9th Nordic Congress for DietitiansAugust 9th–12th 2006

Grand Hotel, Reykjavik, Iceland

Program and Abstracts

Nordic Dietetic Association

Abbott, Sweden

Danól, Iceland

E.S.Ólafsson ehf, Iceland

Fazer, Finland

Fresenius Kabi, Norge, Sweden

Icepharma, Iceland

Mead Johnson Nutritionals, Sweden

MS, Iceland Dairies, Iceland

SponsorsWe would like to thank our sponsors for their support to the 9th Nordic congress for dietitians.

Nathan & Olsen, Iceland

Noi-Sirius, Iceland

Novartis, Iceland, Finland, Sweden

Nutricia, Iceland, Denmark

Unilever, Sweden

Vistor, Iceland

Vífilfell, Iceland

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Welcome

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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 inIceland. In the scientific program a prominentlecturers will give different perspectives on nutrition and clinical nutrition and give you a lot to discuss.

For the first time the congress language will beEnglish, 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 outstandingBlue 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 greatprofessional benefit.

Kolbrún EinarsdóttirNordic Dietetic Association

Welcome to the 9th Nordic Congress for Dietitians at Grand Hotel Reykjavík, Iceland, 9.–12. August 2006

Member Associations of the Nordic Dietetic AssociationIcelandic Association of Food and Nutrition Scientists Matvæla- og næringarfræðafélag Íslands (MNÍ)

The Association of Danish Clinical Dietitians Foreningen af Kliniske DiætisterThe 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 SecretariatGestamóttakan • Your host in IcelandÞingholtsstræti 6 • 101 ReykjavikPhone: + 354 551 1730 • GSM: +354 692 1730yourhost@yourhost.is

Organizing Committee Nordic Dietetic AssociationKolbrún Einarsdóttir, president, Iceland Hildur Ósk Hafsteinsdóttir, Iceland Helle S. Vestergaard, cashier, Denmark Berit Haglund, secretary, Finland Charlotte Peersen, NorwayEllen Svensson, Sweden Elina Ikkala, Sweden

Local CommitteeGuðlaug GísladóttirHelga SigurðardóttirHildur Ósk HafsteinsdóttirKolbrún Einarsdóttir

Program

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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 Blue Lagoon and dinner at Salthúsið, Grindavík Departure from Grand Hotel

Program

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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 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

11:00-11:45 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 LunchLocal: 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

Abstracts

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Regulation of food intakeLeila KarhunenDepartment 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 energybalance 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 long-term regulation is also influenced by more recent energy intaketo 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.

Oral Presentations

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Body composition and energy balance in the normal and the obese state Ingrid LarssonObesity 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 inter-individual 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 fluxof 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 betweenenergy 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.

Abstracts

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The importance of vitamin D and calcium for the maintenance of bone healthGunnar Sigurdsson MD, PhDProfessor, University of IcelandChief, 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 concentrationis 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 howimportant 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 ofvitamin 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 calciumintake 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 thanhigh 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).

Oral Presentations

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SEAFOODplus diet intervention to improve health among young overweight adultsInga Þórsdóttir PhD, Professor, University of IcelandChief, 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-restricteddiet 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, noseafood). The macronutrient composition of the diets was similar between the groups. Data were collected on anthropometry, blood lipids, glucose, insulin, inflammatory markers and antioxidantcapacity. 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:4.13-4.87] 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 bereported.

Conclusion In young, overweight men, the inclusion of either lean or fatty fish, or fish oil as part of an energy-restricted diet resultedin ~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.Martinéz41Unit 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.

Abstracts

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Sofia HallbergClinical Dietitian, Unilever, Sweden

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 andmade 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 healtheffects 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/dLevel 2 Tea and coffee 1180 ml /dLevel 3 Low fat milk and soy beverages 0-470 ml/dLevel 4 Noncalorically sweetened beverages 0-940 ml/dLevel 5 Caloric beverages with some nutrients 0-240 ml/dLevel 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

Health beverage guidelines. Do we need to rethink our drink?

to develop a Nordic Health beverage guideline?

