We are eating healthier - but getting heavier
Many people - 80 percent of those surveyed - think that it is important to eat healthy food, and most also know that the green keyhole symbol signifies low-fat foods. That it is also used to indicate high-fiber food is less widely known. Almost everyone surveyed - 97 percent - eats a varied diet. 1.5 percent eat a partially or entirely lacto-vegetarian diet. The use of liquid margarine in cooking has become more common. And people have put on weight. These are some of the findings of the big 1997-1998 dietary survey, Riksmaten.
By Wulf Becker, Nutritionist, National Food Administration
Vegetables, rice, pasta and juice are appearing on the menu of Swedes more often than before (1). This article presents how our eating habits and lifestyle are connected.
In the study, participants were asked to keep a record of what they ate and complete a questionnaire. The results from the revordbook on food consumption and nutrient intake are published elsewhere LÄNK. The results from the questionnaire are presented here.
The questionnaire contained 32 questions including the participant's height, weight, type of diet, use of dietary supplements, type of fat and salt used in cooking, smoking and the use of snuff, exercise, education, general state of health, working hours and frequency of consumption of different types of fish. Similar information was gathered in an introductory interview used in connection with an earlier dietary survey, HULK 1989 (2,3).
The findings
1213 (approx. 59 percent) of total 2057 questionnaires sent out were answered. One of the questionnaires returned was not filled in, and 9 participants filled in only the questionnaire and not the menu book. 1212 questionnaires (581 men and 631 women) were therefore processed.
The average age for women was 43.4 years, and 42.9 years for men. The age distribution of the participants is presented in Table 1. The sample also included 7 persons who were 17 years old during the survey period, and 3 persons over 74 years. Height, weight and body mass index (BMI) are also presented in Table 1. Both weight and BMI increase with age up to 55-64 years of age.
More women than men had university or other post-secondary education (Table 2). Approximately three quarters stated that they werer gainfully employed. Most worked days or had some form of regularly scheduled work. 11 percent stated having irregular working hours. 339 persons (28 percent) responded that they were not gainfully employed. Reasons given for this included studies, unemployment, parental or maternity leave, or that they were retired. Some students also stated that they were gainfully employed.
Type of diet and use of dietary supplements
Most of the participants (97 percent) responded that they ate a normal varied diet. Only a few stated that they were vegetarian or had some other modified diet. None of those surveyed said that they ate a vegan diet. No difference was observed between men and women (Table 3).
13 percent stated that they regularly took some form of vitamin or mineral supplement regularly, and 34 percent stated that they sometimes took supplements. Women took supplements more often than men did(Table 4). The types of supplements used were vitamin and mineral preparations, above all multivitamin compounds and preparations with individual nutrients (Table 5). Just under 2 percent of those who took supplements once in a while stated that they took only fish oil, while 14 percent took several kinds of supplements and 8 percent other types of preparations.
Fat used in cooking
The household member selected to keep a record in the 7-day menu book was asked to state the type of margarine or butter used on bread, while fat (margarine, butter or oil) used in cooking was dealt with under the standard recipes used in food preparation. The questionnaire included a question on the type of fat usually used in cooking at home. The results show that a majority (52 percent) use regular margarine, followed next by cooking oil (16 percent), see tables 6.
Salt used in cooking
Slightly less than three quarters of the respondents used iodised table salt in their cooking, while another 13 percent used mineral salt, which is normally also iodised. 10 percent use non-iodised salt (Table 7). Adding extra salt to food at the table does not seem to be a regular habit for most people (Table 8).
Smoking and use of snuff
One fifth of the participants responded that they smoked daily, and 30 percent used to smoke but have quit (Table 9). More women smoke daily than men. Slightly over one fifth of the men used snuff daily, compared to only 3 percent of the women (Table 10).
Exercise at work and leisure
The participants were asked to estimate the level of physical exertion required at work, based on descriptions of different jobs. 40 percent stated they did light work, while about 25 percent classified their work as either sedentary or moderately strenuous (Table 11). Most of the participants (70 percent) take light or moderate exercise at least once a week (Table 12).
Healthy food and the keyhole symbol
Just under 20 percent of people consider it "very important" that their food is "nutritious/healthy". The majority (65 percent) consider it "quite important", and 10 percent consider it "not important" (Table 13). More women than men think it is important.
The questionnaire included a picture of the keyhole symbol and a number of possible answers as to what it means. There was also room to add other answers. Most respondents thought the symbol meant "low fat", following by "low calorie" and "high fibre" (Table 14).
Another question addressed how often they chose foods marked with the keyhole symbol when they shopped. Over one third replied that they often consciously chose foods marked with the symbol when shopping, and as many again that they sometimes did (Table 15). Only a few respondents were unfamiliar with the symbol or did not shop for food.
Health problems
One question dealt with various health problems such as diabetes, high blood pressure, high blood lipids, allergies, etc. Most people (79 percent) answered that they did not have any of these health problems (Table 16). The participants were also asked how they thought their general state of health had been over the past year. The responses to this question are presented in Table 17.
