nutrition policy in finland - thl...28/03/2011 presentation name / author 2 main emphasis in...

28/03/2011 Presentation name / Author 1

Nutrition policy in FinlandPirjo Pietinen, Professor

16.3.2011


Main Emphasis in Nutrition Policy in Finland

• Historically (since 1940’s):preventing various deficiencies- e.g. free school lunches, fortification programmes

• Chronic disease prevention since 1970’s:reduction of blood cholesterol and

blood pressure levels

• More recently:also weight control and prevention of diabetes

5


How to influence?

• Research and monitoring

• Nutrition policy – collaboration between various actors

• Legislation

• Education (nutritionists, dietitians, nurses, doctors, teachers, food scientists)

• Nutrition recommendation and dietary guidelines

• Implementation programs of the recommendations and guidelines

• Enrichment of foods

• Food production

• Catering services


Monitoring the Finnish Diet

• Food Balance Sheets since 1950s (Ministry of Agriculture and Forestry) – per capita data

• FINRISK/Findiet Surveys every 5 years: large population surveys (2007: 6000/2000 persons)

• National Health Behaviour Questionnaires (AVTK) –annual data since 1978 (questionnaire data)


Type of bread spread in Finland, men 1978-2007

0

10

20

30

40

50

60

70

80

90

100

19

78

19

79

19

80

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

year

%

no fat at all

Low fat spread

Plant sterol/stanol margarine

Softmargarine

Mixture of butter and oil

Butter


Type of bread spread in Finland, women 1978-2007

0

10

20

30

40

50

60

70

80

90

100

19

78

19

79

19

80

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

year

%

no fat at all

Low fat spread

Plant sterol/stanol margarine

Softmargarine


Butter


Fat used for cooking at home in Finland 1978-2007

//0

10

20

30

40

50

60

70

80

90

100

19

78

19

79

19

80

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

year

%

no fat at all

Vegetable oil

Liquid vegetable oil preparation

Low fat spread

Soft margarine

Hard margarine


Butter


Type of milk usually consumed in Finland 1978-2007, men

0

10

20

30

40

50

60

70

80

90

100

19

78

19

79

19

80

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

year

%

No milk at all

Skimmed milk

1-milk, fat 1 %

Low-fat milk, fat 1.5 %

Whole milk, fat 3,5 %

Whole milk, fat 4.4 %


Type of milk usually consumed in Finland 1978-2007, women

0

10

20

30

40

50

60

70

80

90

100

19

78

19

79

19

80

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

year

%

No milk at all

Skimmed milk

1-milk, fat 1 %

Low-fat milk, fat 1.5 %

Whole milk, fat 3,5 %

Whole milk, fat 4.4 %


FINRISK/FINDIET survey areas

Southwestern Finland 1982 -

Helsinki area 1992 -

North Karelia 1982-

Kuopio area 1982-

Oulu area 1997-


Fat intake in Finland1982-2007

0

10

20

30

40

1982 1987 1992 1997 2002 2007

Total fat (25-35 E%)

SAFA (10 E%)

MUFA (10-15 E%)

PUFA (5-10 E%)

E%

Year

Recommendations


Intake of fat and fatty acids in 2002 and 2007

E%

Men Women

Recomm.2002 2007 2002 2007

Total fat 34,9 33,1 32,4 31,2 25-35

SFA 14,4 12,9 13,6 12,0 ~10

MUFA 11,8 12,0 10,6 10,9 10-15

PUFA 5,2 5,9 4,9 5,7 5-10

- n-3 fatty acids 1,0 1,2 1,0 1,2 1

Trans fatty acids 0,5 0,4 0,5 0,4 -


Salt reduction: Thirty years of systematic work

• Recommendation to reduce salt intake by the National Nutrition Council in 1978

• 1979-1982 The North Karelia Salt project with population surveys in 1979 and 1982

• Mass media campaigns, cooperation with food industry to reduce salt voluntarily, education of health care personnel

• Expanded after the 3-year project to the whole country

• The public became aware of salt and BP, regular monitoring was established, and the first national labelling decrees were launched in the 1980s


Salt reduction – an integrated approach

• Research: salt reduction interventions (North Karelia Salt Project, local projects, e.g. Turku area etc.)

