nutrition policy in finland - thl

20/03/2012 20/03/2012 Nutrition policy in Finland / SM Virtanen 1

Nutrition policy in Finland

Suvi M. Virtanen, Professor

13.3.2012

The top of Europe

•Population 5,4 million

•Life expectancy at birth:

• male: 76 years

• female: 83 years

•Infant mortality rate: 3.4

deaths /1,000 live births

Four

seasons


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, blood pressure and cardiovascular diseases

• More recently: weight control and prevention of type 2 diabetes

5


How to influence?

• Research and monitoring

• Nutrition policy – collaboration between various actors

• Legislation

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

• Nutrition recommendations and dietary guidelines

• Implementation programs of the recommendations and guidelines

• Fortification of foods

• Food production

• Catering services


National Nutrition Council • Public Nutrition Committee in 1936

• National Nutrition Council established in1954

• Appointed by the Ministry of Agriculture and Forestry

• Members are representatives of authorities handling nutrition, food safety, consumer, health promotion, catering, food industry, trade and agricultural issues

• Observes and improves nutritional situation in Finland - by making recommendations - by action programmes

• Promotes comprehensive nutritional risk monitoring

• Coordinates the action plan concerning nutrition in the Government resolution for promoting healthy diet and physical activity

• Observes the development of nutrition policy in Europe


Nutrition recommendations and guidelines

• Finnish nutritional recommendations are based on the Nordic recommendations, published 4 times since 1981

• Additional recommendations for special purposes:

– catering services, schools

– hospitals and nursing homes

– prisons, armed forces

– athletes

– infants and young children

– pregnant and lactating mothers

– beverage use recommendations

– vitamin D supplementation recommendations

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Long history of school lunches

• 1948: free lunch for all pupils at elementary schools

• 1970: guidelines for the quality of school lunches

• 2007: special recommendations for school lunches

• Today: law guarantees free, adequate, balanced lunch for all pupils at primary and secondary schools and upper secondary and vocational schools on every school day

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Why to provide free school lunches?

• The aim is to promote pupil’s well-being, growth and development

• Good lunch helps to concentrate during the school day

• School meals are important for nutrition and also for education

• Not only food, also a social event

• Meals served at schools are model of nutritionally balanced diet which helps to develope healthy eating habits

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Why to provide free school lunches?

• Food preferences develop early in the childhood and eating habits in childhood persist into adulthood

• Eating habits of school children have lifelong effects on health

• Thus adopting healthy food habits in the childhood prevents health problems in the adulthood and decreases health expenditures in the future

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Nutritional criteria for school lunches • School lunch should meet one third of the students,

daily nutritional energy requirements (depending on age 550-860 kcal)

• Recommended intakes for energy nutrients:

– Fat 30% of energy, saturated fat max 10% of energy

– Protein 15% of energy

– Carbohydrates 55% of energy

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• Quality of fat, quantity of salt

• The menu changes in six

weeks intervals

• Fish meal at least once a week


Fortification and supplementation

• 1941 Fortification of margarine with vitamins A and D

• 1949 Fortification of salt with iodine

• 1974 Fortification of milled wheat with thiamine and iron (ended in 1994)

• 1985 Selenium supplementation of all fertilizers

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

• 1995 Finland became a member of the EU

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

• 2003 Fortification of liquid milks and dietary fats with vitamin D renewed

• 2010 Increased fortification of liquid milks and dietary fats with vitamin D

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Monitoring the Finnish Diet

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

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

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

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Food habits among men aged 15–64 years in Finland in 1978–2010

Source: Health Behaviour and Health among the Finnish Adult Population -surveys 1978-2010

0

20

40

60

80

100

19

78

19

80

19

82

19

84

19

86

19

88

19

90

19

92

19

94

19

96

19

98

20

00

20

02

20

04

20

06

20

08

20

10

year

%

Butter on bread

Vegetables daily

Skimmed milk

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Food habits among women aged 15–64 years in Finland in 1978–2010


0

20

40

60

80

100

19

78

19

80

19

82

19

84

19

86

19

88

19

90

19

92

19

94

19

96

19

98

20

00

20

02

20

04

20

06

20

08

20

10

year

%

Butter on bread

Vegetables daily

Skimmed milk

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Type of bread spread in Finland, men 1978–2010

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

20

08

20

09

20

10

year

%

No fat at all

Spread with at most 60% fat

Plant stanol spread

Softmargarine

Mixture of butter and oil

Butter


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Fat used for cooking at home in Finland in 1978–2010

0

10

20

30

40

50

60

70

80

90

10019

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

20

08

20

09

20

10

year

%

no fat at all

Vegetable oil

Liquid vegetable oil

preparation

Low fat spread

Soft margarine

Hard margarine

Mixture of butter and oil

Butter


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Type of milk usually consumed in

