Nordic Dietetic Association
9th Nordic Congress for Dietitians
August 9th–12th 2006
Grand Hotel, Reykjavik, Iceland
Program and Abstracts
Sponsors
We would like to thank our sponsors for their support to the 9th Nordic congress for dietitians.
Abbott, Sweden
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Danól, Iceland
E.S.Ólafsson ehf, Iceland
Fazer, Finland
Fresenius Kabi, Norge, Sweden
Icepharma, Iceland
Mead Johnson Nutritionals, Sweden
MS, Iceland Dairies, Iceland
2
Nathan & Olsen, Iceland
Noi-Sirius, Iceland
Novartis, Iceland, Finland, Sweden
Nutricia, Iceland, Denmark
Unilever, Sweden
Vistor, Iceland
Vífilfell, Iceland
Welcome
Welcome to the 9th Nordic Congress for Dietitians
at Grand Hotel Reykjavík, Iceland, 9.–12. August 2006
After a very successful congress in Copenhagen
in 2004 it is a pleasure to welcome you to
Reykjavik. This is the 9th time that dietitians from
the Nordic countries get together to share
experiences and discuss the profession, and what
more the congress is held for the first time in
Iceland. In the scientific program a prominent
lecturers will give different perspectives on
nutrition and clinical nutrition and give you a lot
to discuss.
For the first time the congress language will be
English, which will hopefully dissolve some
problems in understanding the scientific program.
As well as offering great variety in the scientific
program we have also put together a social
program with tours allowing you to experience
Iceland’s magnificent nature, visiting outstanding
Blue Lagoon and other social activities. The social
program will give you good opportunity to share
experiences, discuss your profession and network
with dietitians from the other Nordic countries.
We are pleased to see you all in Reykjavik and
hope you will enjoy your visit to Iceland and will
find the congress inspiring with a great
professional benefit.
Kolbrún Einarsdóttir
Nordic Dietetic Association
Organizing Committee Nordic Dietetic Association
Kolbrún Einarsdóttir, president, Iceland
Hildur Ósk Hafsteinsdóttir, Iceland
Helle S. Vestergaard, cashier, Denmark
Berit Haglund, secretary, Finland
Charlotte Peersen, Norway
Ellen Svensson, Sweden
Elina Ikkala, Sweden
Local Committee
Guðlaug Gísladóttir
Helga Sigurðardóttir
Hildur Ósk Hafsteinsdóttir
Kolbrún Einarsdóttir
Member Associations of the Nordic Dietetic Association
Icelandic Association of Food and Nutrition Scientists
Matvæla- og næringarfræðafélag Íslands (MNÍ)
The Association of Danish Clinical Dietitians
Foreningen af Kliniske Diætister
The Swedish Association of Clinical Dietitians
Dietisternas Riksförbund (DRF)
Norwegian Association of Dietitians affiliated to the Norwegian Association of Research Workers
Kliniske ernæringsfysiologers forening tilsluttet forskerforbundet (keff)
The Association of Clinical and Public Health Nutritionists in Finland
Näringsterapeuternas Förening/Ravitsemusterapeuttien yhdistys ry (RTY)
Congress Secretariat
Gestamóttakan • Your host in Iceland
Þingholtsstræti 6 • 101 Reykjavik
Phone: + 354 551 1730 • GSM: +354 692 1730
[email protected]
3
Program
WEDNESDAY 9. August
17:30-19:00 Welcome at the City Hall
THURSDAY 10. August
08:00-09:00 Registration at Grand Hotel
Local: Gullteigur A 09:00-09:45 Regulation of food intake
Leila Karhunen PhD, Nutritionist
Department of Clinical Nutrition, University of Kuopio, Finland
09:45-10:30 Body composition and energy balance in the normal and the obese state
Ingrid Larsson PhD, Nutritionist
Obesity Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
Local: Gullteigur B 10:30-11:00
Coffee/tea
Exhibition and posters
Local: Gullteigur A 11:00-11:45
The importance of vitamin D and calcium for the maintenance of bonehealth
Gunnar Sigurðsson MD, PhD, Professor, University of Iceland
Chief, Department of Endocrinology & Metabolism, Landspítali University Hospital, Reykjavík, Iceland
Local: Setrið
11:45-13:15 Lunch
Local: Gullteigur B
Exhibition and Posters
Local: Gullteigur A 13:15-14:00 SEAFOODplus diet intervention to improve health among young overweight adults
Inga Þórsdóttir PhD, Professor, University of Iceland
Chief, Unit for Nutrition Research, Landspítali University Hospital, Reykjavík, Iceland
14:00-14:30 Health beverage guidelines. Do we need to rethink our drink?
Sofia Hallberg, Clinical Dietitian, Unilever, Sweden
Local: Gullteigur B 14:30-15:00 Coffee/tea
Exhibition and posters
Local: Gullteigur A 15:00-15:30 Glycemic Index. From science to dietary advice?
Bryndís Eva Birgisdóttir PhD, Nutritionist and Clinical Dietitian
Unit for Nutrition Research, Landspítali University Hospital, Reykjavík, Iceland
15:30-16:15 Improved image of seafood. Consumer’s attitudes and fish consumption
Emilía Martinsdóttir MSc. Chemical engineer
Head of Department, R&D Division/Consumer and Food Safety Icelandic Fisheries Laboratories, Iceland
18:00
4
Blue Lagoon and dinner at Salthúsið, Grindavík
Departure from Grand Hotel
Program
FRIDAY 11. August
Local: Gullteigur A 08:30-09:15 Nutrition practice in Scandinavian hospitals, the role of the dietitian
Elisabet Rothenberg PhD, Clinical Dietitian
Chief Dietitian, Department of Clinical Nutrition, Sahlgrenska University Hospital, Gothenburg, Sweden
Lene Thoresen MSc, Chief Clinical Dietitian, PhD student
Oncology Clinic, University Hospital, Trondheim, Norway
09:15-10:00 Nutrition and weight gain in pregnancy
Anna Sigríður Ólafsdóttir, PhD, Nutritionist
Iceland University of Education, Reykjavík, Iceland
Local: Gullteigur B 10:00-10:30 Coffee/tea
Exhibition and posters
Local: Gullteigur A 10:30-11:00
11:00-11:45
Iron status in Icelandic children and associations with nutrition, growth and development
Björn Sigurður Gunnarsson, PhD, Nutritionist
Unit for nutrition research, Landspítali University Hospital, Reykjavík, Iceland
Energy and protein requirements in sick children. Enteral and parenteral nutrition
Karin Kok, Clinical Dietitian
Chief Dietitian, Pediatric Nutrition Unit, National University Hospital, Copenhagen, Denmark
Local: Setrið
11:45-13:15 Lunch
Local: Gullteigur B
Exhibition and Posters
Local: Gullteigur A 13:15-13:45 Experiences from implementation of nutritional screening
Johanne Alhaug, Clinical Dietitian
Lovisenberg Diakonale Sykehus, Oslo, Norway
13:45-14:30 Why shall clinical dietitians do research? The process of a doctoral study
Lene Thoresen MSc, Chief Clinical Dietitian, PhD student
Oncology Clinic, University Hospital, Trondheim, Norway
Local: Gullteigur B 14:30-15:00 Coffee/tea
Exhibition and Posters
Local: Gallerí
15:00-15:45 Women at work: Best friends or sworn enemies? On communication and relationships at work.
