Anne Dahl Lassen

Purpose: To evaluate changes in greenhouse gas emissions (GHGE) and nutritional composition of food procured for public meals for senior citizens from 2018 to 2022 in the city of Copenhagen. This provides a mid-way evaluation of the Food Strategy aimed at reducing the GHGE of public meals by 25% and assessing whether the municipality is on track to meet its reduction goals. Methods: Each food item purchased was matched with food composition and GHGE data, both with and without carbon opportunity costs. Data was analyzed separately for 2018, 2022, and both halves of 2022, as well as for different settings. Additionally, materials and initiatives provided by the City of Copenhagen were identified. Results: Across settings, a GHGE reduction of 14% (GHGE including carbon opportunity costs), and an 11% decrease in meat content was found from 2018 to 2022. Changes varied widely between settings with the largest reduction (30%) seen for the central kitchen producing mainly hot meals, while nursing homes providing full-day meals reduced GHGE by 10%. No changes were observed for the protein content, which did not meet the nutritional target for older adults. Municipal initiatives included meal guidelines and a recipe database provided in 2021. Additionally, by 2022, approx. one in five nursing homes, along with the central kitchen, had completed a tailored training program. Conclusion: The municipality is making progress towards meeting GHGE reduction goals for public meals for senior citizens. Further efforts are needed to increase pulses and other protein-rich plant-based products in daily meals.

Objective: To evaluate the effectiveness of the multicomponent intervention trial ‘Are You Too Sweet?’ in reducing discretionary foods and drinks intake among young schoolchildren. Design: The study was a 3·5-month two-arm cluster-randomised controlled trial among primary schoolchildren and their families. School health nurses provided guidance to families regarding discretionary foods and drinks for the children. Moreover, families were given a variety of knowledge- and capability-building materials to utilise at home. Dietary intake was assessed using a web-based 7-d dietary record. Linear mixed regression models were used to estimate intervention effects as changes in child intake of discretionary foods and drinks and sugar between groups. Setting: Six schools from a Danish municipality were randomised to the intervention group (n 4) or the control group (n 2). Participants: A total of 153 children aged 5–7 years. Results: No significant reduction in the children’s intake of total discretionary foods and drinks or discretionary foods alone was observed between the intervention and control group, while a decreased intake of discretionary drinks of 40·9 % (P = 0·045) was observed compared with control. Secondary subgroup analysis showed that children of parents with shorter educational level significantly reduced their intake of added sugar by 2·9 E% (P = 0·002). Conclusion: The results of this study indicate that multicomponent interventions involving school health nurses may have some effects in reducing, especially, discretionary drinks.

Public food procurement has been emphasized as a powerful tool to promote a healthier and more sustainable food system, but there is still a long way to go to reach full potential. This study aimed to investigate practices and opportunities for sustainable and healthy public food procurement. A qualitative cross-sectional study was performed among Danish municipalities and regions stratified and randomly selected to cover standard practice (n = 17). In addition, interviews were performed among selected best-practice municipalities (n = 5) providing examples of ambitious goals and well-defined processes for obtaining sustainable food procurement. Large differences were observed in the cross-sectional analysis in relation to policy support and goals for sustainable food procurement, including organic purchase. Generally, there was a great attentiveness to reduce food waste and many valued the use of local food, especially among rural municipalities, whereas experience with climate impact reduction and shifts towards more plant-based menus was still in an early implementation stage. Results suggest a possible synergy effect between the use of organic food and efforts to reduce food waste and climate impact and emphasize the importance of local government policies to promote healthy and sustainable food procurement. Enabling factors to move sustainable food procurement forward are discussed.

Successful strategies for policy makers and the food industry are required to reduce population salt intake. A 4-month cluster randomized controlled trial was conducted to evaluate whether the provision of salt-reduced bread with or without dietary counselling affected the dietary intake of selected food groups, energy, macronutrients, sodium, and potassium. Eighty-nine families (n = 309) consisting of minimum one parent and one child were assigned to receive bread gradually reduced in salt content alone (Intervention A), combined with dietary counselling (Intervention B), or bread with regular salt content (control). Food intake was recorded for seven consecutive days at baseline and follow-up. Salt intake was reduced in both Intervention A (−1.0 g salt/10 MJ, p = 0.027) and Intervention B (−1.0 g salt/10 MJ, p = 0.026) compared to the control. Consumption of bread and both total and salt-rich bread fillings remained similar between groups, while ‘cheese and cheese products’ were reduced in Intervention A (−38%, p = 0.011). Energy intake and macronutrient distribution were not affected in Intervention A, but Intervention B resulted in a higher energy intake (512 kJ, p = 0.019) and a lower energy % (E%) from saturated fat (−1.0 E%, p = 0.031) compared to the control. In conclusion, provision of salt-reduced bread both with and without dietary counselling successfully reduced dietary salt intake without adversely affecting the dietary nutritional quality.