Comments
The results presented in the tables are uncorrected, i.e no upward correction has been made for differences due to omissions with respect to background factors such as age, education, region of residence, etc. Comparison with results from the earlier HULK study of 1989 are therefore somewhat uncertain. The response rate for the Riksmaten study was lower than for HULK, 60 versus 70 percent respectively. The age distribution in the two studies is similar. The number of people with post-secondary education is somewhat higher in Riksmaten (20 percent) than in HULK (17 percent), while the number of people whose education consists of basic compulsory school is lower 28 versus 35 percent.
The Riksmaten survey findings show a generally higher average weight and BMI than the HULK survey, especially when it comes to young women, see Figure 1. This finding is in line with Statistics Sweden data from the so-called ULF annual surveys on living conditions (4).
Men, Riksmaten Men, HULK
Women, Riksmaten Women, HULK
Figure 1. Average BMI according to age group for Riksmaten 1997-98 and HULK 1989.
Both the HULK and Riksmaten surveys asked about the level of exercise at work and during leisure time. In HULK, the omission rate for these questions was high (13-14 percent), making it difficult to compare the two studies. When the omissions are excluded, a trend can be seen towards a greater number of sedentary jobs in the Riksmaten study. When leisure exercise activities are compared in the same way, a tendency is seen towards an increase in regular physical activity in leisure time. Since however the wording of the questions differs somewhat between the studies, it is even harder to interpret the results with any certainty. The findings of the ULF surveys indicate, however, that regular exercise has become more common (4).
Fewer participants stated that they smoked less in the Riksmaten study than in HULK. In Riksmaten, 13 percent of the men and 23 percent of the women smoked daily, while the corresponding figures for HULK were 25 and 28 percent respectively. 12 percent of the male Riksmaten respondents male and 8 percent of the women stated that they smoked "occasionally". This answer option was not included in the HULK study. The decrease in smoking, especially among men, is also seen in the ULF surveys (5).
There does not appear to have been any change in the type of diet eaten. In both the Riksmaten and HULK studies, approximately 97 percent ate a normal varied diet, while 1-2 percent ate a completely or partially vegetarian diet. Taking dietary supplements does not appear to have become more common. In HULK, 16 percent stated that they took supplements regularly and 23 percent during certain periods. Corresponding figures for Riksmaten are 13 and 34 percent respectively.
Compared to earlier questionnaire surveys (6,7), the use of cooking oil and liquid margarine in cooking appears to have become more common, which is a positive trend. About 20 percent of Riksmaten respondents answered that they usually cooked with oil or liquid margarine, compared to about 10 percent in 1991 (Figure 2). In order to meet the recommendations on reducing the proportion of saturated fat in our diets, soft or fluid fats should replace harder fats, both in home-cooking and in the food industry.
K&H diet and health survey 1991
Riksmaten 97-98
Butter Bregott (soft margarine) Cooking margarine Table margarine Liquid margarine Cooking oil
Figure 2. Type of fat used in cooking at home, according to National Food Administration surveys.
The survey also looked at the use of iodised table salt. Three out of four respondents answered that they usually used iodized salt, while 13 percent use low-sodium salts (mineral salt), which are also iodised. The results are satisfactory. Iodised salt is normally the most important source of iodine in our diet. For the 10-12 percent who do not use iodised salt, iodine intake is generally significantly lower since the salt used in the food industry and the catering trade is most often not iodised (8). However, few studies have been done on the iodine intake (9).
According to the Swedish Nutrition Recommendations (SNR 1997), a lower salt intake is desirable. The main sources of salt in our diet are processed foods and salt added during food preparation. Another source is salt added to food at the table. According to the Riksmaten survey, adding salt regularly at the table is not very common, although 11 percent of the men and 6 percent of the women answered that they "usually" do this.
Riksmaten participants were fairly familiar with the fact that the keyhole symbol means "low fat". Compared to earlier questionnaire surveys done in the 1990s, the percentage of respondents familiar with the low-fat meaning was higher, while the percentage who answered that the symbol means "high fibre" was about the same or slightly lower, see Figure 3 (6,7). There was no notable difference in knowledge about the symbol between those who stated that they "often" or "sometimes" consciously chose foods marked with the symbol when shopping, compared to those who "rarely" or "never" chose these foods (83 percent as opposed to 75 percent). Even if knowing what the keyhole means is not a prerequisite for choosing keyhole-labelled goods, the findings can indicate a need to consider increased focus on high-fibre foods.
K&H diet and health survey 1991
K&H diet and health survey 1993
Riksmaten 97-98
Low calorie No preservatives Low fat Environmentally friendly High fibre No cholesterol Organically grown Don't know
Figure 3. Answers to the questions on the meaning of the keyhole symbol in National Food Administration surveys.
Most participants - about 80 percent - answered that they had no specific health problems. A majority perceived their general state of health as good or quite good. Seven percent answered that they had high blood pressure, and 3-4 percent that they had high cholesterol levels in their blood. In the previous HULK 1989 study, participants were asked if they took medicine for high blood pressure or high cholesterol. 8 percent and less than 1 percent respectively answered Yes to these questions. In the HULK study, medication for high blood pressure was seen mostly in the middle-aged and older groups.