Þórkatla Aðalsteinsdóttir, Psychologist.
Lecturer and a Therapist at her own clinic in Reykjavík, Iceland.
15:45-16:30 Annual general meeting
Nordic Dietetic Association
17:15
Whale watching, horse riding or mountain hike
Departure from Grand Hotel
SATURDAY 12. August
09:00-22:00 Golden Circle Trip
Departure from Grand Hotel
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Abstracts
Regulation of food intake
Leila Karhunen
Department of Clinical Nutrition, University of Kuopio, Finland
Food intake is a fundamental and complexly regulated process.
However, despite a large variation in day-to-day food intake, body
weight tends to remain within a relatively narrow range at the long
term indicating the existence of a regulated system.
Regulation of food intake can be divided into two distinct
but interacting systems: short- and long-term regulation. The
short-term regulation primarily determines the timing, size and
composition of individual meals. The short-term regulation consists
both of the physiological signals arising from the gastrointestinal
tract and the brain as well as the signals arising from the subjective
experiences and environment. The short-term signals by themselves
are however insufficient to produce sustained changes in energy
balance and body adiposity but rather interact with the long-term
ones.
The activation of the long-term regulators of energy balance
depends on the amount of adipose tissue and the amount of energy
consumed over a more prolonged period of time. The key regulators
of long-term energy balance, leptin and insulin, are synthesised in
the body in proportion to the amount of body fat mass. The longterm regulation is also influenced by more recent energy intake
to ensure that food intake can be affected even before changes in
the amount of body fat mass has occurred. To mediate this effect,
the long-term regulators interact and modify the sensitivity of the
short-term ones.
Food intake is also influenced by various environmental, social,
emotional and cognitive factors. They include factors associated
with eating of food and food itself. Many of these factors can
influence food intake even far more than often realized. Moreover,
despite the existence of the regulated system, the increasing trends
of obesity suggest also the asymmetry of the system. Indeed, in
many cases systems stimulating food intake tend to override the
ones that would inhibit it. As a consequence, it is easier to gain
weight than lose it.
6
Oral Presentations
Body composition and energy balance in the
normal and the obese state
Ingrid Larsson
Obesity Unit, Department of Body Composition and Metabolism,
Sahlgrenska University Hospital, Göteborg, Sweden.
The fat depot of an obese subject is many times larger than that
of a normal-weight subject. Also, the lean mass is enlarged in the
obese compared to the normal state The adipose tissue represents
an energy reserve while the enlargement of lean mass with
increasing body weight, represents the increased energy needs in
moving a larger body. On the contrary, the size of the glycogen
depot is approximately the same in both obese and normal-weight
subjects. The difference in body composition between obese and
normal weight subjects determines BMR (basal metabolic rate) and
total energy expenditure. It is important to note the large interindividual difference in BMR between obese subjects, which shows
large inter-individual differences in body composition in the obese
state. While the energy needs of a normal-weight subject often
vary between 2000 to 3500 kcal/day, the obese subject may need
many thousands of kcal more especially young men above 150 kg
body weight. The distribution of fat mass becomes more centralised
with increasing body weight and age primarily in men but also in
women, indicating a major health hazard in both sexes.
Energy balance represents the balance between energy intake and
energy expenditure. Any long-term imbalances between energy
intake and expenditure will induce changes in the adipose tissue.
A stable body weight indicates energy balance, with a higher flux
of energy in the obese subject compared with the normal-weight
subject. Body weight will increase when energy intake exceed
energy expenditure i.e. positive energy balance, while the opposite
will happen after a period of negative energy balance. Biochemical-,
physiological, endocrine-, and neural factors as well as behavioural
and several environmental factors influences the balance between
energy intake and expenditure and determines whether energy
would be used to different energy dependent processes or to be
stored. The energy balance is tightly regulated so that a surplus of
50 - 100 kcal/day that is not corrected in few days will produce
weight gain. With this in mind, it is interesting to note that many
individuals can keep normal body weight, through adulthood
although large day-to-day variations in energy intake and
expenditure. A favourable body composition for keeping long-term
energy balance may go through regular physical activity.
7
Abstracts
The importance of vitamin D and calcium for
the maintenance of bone health
Gunnar Sigurdsson MD, PhD
Professor, University of Iceland
Chief, Department of Endocrinology and Metabolism,
Landspitali – University Hospital, Reykjavik, Iceland.
Calcium has two predominant roles in the body. Firstly, the calcium
salts provide the structural integrity of the skeleton and secondly, in
extracellular and intracellular fluids, ionized calcium concentration
is critically important especially for neuromuscular function and
various biochemical processes. Therefore, serum ionized calcium
concentration is kept within narrow limits by the action of
parathyroid hormone (PTH) and vitamin D. As a reflection of how
important it is to maintain normal calcium concentration in the
blood this may be at the cost of calcium in the skeleton if necessary.
Adequate calcium and phosphate concentration in the blood is also
necessary for the mineralization of bone. Absolute deficiency of
vitamin D, which controls the absorption of calcium and phosphate
from the gut leads to rickets in children and osteomalacia in adults.
However, relative deficiency of vitamin D, especially if calcium
intake is also low, may cause secondary rise in serum PTH to elevate
calcium in blood and this secondary hyperparathyroidism may if
longstanding lead to bone loss and osteoporosis as PTH activates
osteoclasts for bone resorption.
We have studied the relative importance of high calcium intake and
vitamin D for calcium homeostasis in healthy adults and our studies
indicate that vitamin D sufficiency may be more important than
high calcium intake in maintaining desired values of parathyroid
hormone levels in blood. Vitamin D may thus have a considerable
calcium sparing effect and as long as vitamin D status is ensured,
calcium intakes above 800 mg may be unnecessary for maintaining
calcium homeostasis. Vitamin D supplements are necessary to
ensure adequate vitamin D status for most of the year in northern
climates (10-15 µg/day up to 20 µg during mid-winter).
8
Oral Presentations
SEAFOODplus diet intervention to improve
health among young overweight adults
Inga Þórsdóttir PhD,
Professor, University of Iceland
Chief, Unit for Nutrition Research,
Landspítali University Hospital, Reykjavík, Iceland
Aim Fish constituents affect risk factors for chronic diseases and
have been suggested to decrease adipose tissue in rodents. The aim
was to investigate effects of fish and fish oils in energy-restricted
diet on weight loss and other variables in young overweight adults.