Danish children have a much larger intake of sugar-rich foods and drinks than recommended. This study aimed to (1) explore social aspects and practices of pre-school children’s intake of sugar-rich foods and drinks and (2) evaluate barriers and parental strategies to reduce their children’s intake of sugar-rich foods and drinks employed in connection with the 3.5-month family-centred intervention trial ‘Are you too sweet?’. Intervention components included communication of the recommended maximum intake and reduction strategies, supported by resources encouraging and facilitating behavioural changes. A random sample of families (n = 24) from intervention schools participated in post-intervention semi-structured interviews. A thematic content analysis was conducted, revealing three main domains of social practices: (1) ‘family treats’, including the weekly Danish concept ‘Friday sweets’, (2) ‘everyday treats’, such as sweet snacks in lunch packs, between-meals snacks and soft drink habits and (3) ‘socialized treats’, including treats at special occasions. Parents employed several strategies, most often substitution and portion-size reduction, but also limiting home availability. Families most frequently made changes that were easily adoptable and close to existing routines at home. In conclusion, the intervention components provided families with knowledge and strategies that facilitated behavioural changes towards reducing the intake of sugar-rich foods and drinks.

Knowledge is needed about effective tools that reach public health objectives focused on reducing the intake of sugar-rich foods and drinks. The purpose of this study was to assess the parental acceptability, use and motivational potential of intervention components developed in the randomized family-based trial ‘Are you too sweet?’ aimed at reducing the intake of sugar-rich foods and drinks among children (5–7 y). Intervention components included guidance on sugar-rich foods and drinks at a school health nurse consultation, a box with home-use materials and a digital platform. The methods used were a questionnaire among intervention families (n = 83) and semi-structured interviews with parents in selected intervention families (n = 24). Results showed the good acceptability and usefulness of the components, with reported frequencies of use of materials ranging from 48% to 94% and a high satisfaction rate with the school health nurse consultation. Personalized feedback and guidance from the school health nurse seemed to be a motivational trigger, and components that were compatible with existing practices were most frequently used. However, the components were not considered engaging by all families. Overall, intervention components were well received and hold the potential for enhancing parental knowledge and parenting practices regarding limiting the intake of sugar-rich foods and drinks.

Dietary transitions are important for combating many of the environmental challenges humanity is facing today and reducing the global burden of disease. Different dietary patterns are associated with substantially different carbon footprints (CFs). This study aims to estimate the potential CF reduction on a transition from the current Danish diet to a plant-rich diet consistent with the Danish food-based dietary guidelines (FBDG) and to compare results obtained from the use of two different CF databases. Dietary intake data for adults aged 18–64 years from the national dietary survey 2011–2013 were used to calculate the CF of the current diet, and this was compared with the estimated CF of the plant-rich diet modelled for the FBDG. Calculations were carried out using an attributional life cycle assessment (LCA) database (AU-DTU data) and compared to calculations using a top-down hybrid consequential LCA database (BCD data). The transition from the current diet to the plant-rich diet showed a substantial estimated CF reduction of 31% with AU-DTU data, and a greater reduction with BCD data (43%). Ruminant meat reduction was the largest contributor to this CF reduction, especially with the use of BCD data, and other animal-based foods also contribute considerably to the CF reduction, especially with AU-DTU data. These results indicate that the choice of LCA methodology and CF database is important in estimation of dietary CF and for the development of guidelines to promote dietary change.

A high consumption of discretionary foods and drinks has been associated with increased risk of multiple adverse health outcomes, including risk of overweight and dental caries. The family-based cluster randomized intervention study “Are you too sweet?” aimed at reducing the intake of discretionary foods and drinks in a population of children starting pre-school. As part of the intervention a new short web-based sugar-rich food screener (SRFS), was developed to make the parents and the school health nurses aware of the children’s intake of discretionary foods and drinks. In addition to the short assessment tool the parents also completed a validated web-based 7-day dietary record for the children. In the present study, estimates for intake of discretionary foods and drinks from the two assessment tools were compared (n = 80). There was significant correlation between estimates from the two assessment tools, but the SRFS provided lower estimates for intake of discretionary foods and drinks compared to the 7-day dietary record. The correlation coefficient between the two assessment tools was 0.49 (p < 0.001) and Kappa coefficient was 0.33. It is concluded that the SRFS can provide a fairly ranking of participants according to their intake of discretionary foods and drinks when compared to a validated 7-day dietary record. The screener may be a useful tool in practical settings, such as school health nurse consultations, in order to gain insight into the child’s sweet intake habits.

Reducing the climate impact of food provided for residents in nursing homes is challenging, as the diets for older, frail adults must be high in protein content and energy density while at the same time ensuring that the meals are palatable and recognizable. This study aimed at providing guidance on healthy and more climate-friendly diets for nursing homes in the City of Copenhagen. The goal was to decrease greenhouse gas emissions (GHGE) by at least 25% while at the same time providing nutritionally adequate and recognizable menus. First, food purchase data were compiled with datasets matching each food item to a proxy food item and then to databases containing GHGE and nutrient information. Secondly, two diet scenarios were modelled based on current procurement practices, i.e., an energy- and protein-dense diet and a standard protein-dense diet, and converted into guidelines for menu planning. The diets contained less total meat, especially beef, and significantly more pulses, nuts and seeds in order to increase protein content according to recommendations for older adults. Finally, a combined scenario was calculated to reflect the joint climate impact reduction. This kind of innovation in food procurement is required in order to achieve the necessary transition to a sustainable food system.