Fismen Anne-Siri, Smith Otto Robert Frans, Torsheim Torbjørn, Rasmussen Mette, Pedersen Pagh Trine, Augustine Lilly, Ojala Kristiina, Samdal Oddrun
Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway.
PLoS One. 2016 Feb 9;11(2):e0148541. doi: 10.1371/journal.pone.0148541. eCollection 2016.
In the Nordic countries, substantial policy and intervention efforts have been made to increase adolescents' consumption of fruit and vegetables and to reduce their intake of sweets and soft drinks. Some initiatives have been formulated in a Nordic collaboration and implemented at national level. In recent years, social inequalities in food habits have been attracted particular governmental interest and several initiatives addressing the socioeconomic gradient in food habits have been highlighted. However, few internationally published studies have evaluated how trends in adolescents' food habits develop in the context of Nordic nutrition policy, or have compared differences between the Nordic countries.
The study was based on Danish, Finnish, Norwegian and Swedish cross-sectional data from the international Health Behaviour in School-Aged Children (HBSC) study, collected via three nationally representative and comparable questionnaire surveys in 2001/2002, 2005/2006 and 2009/2010. Food habits were identified by students' consumption of fruit, vegetables, sweets and sugar sweetened soft drink. Socioeconomic status (SES) was measured with the Family Affluence Scale (FAS). Multilevel logistic regression was used to analyze the data.
Trends in fruit consumption developed differently across countries, characterized by an increase in Denmark and Norway and more stable trends in Sweden and Finland. Vegetable consumption increased particularly in Denmark and to a lesser extent in Norway, whereas Sweden and Finland displayed stable trends. Decreased trends were observed for sweet and soft drink consumption and were similar in Norway, Sweden and Finland. Sweet consumption decreased across all survey years, whereas soft drink consumption decreased between 2001/2002-2005/2006 and was stable thereafter. Denmark displayed an increase between 2001/2002-2005/2006 followed by a similar decrease between 2005/2006-2009/2010 for both sweet and soft drink consumption. Socioeconomic inequalities in fruit and vegetable consumption were observed in all countries, with no cross-country differences, and no changes over time. Small but not significant cross-country variation was identified for SES inequalities in sweet consumption. Reduced SES inequalities were observed in Sweden between 2005/2006 and 2009/2010. SES was not associated with soft drink consumption in this study population, with the exception of Denmark for the survey year 2009/2010.
Different trends resulted in increased country differences in food habits during the time of observations. In survey year 2009/2010, Danish students reported a higher intake of fruit and vegetable consumption than their counterparts in the other Nordic countries. Finnish students reported the lowest frequency of sweets and soft drink consumption. Despite the positive dietary trends documented in the present study, the majority of Nordic adolescents are far from meeting national dietary recommendations. Our findings underline the need for more comprehensive initiatives targeting young people's food habits as well as a more deliberate and focused action to close gaps in social inequalities that affect food choices.
在北欧国家，已采取了大量政策和干预措施来增加青少年水果和蔬菜的消费量，并减少他们对糖果和软饮料的摄入量。一些举措是在北欧合作框架下制定并在国家层面实施的。近年来，饮食习惯方面的社会不平等现象尤其引起了政府的关注，一些针对饮食习惯社会经济梯度的举措也备受瞩目。然而，国际上发表的研究很少评估北欧营养政策背景下青少年饮食习惯的趋势发展情况，也很少比较北欧国家之间的差异。
该研究基于丹麦、芬兰、挪威和瑞典从国际学龄儿童健康行为（HBSC）研究中收集的横断面数据，这些数据通过2001/2002年、2005/2006年和2009/2010年三次具有全国代表性且可比的问卷调查收集。通过学生对水果、蔬菜、糖果和含糖软饮料的消费情况来确定饮食习惯。社会经济地位（SES）采用家庭富裕量表（FAS）进行衡量。使用多水平逻辑回归分析数据。
各国水果消费趋势发展不同，丹麦和挪威呈上升趋势，瑞典和芬兰则较为稳定。蔬菜消费尤其在丹麦增加，在挪威增加幅度较小，而瑞典和芬兰呈稳定趋势。糖果和软饮料消费呈下降趋势，挪威、瑞典和芬兰情况相似。所有调查年份糖果消费均下降，而软饮料消费在2001/2002 - 2005/2006年间下降，此后保持稳定。丹麦在2001/2002 - 2005/期间糖果和软饮料消费均有所增加，随后在2005/2006 - 2009/2010年间出现类似下降。所有国家在水果和蔬菜消费方面均存在社会经济不平等现象，且不存在跨国差异，也未随时间变化。在糖果消费的社会经济不平等方面存在微小但不显著的跨国差异。2005/2006年至2009/2010年间瑞典的社会经济不平等有所减少。在本研究人群中，社会经济地位与软饮料消费无关，但2009/2010年调查年份的丹麦除外。
不同的趋势导致观察期内各国饮食习惯差异增大。在2009/2010年调查年份，丹麦学生报告的水果和蔬菜摄入量高于其他北欧国家的同龄人。芬兰学生报告的糖果和软饮料消费频率最低。尽管本研究记录了积极的饮食趋势，但大多数北欧青少年远未达到国家饮食建议。我们的研究结果强调需要采取更全面的举措来针对年轻人的饮食习惯，以及采取更审慎和有针对性的行动来缩小影响食物选择方面的社会不平等差距。