Methods 324 men and women (20-40 years, BMI 27.5-32.5 kg/m2)
from Iceland, Spain and Ireland were randomized into 4 groups of
energy-restricted diet for 8 weeks (30% energy restriction relative
to requirements): (1) control (sunflower oil capsules, no seafood),
(2) lean fish (3 x 150g portions of cod/week), (3) fatty fish (3 x
150g portions of salmon/week), (4) fish oil (DHA/EPA capsules, no
seafood). The macronutrient composition of the diets was similar
between the groups. Data were collected on anthropometry, blood
lipids, glucose, insulin, inflammatory markers and antioxidant
capacity. Confounding factors were accounted for with linear
models for repeated measures with two-way interactions.
Results In four weeks, from baseline to midpoint, an average man
(95 kg having 1600 kcal/day) lost 3.55 kg (95%CI:3.14-3.97) on diet
(1), 4.35 kg [95%CI:3.94-4.75] on diet (2), 4.50 kg [95%CI:4.134.87] on diet (3) and 4.96 kg [95%CI:4.53-5.40] on diet (4). The
weight-loss from midpoint to endpoint was 0.45 [0.41-0.49] times
that observed from baseline to midpoint. The diets did not differ
in their effect on weight- loss in women. Changes in measures of
body composition were in line with changes in body weight. Results
on blood lipids, inflammation, and antioxidant capacity will be
reported.
Conclusion In young, overweight men, the inclusion of either lean
or fatty fish, or fish oil as part of an energy-restricted diet resulted
in ~1 kg more weight-loss after four weeks, than did a similar diet
without seafood or supplement of marine origin. The addition
of seafood to a nutritionally balanced energy-restricted diet may
influence energy control and other health related variables.
I.Thorsdottir1, H.Tomasson2, I.Gunnarsdottir1, E.Gisladottir1, K.Einarsdottir1, M.Kiely3, M.D.Parra4,
N.M.Bandarra5, G.Schaafsma6, J.A.Martinéz4
1Unit Nutr Res, Landspitali-Univ Hosp & Dept Food Sci & Human Nutr, Univ Iceland. 2Fac Econom &
Business Admin, Univ Iceland. 3Dept Food & Nutr Sci, Univ College Cork, Ireland. 4The Dept Physiol &
Nutr, Univ Navarra, Spain. 5The National Res Inst Agric & Fisheries Res, Lisbon, Portugal. 6TNO Nutr &
Food Res, Netherland & The Wageningen Univ, Netherlands.
9
Abstracts
Health beverage guidelines. Do we need to rethink our drink?
Sofia Hallberg
Clinical Dietitian, Unilever, Sweden
to develop a Nordic Health beverage guideline?
The number of overweight people is increasing in almost all
European countries1. In the media the discussions vary between
low-fat diets and low-carbohydrate diets as a solution to the
problem. According to nutritionists and dietitians, excess intake of
calories during an extended time increases the risk of overweight
in people, irrespective of calories from fat or carbohydrates.
During weight management sessions nutritionists and dietitians
use different food pyramids, plate models and food circles as
educational models for foods, but there are no educational models
for beverages.
In a review, recently published in American Journal of Clinical
Nutrition, an American panel of independent nutrition experts
highlighted the high intake of calories from fluids in America and
made a proposed educational model for beverages2.Today, energy
intake from beverages represents 21 E % of total energy intake in
Americans aged > 2 y. From a Nordic perspective, the energy intake
from beverages in Sweden is 18 E %3 and in Denmark calories
from beverages has increased with 21 % between 1995-20024.
According to WHO, there is a convincing relation between a high
intake of calorically sweetened beverages and overweight and
obesity1. In order to decrease the intake of calories from beverages,
the American panel proposed a new guidance system for beverage
consumption.
The beverages were classified based on energy and nutrient density,
contribution to total energy intake and bodyweight, contribution to
the daily intake of essential nutrients, evidence for beneficial health
effects and evidence of negative health effects. This Beverage
Guidance system ranks beverages in six levels, from the most
preferred choice (water) to the least preferred choice (calorically
sweetened beverage with no nutrients). According to the panel,
a contribution of 14 E % from beverages is reasonable and the
recommended intake of beverages is:
Level 1 Water 590-1475 ml/d
Level 2 Tea and coffee 1180 ml /d
Level 3 Low fat milk and soy beverages 0-470 ml/d
Level 4 Noncalorically sweetened beverages 0-940 ml/d
Level 5 Caloric beverages with some nutrients 0-240 ml/d
Level 6 Calorically sweetened beverages 0-240 ml/d
In the Nordic countries the energy intake from beverages seems
to increase. To avoid the levels in America it might be necessary to
increase awareness of energy intake from beverages. Do we need to
develop a Nordic Health beverage guideline?
1WHO MONICA study, 2A new proposed guidance system for beverage consumption in
the United States. Am J Nutr 2006;83:3 529-542 2006, 3Riksmaten 97-98, 4Danskernes
kostvaner 2000-2002
10
Oral Presentations
Glycemic Index. From science to dietary advice?
Bryndís Eva Birgisdóttir PhD, Nutritionist and Clinical Dietitian
Professor Inga Thorsdottir PhD, Nutritionist and Clinical Dietitian,
Unit for Nutrition Research,
Landspitali-University Hospital, Reykjavík, Iceland
The importance of varying glycemic index (GI) of food in the etiology and
treatment of chronic diseases, such as type 2 diabetes and obesity, has
been debated for many years. Numerous epidemiological and intervention
studies on the subject have been published in scientific papers and many
books and newspaper articles have been printed for the public.
Generally low GI food is considered beneficial due to less incremental
increase in blood levels of glucose than food with a high GI. Examples
of food with low GI are whole cereal grains and whole kernel bread
(pumpernickel), legumes, and many fruits while examples of high GI
food are common bread and highly processed cereal grains. The concept
of glycemic load (GL) is the arithmetic product of GI and total available
carbohydrates in a portion, or the overall diet.
It has been suggested that GI and GL values should only be applied for
food items that have at least 15-20 grams of available carbohydrates
per normal portion. Furthermore, comparison of GI values should only
be made between foods in the same food group such as different types
of bread, morning cereals, etc. If these principles are followed, a low GI
could be used to stimulate good choice without disturbing the nutritional
value of the diet and prevent the misuse and misunderstanding that
has occurred. The GI concept should not be used to stimulate otherwise
unhealthy food habits.
When giving dietary advice to people with diabetes, products with low GI
are often recommended and these might be of importance for individuals
with impaired glucose tolerance as well. More evidence from wellcontrolled, long-term, randomised clinical intervention trials is urgently
needed to draw secure conclusions on the importance of low GI food for
healthy individuals in prevention of diseases as well as the importance of
GI in weight maintenance or weight loss. Epidemiological studies so far
indicate mainly health effects of low GI or GL diets in overweight people.
