The European Food Safety Authority has suggested that EU countries implement the 2 × 24 h diet recall (2 × 24 h DR) method and physical activity (PA) measurements for national dietary surveys. Since 2000, Denmark has used 7 d food diaries (7 d FD) with PA questionnaires and measurements. The accuracy of the reported energy intakes (EI) from the two diet methods, pedometer-determined step counts and self-reported time spent in moderate-to-vigorous PA (MVPA) were compared with total energy expenditure measured by the doubly labelled water (TEEDLW) technique and with PA energy expenditure (PAEE), respectively. The study involved fifty-two male and sixty-eight female volunteers aged 18–60 years who were randomly assigned to start with either the 24 h DR or the web-based 7 d FD, and wore a pedometer for the first 7 d and filled in a step diary. The mean TEEDLW (11·5 MJ/d) was greater than the mean reported EI for the 7 d FD (9·5 MJ/d (P < 0·01)) but the same as the 2 × 24 h DR (11·5 MJ/d). The proportion of under-reporters was 34 % (7 d FD) and 4 % (2 × 24 h DR). Most participants preferred the 7 d DR as it was more flexible, despite altering their eating habits. Pearson’s correlation between steps corrected for cycling and PAEE was r = 0·44, P < 0·01. Spearman’s correlation for self-reported hours spent in MVPA and PAEE was r = 0·58, P < 0·01. The 2 × 24 h DR performs better than the existing 7 d FD method. Pedometer-determined steps and self-reported MVPA are good predictors of PAEE in adult Danes.

Excess dietary sodium plays an important role in hypertension, a leading risk factor for cardiovascular disease (CVD). To counteract some of the negative effects of sodium, an increased intake of potassium has shown beneficial effects on blood pressure. In fact, the sodium to potassium ratio might be a stronger risk factor for CVD than either sodium or potassium alone. The objective of the present study was to estimate the effect of A) a salt reduction strategy (providing salt reduced bread) and B) a salt reduction and potassium promoting strategy (providing salt reduced bread combined with dietary counselling), on intake of sodium, potassium and the sodium/potassium ratio. The study is a 4-month cluster randomized controlled trial with families randomly assigned to either intervention A, intervention B or control. Participants in intervention A received bread gradually reduced in salt content from 1.2 g salt/100 g to 0.6 g salt/100 g in ryebread and 0.4 g salt/100 g in wheat bread. Participants in intervention B received the same salt reduced bread and in addition dietary counselling on how to eat food with less salt and more potassium. The control group received standard bread (1.2 g salt/100g). Sodium and potassium intake were measured through three consecutive 24-hour urine measurements in adults and one in children at baseline and follow-up. Changes in outcomes were assessed using linear mixed models. Eighty-nine families, including 155 adults (46.5 % men) and 156 children (51.9 % boys), from the suburb of Copenhagen, Denmark, participated in the study. The sodium/potassium ratio was significantly reduced by -0.57 ± 0.19 mmol/L (P = 0.003) in intervention B compared to control group, resulting from a non-significant lower sodium and increased potassium intake. No significant differences were found between intervention A and control group (preliminary results). These findings support future actions to reduce salt intake, focusing on a combination of structural and educational strategies.

Dietary salt intake in most countries is far beyond the recommended level and many countries have initiated national programs to decrease salt intake. However, potential adverse effects of reducing salt intake in the general population are currently discussed. Hence some randomized studies have shown adverse effects on plasma lipids, the renin-angiotensin-aldosterone system and the sympathetic nervous system, which may again increase risk of CVD. These findings are however mainly based on short-term studies with a very large acute salt reduction. This study aims to explore the effect of gradually reducing salt intake in a real life setting according to recommendations, and to examine the effect of different salt reduction strategies among families.

