Christel Larsson

Purpose: When adopting plant-based diets, animal-sourced foods need to be replaced with nutritionally adequate plant-based alternatives. However, limited studies have assessed which foods provide key nutrients in plant-based diets among youth. This study investigated the contribution of food categories to intakes of energy and nutrients among youth adhering to vegan, lacto-ovo-vegetarian, pescatarian or omnivorous diets in Sweden. Methods: Dietary intakes of 16–24 year-olds (60 vegans, 59 lacto-ovo-vegetarians, 55 pescatarians, 61 omnivores) were assessed using four 24-h dietary recalls. The contribution of each food category ( n = 24) to average intakes of energy, macro-, and micronutrients were calculated and investigated. Results: With increasing exclusion of animal-sourced food categories from the diet, a greater proportion of youths’ intakes of protein, iron, calcium, selenium, and zinc came from meat analogs, legumes, and cereals and grain products. Similarly, a greater proportion of intakes of vitamins (D, B ₂ , B ₁₂ ) and calcium came from dairy alternatives (highest among vegans). Nevertheless, average intakes of vitamin D, B ₁₂ , calcium (vegans only), and selenium were lower among vegans and lacto-ovo-vegetarians than among omnivores. In contrast, replacing animal-sourced foods with plant-based alternatives led to higher intakes of fiber and lower intakes of saturated fat. Conclusion: The more animal-sourced food categories that were excluded from the diet, the more youths’ relied on cereals and grain products, meat analogs, dairy alternatives (fortified), and legumes as sources of energy and nutrients. Particular attention to vitamin D, B ₁₂ , selenium, and calcium (vegans only) and their food sources may be needed when planning vegan and lacto-ovo-vegetarian diets.

Background: Parents play a central role in shaping children’s health behaviours and dietary habits. Previous research has provided insight into parents’ feeding practices, especially regarding preschoolers. Less is known about how parents of 10–12-year-old children, whose fruit and vegetable (F&V) intake is particularly low relative to recommendations, perceive F&V and translate their intentions regarding F&V into everyday practices. This study explored parents’ perspectives on F&V, their reasons for serving them, and their experiences of influencing their children’s intake. Methods: Fifteen parents of 10–12-year-old children (12 mothers, three fathers) were purposively recruited from diverse socioeconomic backgrounds in southern Sweden and participated in individual interviews. Data were analysed using inductive thematic analysis. Results: Parents perceived F&V as beneficial, primarily due to vitamin content and immediate health effects. However, most were unfamiliar with recommendations and often considered relatively small amounts sufficient. Vegetables were primarily served at dinner, with less attention to other eating occasions, which may reduce opportunities to meet the recommended daily intake. Parents described a range of strategies to influence their children’s consumption, including mixing F&V into other foods, accommodating preferences, encouragement, and providing rules or benchmarks (e.g. 'Always two colours on the plate'). Some parents expressed concerns about sugar content, occasionally leading to unnecessary restriction of F&V. The analysis generated five themes regarding parents’ knowledge and beliefs, sources of information, preferences and resources, agency, and intentions. In addition, four parental roles were conceptualised to illustrate patterns in the intentions and strategies the parents used when influencing their 10–12-year-old children’s F&V consumption— The Enforcer, The Accommodator, The Teacher, and The Role Model —ranging from direct influence on consumption to more indirect and future-oriented approaches. Conclusions: The findings suggest potential mismatches between the participants’ perceptions of F&V, including their understanding of amounts, health benefits, and some facilitating feeding practices, and public health messages such as recommendations. More accessible guidance on why, but also on how, how much, and how often to serve F&V may support parents similar to the participants in the present study in promoting their children’s consumption.