The various methodological considerations in studies on GI have to be
solved in a sensible way.
Furthermore there is a pressing need for more local information on GI
of different food items in the Nordic countries, for example to use in
epidemiological studies and to give a larger outbid of palatable low GI
food. It is important to remember that the concept of glycemic index
cannot be used in isolation and is only one measure of many which
together indicate a healthy diet.
Ref: Glycemic index – from research to nutrition recommendations? TemaNord 2005:589. Published after the
satellite meeting; Glycemic Index: From Research to Nutrition Recommendations, June 20th 2004, at the 8th
Nordic Nutrition Congress, June 20th-23rd 2004 in Tönsberg, Norway. Organized by the Unit for Nutrition
Research, Iceland.
11
Abstracts
Improved image of seafood.
Consumer’s attitudes and fish consumption
Emilía Martinsdóttir MSc, Chemical engineer
Head of Department, R&D Division/Consumer and Food Safety,
Icelandic Fisheries Laboratories, Iceland
The health benefits of fish as a part of a well-balanced diet are
univocal. Fish has been celebrated for its vital nutrients and amino
acids, trace elements, vitamins and “good” fat (omega-3 fatty acids).
Research has shown that fish consumption has positive effects on
health, such as decreasing the risk of cardiovascular diseases.
Fish has been a significant part of the Icelandic people’s diet for
a long time, with very high fish consumption in comparison with
most other European countries. However, fish consumption has
decreased by at least 30% over the past few years in Iceland, most
conspicuously among young consumers. Unless this trend can be
reversed it could have various, negative impacts on marketing and
sales of seafood products in the future. It is therefore important
to consider actions to reverse this development with education,
advertising and marketing.
Young people today are, of course, the consumers of the future
and their health, habits and, last but not the least, their preferences
for food will greatly influence the demand for food products in
the next few years and well into the future. When it comes to
preference for food, young people in Iceland are not any different
from young people in other Western countries. Research on young
Icelandic consumers can therefore be used as a tool for marketing
seafood products, both in Iceland as well as in foreign markets.
Recent studies have demonstrated that young consumers have
other preferences than older consumers and that young consumers
have generally more negative attitudes toward fish.
The on-going project ”Young consumer attitudes and fish
consumption: Improved image of seafood” has the objective to
study the preferences of the young consumer. The aim is to increase
consumption of seafood with publications and surveys on diet
and to influence attitudes regarding seafood. The results will be
used to customize the supply of seafood products to the needs
and demands of consumers and to support marketing of seafood.
The ultimate purpose of the project, however, is health promotion
and improved appeal of seafood. The first preliminary results are
very interesting, and show e.g. that education about fish in general
is very limited and that debate in the society greatly influences
attitudes toward fish consumption.
Authors: Emilía Martinsdóttir, Kolbrún Sveinsdóttir, Gunnþórunn Einarsdóttir,
Icelandic Fisheries Laboratories (IFL), Skulagata 4, 101 Reykjavik, IS
12
Young consumer attitudes and fish
consumption: Improved image of
seafood” is a collaborative project
involving the Icelandic Fisheries
Laboratories, University of Iceland
(Dept. for Nutrition Research and
Social Science Research Institute)
and the company Icelandic Services.
Funding by the AVS R&D Fund of
the Ministry of Fisheries in Iceland
is gratefully acknowledged.
Oral Presentations
Nutrition practice in Scandinavian hospitals, the role of the dietitian
Elisabet Rothenberg PhD
Chief Clinical Dietitian, Department of Clinical Nutrition, Sahlgrenska University Hospital, Gothenburg,
Sweden
Lene Thoresen MSc
Chief Clinical Dietitian, PhD student, Oncology Clinic, University Hospital, Trondheim, Norway
Rationale According to the Council of Europe dietitians should have a more central role in nutritional
support (1). The purpose was to assess whether departments in Scandinavian hospitals, which used
dietitians often (>=3-4 times a week) had better nutritional practice than departments, which used
dietitians seldom (<=2 times a week).
Methods A questionnaire covering the ESPEN’S standards of nutritional practice, highlighted by the
Council of Europe (1). Topics were screening of all patients, assessment of patients with problems,
prescription of nutritional interventions and monitoring. 12.000 physicians and nurses working in
departments where nutritional problems were expected to be common got the questionnaire. Descriptive
statistics were used calculating response frequency, Mann-Whitney U-test to compare departments
(SPSS 13.0). Level of significance was defined as p <0.05. More details in (2-4)
Results 4512 nurses and physicians (response rate 37 %) answered. 3796 (84%) had dietitians in their
hospital. Dietitians spent 40% of their time in ward and 60% on outpatients. 56% of the dietitians meet
malnourished patients regularly. Departments who used dietitians most often were oncology, medical
gastroenterology and other medical specialties. Of the units 12% used dietitians often compared 85% of
the units how used dietitian seldom (85%).
Dietitians experienced the staff had a strong positive attitude towards them but to a lesser degree found
that their competence was known and used. There was a difference in experience between dietitians
visiting the units often compared to seldom. About half of them took regularly part in multidisciplinary
conferences. Those visiting the units often received more referrals about malnourished patients and took
more regularly part in conferences.
Nurses and physicians who saw dietitians often found it less difficult to identify malnourished patients
and to a less degree found nutrition to be of low priority.
Departments who used dietitian often had better routines with regard to screening, assessment,
treatment, monitoring and communication. Physicians and nurses in units who used dietitian often
pointed out the responsibility of the dietitian to a higher degree than those at units how used dietitian
more seldom.
Conclusion Departments, which used dietitians often, fulfilled the standards suggested by ESPEN better
than departments, which used dietitians seldom. Still good nutritional practice was present in only a
minor part of the respondents. The responsibility of the dietitian was clearer in units who used dietitian
often. Hence, as recommended by the Council of Europe dietitians should have a more central role in
nutritional support.
Anne Marie Beck1, Elisabet Rothenberg2, Lene Thoresen3
1 RD, PhD, Senior researcher, Department of Nutrition, Danish Food and Veterinary Research Soeborg, Denmark, [email protected], 2 PhD, Chief dietitian,
Department of Clinical Nutrition, Göteborg University, Gothenburg, Sweden, [email protected] , 3 MSc, Chief Clinical dietitian, Oncology
Clinic, University Hospital, Trondheim, Norway, [email protected]
1 Beck AM, Balknäs UN, Fürst P, et al. Food and nutritional care in hospitals: how to prevent undernutrition – report and guidelines from the Council of
Europe. Clin Nutr 20: 455-460, 2001. 2 Beck AM, Rothenberg E, Thoresen L. Viden om og holdninger til klinisk ernæring blandt kliniske diætister I Danmark,
Norge og Sverige. DietistAktuellt 15;4:18-21, 2005. 3 Johansson U, Larsson J, Rothenberg E et al. Nutritionsbehandling inom slutenvården. Svenska sjukhus
klarar inte Europarådets riktlinjer. Läkartidningen 103; 21-22: 1718-1724, 2006. 4 Mowe M, Bosaeus I, Højgaard Rasmussen H, et al. Nutritional routines and
attitudes among doctors and nurses in Scandinavia: A questionnaire based survey. Clin Nutr 25:524-532, 2006.