The study was a 4-month cluster randomized controlled trial with families randomly assigned to either A) salt reduced bread, B) salt reduced bread and dietary counselling or C) standard bread (control) Participants in intervention A received bread gradually reduced in salt content from 1.2 g salt/100 g (regular) to 0.6 g salt/100 g in ryebread and 0.4 g salt/100 g in wheat bread. Participants in intervention B received the same salt reduced bread and in addition, they received dietary advise on how to further reduce their salt intake and promote potassium. The control group received regular bread. Changes in outcomes were assessed using linear mixed models.

Dietary intake among Danish children, in general, does not comply with the official recommendations. The objectives of the present study were to evaluate the 3-year effect of a multi-component school-based intervention on nutrient intake in children, and to examine whether an intervention effect depended on maternal education level. A total of 307 children (intervention group: n 184; comparison group: n 123) were included in the present study. All had information on dietary intake pre- and post-intervention (mean age 6·8 and 9·5 years for intervention and comparison groups, respectively) assessed by a 7-d food record. Analyses were conducted based on the daily intake of macronutrients (energy percentage (E%)), fatty acids (E%), added sugar (E%) and dietary fibre (g/d and g/MJ). Analyses were stratified by maternal education level into three categories. Changes in nutrient intake were observed in the intervention group, mainly among children of mothers with a short education ( < 10 years). Here, intake of dietary fibre increased (β = 2·1 g/d, 95 % CI 0·5, 3·6, P= 0·01). Intake of protein tended to increase (β = 0·6 E%, 95 % CI − 0·01, 1·2, P= 0·05), while intake of fat (β = − 1·7 E%, 95 % CI − 3·8, 0·3, P= 0·09) and SFA (β = − 0·9, 95 % CI − 2·0, 0·2, P= 0·10) tended to decrease. Also, a significant intervention effect was observed on the intake of SFA among children of mothers with a long education (β = − 0·8, 95 % CI − 1·5, − 0·03, P= 0·04). This multi-component school-based intervention resulted in changes in the dietary intake, particularly among children of mothers with a short education. As the dietary intake of this subgroup generally differs most from the recommendations, the results of the present study are particularly encouraging.

The aim of the present study was to validate thirty-eight picture series of six pictures each developed within the PANCAKE (Pilot study for the Assessment of Nutrient intake and food Consumption Among Kids in Europe) project for portion size estimation of foods consumed by infants, toddlers and children for future pan-European and national dietary surveys. Identical validation sessions were conducted in three European countries. In each country, forty-five foods were evaluated; thirty-eight foods were the same as the depicted foods, and seven foods were different, but meant to be quantified by the use of one of the thirty-eight picture series. Each single picture within a picture series was evaluated six times by means of predefined portions. Therefore, thirty-six pre-weighed portions of each food were evaluated by convenience samples of parents having children aged from 3 months to 10 years. The percentages of participants choosing the correct picture, the picture adjacent to the correct picture or a distant picture were calculated, and the performance of individual pictures within the series was assessed. For twenty foods, the picture series performed acceptably (mean difference between the estimated portion number and the served portion number less than 0·4 (sd < 1·1)). In addition, twelve foods were rated acceptable after adjustment for density differences. Some other series became acceptable after analyses at the country level. In conclusion, all picture series were acceptable for inclusion in the PANCAKE picture book. However, the picture series of baby food, salads and cakes either can only be used for foods that are very similar to those depicted or need to be substituted by another quantification tool.

