·0) nmol/l) and the 6–9-year-old girls (41·2 (sd 9·3) nmol/l). Parathyroid hormone status was highest in the 15–18-year-old girls in comparison to boys of the same age. A total of 64 % of 15–18-year-old girls had 25-hydroxyvitamin D (25OHD) status <25 nmol/l in comparison to 31 % in the 13–14 years age category, 26 % in the 10–12 years category and 2·5 % in the 6–9 years category. No boys had 25OHD status <25 nmol/l. Fully veiled girls had lower 25OHD status than partly veiled or unveiled girls (P < 0·05). Low 25OHD and high parathyroid hormone was associated with lower bone mass in the 6–9 years and 13–14 years age groups (P < 0·05).

These data suggest significant hypovitaminosis D in older adolescent females, which is a cause for concern given that there is currently no public health policy for vitamin D in the Kingdom of Saudi Arabia.

To determine whether household food insecurity (HFI) is associated with a higher prevalence of excessive weight (EW) in a large random sample of Brazilian female adolescents.

Nationally representative cross-sectional study. EW was the outcome variable (BMI ≥ 85th percentile of WHO reference for adolescents aged 15–18 years and BMI ≥ 25 kg/m2 for those aged 19 years). HFI was measured with the Brazilian Food Insecurity Scale. Associations were measured using crude and adjusted prevalence ratios (PR) with 95 % confidence intervals through Poisson regression models taking into account the complex sampling design.

Data were derived from the third wave of the Demographic and Health Survey conducted in 2006–2007, in Brazil.

The sample included 1529 female adolescents aged 15–19 years.

The prevalence of any level of HFI was 40·8 %, with 26·6 % of households experiencing mild, 9·4 % moderate and 4·8 % severe food insecurity. The overall prevalence of EW was 21·9 % (12·9 % were overweight and 9·0 % obese). EW prevalence among those living in severely, moderately and mildly food-insecure households was 36·8 %, 14·9 % and 16·5 %, respectively (P for the overall association = 0·036). Women living in severely food-insecure households had an increased prevalence of EW compared with their food-secure counterparts (PR = 1·96; 95 % CI 1·18, 3·27; P = 0·007), after adjusting for important confounders.

The study suggests that severe but not mild or moderate HFI is independently associated with EW among adolescents residing in Brazil, a middle-income country undergoing the nutrition transition.

Previous studies on maternal work hours and child diet quality have reported conflicting findings possibly due to differences in study design, lack of a comprehensive measure of diet quality and differing ages of the children under investigation. The present study aimed to prospectively examine the impact of parental work hours from age 1 year to age 14 years on adolescent diet quality.

Multivariate linear regression models were used to examine independent associations between parents’ work hours at each follow-up and across 14 years and adolescent diet quality at age 14 years. A diet quality index was based on the international literature and Australian recommendations, consisting of six food groups and nine nutrients.

Perth, Western Australia.

Children (n 1629) participating in the Western Australian Pregnancy Cohort (Raine) Study.

Compared with children of mothers in full-time employment, children of mothers who were not employed in early childhood up to age 5 years had a higher average diet quality score at age 14 years, independent of maternal and family socio-economic status. Across 14 years the number of years the mother worked full time and increasing average weekly hours were associated with lower diet quality. Father's work hours had little association with adolescent diet quality.

Having a mother stay at home in early to middle childhood is associated with better diet quality in adolescence. Support may be beneficial for families where the mother returns to full-time employment before the child reaches 8 years of age.

To examine the contribution of 100 % fruit juice (FJ) consumption to dietary adequacy of shortfall nutrients by children and adolescents.

Cross-sectional.

Secondary analysis of data from the 2003–2006 National Health and Nutrition Examination Survey (NHANES).

Children and adolescents aged 2–18 years (n 7250). Usual intake, determined from two 24 h dietary recalls, was calculated using the National Cancer Institute method. The population was dichotomized into consumers or non-consumers of 100 % FJ. The age/gender-specific percentage of the two consumption groups with intakes less than the Estimated Average Requirement or that exceeded the Adequate Intake for selected nutrients was determined. A Z-statistic for differences in population proportions was used to determine significance (P < 0·05).