13
Abstracts
Nutrition and weight gain in pregnancy
Anna Sigríður Ólafsdóttir
PhD nutritionist, Iceland University of Education
The rising prevalence of obesity in the world is one of the most
alarming health issues of today. It is a commonly held notion
that excessive pregnancy weight gain contributes to increased
obesity rates in women. At the same time adequated weight gain
is of high importance for optimal birth outcome as birthweight
is strongly associated with maternal weight gain, and higher
birthweight has been associated with less risk for several diseases
in adulthood, even in Iceland. Birthweight has been used as a proxy
for nutrition in fetal life, even if other factors, such as genetics,
of course, play their part in birthweight. The amount, type, and
quality of food consumed during pregnancy may have an impact
on both maternal and infant health. Few studies have been made
in order to investigate the relationship between changes in food
consumption during pregnancy with women’s subsequent weight
gain at different prepregnant weights and birth outcome. Smoking
status is one of the factors associated with maternal weight gain.
Smokers tend to have different dietary habits than nonsmokers and
smoking may significantly reduce the fetal nutrient supply. Thus the
effects of maternal nutrition and smoking status during pregnancy
are combined.
In our study questionnaires on diet and lifestyle were filled out early
and late in pregnancy and data collected from maternity records. At
the beginning of pregnancy, 39% of the women were overweight
or obese, and 26% gained suboptimal weight and 34% excessive
weight during pregnancy. Results suggest that the composition of
macronutrients may have an impact on weight gain, but women
especially have to avoid increasing their energy intake too much
and should limit their sweets consumption, as these factors
increased the odds of excessive weight gain. Additionally, increased
milk consumption in late pregnancy was associated with a two- to
threefold increased likelihood of gaining both optimal and excessive
weight, depending on the amount consumed. Smoking cessation
doubled the risk of excessive weight gain, but this association
was no longer significant after adjustment for dietary and other
confounding factors. Excessive weight gain following smoking
cessation may be prevented through healthier dietary habits, most
profoundly through increased fruit and vegetable consumption,
but consumption of these food groups was lowest among former
smokers. Pregnancy may be a time of life that women are especially
responsive to smoking cesstion and dietary change.
14
Oral Presentations
Iron status in Icelandic children and associations with
nutrition, growth and development.
Björn Sigurður Gunnarsson, PhD
Nutritionist, Unit for Nutrition Research, Landspitali-University Hospital and
University of Iceland, Reykjavík, Iceland.
Aim: The aim of this study is to investigate iron status and its association
with growth, diet and development in infancy and childhood in the Icelandic
population.
Design: The studied sample comprises two cohorts. In a longitudinal study on
infants (cohort 1), where participation was 77% (138 of 180), dietary intake
was recorded at 6, 9 and 12 months; blood samples were taken at 12 months
and growth and sociodemographic data collected. A cross-sectional study
on 2-year-old children (cohort 2), where participation was 72% (94 of 130),
recorded dietary intake, growth, and blood samples were taken. At 6 years the
two cohorts were combined and dietary records, blood samples, growth and
developmental scores from The Icelandic Developmental Inventory collected.
Results: At 1 year 20% of children were iron deficient (serum ferritin (SF)<12
�g/l; mean corpuscular volume (MCV)<74 fl), and 41% had depleted iron
stores (SF<12 �g/l), while 3 children (2.7%) had iron deficiency anaemia
(IDA) (haemoglobin (Hb)<105 g/l, SF<12 �g/l and MCV<74 fl). Comparable
values for 2-year-olds were 9% and 28%, respectively, but one 2-year-old
child (1.4%) had IDA. At 6 years one child was iron-deficient (SF<15 �g/l and
MCV<76 fl), and 16% had depleted iron stores (SF<15 �g/l), but no children
had IDA (Hb<115 g/l, SF<15 �g/l and MCV<76 fl).
At 1 and 2 years iron deficiency and depleted iron stores were mainly
associated with fast growth from birth and high consumption (above 500
ml/day) of unmodified cow’s milk. Iron status at 1 and 2 years was positively
associated with subsequent growth and iron status at 6 years. Early iron
status was positively associated with some aspects of development at 6 years.
Iron-deficient children at 1 and 2 years had worse fine motor scores, and
haemoglobin at 6 years was positively associated with gross motor scores.
Conclusions: In this population of high birth weight, early iron status is
worse than in many neighbouring countries. Fast growth in infancy and
early childhood and cow’s milk consumption above half a litre per day are
negatively associated with iron status at 1 and 2 years. Worse early iron
status is related to deficits in fine motor development at 6 years. Further
studies are needed.
Key words: Haemoglobin (Hb), serum ferritin (SF), mean corpuscular volume
(MCV), iron deficiency, iron deficiency anaemia, depleted iron stores, growth,
cow’s milk, development.
15
Abstracts
Energy and protein requirements in sick children.
Enteral and parenteral nutrition
Karin Kok
Chief Dietitian, Paediatric Nutrition Unit, National University Hospital
Copenhagen Denmark
Malnutrition is common in chronically ill children. We need guidelines for
identifying children in risk for malnutrition. For assessment we must look
at growth charts, food intake, pain, severity of disease and biochemical
parameters. Energy malnutrition is the most common problem in children
with chronic diseases in the Western countries.
Nordic Nutrition Recommendations values (2004) are based on total
energy expenditure (EE) using estimates of basal metabolic rate (BMR) and
physical activity level (PAL). There are values for different physical activity
levels from the age of 10 years and up.
Energy needs for sick children vary depending on the disease. The children
need energy for BMR, growth and physical activity, which is reduced in
sick children. Children, who are not critically ill or do not have special
needs because of their diseases, need less energy than healthy children
with light physical activity. Most chronically ill children need BMR with
physical activity level (PAL) about 1,1-1,2. Some sick children need more
energy than healthy children due to severe illness. BMR for Cystic Fibrosis
patients is up to 35% greater than in healthy children, and a metaanalysis showed that infants with congenital heart disease (CHD) have a
35% increase in EE.
In Western countries protein malnutrition is not a problem for most
children with chronic diseases. The need for protein is elevated with severe
disease and in critically ill children requirements can be 3-4 g protein/kg.
