Riksmaten 1997-98. Dietary habits and nutrient intake in Sweden

The second national food consumption survey.

Background

In 1997-98, the Statistics Sweden in co-operation with the National Food Administration (NFA) carried out the second nation-wide Swedish dietary survey, Riksmaten (1). The study was a follow-up of the previous survey (Hulk) carried out in 1989 (2,3), using similar design and methods. In Riksmaten a representative sample of 2000 households consisted the survey base. In each household one person aged 18-74 years was selected filled in a pre-coded 7-d record book. The participants also filled in a questionnaire with information on body weight, height, education, occupation, physical activity, smoking habits and other lifestyle factors. The sampling design was continuous, i.e. a number of households were invited to participate every second week, thus covering the whole year. In table 1 the age distribution in the Hulk and Riksmaten samples is given.

Dietary assessment

Main results

Food consumption

The results indicate that certain changes in dietary habits have occurred since the first survey carried out in 1989 (3,4). In Riksmaten a more frequent consumption of juice and nectar, pizza, rice, pasta, nuts and snacks and sweets were seen for both men and women. Women also more often consumed vegetables, milk, meat and poultry and alcoholic beverages, and men more often consumed jam and marmalade, ice cream, and soft drinks. A less frequent consumption was seen for cheese, offal, bread, sweet bakery products, spreads, cream and sugar (as additional foods), and desserts. Men also less frequently consumed eggs, fish, pulses, and porridge. (table 2).

The observed differences in consumption frequency were mostly reflected in consumed amounts (table 3). Exceptions were bread and sweet bakery products. A higher consumption was also seen for vegetables (men), sausages (men and women), meat and poultry (men). Part of these differences could be explained by changes in the standard portion sizes used in the record book.

Energy and nutrient intake

The average daily energy intake was similar or somewhat higher than in the Hulk survey (table 4). The dietary fat content was on average 34 energy percent (E%), which is lower than in the Hulk-survey, but still higher than the recommended level of 30 E% (5,6, table 5). The differences among different sex and age groups were generally small, but the youngest age group (18-24 yr.) tended to have a lower fat percentage. The proportion of saturated fatty acids was 14 E%, also lower than in Hulk. Together with trans-fatty acids "hard fat" contribute 15 E%, considerably higher than the recommended level of 10 E%.

Carbohydrates provided on average 47 E% and 46 E% among women and men, respectively. The proportion was higher in the youngest age group. The proportion of sucrose in the diet was higher among women than among men. The average intake of fibre was 17-18 g/d, corresponding to 1.8 g/MJ among men and 2.0 g/MJ among women, which is about two thirds of the recommended level of 3 g/MJ. The intake has not changed compared to the Hulk-survey.

The alcohol intake was higher among men than women and provided on average 4 E% and 3 E% among men and women, respectively.

An evaluation of under-reporting using the Goldberg technique (7) showed that around 20 % of the subjects reported an energy intake below cut-off. Under-reporters had a somewhat lower fat proportion and a somewhat higher carbohydrate proportion compared to acceptable reporters.

The average intakes of vitamins and minerals (table 6) were generally close to or above the recommended daily intakes (RI). The intake of vitamin D was lower than recommended for older persons, while the intake of folate corresponds to c. 75 % of the RI. The intake of iron among women in fertile ages corresponds to two thirds of the RI. The selenium intake corresponds to three fourths of the RI. The intake of retinol was lower in Riksmaten than in Hulk, mainly due to a lower consumption of spreads and liver. The intake of vitamin C was higher in Riksmaten than in Hulk. The iron intake was lower than in Hulk due to the termination of iron fortification of flour in 1995.

The intake of sodium from food and drink (excl. salt added at the table) was 2.8 g/d and 3.6 g/d among women and men, respectively.

Average intakes of individual fatty acids are given in table 7. The ratio of n-6 and n-3 fatty acids is around 5:1.

Socio-demographic differences

Pronounced age differences in dietary habits were seen. Older people eat more of "traditional" foods like potatoes, root vegetables, fish, offal and blood, porridge and sweet bakery products, while young people eat and drink more of more "modern" foods, e.g. pasta, rice, pizza, sweets, nuts and snacks, and soft drinks. Older people also eat more fruit and vegetables. Women eat more fruit and vegetables than men do. There were generally small differences in the nutrient composition of the diet between men and women.

Low education was among men linked to a lower consumption of e.g. fruit and vegetables and a higher intake of spreads. Men with low education consumed a diet with higher fat content compared to high-educated men (35 E% and 33 E%, respectively). No such difference was observed for women. High education was linked to a higher alcohol intake, in both sexes. High education was linked to a higher intake of beta-carotene (women only), vitamin C and folate compared to low education. Similar tendencies, although less pronounced, were seen when the participants were classified into socio-economic groups.

Smokers, especially men, had poorer dietary habits than non-smokers did, with e.g. a lower consumption of fruit and vegetables. Smoking men ate a diet with a higher fat percentage than non-smokers did (36 E% and 34 E%, respectively). Men that snuffed drank more alcohol compared to those that never had snuffed.

Regional differences were identified but generally these were minor. The consumption of fruit and vegetables were lower in the Northern Sweden compared to that in the Stockholm region, while the consumption of spreads and milk was higher. The proportion of saturated fatty acids in the diet was higher in Northern Sweden than in the Stockholm area, while the consumption of alcohol was higher in Stockholm. The intake of calcium was higher in Northern Sweden than in the Stockholm region and Southern Sweden, while the intake of vitamin C was higher in the Stockholm region than in Northern Sweden.