Background: Dietary recommendations promote a predominantly plant-based diet, and the growing interest in such diets has resulted in an increased supply of ultra-processed plant-based alternatives to animal-based foods such as milk and meat. However, most evidence points towards adverse health effects of a high intake of ultra-processed foods (UPF). The purpose of this study was to investigate differences in UPF intake and its nutritional consequences in a youth population in Sweden consuming vegan, lacto-ovo-vegetarian, pescatarian, or omnivore diets. Methods: In total, 244 participants, 16–24 y old, participated in the cross-sectional study VeggiSkills-Sweden. Foods reported in four 24-h recalls were classified into UPF or non-UPF according to the Nova classification system. Percentage contribution of UPF to energy, nutrients, and other food components was investigated and compared between the four dietary groups. Associations between UPF intake and demographic variables, health-related lifestyle factors and nutrient status were analysed. Results: Vegans obtained more energy, nutrients (e.g., n-3 fatty acids, vitamin D, B ₁₂ , calcium and zinc), and salt from UPFs compared to the other dietary groups but did not have a higher energy intake or higher body mass index. They consumed more total dietary fiber and polyunsaturated fatty acids (PUFA), and less saturated fatty acids (SFA). Also, vegans obtained all vitamin D and B ₁₂ from UPFs. Across the entire study population, participants with the highest intake of UPF had a lower level of general nutrition knowledge and consumed less whole grain and more free sugars, but less SFA and more PUFA. UPF intake was not associated with biochemical indicators of nutritional status. Conclusions: Youths adhering to a vegan diet obtained more energy and nutrients, including nutrients of concern in a plant-based diet, from UPFs than youth adhering to lacto-ovo-vegetarian, pescatarian or omnivore diets. As UPFs are defined today, authorities should be careful discouraging UPF intake while at the same time promoting a more plant-based diet among youths.

Food education is essential for promoting consumer awareness and sustainable food choices, and for supporting health equity. Yet it remains largely absent in Swedish primary schools (ages 6–11), revealing a noteworthy knowledge and practice gap. This study explores key elements in a co-design process for developing subject-integrated food education in collaboration with early primary school teachers. The research question guiding the study was: What elements are considered significant in the co-design process when using food as a pedagogical tool in primary school? A co-design case study approach was adopted, involving collaboration between primary school teachers and researchers to develop subject-integrated food education. Data were collected through interviews, questionnaires, observations, and field notes. Five significant elements emerged: (1) “creating space for food education”, (2) “igniting inspiration and fostering collective creativity”, (3) “engaging in collaborative thinking to strengthen and motivate”, (4) “addressing food-related questions”, and (5) “navigating the practical boundaries between creativity and collaboration.” The findings highlight that successful implementation of subject-integrated food education in early primary education depends on teachers’ knowledge and skills in food education, their recognition of the value of collaborative engagement, and the support of a food education facilitator. This study contributes to understanding how co-design can advance sustainable and health-oriented education in early primary education.

Global economic development has been associated with an increased prevalence of obesity and related health problems. Increased caloric intake and reduced energy expenditure are both cited as development-related contributors to the obesity crisis, but their relative importance remains unresolved. Here, we examine energy expenditure and two measures of obesity (body fat percentage and body mass index, BMI) for 4,213 adults from 34 populations across six continents and a wide range of lifestyles and economies, including hunter-gatherer, pastoralist, farming, and industrialized populations. Economic development was positively associated with greater body mass, BMI, and body fat, but also with greater total, basal, and activity energy expenditure. Body size–adjusted total and basal energy expenditures both decreased approximately 6 to 11% with increasing economic development, but were highly variable among populations and did not correspond closely with lifestyle. Body size–adjusted total energy expenditure was negatively, but weakly, associated with measures of obesity, accounting for roughly one-tenth of the elevated body fat percentage and BMI associated with economic development. In contrast, estimated energy intake was greater in economically developed populations, and in populations with available data (n = 25), the percentage of ultraprocessed food in the diet was associated with body fat percentage, suggesting that dietary intake plays a far greater role than reduced energy expenditure in obesity related to economic development.

Purpose: The nutritional adequacy of plant-based diets for youth is of public health relevance but is insufficiently studied. This cross-sectional study aims to assess the micronutrient intake and nutritional status in youth adhering to vegan, lacto-ovo-vegetarian, pescatarian or omnivorous diets in Sweden. Methods: Healthy 16-to-24-year-olds (n = 60 vegans, n = 59 lacto-ovo-vegetarians, n = 55 pescatarians, n = 61 omnivores) completed a 255-item web-based questionnaire, conducted four non-consecutive 24-hour dietary recalls, provided capillary blood samples and one spot urine sample. Usual micronutrient intakes were estimated by the Multiple Source Method. At the group level, risk of inadequate intake was defined as > 50% with intakes below average requirements. Samples were analysed for haemoglobin (HB), serum transferrin receptor (sTfR), homocysteine (tHcy), methylmalonic acid (MMA), 25-hydroxyvitamin D3 (25-OH-D3), and urinary iodine concentration (UIC). Results: From foods and supplements, all dietary groups demonstrated a risk of inadequate intakes of vitamin D and selenium, additionally vitamin A and calcium in vegans, B₁₂ in lacto-ovo-vegetarians, and potassium in pescatarians. Median blood marker values of HB, sTfR, tHcy and MMA were within normal ranges across dietary groups. Insufficient 25-OH-D3 concentration (< 50 nmol/L) was observed in vegans, lacto-ovo-vegetarians, and omnivores. A significantly higher proportion of vegans were at risk of vitamin D deficiency (25-OH-D3 < 30 nmol/L) than pescatarians and omnivores. Median UIC (< 100 µg/L) indicated a risk of inadequate iodine intake in vegans, pescatarians, and omnivores. Conclusion: Youth, regardless of dietary practice, need support to ensure adequate micronutrient intakes, particularly for vitamin D and selenium. Further research is required to evaluate iodine nutrition in Swedish youth.