Enteral nutrition is safe, more physiological correct, cheaper and
simpler to provide than parenteral nutrition, both in hospital and at
home. Gastrostomy feeding should be considered if the child needs
tube feeding for more than 2 months. Type of product depends on
disease and placement of the tube, and the mode of administration is
depending on the individual child. ESPGHAN guidelines on parenteral
nutrition (PN, 2005) are available. Indications for PN depend on individual
circumstances and situation, disease and the age and size of the infant
or child. Lipid intake should usually provide 25-40 E% of non-protein
calories to avoid carbohydrate overload and supplementing essential fatty
acids. Triglyceride levels should be monitored and reduction of dosage of
lipid emulsion should be considered if triglyceride concentration during
infusion exceeds 250 mg/dl in infants or 400 mg/dl in children. Glucose
intake above 18g/kg/day tends to induce net lipogenesis in infants, and
should usually be avoided.
16
Oral Presentations
Experiences from implementing nutritional
screening
Johanne Alhaug
Clinical Dietitian, Lovisenberg Diakonale Sykehus, Oslo, Norway
Disease-related malnutrition has become a common term of use. A
report from the European Committee concluded that ”A significant
amount of patients admitted to hospital suffers from diseaserelated malnutrition.” The same report concluded that nutritional
screening is the first step to detection, prevention and treatment
of disease-related malnutrition in hospitals. It is recommended
to accept nutritional screening as a routine for all patients when
hospitalized.
The unit of clinical nutrition at Lovisenberg Diakonale Sykehus (LDS)
carried out a two months project (Oct.-Dec. 2004) on implementing
nutritional screening for all patients admitted to the four medical
wards. Our aim was to make this into a natural daily routine. NRS
2002 (Nutritional Risk Screening) was chosen as a screening-tool.
This is composed by the Danish Society of Clinical Nutrition in
collaboration with ESPEN and recommended for use in hospitals.
Representatives from the medical staff were included in redesigning NRS 2002 for LDS use.
Conclusions: The staff found NRS 2002 initial screening to be
practical and simple, while the final screening was found more
difficult (determine % weight loss and severity of disease). Initial
screening was completed on 29 % of all patients admitted to the
hospital during the project-period (225 out of 786). This was far less
than expected, in spite of carefully training of ward personnel. Final
screening was completed on all 225 at a later stage by a clinical
dietitian. 29% of the patients were found to be malnourished or at
risk of malnutrition. It was not possible to follow all at risk patients
with a satisfactory nutritional care plan during the project-period.
To make nutritional screening an established routine, it is necessary
to have definite procedures, to provide time and personnel when
starting implementation. Screening must be followed by efficient
nutritional care plans. It is important that screening is set by the
hospital management and accepted by the clinicians.
Implementing nutritional screening takes time and effort. However
it is an important factor for detecting, preventing and efficiently
treat malnourished patients and patients at risk of developing
malnutrition.
17
Abstracts
Why shall clinical dietitians do research?
The process of a doctoral study
Lene Thoresen MSc
Chief Clinical dietitian, PhD student, Oncology Clinic,
University Hospital, Trondheim, Norway,
Nutritional oncology was established as a new defined and
evolving field with the edition of ”Nutritional Oncology”
edited by David Heber, George L. Blackburn and Vay Liang W.
Go in 1999. This first edition provided a synthesis of research
into the relationship between cancer and nutrition focusing
on nutrition in cancer prevention. The aspect of nutrition
in treatment of cancer was a very minor part of the book.
The daily work of a dietititian, however, entails a far greater
proportion of time spent, and thus a need for knowledge,
on treatment rather than prevention. Oncology is one of
the specialties dietitians most often are involved in and the
demand for knowledge-based intervention is increasing.
Today one out of three persons will suffer cancer during their
lifetime. In 2020 it is anticipated that cancer will develop in
one out of two persons. About half of the patients are cured
of cancer. While half of the patients with incurable cancer die
within one year from diagnosis, the prevalence of patients
living with the disease is constantly increasing. It is estimated
that roughly 20% of cancer patients die of malnutrition
rather than the malignency. Thus, the need for competent
dietitians should be recognized and taken seriously.
My decision to do a doctorate was rooted back in 1995 when
I was offered a job in the Palliative Unit at the Oncology
Clinic in Trondheim. Professor Kaasa at the unit was then
supervising clinical dietitian Asta Bye in her PhD research.
My final decision, however, was taken in 2002 when my
present supervisor, Ursula Falkmer, was opponent in Christina
Persson’s defence of her doctoral thesis in Uppsala. Since
then I have experienced that the way toward the final thesis
is not a straight forward chain but rather a puzzle of pieces
that finally will form a thesis. One of the most important
messages I can communicate to dietitians that are interested
in doing a doctorate is; to look at the possibilities and not the
limitations. Work hard and decide to finish. Always prepare
for a plan B.
18
Oral Presentations
Women at work:
Best friends or sworn enemies?
On communication and relationships at work
Þórkatla Aðalsteinsdóttir
Psychologist
There are three important sectors of life, where we fulfill our
needs, set our goals and reach them and in that way, exercise and
withhold our human rights and our natural need to keep a positive
and satisfying image of ourselves – the home, the work and our
hobbies. Our role in each of these phases differs because we are
meeting our different needs. Women have through the centuries
held the important role of a homemaker or housewife. Now we are
out there in the workplace in a quite different role which demands
other things from us. We have to be professional, be able to look
at issues and communication with logic and reason and cannot let
our feelings get in the way. Also we feel we have to proof that we
are able to get the job done. In some ways we still lack confidence
and of course experience for this role and we lack role models
in this aspect (field). Our mothers and grandmothers were (as a
rule) working as homemakers, bringing up children, taking care of
business in the homes.
This situation often brings us into conflict with each other and we
– I’m sad to say- tend to look at each other as rivals, instead of
supporting each other and acting according to our situation – we
have just arrived to the scene, that is the work environment and we
do better by being there for each other. We are often confused: am
I a mother and the home maker or am I the professional who lets
work take over everything else? Where lies the balance? We have
to find out and do that without using arrogance or be judge mental
towards other women.
But of course that is the darker side of women at the workplace.
We also know how to build up a relaxed atmosphere at the
workplace, we know how to put ourselves in each other’s shoes and
often use that knowledge to support each other, show sympathy
and be the backland everyone needs in a world that can be harsh
and demanding.
19
Abstracts
Determinants of fruit and vegetable intake
among 11-year-old schoolchildren in a country
of traditionally low fruit and vegetable
consumption
Kristjansdottir A.G. (1), Thorsdottir I. (1), De Bourdeaudhuij I. (2),
Due P. (3), Wind M. (4), Klepp K.I. (5)
1 Unit for Nutrition Research, Landspitali-University Hospital & Department of Food
Science, University of Iceland, Reykjavik, Iceland.
2 Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
3 Department of Social Medicine, University of Copenhagen, Copenhagen, Denmark.
4 Department of Public Health, Erasmus University Medical Centre, Rotterdam,
The Netherlands.
5 Department of Nutrition, University of Oslo, Oslo, Norway
Purpose
To identify determinants of fruit and vegetable intake among 11-yearold schoolchildren in Iceland.