Oral Presentations

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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 manybooks and newspaper articles have been printed for the public.

Generally low GI food is considered beneficial due to less incrementalincrease 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 well-controlled, 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.

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

Abstracts

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Improved image of seafood. Consumer’s attitudes and fish consumptionEmilía Martinsdóttir MSc, Chemical engineerHead 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 areunivocal. 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 onhealth, such as decreasing the risk of cardiovascular diseases.

Fish has been a significant part of the Icelandic people’s diet fora long time, with very high fish consumption in comparison withmost other European countries. However, fish consumption hasdecreased 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 inthe 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 fishconsumption: 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 beused 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 arevery interesting, and show e.g. that education about fish in generalis very limited and that debate in the society greatly influencesattitudes toward fish consumption.

Authors: Emilía Martinsdóttir, Kolbrún Sveinsdóttir, Gunnþórunn Einarsdóttir, Icelandic Fisheries Laboratories (IFL), Skulagata 4, 101 Reykjavik, IS

Young consumer attitudes and fishconsumption: 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

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Elisabet Rothenberg PhDChief Clinical Dietitian, Department of Clinical Nutrition, Sahlgrenska University Hospital, Gothenburg, Sweden

Lene Thoresen MScChief 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 patientsand 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 betterthan 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, ambe@dfvf.dk, 2 PhD, Chief dietitian, Department of Clinical Nutrition, Göteborg University, Gothenburg, Sweden, elisabet.rothenberg@vgregion.se , 3 MSc, Chief Clinical dietitian, Oncology Clinic, University Hospital, Trondheim, Norway, lene.thoresen@stolav.no

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.

Nutrition practice in Scandinavian hospitals, the role of the dietitian

Abstracts

14

Nutrition and weight gain in pregnancyAnna Sigríður ÓlafsdóttirPhD 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 theeffects of maternal nutrition and smoking status during pregnancy are combined.

In our study questionnaires on diet and lifestyle were filled out earlyand 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 otherconfounding 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.

Oral Presentations

15

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 ironstores (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). Comparablevalues 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 andMCV<76 fl), and 16% had depleted iron stores (SF<15 �g/l), but no childrenhad 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 mainlyassociated 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 positivelyassociated 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, andhaemoglobin 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. Furtherstudies 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.

Iron status in Icelandic children and associations with nutrition, growth and development. Björn Sigurður Gunnarsson, PhDNutritionist, Unit for Nutrition Research, Landspitali-University Hospital and University of Iceland, Reykjavík, Iceland.

Abstracts

16

Energy and protein requirements in sick children. Enteral and parenteral nutritionKarin KokChief 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 meta-analysis 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.

Oral Presentations

17

Experiences from implementing nutritional screeningJohanne AlhaugClinical 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 significantamount of patients admitted to hospital suffers from disease- related malnutrition.” The same report concluded that nutritional screening is the first step to detection, prevention and treatmentof 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 re-designing NRS 2002 for LDS use.

Conclusions: The staff found NRS 2002 initial screening to be practical and simple, while the final screening was found moredifficult (determine % weight loss and severity of disease). Initialscreening 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 whenstarting implementation. Screening must be followed by efficientnutritional 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 efficientlytreat malnourished patients and patients at risk of developing malnutrition.

Abstracts

18

Why shall clinical dietitians do research? The process of a doctoral studyLene Thoresen MScChief Clinical dietitian, PhD student, Oncology Clinic, University Hospital, Trondheim, Norway,

Nutritional oncology was established as a new defined andevolving 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 researchinto 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 mypresent 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 thesisis not a straight forward chain but rather a puzzle of pieces that finally will form a thesis. One of the most importantmessages 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 preparefor a plan B.

Oral Presentations

19

Women at work: Best friends or sworn enemies? On communication and relationships at workÞórkatla AðalsteinsdóttirPsychologist

There are three important sectors of life, where we fulfill ourneeds, 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 confidenceand of course experience for this role and we lack role models in this aspect (field). Our mothers and grandmothers were (as arule) 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 mentaltowards 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.