Purpose: Swedish adolescents’ free and added sugars intake exceeds recommended levels. This poses potential health problems; however, little is known about dietary sources within the Swedish population. This study investigated dietary sources of sugars among Swedish adolescents, as well as timing and location of free sugars intake. Methods: A nationally representative sample of 3099 adolescents in school years 5, 8 and 11 (ages around 12, 15 and 18) was derived from the Riksmaten Adolescents 2016-17 cross-sectional survey. Dietary intake was self-reported over two non-consecutive days of retrospective registration. Various food categories’ contribution to sugars intake were evaluated in relative and absolute terms. To analyse differences between subsamples in consumption, non-parametric tests and logistic regression analyses were performed. Results: Sugar sweetened beverages (SSBs) were the biggest source of free (30%) and added sugars (34%) within the population, contributing with 4.4% of total energy intake among consumers. SSBs were particularly consumed by boys, adolescents to parents with lower education levels, and those residing in smaller cities/rural areas. Other food categories contributing substantially to free sugars intake were sweets and chocolates (20%), sweet bakery products and desserts (11%), fruit juices (11%), and sweetened dairy products (9%). Intakes of free sugars were higher during weekends, mostly consumed outside of main meals, predominantly within the home environment. Conclusion: The majority of free and added sugars consumed by Swedish adolescents comes from nutrient-poor food sources. SSB intake is highly associated with free and added sugars intake and is the primary source of sugars in the adolescent diet.

Background: Nutrition misinformation is pervasive on frequently accessed online sources such as social media platforms and websites. Young adults are at a high risk of viewing or engaging with this content due to their high internet and social media usage. Objective: This study aimed to understand young adults’ preferences, perceptions, and use of online nutrition content. Methods: Young Australian adults (aged 18-25 years) were recruited and interviewed individually via video calling (Zoom; Zoom Video Communications) between December 2023 and February 2024. Participants were recruited via convenience sampling using Facebook advertising. The interviewer followed a semistructured format, and questions were guided using a piloted template. Reflexive thematic analysis was conducted using NVivo (Lumivero) to explore the preferences, perceptions, and use of online nutrition content among the sample. Results: The sample (N=20; mean age 22.9 y, SD 2.3 y) was predominantly female (n=13, 65%) and had, or was studying toward, a tertiary qualification (16/17, 94%). Most participants used social media (19/20, 95%) and internet websites (16/20, 80%) to access nutrition content. Other platforms used included generative artificial intelligence (n=1), apps (n=1), eBooks (n=1), newsletters (n=1), and podcasts (n=1). When exploring perceptions, most participants agreed that online nutrition content was quick and easy to find and informative. Furthermore, perceived reliability and engagement depended on several factors such as the creator’s credentials, length and format of content, consensus on topics, and sponsorships. Short-form content was not considered reliable, despite its engaging nature. Content containing sponsorships or product endorsements was met with skepticism. However, participants were more likely to trust content reportedly created by health professionals, but it was unknown whether they were accessing verified professionals. The oversaturation of content demotivated participants from evaluating the reliability of content. When asked about preferences, participants valued both short- and long-form content, and evidence-based content such as statistics and references and preferred casual and entertaining content that incorporated high-quality and dynamic editing techniques such as voiceovers. Conclusions: The study identified the online nutrition content sources and topics young Australian adults access and the key factors that influence their perceptions and preferences. Young Australian adults acknowledge that misinformation is not exclusive to certain platforms. The accessibility and engagement of content and the ambiguity of professional “credentials” may lead them to trust information that is potentially of low quality and accuracy. Findings also show that there needs to be a balance between engaging formats and presenting evidence-based information when designing online nutrition content to engage these audiences while combatting nutrition misinformation. Future research should explore how these factors impact usage of online nutrition content and dietary behaviors among young Australian adults. Further consultation with this cohort can inform tailored interventions that aim to enhance their food and nutrition literacy and diet quality.