Methods
A cross-sectional survey was performed in Iceland in the autumn
of 2003 as a part of the Pro Children cross-Europe survey. The
survey was designed to provide information on actual consumption
levels of vegetables and fruits by 11-year-old schoolchildren and
to assess potential determinants of consumption patterns. A total
of 1235 Icelandic children (89%) from 32 randomly chosen schools
participated. Hierarchical regression analyses were performed to
determine the explained variance of the children’s fruit and vegetable
intake. In these analyses socio-demographic background variables were
entered as a first block, perceived physical-environmental variables as a
second block, perceived socio-environmental variables as a third block
and personal variables as a fourth block.
Results
64% of the children ate fruit less than once a day, and 61% ate
vegetables less than once a day. Respectively, 31% and 39% of the
variance in children’s fruit and vegetable intake was explained by
the determinants studied. About 7% and 13% of the variance in
fruit and vegetable intake was explained by the perceived physicalenvironmental determinants, mainly by availability at home. About
18% and 16% of the variance in fruit and vegetable intake was
explained by the personal determinants. For both frequency of fruit
and vegetable intake, the significant personal determinants were
preferences, liking, knowledge of recommendations and self-efficacy.
Conclusion
Interventions to increase fruit and vegetable intake among children
should aim at both environmental factors such as greater availability
of fruit and vegetables, and personal factors as self-efficacy and
knowledge levels concerning nutrition.
20
Posters
Icelandic follow-on milk ready to drink – to
combat iron deficiency in early childhood
B. S. Gunnarsson, I. Thorsdottir
Unit for Nutrition Research, Landspitali-University Hospital &
Department of Food Science, University of Iceland.
Background
Study results in Iceland
Outcome
Iron deficiency is the most common deficiency of a single nutrient
worldwide. In industrialized countries infants and young children
are at risk for developing iron deficiency due to high iron demands
from rapid growth. Also, weaning diet is often composed of foods
with low iron content and where bioavailability is low.
In new studies on iron status in infancy and early childhood, high
prevalence of iron deficiency was observed, mainly at 1 year of age,
but also at 2 years. At 1 year 20% of children were iron deficient
(serum ferritin < 12 �g/l; MCV < 74 fl), and 41% had depleted iron
stores (serum ferritin < 12 �g/l). Comparable values for 2-year-olds
were 9% and 27%, respectively. Iron deficiency and depleted iron
stores in the studies were mainly associated with fast growth from
birth and high consumption of unmodified cow’s milk. Consumption
of cow’s milk above 500 ml per day was associated with worse iron
status indices in both 1-year-old and 2-year-old children.
Studies have shown that when infants consume iron-fortified
formula instead of cow’s milk iron status is less likely to be
threatened. Therefore, to combat the iron deficiency observed in
infants in Iceland, a follow-on formula from Icelandic cow’s milk
fortified with iron and with reduced protein content was developed
and manufactured by an Icelandic milk producer in cooperation
with Unit for Nutrition Research. This product is similar in nutrient
composition to other follow-on formula available, but is sold in
cartons ready to drink and based on Icelandic cow’s milk. Icelandic
cow’s milk is unique in protein and fat composition compared
to milk from other cow breeds, and is considered to be less
diabetogenic than cow’s milk from the neighbouring countries.
21
Abstracts
HOW TO LAUNCH A WEIGHT-MANAGEMENT GROUP
– A Learner-Oriented Small-Group Training Programme for
the Health Care Professionals
Liisa Heinonen, Clinical Nutritionist; Anna-Liisa Ventola, Licentiate in Food Science
Taru Poukka, MPhEd; Auli Pölönen, Regional Coordinator, Clinical Nutritionist
The Implementation Project 2003-07 of the Programme for the Prevention of Type 2
Diabetes at Pirkanmaa Hospital District in Finland
Background
The double epidemic concerning overweight and type 2 diabetes presents a serious
challenge for the public health in Finland. This made authorities in various fields launch
a Programme for the Prevention of Type 2 Diabetes for finding methods to treat obesity.
At Pirkanmaa Hospital District we have carried out a training programme for health care
professionals working in the local health care centres. Our main objective has been to
promote the weight-management group education to become a permanent part of the
daily work in local health-care.
Objectives
The objective of our training programme has been double-fold. On one hand we have
wanted to help and encourage new educators to start local weight-management groups.
On the other hand we have supervised experienced educators and encouraged them to
continue this type of work. Additionally we have also wanted to encourage collaboration
between multidisciplinary professionals. As a result of this activity we want to increase the
number of the weight-management groups and integrate them into the daily functions of
the health care centres.
General
framework
Five training programmes were arranged from June 2005 to January 2006 in local health
care centres in 5 municipalities in the Pirkanmaa Hospital District. The group size was 6-11
health care professionals per group (nurses, nurses specialized in diabetes, physiotherapists
etc), their total number was 35 people. Training groups met in 4-6 sessions, 2-3 hours each.
60 % of the participants had no previous experience in managing weight-management
groups. The training group educators were coached and supervised by a Clinical Nutritionist
and an MphEd.
Course
contents
The course contents were chosen during the first session in collaboration with the
participants. Thus the emphasis varied from course to course in accordance with the
participants´ needs and interests. It was of interest to find out that the participants
expressed two primary needs: one is the need for learning to use solution oriented group
pedagogical methods, the other is knowledge issues: how to take into account the role
of physical activity, dietary questions, and realistic expectations related to the weight
management.
Progress
perceived
Current Care Guideline on Adult Obesity in Finland 2006 recommends founding local
obesity treatment teams. Two of our training groups have taken an initiative to establish
them. So far (May 2006), three of the participants have launched their own weightmanagement groups.
Liisa Heinonen, Finnish Diabetes Association, Kirjoniementie 15, 33680 Tampere, Finland. +358503461868, liisa.heinonen@diabetes.fi
22
Posters
Working conditions and health behaviours:
Comparing British, Finnish and Japanese public
sector employees
Lallukka T. (1), Laaksonen E. (1), Martikainen P. (2), Rahkonen O. (1),
Lahelma E. (1), Head J. (3), Brunner E. (3), Mosdol A. (3), Marmot M. (3),
Sekine M. (4), Nasermoaddeli A. (4), Kagamimori S. (4)
1 Department of Public Health, University of Helsinki
2 Population Research Unit, Department of Sociology, University of Helsinki, Finland
3 Department of Epidemiology & Public Health, University College London, UK
4 Department of Welfare Promotion and Epidemiology, University of Toyama, Japan
Background
Key cardio-vascular risk factors include dietary habits, heavy drinking,
smoking, and obesity. Less is known about work-related determinants of
these risk factors and especially comparative evidence on the patterning
of these behaviours between countries is lacking. Thus, we aimed to
examine whether there are associations between working conditions
and health behaviours among British, Finnish and Japanese public sector
employees.