• Monitoring (The National Public Health Institute, KTL, since 1.1.2009 The National Institute for Health and Welfare):

• Sodium in the food composition database since early 1980s (regular updates).


Research: Salt reduction and CVD

Tuomilehto et al. Lancet 2001:

– The 1982 and 1987 cohorts form North Karelia and Kuopio with 24-h urines with follow-up for CVD events

– 100 mmol higher Na ( 6 g NaCl) increased risk of CHD by 51%, CVD mortality by 45 % and all-cause mortality by 26 %


Monitoring sodium excretion and dietary intake in Finland

24-h urinary collections in population surveys in 1879, 1982, 1987, 2002

FINDIET Studies in 1992, 1997, 2002, 2007: calculated intake of sodium

Food Balance Sheets: estimations of sources of salt


24-h sodium excretion as NaCl

Laatikainen et al. Eur J Clin Nutr 2006

YEAR

NaC

l g

1979 1982 1987 2002

68

10

12

14

16

18

20

Men, North Karelia

Men, Kuopio area

Men, Southwestern Finland

Men, Helsinki area

Women, North Karelia

Women, Kuopio area

Women, Southwestern Finland

Women, Helsinki area


24-h sodium/potassium ratio

Laatikainen et al. Eur J Clin Nutr 2006

YEAR

Na /

K m

mol

1979 1982 1987 2002

1.8

2.0

2.2

2.4

2.6

2.8

3.0

Men, North Karelia

Men, Kuopio area

Men, Southwestern Finland

Men, Helsinki area

YEAR

Na /

K m

mol

1979 1982 1987 2002

1.8

2.0

2.2

2.4

2.6

2.8

3.0

Women, North Karelia

Women, Kuopio area

Women, Southwestern Finland

Women, Helsinki area

24-h sodium excretion and salt intakein Finland 1977-2007

0

2

4

6

8

10

12

14

16

18Calculated, men

Calculated, women

24h urine, men

24h urine, women

NaCl

g/d

Year

Sources: Karvonen ym. 1977, Nissinen ym. 1982, Pietinen ym. 1981,

Pietinen ym.1990, Valsta 1992, THL/ FINDIET 1992, 1997, 2002 and

2007 Surveys


Sources of salt. Food Balance Sheets 1980-1999.

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

1980 1991 1997-1999

YEAR

Na

Cl

g/d

ay

Milk products

Fat spreads

Bread

Sweet bakery

Meat products

Fish products

Prepared, canned or frozen

food, condiment sauces

Catering

Salt used in households

Other sodium sources

Reinivuo et al. Eur J Clin Nutr 2006



• Legislation, consumer information (Ministry of Ariculture and Forestry/The Finnish Food Authority)

• Product development: e.g. mineral salt (Prof. Heikki Karppanen, Univ. Of Helsinki), meat products (Prof. Eero Puolanne, UH), bread (Prof. Hannu Salovaara, UH)

• Salt seminars (publications) for the nutrition experts and medical community (e.g. the Finnish Food Industry, Finnish Association for Nutrition Research etc.)

• Information on salt reduction: NGOs, e.g. The Finnish Heart Association, Consumer organisations


National legislation: Compulsory labelling of salt

• Cheese

• Sausages and other meat products

• Fish products

• Bread, crisp bread and thin crisp bread

• Broths, soups and sauces, also as powder and concentrate

• Other prepared or semi-prepared foods

• Mixed spices containg table salt


Labelling of salt in foods: the criteriaNaCl % limits

Food category ”Highly salty”

(reduced by 0.1 %)

”Reduced salt”

>25 % less salt than normal product

Fresh bread >1.2 max 0.9

Crisp bread >1.6 max 1.2

Cheese >1.3 max 1.0

Sausages >1.7 max 1.3

Cold whole meat cuts >1.9 max 1.4

Breakfast cereals >1.6 max 1.2

Soups, broths, sauces >0.9 max 0.7

Prepared and semi-prepared foods

>1.1 max 0.8


1 9 7 5 1 9 8 0 1 9 8 5 1 9 9 0 1 9 9 5

Y E A R

1 . 6

1 . 8

2 . 0

2 . 2

2 . 4

Sa

lt

c

on

ce

nt

ra

ti

on

(

%)