Finland in 1978–2010, men

0

10

20

30

40

50

60

70

80

90

10019

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

20

08

20

09

20

10

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 %


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FINRISK/FINDIET survey areas

Southwestern Finland 1982 -

Helsinki area 1992 -

North Karelia 1982-

Kuopio area 1982-

Oulu area 1997-

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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

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The significance of medication and dietary changes in the decrease of serum cholesterol in the Finnish population

Year

mm

ol/l

1982 1992 2002 2007

-1.0

-0.8

-0.6

-0.4

-0.2

0.0

Medication effectDietary effectMedication+dietary effectObserved S-Chol

Valsta et al. Pub Health Nutr 2010


Conclusions concerning fats

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

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

• Consumer education is very important

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


Salt reduction: 30 yrs 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, co-operation 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 blood pressure, 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 %

24-hour sodium excretion and salt intake in 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

Karvonen et al. 1977, Nissinen et al. 1982, Pietinen ym. 1981, Pietinen

ym.1990, Valsta 1992, THL/ FINDIET 1992, 1997, 2002 and 2007

Surveys 20/03/2012 25 Nutrition policy in Finland / SM Virtanen


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: Compulsory labelling of salt

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

• Product development: e.g. mineral salt, meat products, bread

• Salt seminars (publications) for the nutrition experts and medical community

• Information on salt reduction: non-governmental organizations, e.g., The Finnish Heart Association, consumer organisations

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Nutrition policy in Finland / SM Virtanen

28

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 criteria NaCl % limits

Food category ”Highly salty”

”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 51 9 8 01 9 8 51 9 9 01 9 9 5

Y E A R

1 . 6

1 . 8

2 . 0

2 . 2

2 . 4S

al

t

co

nc

en

tr

at

io

n

(%

)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

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Nutrition policy in Finland / SM Virtanen

31

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

(Source: Pietinen & al. 2007)

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• 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

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Proportion of men and women with

overweight (BMI ≥ 25 kg/m²) 1978–2010


Men

0

20

40

60

80

78

-79

80

-81

82

-83

84

-85

86

-87

88

-89

90

-91

92

-93

94

-95

96

-97

98

-99

20

00-0

120

02-0

320

04-0

520

06

20

07

20

08

20

09

20

10

year

%

15-24 25-34 35-44 45-54 55-64 Total

Women

0

20

40

60

80

78

-79

80

-81

82

-83

84

-85

86

-87

88

-89

90

-91

92

-93

94

-95

96

-97

98

-99

20

00-0

120

02-0

320

04-0

520

06

20

07

20

08

20

09

20

10

year

%

Age group

• Overweight defined by International Obesity Task Force criteria (Cole et al. 2000)

• Data from Adolescent Health Survey

Overweight among Finnish adolescents aged 12 to 18 years in 1977 - 2005

Kautiainen 2008

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Government Resolution

ON DEVELOPMENT GUIDELINES FOR

HEALTH ENHANCING PHYSICAL ACTIVITY

AND NUTRITION 2008

• First governmental strategy document on nutrition

• A concrete plan for the implementation of the different target areas for 2008–2011

• The implementation of the resolution coordinated and followed up by

– Ministry of Social Affairs and Health

– Ministry of Education

– Ministry of Agriculture and Forestry

– Committee for Health-Enhancing Physical Activity and National Nutrition Council as advisory bodies

20/03/2012 Nutrition policy in Finland / SM Virtanen 39

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Targets of the governmental resolution

1. number of people that pursue physical activities sufficiently for health benefits and number of people marginalised from physical activity

2. number of people following nutrition recommendations through increasing intake of vegetables and fruits and through decreasing intake of saturated fat, salt and sugar

3. overweight and obesity as well as other health problems related to nutrition and physical inactivity

4. dietary and physical activity habits that promote health increase especially among population groups with lowest socioeconomic status


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Health-enhancing physical activity and healthy diets are promoted by

1. influencing culture, living environment, circumstances, products and structures

2. ensuring that all population groups have sufficient information and skills for a health-enhancing lifestyle

3. encouraging, supporting and guiding individuals and communities, especially the most vulnerable

Health in all policies, appropriate allocation of resources, intensified cooperation and follow-up, international cooperation



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 mainly beneficial: less saturated fat and salt, more fruits and vegetables

• Dietary challenges: energy intake vs. expenditure, saturated fat, vitamin D, folate, sugars, alcohol

• Nutritional monitoring of children is urgently needed

• Obesity is increasing, especially among men and in children

• Diabetes is increasing

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THANK YOU!

20/03/2012

nutrition policy in finland - thl

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