Abstracts

20

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

To identify determinants of fruit and vegetable intake among 11-year-old schoolchildren in Iceland.

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 asecond block, perceived socio-environmental variables as a third block and personal variables as a fourth block.

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 physical-environmental 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 werepreferences, liking, knowledge of recommendations and self-efficacy.

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 andknowledge levels concerning nutrition.

Purpose

Methods

Results

Conclusion

Posters

21

Icelandic follow-on milk ready to drink – to combat iron deficiency in early childhoodB. S. Gunnarsson, I. ThorsdottirUnit for Nutrition Research, Landspitali-University Hospital & Department of Food Science, University of Iceland.

Iron deficiency is the most common deficiency of a single nutrientworldwide. In industrialized countries infants and young children are at risk for developing iron deficiency due to high iron demandsfrom 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 ironstores (serum ferritin < 12 �g/l). Comparable values for 2-year-olds were 9% and 27%, respectively. Iron deficiency and depleted ironstores in the studies were mainly associated with fast growth from birth and high consumption of unmodified cow’s milk. Consumptionof 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-fortifiedformula instead of cow’s milk iron status is less likely to be threatened. Therefore, to combat the iron deficiency observed ininfants in Iceland, a follow-on formula from Icelandic cow’s milk fortified with iron and with reduced protein content was developedand 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.

Outcome

Study results in Iceland

Background

Abstracts

22

HOW TO LAUNCH A WEIGHT-MANAGEMENT GROUP – A Learner-Oriented Small-Group Training Programme for the Health Care ProfessionalsLiisa Heinonen, Clinical Nutritionist; Anna-Liisa Ventola, Licentiate in Food ScienceTaru 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

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 launcha 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.

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.

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.

The course contents were chosen during the first session in collaboration with theparticipants. 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 participantsexpressed 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.

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 weight-management groups.

Liisa Heinonen, Finnish Diabetes Association, Kirjoniementie 15, 33680 Tampere, Finland. +358503461868, liisa.heinonen@diabetes.fi

Background

Objectives

General framework

Course contents

Progress perceived

Posters

23

Working conditions and health behaviours: Comparing British, Finnish and Japanese public sector employeesLallukka 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 Helsinki2 Population Research Unit, Department of Sociology, University of Helsinki, Finland3 Department of Epidemiology & Public Health, University College London, UK4 Department of Welfare Promotion and Epidemiology, University of Toyama, Japan

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.

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.

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 age-adjusted model only. Obesity was associated with working overtime in women in London and with job control in women in Helsinki.

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

Background

Methods

Results

Conclusions

Participants

24

Birgitte Kjaer ..................................... Kolding SygehusCharlotte Peersen ........................... JCVU - Center of Higher Education, JutlandGitte Andersen ................................. Fredericia SygehusHeidi Neumann ................................ Kolding SygehusHelle Vestergaard ............................ National University HospitalInger Frandsen ................................. Nutricia A/SKarin Kok ............................................ Pediatric Unit, RigshospitaletKirsten Buhl ...................................... Fredericia SygehusKirsten Færgeman .......................... Århus Kommune, Børn og Unge, Videncenter for Pædagogisk UdviklingLouise Enevoldsen .......................... KostkompagnietMargit Vesterlund ........................... Kolding SygehusMette Pedersen ................................ Nutricia A/SMia Skøn Nielsen

Anne Koskinen ................................. Fresenius Kabi AbAnneli Ollus ....................................... Helsinki University HospitalBerit Haglund ................................... Helsingfors stadEetu Koski .......................................... Novartis Finland Oy / Medical NutritionHelena Selkälä .................................. Lapland Central HospitalHilkka Pakarinen .............................. Central hospital of KainuuK. Tuulikki Koistinen ....................... Åbo universitets centralsjukhusKatri Tolonen .................................... Helsinki PolytechnicLeena Alppinen ................................ Health centre of HelsinkiLeila Karhunen ................................. University of Kuopio, Department of Public Health and Clinical NutritionLiisa Ilona Heinonen ...................... Finnish Diabetes Association/Diabetes CentreMaija Heikura ................................... PKSSK, (North Karelia Hospital Distritct)Marja Aho .......................................... Free lancerMarja Mikkola .................................. Helsinki PolytechnicMerja Herranen-Kallio .................. Valkeakoski HospitalPauliina Pietilä ................................. Valio LtdTarja Heino ........................................ Fresenius Kabi AbTea Lallukka ....................................... University of HelsinkiTuija Helminen ................................. Health Care Centre HeinolaTuula Heikkinen ............................... City of Helsinki/HealthcareUlla Siljamäki-Ojansuu ................. Tampere University Hospital