S a l t l e v e l i n F i n n i s h s a u s a g e s


Mean salt intake by systematic choice of low or high salt products (Findiet 2002 Survey)

Men (g) Women (g)

Current situation 9.9 6.8

Low salt 1 8.5 (-1.4) 6.0 (-0.8)

Low salt 2 6.1 (-3.8) 4.3 (-2.5)

High salt 1 11.6 (+1.7) 7.9 (+1.1)

High salt 2 13.9 (+2.3) 9.5 (+2.7)

Low salt 1= low-salt products used systematically

Low salt 2= low-salt products plus 50% reduction of salt in recipes

High salt 1= high-salt products used systematically

High salt 2= high-salt products plus 50 % increase of salt in recipes

(Source: Pietinen & al. 2007)


Distribution of salt intake by choice of low or high-salt products (Findiet 2002, men)

0 5 10 15 20 25 30

0 e

+0

01

e

-04

2 e

-04

3 e

-04

4 e

-04

5 e

-04

Salt intake g

De

nsity

Low-salt2Low-salt1Present situationHigh-salt1High-salt2

Men



0 5 10 15 20 25 30

0 e

+0

01

e

-04

2 e

-04

3 e

-04

4 e

-04

5 e

-04

Salt intake g

De

nsity

Low-salt2Low-salt1Present situationHigh-salt1High-salt2

Women

Distribution of salt intake by choice of low or high-salt products (Findiet 2002, women)




• Dietary recommendations and dietary guidelines for different population groups (National Nutrition Council, Ministry of Social Affairs and Health)

• The Heart Symbol, better choice in a certain food group concerning salt content and fat quality (additionally fiber and sugar in some product groups)


Nutrition Recommendations and Dietary Guidelines

Source: National Nutrition Council 2005

WHO 2003

Children under 2 years: 0.5 g NaCl/ MJ

Adults: women 6 g /day and men 7 g /day

WHO and other international recommendations: 5 g/day


• Over 430 ”Heart symbol foods” on the market

• More than 70 food companies

• The Heart Meal has also been launched

• Better choice in a food category (salt, total fat/ fat quality)

• In some food categories also fibre, sugar and cholesterol)

• Food group based criteria available: http://www.sydanmerkki.fi


Criteria for the Finnish ”Heart symbol”

Milk, milk products and other similar products

The purpose is to decrease the intake of the total fat and especially hard fat, but also to increase

the proportional intake of the soft fat.

Product groups Criteria relating to product groups

Milk, sour milk and similar products Fat 0.5 g/100 g or

if fat content is 0.51 – 1.0 g/100 g,

hard fat 33 % of the total fat

No added sugars

Cultured milk Fat 1.0 g/100 g

Sugars < 12 g/100 g

Yoghurt, quark and similar products

(non-drinkable products)

Fat 0.5 g/100 g or

if fat content is 0.51 – 2.0 g/100 g,

hard fat 0.4 g/100 g

Sugars < 12 g/100 g

Cream, cremes and other similar products

used in cooking

Fat 10 g/100 g or if fat content 10.1 – 15 g /

100 g, hard fat 33 % of the total fat.

Sodium 300 mg/100 g



Non-ripened cheese and similar products Fat 15 g/100 g or if fat content 15.1 – 30 g

/100 g, hard fat 33 % of the total fat.

Sodium 480 mg/100 g

Cheese spreads and similar products Fat 10 g/100 g if fat content 10.1 – 15 g / 100

g, hard fat 33 % of the total fat.