Nordic comparisons

National food consumption surveys have been carried out in all Nordic countries during the last decade (8-12). Differences in dietary assessment methods, food composition data and calculation systems have to be taken into account when comparing the results (13). The nutrient intake has therefore been adjusted for energy intake and the same energy calculation factors have been used. The data indicate that the Swedish diet has no particular specific feature in terms of nutrients, except for a somewhat lower selenium level. However, more recent analytical data for market baskets, dairy products and meat indicate that the selenium intake is somewhat higher than calculated.

General comments

Although certain improvements in the dietary pattern in the Swedish population have occurred since the late 1980s, the main problem remains with an imbalance between fat (and fat quality) and complex carbohydrates. Factors like smoking and low education are still associated with poorer dietary habits, especially among men, while a certain equalisation seems to have occurred among women in this respect. For the population as a whole the general advice, that part of the dietary fat, mainly hard fat, should be replaced by complex carbohydrates, is still valid. On a food level this means increased consumption of fruit, berries, vegetables, bread and cereal products, to replace high fat meat and dairy products with fat-reduced alternatives, and to limit the consumption of high fat bakery products and sugar containing products like soft-drinks and sweets. Soft or fluid edible fats should replace hard fats to a larger degree. An increased physical activity in the population is equally important. It should be stressed, however, that the degree and magnitude of desirable changes in dietary habits varies between different groups and individuals. Methods and advice to promote changes should be adapted according to the context, conditions and prerequisites relevant for the group or individual.

References

1. Becker W, Pearson M. Riksmaten 1997-98. Befolkningens kostvanor och näringsintag. Metod- och resultatanalys. Livsmedelsverket, Uppsala 2002.
   
2. Becker W. Svenskarna äter nyttigare - allt fler väljer grönt. Vår Föda nr 1, s. 24-27, 1999.
   
3. Becker W. Riksmaten 1997-98: Vi äter nyttigare - men har blivit tyngre. Vår Föda nr 2, s. 3-7, 1999.
   
4. Becker W. Vilka är källorna till våra näringsämnen? Vår Föda nr 3, 16-26, 2000.
   
5. Pearson M, Becker W. Ålder och utbildning – viktigast för våra matvanor. Vår Föda 2001; 53 (3): 12-17.
   
6. Becker W. Befolkningens kostvanor och näringsintag i Sverige 1989. Metod- och resultatanalys. Statens livsmedelsverk, Uppsala 1994.
   
7. Becker W. Dietary guidelines and patterns of food and nutrient intake in Sweden. Br J Nutr 1999; 81 (Suppl. 2): S113-17.
   
8. Becker W, Lennernäs M, Gustafsson I-B, Haraldsdottir J, Nydahl M, Vessby B, Ytterfors A. Precoded food records compared with weighted food records measuring dietary habits in a population of Swedish adults. Scand J Nutrition/Näringsforskning 1998; 42: 145-149.
   
9. Sandström, B, Lyhne, N, Pedersen, JI, Aro, A, Thorsdóttir, I, Becker W. Nordic Nutrition Recommendations. Scand J Nutr/Näringsforskning 1996;40:161-65.
   
10. Svenska Näringsrekommendationer. Vår Föda 1997;49(2):7-14.
    
11. Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, Prentice AM. Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off values to identify under-reporting. Eur. J. Clin. Nutr. 1991; 45, 569-581.
    
12. Johansson L, Solvoll K. Norkost 1997. Landsomfattende kostholdsundersökelser blant menn og kvinner 16-79 år. Rapport nr.2/1999. Statens råd för ernæring og fysisk aktivitet, Oslo 1999.
    
13. Johansson L, Solvoll K. Norkost 1993-94 og 1997. Landsomfattende kostholdsundersökelser blant menn og kvinner 16-79 år. Rapport nr. 3/1999. Statens råd för ernæring og fysisk aktivitet, Oslo 1999.
    
14. Levnedsmiddelstyrelsen. Danskernes kostvaner 1995, hovedresultater. Publikation nr. 235. Sundhetsministeriet Søborg, Danmark, 1996.
    
15. National Public Health Institute. The 1997 dietary survey of Finnish adults. Helsinki, Finland 1998.
    
16. Steingrímsdóttir L, þorgeirsdóttir H, Ægisdóttir S. Könnun á mataræði Íslendinga 1990. 1. Helstu niðurstöður. (Undersökning av islänningarnas kostvanor 1990. 1. Huvudresultat.) Islands Ernæringsråd, Reykjavik 1991.
    
17. Norfoods 2000. Intake calculations of food consumption data in the Nordic countries. A comparison of food composition data, calculation factors and calculation methods In Swedish with English summary) TemaNord 2002:522, Nordic Council of Ministers, Copenhagen.

Table 1. Participants age in Riksmaten 97-98 and Hulk 89

Table 3. Mean consumption of major food groups (g/d) in Riksmaten 1997-8 and Hulk 1989

 Table 4. Mean daily intake of energy and energy providing nutrients
 

¹ excl. fibre
² as fatty acids

Table 5. Mean distribution of energy providing nutrients (energy percent)
 

Table 6. Mean daily intake of vitamins and minerals

¹ Swedish Nutrition Recommendations, see ref. 5 and 6

Tabell 7. Mean intake (g/d) of individual fatty acids in Riksmaten 97-98
 

Table 8. Average nutrient composition expressed per 10 MJ according to
Nordic national food consumtion surveys¹
 

1excl. fibre. Energy factors: protein and carbohydrates 17 kJ/g, fat 37 kJ/g
² preformed niacin only