Non-communicable diseases - Healthy diet, physical activity and

Non-communicable diseases - Healthy diet, physical activity and

Non-communicable diseases - Healthy diet, physical activity and
obesity trends in the Nordic countries: Status and challenges
Prof. Knut-Inge Klepp
Director General, Public Health, The Norwegian Directorate of Health
Burden of disease attributable to 15 leading
risk factors in 2010 expressed as % of DALYs
Denmark
Finland
The Global Burden of Disease Project 2010
2
Nordic Nutrition Recommendations
2012
• Systematic, independent reviews
of the scientific literature
• Recommendations regarding:
– Diet composition
– Nutrient intake
– Physical activity levels
– Reduced sedentary behavior
Physical activity
28.08.2014
6
Proportion (%) reporting at least 1 hour of
moderate-to vigorous physical activity per day
(HBSC)
Gutter
Prosent
40
30
20
10
0
11
13
Finland
11
13
Norge
11
13
Island
11
13
Sverige
11
13
Danmark
11
13
Gj.snitt
HBSC
Land og alder
Boys: age 11 and 13 years; HBSC 2009/2010
(WHO 2012)
28.08.2014
7
Moderate-to-vigorous PA (min/day)
Objectively registered moderate-to-vigorous physical
activity (minutes per day) – Denmark and Norway (The
European Youth Heart Study)
200
175
150
125
100
75
50
25
0
Gutter
Jenter
Gutter
Jenter
Gutter
Jenter
Gutter
Jenter
9 år
9 år
15 år
15 år
Danmark
Norge
Danmark
Norge
Average minutes per day of measured moderate-to-vigorous physical activity; the
European Youth Heart Study
(Riddoch CJ 2004, EYHS)
28.08.2014
8
Self-reported physical activity:
% meeting the recommendation (>7 h MVPA/wk),
being somewhat active (15-419 min MVPA/wk),
or inactive (< 15 min MVPA/wk): 7-12 year olds
Country
N
Active
Somewhat active
Inactive
Finland
500
56
43
1
Iceland
518
52
47
1
Denmark 609
45
53
2
Norway
353
33
64
4
Sweden
499
28
68
4
MVPA=Moderate-to-vigorous PA
(Nordiske ministerråd, Rasmussen LB et al 2012)
28.08.2014
9
Self-reported physical activity:
% meeting the recommendation (>210 min
MVPA/wk), being somewhat active (15-209 min
MVPA/wk), or inactive (< 15 min MVPA/wk):
Adults 18-65 year olds
Country
N
Active
Somewhat active
Inactive
Finland
1835
70
22
8
Sweden
1782
69
22
9
Denmark 2098
66
23
11
Iceland
1866
65
21
14
Norway
1019
61
26
13
MVPA=Moderate-to-vigorous PA
(Nordiske ministerråd, Rasmussen LB et al 2012)
28.08.2014
10
Sedentary behaviour – watching TV at least 2
hours/day (HBSC)
Prosent
Gutter
70
60
50
40
30
20
10
0
11
13
Danmark
11
13
Finland
11
13
Sverige
11
13
Island
11
13
Norge
11
13
Gj.snitt
HBSC 39
Boys: 11 and 13 years old; HBSC 2009/2010
(WHO 2012)
28.08.2014
11
Reported daily transport by foot (by age group):
Denmark & Norway
Denmark (2011); Norway (2009)
(Danmarks Tekniske Universitet 2012 og Transportøkonomisk institutt 2009)
28.08.2014
12
Proportion of bike cyclists in Scandinavia
(Syklistenes landsforening 2010, http://www.tiltakskatalog.no/b-3-1.htm)
28.08.2014
13
Nutrition & healthy
eating
28.08.2014
14
Consumption of fresh fruit and vegetables
kg/person/year (whole sale data)
1995
2000
2005
2010
2012
--
--
--
--
--
Finland
101
113
117
103
109
Iceland
76
74
100
105
115
106
119
126
129
114
121
--
--
Denmark
Norway
Sweden
100
Nordic Statistical Yearbook 2013
28.08.2014
15
Proportion who reported to eat fruit, berries
and vegetables ≥ 5 times a day
Proportion (%)
Denmark
15.0
Finland
8.5
Iceland
8.3
Norway
21.9
Sweden
13.2
28.08.2014
16
Salt intake (grams) per person
per day for adults
↑
↑
↑ ↑
28.08.2014
17
Average dietary index (range 0-12) in
the Nordic Countries
The index is constructed based on reported frequency of intake of fruit & vegetables, bread, fish &
seafood, candy & cakes etc., fat on bread, cheese and sausages
28.08.2014
18
Dietary index: proportion classified as having
a poor diet (0-4); medium nutritional quality
(5-8); or having a ‘healthy diet (9-12)
by country
28.08.2014
19
Norway: the proportion of the adult population meeting
the recommended dietary recommendations:
Norkost 2010-11:






Vegetables
Fruit and berries
Whole grain
Fish
Fatty fish
Red meat
Men
13 %
34 %
27 %
39 %
24 %
45 %
Women
15 %
41 %
25 %
31 %
21 %
67 %
Overweight and obesity
28.08.2014
21
The WHO
European
Childhood Obesity
Surveillance
Initiative (2009-10)
28.08.2014
22
The WHO European Childhood Obesity Surveillance
Initiative, Norway 2008-12: % overweight and obese
Both gender
Boys
Girls
Girls
Boys
National Institute of Public Health, 2013
Health Behaviour in School-aged Children (HBSC) Study:
Self-reported overweight & obesity
Boys
Girls
28.08.2014
24
BMI: Proportion (%) reporting to be
overweight or obese
BMI 25-29.9
BMI ≥ 30
Denmark
32.8 %
12.0 %
Finland
37.2
14.0
Iceland
39.3
17.8
Norway
36.1
8.7
Sweden
34.2
10.2
28.08.2014
25
Obesity (% of pop) related to length of education
Length of education
Prevalence of obesity among
Norwegian women & immigrant groups
HUBRO 2000-02 (age adjusted)
(BMI ≥ 30 kg/m2)
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Kumar et al, 2009
WHO – Marketing of foods to children 2004-12
2009
2007
2007
2012
2006
2004
2010
The Norwegian School Fruit Program
ISBNPA Symposium, ECO2011, Istanbul
29
Tax on non-alcoholic beverages with added
sugar or artificial sweetener
As of January 1, 2009 the
added tax on non-alcoholic
beverages with added sugar or
artificial sweetener was
increased to the same level as
that of beer with low alcohol
content (i.e. alcohol content
between 0,7 and 2,7 volume
percentage)
28.08.2014
30
Sales (NOK) of Keyhole products in
grocery stores 2011-2013
(Nielsen)
18 000 000
16 000 000
14 000 000
12 000 000
10 000 000
8 000 000
6 000 000
4 000 000
2 000 000
-
17 062 046
13 651 470
12 041 524
2011
2012
2013
Active transportation, physical activity at school &
available play and recreational areas within
neighborhoods
28.08.2014
32
Conclusions & future challenges
• We lack comparable, valid (trend) data
related to the WHO NCD indicators from the
Nordic countries
• Existing data indicate some positive trends
related to diet
• There is no robust indication of a leveling off
with respect to overweight and obesity rates
in the Nordic countries
• A number of policy measures have proven to
be promising with respect to promoting
healthy diet and increased physical activity
levels
• There seems to be an under-utilized potential
for Nordic cross-country evaluation studies of
public health measures
Thank you for your
attention!
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