Coeliac disease (CD) affects about 1 % of the general population. Information concerning gluten intake in the general population is scarce. In particular, variation in gluten intake during the complementary feeding period may be an independent risk factor in CD pathogenesis. We determined the intake of gluten from wheat, barley, rye and oats in a cross-sectional National Danish Survey of Dietary Habits among Infants and Young Children (2006–2007). The study population comprised a random sample of 1743 children aged 6–36 months, recruited from the National Danish Civil Registry. The protein contents from wheat, rye, barley and oats were found in the National Danish Food Composition Table, and multiplied with the amounts in the recipes. The amounts of gluten were calculated as the amount of cereal protein × 0·80 for wheat and oats, ×0·65 for rye and ×0·50 for barley. Dietary intake was recorded daily for seven consecutive days in pre-coded food records supplemented with open-answer possibilities. Gluten intake increased with age (P < 0·0001). Oats were introduced first, rapidly outpaced by wheat, the intake of which continued to increase with age, whereas oats started to decrease at 12 months. Boys had a higher intake of energy (P ≤ 0·0001) and all types of gluten, except for barley (P ≤ 0·87). In 8–10-month-old (P < 0·0001) and 10–12-month-old (P = 0·007), but not in 6–8-month-old infants (P = 0·331), non-breast-fed infants had higher total gluten intake than partially breast-fed infants. In conclusion, this study presents representative population-based data on gluten intake in Danish infants and young children.

Web-based Dietary Assessment Software for Children (WebDASC) was developed to estimate dietary intake in a school meal intervention study among 8- to 11-year-old Danish children. The present study validates self-reported fruit, juice and vegetable (FJV) intakes in 8- to 11-year-old children by comparing intake with plasma carotenoid concentration, and by comparing the reported FJV intake to actually eaten FJV, as observed by a photographic method. A total of eighty-one children, assisted by parents, reported their diet for seven consecutive days. For the same five schooldays as they reported their diet, the children's school lunch was photographed and weighed before and after eating. In the week after the diet reporting, fasting blood samples were taken. Self-reported intake of FJV and estimated intake of carotenoids were compared with plasma carotenoid concentration. Accuracy of self-reported food and FJV consumption at school lunch was measured in terms of matches, intrusion, omission and faults, when compared with images and weights of lunch intake. Self-reported intake of FJV was significantly correlated with the total carotenoid concentration (0·58) (P< 0·01). Fruit and juice consumption showed higher correlations than vegetables with plasma carotenoid concentration (0·38 and 0·42 v. 0·33) (P< 0·01). A total of 82 % of the participants fell into the same or adjacent quartiles when cross-classified by FJV intake and carotenoids biomarkers. WebDASC attained 82 % reporting matches overall and a higher percentage match for reporting fruits compared with beverages. The present study indicated that WebDASC can be used to rank 8- to 11-year-old Danish children according to their intake of FJV overall and at school meals.

Fe deficiency is still common in infancy, even in affluent societies, and has prompted Fe fortification of food products and use of Fe supplements in many populations. In the present study, we tested the hypothesis that Fe status among 9-month-old infants following the Danish Fe supplementation recommendation (>400 ml Fe-fortified formula or 8 mg Fe/d) is associated with more favourable levels of Fe status indicators compared to those not following the recommendation. A random sample of 9-month-old infants living in Copenhagen was established and 312 healthy term infants were examined at 9·1 (sd 0·3) months of age. Blood samples were available from 278 infants. Overall, twenty infants (7·8 %) had Fe deficiency (serum ferritin < 12 μg/l) and < 1 % had Fe deficiency anaemia (serum ferritin < 12 μg/l and Hb < 100 g/l). Serum ferritin was positively associated with birth weight (P < 0·001), intake of fortified formula and follow-on formula (P = 0·001), and female sex (P < 0·001). Cow's milk intake and length of exclusive breast-feeding were negatively associated with Hb levels (P = 0·013 and P < 0·001). Serum ferritin levels were significantly higher (P < 0·0001) and transferrin receptor (TfR) was significantly lower (P = 0·003) among infants (n 188) meeting the Fe supplementation recommendation compared to those (n 67) not meeting the recommendation. No significant difference between these two groups was found for Hb. In conclusion, this study confirmed that Fe status of infants following the Danish Fe supplementation recommendation was significantly associated with increased serum ferritin and decreased levels of TfR indicating more favourable Fe status, compared to infants not following the recommendation.