Children aged 2–5 years had the highest percentage of 100 % FJ consumers (71·1 %), followed by children aged 6–12 years (57·0 %) and adolescents aged 13–18 years (44·5 %). Compared with 100 % FJ consumers, a significantly higher percentage of non-consumers had intakes below the Estimated Average Requirement for vitamin A (24·4 (se 2·5) % v. 42·2 (se 2·5) %), vitamin C (0·1 (se 0·2) % v. 38·9 (se 4·1) %), folate (8·8 (se 1·5) % v. 22·1 (se 2·4) %), P (11·6 (se 2·1) % v. 21·3 (se 2·6) %) and Mg (25·8 (se 1·7) % v. 46·1 (se 2·0) %). A greater percentage of 100 % FJ consumers exceeded the Adequate Intake for K (2·4 (se 0·5) v. 0·5 (se 0·2) %) compared with non-consumers.

Consumption of 100 % FJ is associated with improved nutrient adequacy and can contribute to a healthy diet.

To describe breakfast habits at food group level in European adolescents and to investigate the associations between these habits and sociodemographic factors.

Cross-sectional study.

Secondary schools from nine European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Breakfast habits were assessed twice using a computer-based 24 h dietary recall. Adolescents who consumed breakfast on at least one recall day were classified as ‘breakfast consumers’ and adolescents who did not have anything for breakfast on either of the two recall days were considered ‘breakfast skippers’. A ‘breakfast quality index’ to describe breakfast quality was created based on the consumption or non-consumption of cereals/cereal products, dairy products and fruits/vegetables. The sociodemographic factors studied were sex, age, region of Europe, maternal and paternal education, family structure and family affluence.

Adolescents (n 2672, 53 % girls) aged 12–17 years.

The majority of the adolescents reported a breakfast that scored poorly on the breakfast quality index. Older adolescents, adolescents from the southern part of Europe and adolescents from families with low socio-economic status were more likely to consume a low-quality breakfast.

The study highlights the need to promote the consumption of a high-quality breakfast among adolescents, particularly in older adolescents, adolescents from southern Europe and adolescents from families with low socio-economic status, in order to improve public health.

The role of following the recommendations of Canada's Food Guide (CFG) and the Dietary Approaches to Stop Hypertension (DASH) diet on body composition in children is unknown. The present study assessed how conformity to the recommendations of these diets was associated with BMI, waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), waist girth (WG), hip girth (HG) and risk of overweight in peri-adolescents.

CFG and DASH indices were derived from responses to a food questionnaire, with a higher index representing greater conformity to CFG and DASH diet recommendations. Body composition was assessed by trained research assistants.

Schools within the Niagara region (Ontario, Canada).

Children (n 1570) aged 12·4 (sd 0·3) years.

After adjustment for age to peak height velocity and total physical activity, a higher CFG index was associated with lower WHtR (b = −0·001, 95 % CI −0·002, −0·0004), WHR (b = −0·001, 95 % CI −0·002, −0·001) and WG (b = −0·18, 95 % CI −0·30, −0·07) in girls. No associations were observed in boys. In contrast, a higher DASH index was associated with decreased body composition measures in both genders. Specifically, the DASH index was negatively associated with BMI (girls: b = −0·07, 95 % CI −0·10, −0·04; boys: b = −0·05, 95 % CI −0·08, −0·02), WHtR (girls: b = −0·001, 95 % CI −0·002, −0·001; boys: b = −0·001, 95 % CI −0·002, −0·0004), WHR (girls: b = −0·001, 95 % CI −0·002, −0·001; boys: b = −0·001, 95 % CI −0·001, −0·00004), WG (girls: b = −0·24, 95 % CI −0·31, −0·16; boys: b = −0·15, 95 % CI −0·24, −0·07) and HG (girls: b = −0·15, 95 % CI −0·23, −0·07; boys: b = −0·12, 95 % CI −0·19, −0·04). A higher DASH index was also associated with lower odds of overweight in girls (OR = 0·70, 95 % CI 0·56, 0·87) and boys (OR = 0·76, 95 % CI 0·62, 0·93).

The DASH diet may prevent overweight in peri-adolescents.