Ulla Sissel Brandi ............................ Landssygehuset i Tórshavn

Denmark

Finland

Faero Islands

Sweden

Participants

25

Anna S. Ólafsdottir ......................... Public Health Institute of IcelandÁsa Guðrún Kristjánsdóttir ......... Unit for Nutrition Research, Landspítali - University HospitalBertha Ársælsdóttir ........................ Unit for Nutrition Research, Landspítali - University HospitalBryndís Eva Birgisdóttir ............... Landspítali - University HospitalElín Sigurborg Harðardóttir ........ Heilbrigðisstofnun ÞingeyingaElísabet S. Magnúsdóttir .............. Menntaskólinn í KópavogiFríða Rún Þórðardóttir ................. Landspítali - University HospitalGisela Lobers ..................................... Department of Clinical Nutrition, Landspítali - University HospitalGuðlaug Gísladóttir ....................... Department of Clinical Nutrition, Landspítali - University HospitalGuðrún Jóna Bragadóttir ............ Department of Clinical Nutrition, Landspítali - University HospitalHeiða Björg Hilmisdóttir .............. Landspítali - University HospitalHelga SigurðardóttirHildur Ósk Hafsteinsdóttir .......... MSInga Þórsdóttir ................................ Landspítali - University HospitalIngibjörg Gunnarsdóttir ............... Unit for Nutrition Research /University of Iceland & Landspitali - University HostpialKolbrún Einarsdóttir ...................... Department of Clinical Nutrition, Landspítali - University HospitalSigríður Eysteinsdóttir .................. Heilbrigðisstofnun SuðurnesjaSvava Engilbertsdóttir .................. Department of Clinical Nutrition, Landspítali - University HospitalUnnur Björk Gunnarsdóttir ........ IcepharmaValgerður Hildibrandsdóttir ........ Sn-ráðgjöf ehf.

Åse Karine Ruud .............................. Sørlandet SykehusElisabeth Elind .................................. StudentElse Rabbås Holsdal ....................... St. Olavs HospitalGunnhild B. Meldal-Jonsen ........ Aker universitetssykehus SkiHilde Gras .......................................... Sørlandet Sykehus KristiansandJohanne Alhaug .............................. Lovisenberg Diakonale SykehusKjersti Gjermstad ............................ Sykehuset LevangerLene Thoresen .................................. St. Olavs HospitalMarianne Nordlie ............................ Fresenius KabiNina Kirknes ...................................... Sørlandet Sykehus HF, avd MandalRandi J Tangvik ................................ Haukeland Universitetsssykehus

Anette Järvi ....................................... Nestle Sverige ABBirgitta Forsberg ............................. Primärvården SkåneElisabet Rothenberg ...................... Sahlgrenska University HospitalEllen SvenssonEva Davidson .................................... Helsingborgs lasarett (The hospital of Helsingborg)Eva Larsson ........................................ Vårdcentralen SkogsfridIngrid Larsson ................................... Obesity Unit, Sahlgrenska University HospitalIrene Sigfridsson ............................. City of Sundsvall/Sundsvalls kommunKiki Lundberg .................................... Avd f Klinisk NutritionMia Davidsson .................................. Primärvården SkåneSofia Hallberg................................... Unilever Sweden ABTeresa Olefeldt ................................. Helsingborgs lasarett (The hospital of Helsingborg)

Iceland

Norway

Sweden

Notes

26

Sponsors

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