Non-communicable diseases - Healthy diet, physical activity and obesity trends in the Nordic countries: Status and challenges Prof. Knut-Inge Klepp Director General, Public Health, The Norwegian Directorate of Health
Burden of disease attributable to 15 leading risk factors in 2010 expressed as % of DALYs Denmark Finland The Global Burden of Disease Project 2010 2
Nordic Nutrition Recommendations 2012 Systematic, independent reviews of the scientific literature Recommendations regarding: Diet composition Nutrient intake Physical activity levels Reduced sedentary behavior
Physical activity 28.08.2014 6
Prosent Proportion (%) reporting at least 1 hour of moderate-to vigorous physical activity per day (HBSC) Gutter 40 30 20 10 0 11 13 11 13 11 13 11 13 11 13 11 13 Finland Norge Island Sverige Danmark Gj.snitt HBSC Land og alder Boys: age 11 and 13 years; HBSC 2009/2010 (WHO 2012) 28.08.2014 7
Moderate-to-vigorous PA (min/day) Objectively registered moderate-to-vigorous physical activity (minutes per day) Denmark and Norway (The European Youth Heart Study) 200 175 150 125 100 75 50 25 0 Gutter Jenter Gutter Jenter Gutter Jenter Gutter Jenter 9 år 9 år 15 år 15 år Danmark Norge Danmark Norge Average minutes per day of measured moderate-to-vigorous physical activity; the European Youth Heart Study (Riddoch CJ 2004, EYHS) 28.08.2014 8
Self-reported physical activity: % meeting the recommendation (>7 h MVPA/wk), being somewhat active (15-419 min MVPA/wk), or inactive (< 15 min MVPA/wk): 7-12 year olds Country N Active Somewhat active Inactive Finland 500 56 43 1 Iceland 518 52 47 1 Denmark 609 45 53 2 Norway 353 33 64 4 Sweden 499 28 68 4 MVPA=Moderate-to-vigorous PA (Nordiske ministerråd, Rasmussen LB et al 2012) 28.08.2014 9
Self-reported physical activity: % meeting the recommendation (>210 min MVPA/wk), being somewhat active (15-209 min MVPA/wk), or inactive (< 15 min MVPA/wk): Adults 18-65 year olds Country N Active Somewhat active Inactive Finland 1835 70 22 8 Sweden 1782 69 22 9 Denmark 2098 66 23 11 Iceland 1866 65 21 14 Norway 1019 61 26 13 MVPA=Moderate-to-vigorous PA (Nordiske ministerråd, Rasmussen LB et al 2012) 28.08.2014 10
Prosent Sedentary behaviour watching TV at least 2 hours/day (HBSC) Gutter 70 60 50 40 30 20 10 0 11 13 11 13 11 13 11 13 11 13 11 13 Danmark Finland Sverige Island Norge Gj.snitt HBSC 39 Boys: 11 and 13 years old; HBSC 2009/2010 (WHO 2012) 28.08.2014 11
Reported daily transport by foot (by age group): Denmark & Norway Denmark (2011); Norway (2009) (Danmarks Tekniske Universitet 2012 og Transportøkonomisk institutt 2009) 28.08.2014 12
Proportion of bike cyclists in Scandinavia (Syklistenes landsforening 2010, http://www.tiltakskatalog.no/b-3-1.htm) 28.08.2014 13
Nutrition & healthy eating 28.08.2014 14
Consumption of fresh fruit and vegetables kg/person/year (whole sale data) 1995 2000 2005 2010 2012 Denmark -- -- -- -- -- Finland 101 113 117 103 109 Iceland 76 74 100 105 115 Norway 106 119 126 129 Sweden 100 114 121 -- -- Nordic Statistical Yearbook 2013 28.08.2014 15
Proportion who reported to eat fruit, berries and vegetables 5 times a day Proportion (%) Denmark 15.0 Finland 8.5 Iceland 8.3 Norway 21.9 Sweden 13.2 28.08.2014 16
Salt intake (grams) per person per day for adults 28.08.2014 17
Average dietary index (range 0-12) in the Nordic Countries The index is constructed based on reported frequency of intake of fruit & vegetables, bread, fish & seafood, candy & cakes etc., fat on bread, cheese and sausages 28.08.2014 18
Dietary index: proportion classified as having a poor diet (0-4); medium nutritional quality (5-8); or having a healthy diet (9-12) by country 28.08.2014 19
Norway: the proportion of the adult population meeting the recommended dietary recommendations: Norkost 2010-11: Men Women Vegetables 13 % 15 % Fruit and berries 34 % 41 % Whole grain 27 % 25 % Fish 39 % 31 % Fatty fish 24 % 21 % Red meat 45 % 67 %
Overweight and obesity 28.08.2014 21
The WHO European Childhood Obesity Surveillance Initiative (2009-10) 28.08.2014 22
The WHO European Childhood Obesity Surveillance Initiative, Norway 2008-12: % overweight and obese Both gender Boys Girls Girls Boys National Institute of Public Health, 2013
Health Behaviour in School-aged Children (HBSC) Study: Self-reported overweight & obesity Boys Girls 28.08.2014 24
BMI: Proportion (%) reporting to be overweight or obese BMI 25-29.9 BMI 30 Denmark 32.8 % 12.0 % Finland 37.2 14.0 Iceland 39.3 17.8 Norway 36.1 8.7 Sweden 34.2 10.2 28.08.2014 25
Obesity (% of pop) related to length of education Length of education
Prevalence of obesity among Norwegian women & immigrant groups HUBRO 2000-02 (age adjusted) (BMI 30 kg/m2) Kumar et al, 2009
WHO Marketing of foods to children 2004-12 2007 2009 2006 2007 2012 2004 2010
The Norwegian School Fruit Program ISBNPA Symposium, ECO2011, Istanbul 29
Tax on non-alcoholic beverages with added sugar or artificial sweetener As of January 1, 2009 the added tax on non-alcoholic beverages with added sugar or artificial sweetener was increased to the same level as that of beer with low alcohol content (i.e. alcohol content between 0,7 and 2,7 volume percentage) 28.08.2014 30
Sales (NOK) of Keyhole products in grocery stores 2011-2013 (Nielsen) 18 000 000 16 000 000 14 000 000 12 000 000 10 000 000 8 000 000 6 000 000 4 000 000 2 000 000-17 062 046 13 651 470 12 041 524 2011 2012 2013
Active transportation, physical activity at school & available play and recreational areas within neighborhoods 28.08.2014 32
Conclusions & future challenges We lack comparable, valid (trend) data related to the WHO NCD indicators from the Nordic countries Existing data indicate some positive trends related to diet There is no robust indication of a leveling off with respect to overweight and obesity rates in the Nordic countries A number of policy measures have proven to be promising with respect to promoting healthy diet and increased physical activity levels There seems to be an under-utilized potential for Nordic cross-country evaluation studies of public health measures
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