The Nordic Nutrition Recommendations (NNR) aim at preventing diet-associated diseases such as cancer in the Nordic countries. We evaluated adherence to the NNR in relation to prostate cancer (PC) in Swedish men, including potential interaction with a genetic risk score and with lifestyle factors.

Population-based case–control study (Cancer of the Prostate in Sweden (CAPS), 2001–2002). Using data from a semi-quantitative FFQ, we created an NNR adherence score and estimated relative risks of PC by unconditional logistic regression. Individual score components were modelled separately and potential modifying effects were assessed on the multiplicative scale.

Four regions in the central and northern parts of Sweden.

Incident PC patients (n 1386) and population controls (n 940), frequency-matched on age and region.

No overall association with PC was found, possibly due to the generally high adherence to the NNR score and its narrow distribution in the study population. Among individual NNR score components, high compared with low intakes of polyunsaturated fat were associated with an increased relative risk of localized PC. No formal interaction with genetic or lifestyle factors was observed, although in stratified analysis a positive association between the NNR and PC was suggested among men with a high genetic risk score but not among men with a medium or low genetic risk score.

Our findings do not support an association between NNR adherence and PC. The suggestive interaction with the genetic risk score deserves further investigations in other study populations.

Previous work studying vegetarians has often found that they have lower blood pressure (BP). Reasons may include their lower BMI and higher intake levels of fruit and vegetables. Here we seek to extend this evidence in a geographically diverse population containing vegans, lacto-ovo vegetarians and omnivores.

Data are analysed from a calibration sub-study of the Adventist Health Study-2 (AHS-2) cohort who attended clinics and provided validated FFQ. Criteria were established for vegan, lacto-ovo vegetarian, partial vegetarian and omnivorous dietary patterns.

Clinics were conducted at churches across the USA and Canada. Dietary data were gathered by mailed questionnaire.

Five hundred white subjects representing the AHS-2 cohort.

Covariate-adjusted regression analyses demonstrated that the vegan vegetarians had lower systolic and diastolic BP (mmHg) than omnivorous Adventists (β = −6·8, P < 0·05 and β = −6·9, P < 0·001). Findings for lacto-ovo vegetarians (β = −9·1, P < 0·001 and β = −5·8, P < 0·001) were similar. The vegetarians (mainly the vegans) were also less likely to be using antihypertensive medications. Defining hypertension as systolic BP > 139 mmHg or diastolic BP > 89 mmHg or use of antihypertensive medications, the odds ratio of hypertension compared with omnivores was 0·37 (95 % CI 0·19, 0·74), 0·57 (95 % CI 0·36, 0·92) and 0·92 (95 % CI 0·50, 1·70), respectively, for vegans, lacto-ovo vegetarians and partial vegetarians. Effects were reduced after adjustment for BMI.

We conclude from this relatively large study that vegetarians, especially vegans, with otherwise diverse characteristics but stable diets, do have lower systolic and diastolic BP and less hypertension than omnivores. This is only partly due to their lower body mass.

To examine gender-specific relationships between alcohol drinking patterns (average drinking frequency, typical drinking quantity and frequency of binge drinking) and the prevalence of metabolic syndrome (MetS) and its components in the Korean population.

Cross-sectional study using complex sampling design analyses.

The Korea National Health and Nutrition Examination Survey IV, which was conducted in 2008.

Current drinkers (n 3793, 1963 men and 1830 women).

After adjusting for confounders (age, educational level, income, physical activity, smoking, energy intake and drinking frequency in the analysis for drinking quantity), the associations of drinking quantity and frequency of binge drinking with the prevalence of MetS were gender-specific. Seven or more drinks for men and ≥3 drinks for women per typical occasion and binge drinking ≥1 time/week for both sexes resulted in significantly higher odds for the prevalence of MetS compared with men and women who had 1 or 2 drinks and no instances of binge drinking. The association of drinking quantity and the criteria of MetS was stronger for men with high blood pressure and abdominal obesity, whereas it was stronger for women with high glucose. Binge drinking frequency was dose-dependently associated with high TAG, high glucose, high blood pressure and abdominal obesity in men, and with high glucose and high blood pressure in women. Interestingly, average drinking frequency was not associated with the prevalence of MetS in either sex.