Sodium 700 mg/100 g

Cottage cheese Fat 2.0 g/100g

Sodium 300 mg/100g

Ripened cheese and similar products Fat 17 g/100 g or if fat 17.1-30 g/100g,

hard fat 33 % of fat

Sodium 480 mg/100g

Ice-cream, sherbet Hard fat 4 g/100 g

Milk, milk products and other similar products, cont’



Meat products

The purpose is to decrease the intake of total fat i.e. the intake of invisible fat. At the same time

the intake of hard fat decreases as well. Some meat products may contain high amount of

cholesterol; therefore a cholesterol limit has been set. It is based on the recommended maximum

intake of cholesterol.

Product groups Criteria relating to product groups

Whole meat products Fat 4 g/100 g

Sodium 800 mg/100g

Cold cut sausages and other sausages to be

cooked

Fat 12 g/100 g

Hard fat 40 % of fat

Sodium 600 mg/100g

Cholesterol 100 mg/100g


NATIONAL NUTRITION COUNCIL

• An expert body established in1954

• It is appointed by the Ministry of Agriculture and Forestry

• The members serve three-year terms

• The members are representatives of authorities handling nutrition issues, consumer, health promotion and catering organisations, food industry and agricultural organisations.

• Chair: Prof. Pekka Puska, secretary general Ms. Raija Kara since 2004 ([email protected])

mailto:[email protected]


THE AIMS OF THE NATIONAL NUTRITION COUNCIL

• To observe and improve the nutritional situation in Finland- by making Nutrition recommendations - by giving Action programmes- by observing how Action programmes are fullfilled and what the effects on the nutritional situation are

• To promote the comprehensive nutritional riskmonitoring

• To submit proposals, reports and issue statements concerning the nutritional and health situation in Finland and taking into account the food chain as a whole

• To observe the development of nutrition policy in Europe and to promote the Councils information services


Nutrition recommendations and dietary guidelines

• 1968 Nordic nutrition recommendations (adopted officially in 1978)

• 1981 National Committee on Diet and Health: Dietary guidelines

• 1987 National Nutrition Council (NNC): Dietary guidelines

• 1998 NNC: Nutrition recommendations and dietary guidelines

• 2003 NNC: Program on implementation of the Nutrition Recommendations

• 2005 NNC: Recommendations on dietary intake and physical activity

• 2008 NNC: Beverage report and guidelines


Enrichment and supplementation procedures

• 1941 Enrichment of margarine with vitamins A and D started

• 1949 Enrichment of salt with iodine started

• 1959 Addition of fluorine to drinking water in Kuopio city started

• 1974 Enrichment of milled wheat with thiamine and iron started

• 1985 Selenium supplementation of all fertilizers started

• 1992 Enrichment of skimmed and low-fat milk with vitamin D started

• 1993 Addition of fluorine to drinking water in Kuopio discontinued

• 1994 Enrichment of milled wheat with thiamine and iron discontinued

• 1995 Finland became a member of the EU

• 1998 Ministry of Trade and Industry: Decision on Common rules for enrichment of foods with vitamins and other nutrients

• 2003 Enrichment of certain foods with vitamin D renewed


Conclusions on salt

• Salt intake has decreased by about 30% in Finland since the end of 1970s.

• Intake is still far from the recommendations

• Reducing salt intake in the population requres long-lasting, systematic work

• National legislation works – especially setting maximum salt levels for normal products

• Consumer education is very important

• Overall agreement within Europe helps - food travels

• Challenges remain


Conclusions concerning fats

• Changing the quality of fat in the population requires long-lasting, systematic work

• Cooperation with food industry is very important –the availability of soft, healthy fats is crucial as well as the availability of low-fat milk products and cheeses

• Consumer education is very important

• Changes in the quality of fat are reflected in lower serum cholesterol levels and further also in lower coronary heart disease mortality


Nutrition policy in Finland: conclusions

• Broad spectrum of bodies working together

• Long history of activities

• Dietary changes in Finland during the last decades have been pronounced (less fat, saturated fat, salt, more fruit and vegetables, increased consumption of alcohol)

Dietary challenges: energy intake vs. expenditure, SFAs, Vit D, folates, sugars, alcohol

• Obesity is increasing, especially among men and in children

• Diabetes has increased considerably.

nutrition policy in finland - thl...28/03/2011 presentation name / author 2 main emphasis in...

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