Methods
Employees aged 45-60 from the London Whitehall II Study (n=3397),
Helsinki Health Study (n=6070) and a local Japanese government
(n=2213) were compared. Outcomes in logistic regression analyses were
healthy food habits, heavy drinking, smoking, and obesity. Working
conditions consisted of Karasek’s job demands and job control, and
working overtime. Age, occupational class, and marital status were
adjusted for.
Results
Healthy food habits were inversely associated with high job demands in
women in London. Heavy drinking was associated with job demands in
men, but inversely associated with job demands in women in London. In
addition, heavy drinking was associated with working overtime, and with
job control in men in Helsinki. Smoking was inversely associated with
working overtime in Japanese men. In men in Helsinki a similar pattern
was found but the association reached statistical significance in the ageadjusted model only. Obesity was associated with working overtime in
women in London and with job control in women in Helsinki.
Conclusions
Psychosocial working conditions have some, albeit limited associations
with health behaviours. The associations are weak and rather inconsistent
within and between the genders and cohorts. Promoting normal working
hours is potentially important in encouraging healthy behaviours and
preventing obesity.
Tea Lallukka, MSc, Department of Public Health; University of Helsinki, Finland; Tel: +358 (0)919127566;
tea.lallukka@helsinki.fi
23
Participants
Denmark Birgitte Kjaer ..................................... Kolding Sygehus
Charlotte Peersen ........................... JCVU - Center of Higher Education, Jutland
Gitte Andersen ................................. Fredericia Sygehus
Heidi Neumann................................ Kolding Sygehus
Helle Vestergaard ............................ National University Hospital
Inger Frandsen ................................. Nutricia A/S
Karin Kok ............................................ Pediatric Unit, Rigshospitalet
Kirsten Buhl ...................................... Fredericia Sygehus
Kirsten Færgeman .......................... Århus Kommune, Børn og Unge, Videncenter for
Pædagogisk Udvikling
Louise Enevoldsen .......................... Kostkompagniet
Margit Vesterlund ........................... Kolding Sygehus
Mette Pedersen ................................ Nutricia A/S
Mia Skøn Nielsen
Finland Anne Koskinen ................................. Fresenius Kabi Ab
Anneli Ollus ....................................... Helsinki University Hospital
Berit Haglund ................................... Helsingfors stad
Eetu Koski .......................................... Novartis Finland Oy / Medical Nutrition
Helena Selkälä .................................. Lapland Central Hospital
Hilkka Pakarinen .............................. Central hospital of Kainuu
K. Tuulikki Koistinen ....................... Åbo universitets centralsjukhus
Katri Tolonen .................................... Helsinki Polytechnic
Leena Alppinen ................................ Health centre of Helsinki
Leila Karhunen ................................. University of Kuopio, Department of Public Health
and Clinical Nutrition
Liisa Ilona Heinonen ...................... Finnish Diabetes Association/Diabetes Centre
Maija Heikura ................................... PKSSK, (North Karelia Hospital Distritct)
Marja Aho .......................................... Free lancer
Marja Mikkola .................................. Helsinki Polytechnic
Merja Herranen-Kallio .................. Valkeakoski Hospital
Pauliina Pietilä ................................. Valio Ltd
Tarja Heino ........................................ Fresenius Kabi Ab
Tea Lallukka ....................................... University of Helsinki
Tuija Helminen ................................. Health Care Centre Heinola
Tuula Heikkinen ............................... City of Helsinki/Healthcare
Ulla Siljamäki-Ojansuu ................. Tampere University Hospital
Faero Islands Ulla Sissel Brandi ............................ Landssygehuset i Tórshavn
24
Participants
Iceland
Anna S. Ólafsdottir ......................... Public Health Institute of Iceland
Ása Guðrún Kristjánsdóttir ......... Unit for Nutrition Research, Landspítali - University Hospital
Bertha Ársælsdóttir........................ Unit for Nutrition Research, Landspítali - University Hospital
Bryndís Eva Birgisdóttir ............... Landspítali - University Hospital
Elín Sigurborg Harðardóttir ........ Heilbrigðisstofnun Þingeyinga
Elísabet S. Magnúsdóttir .............. Menntaskólinn í Kópavogi
Fríða Rún Þórðardóttir ................. Landspítali - University Hospital
Gisela Lobers ..................................... Department of Clinical Nutrition, Landspítali - University Hospital
Guðlaug Gísladóttir ....................... Department of Clinical Nutrition, Landspítali - University Hospital
Guðrún Jóna Bragadóttir ............ Department of Clinical Nutrition, Landspítali - University Hospital
Heiða Björg Hilmisdóttir .............. Landspítali - University Hospital
Helga Sigurðardóttir
Hildur Ósk Hafsteinsdóttir .......... MS
Inga Þórsdóttir ................................ Landspítali - University Hospital
Ingibjörg Gunnarsdóttir ............... Unit for Nutrition Research /University of Iceland
& Landspitali - University Hostpial
Kolbrún Einarsdóttir ...................... Department of Clinical Nutrition, Landspítali - University Hospital
Sigríður Eysteinsdóttir .................. Heilbrigðisstofnun Suðurnesja
Svava Engilbertsdóttir .................. Department of Clinical Nutrition, Landspítali - University Hospital
Unnur Björk Gunnarsdóttir ........ Icepharma
Valgerður Hildibrandsdóttir........ Sn-ráðgjöf ehf.
Norway
Åse Karine Ruud .............................. Sørlandet Sykehus
Elisabeth Elind .................................. Student
Else Rabbås Holsdal ....................... St. Olavs Hospital
Gunnhild B. Meldal-Jonsen ........ Aker universitetssykehus Ski
Hilde Gras .......................................... Sørlandet Sykehus Kristiansand
Johanne Alhaug .............................. Lovisenberg Diakonale Sykehus
Kjersti Gjermstad ............................ Sykehuset Levanger
Lene Thoresen .................................. St. Olavs Hospital
Marianne Nordlie ............................ Fresenius Kabi
Nina Kirknes ...................................... Sørlandet Sykehus HF, avd Mandal
Randi J Tangvik ................................ Haukeland Universitetsssykehus
Sweden
Anette Järvi ....................................... Nestle Sverige AB
Birgitta Forsberg ............................. Primärvården Skåne
Elisabet Rothenberg ...................... Sahlgrenska University Hospital
Ellen Svensson
Eva Davidson .................................... Helsingborgs lasarett (The hospital of Helsingborg)
Eva Larsson........................................ Vårdcentralen Skogsfrid
Ingrid Larsson................................... Obesity Unit, Sahlgrenska University Hospital
Irene Sigfridsson ............................. City of Sundsvall/Sundsvalls kommun
Kiki Lundberg .................................... Avd f Klinisk Nutrition
Mia Davidsson.................................. Primärvården Skåne
Sofia Hallberg................................... Unilever Sweden AB
Teresa Olefeldt ................................. Helsingborgs lasarett (The hospital of Helsingborg)
25
Notes
26
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