Higher drinking quantity and frequent binge drinking are indicators of a higher prevalence of MetS, and the association strength is thought to be gender-specific.

Nutrition has long been considered one of the most important environmental factors affecting human intelligence. Although carbohydrates are the most widely studied nutrient for their possible effects on cognition, limited data are available linking usual refined carbohydrate intake and intelligence. The present study was conducted to examine the relationship between long-term refined carbohydrate intake and non-verbal intelligence among schoolchildren.

Cross-sectional study.

Tehran, Iran.

In this cross-sectional study, 245 students aged 6–7 years were selected from 129 elementary schools in two western regions of Tehran. Anthropometric measurements were carried out. Non-verbal intelligence and refined carbohydrate consumption were determined using Raven's Standard Progressive Matrices test and a modified sixty-seven-item FFQ, respectively. Data about potential confounding variables were collected. Linear regression analysis was applied to examine the relationship between non-verbal intelligence scores and refined carbohydrate consumption.

Individuals in top tertile of refined carbohydrate intake had lower mean non-verbal intelligence scores in the crude model (P < 0·038). This association remained significant after controlling for age, gender, birth date, birth order and breast-feeding pattern (P = 0·045). However, further adjustments for mother's age, mother's education, father's education, parental occupation and BMI made the association statistically non-significant. We found a significant inverse association between refined carbohydrate consumption and non-verbal intelligence scores in regression models (β = −11·359, P < 0·001). This relationship remained significant in multivariate analysis after controlling for potential confounders (β = −8·495, P = 0·038).

The study provides evidence indicating an inverse relationship between refined carbohydrate consumption and non-verbal intelligence among Tehrani children aged 6–7 years. Prospective studies are needed to confirm our findings.

The potential effects of four interventions to improve iodine intakes of six New Zealand population groups are assessed.

A model was developed to estimate iodine intake when (i) bread is manufactured with or without iodized salt, (ii) recommended foods are consumed to augment iodine intake, (iii) iodine supplementation as recommended for pregnant women is taken and (iv) the level of iodization for use in bread manufacture is doubled from 25–65 mg to 100 mg iodine/kg salt.

New Zealanders have low and decreasing iodine intakes and low iodine status. Predictive modelling is a useful tool to assess the likely impact, and potential risk, of nutrition interventions.

Food consumption information was sourced from 24 h diet recall records for 4576 New Zealanders aged over 5 years.

Most consumers (73–100 %) are predicted to achieve an adequate iodine intake when salt iodized at 25–65 mg iodine/kg salt is used in bread manufacture, except in pregnant females of whom 37 % are likely to meet the estimated average requirement. Current dietary advice to achieve estimated average requirements is challenging for some consumers. Pregnant women are predicted to achieve adequate but not excessive iodine intakes when 150 μg of supplemental iodine is taken daily, assuming iodized salt in bread.

The manufacture of bread with iodized salt and supplemental iodine for pregnant women are predicted to be effective interventions to lift iodine intakes in New Zealand. Current estimations of iodine intake will be improved with information on discretionary salt and supplemental iodine usage.

Diet has a significant impact on health, and ensuring that the population eats a healthy diet remains a public health challenge. Research is needed in order to improve the palatability of a healthy diet and make it attractive to the consumer. It has also been suggested that dietary recommendations should be tailored to regional conditions. The OPUS (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet) project investigates whether it is possible to develop a healthy New Nordic Diet (NND) that is palatable, environmentally friendly and based on foods originating from the Nordic region. The present paper describes the overall guidelines for the NND, developed and investigated in the multidisciplinary, 5-year OPUS research project. All guidelines are described in relation to the key principles: health, gastronomic potential and Nordic identity, and sustainability.

The NND is described by the overall guidelines: (i) more calories from plant foods and fewer from meat; (ii) more foods from the sea and lakes; and (iii) more foods from the wild countryside. These overall guidelines result in a set of proposed dietary components which will be presented in a subsequent paper.

Both the guidelines and the diet are composed taking the potential health-promoting properties and Nordic identity of the NND into account, as well as concern for environmental issues and gastronomic potential.