Whole grain intake, overall diet quality and key components of sustainable diets in Finnish adults

Abstract Background and objectives Whole grains have been deemed a core component in diets promoting human health and environmental sustainability. Yet, research is scarce on whole grain intake in relation to overall diet quality and diet sustainability. We aimed to examine the association of whole grain intake with overall diet quality and key components of sustainable diets (fruits, vegetables, legumes, red and processed meat, plant-based and animal-based proteins) in Finnish adults. Methods Our data comprised 3127 adults (58% women, energy underreporters excluded) aged 18 − 74 years participating in the population-based FinHealth 2017 Study. Dietary intake was assessed by a validated 134-item food frequency questionnaire. Food, nutrient, energy and whole grain intakes were calculated utilizing the Finnish Food Composition Database. Overall diet quality was examined by the modified Baltic Sea Diet Score (excluding cereals). Associations were assessed by linear regression analysis adjusted for relevant confounders. Results Whole grain intake was positively associated with overall diet quality and fruit consumption (p < 0.001) in women and men. A positive association also occurred with plant-based protein intake (p < 0.001, women and men). Yet, whole grain intake was inversely associated with legume consumption in women (p = 0.001), while no association was found in men (p > 0.05). The association between whole grain intake and the intake of animal-based proteins and red and processed meat was inverse (p < 0.001) in both sexes. No association was found between whole grain and vegetable intakes (p > 0.05). Conclusions Our results suggest that whole grain intake is associated with healthier diets and more sustainable protein intake in Finnish adults. However, challenges in furthering healthy and sustainable diets in the population may occur regarding legume consumption. Legumes are especially important in plant-based diets as they complement cereals as a source of essential amino acids. Key messages • Higher whole grain intake may indicate higher overall diet quality and more sustainable protein intake in Finnish adults. • Legume consumption requires further attention among Finnish adults with high whole grain intake despite their generally higher overall diet quality and more sustainable protein intake.


Background:
Fish intake is included in several national food-based dietary guidelines as a component of healthy diet because of its rich source of beneficial omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). However, heterogeneity among types of fish intake is rarely studied. We investigated the associations of socio-economic status (SES) with total and types of fish intake and validated whether types of fish intake was associated with plasma EPA and DHA. Methods: From the Lifelines cohort study, 94 246 participants aged 44 AE 13 years old were included to test the association of two SES indicators, i.e., education level and income level, with dietary intakes of total, fatty, lean, fried, and other types of fish. Plasma EPA and DHA were measured in a minor subset of 575 participants (mean age: 50 AE 13 years old). Total and types of fish intake was assessed using Food Frequency Questionnaire. Linear regressions were applied, adjusted for relevant covariates.

Results:
After adjusting for covariates, middle and low education were negatively associated with total, fatty, lean, and other fish intake (p < 0.001 for all), and positively associated with fried fish intake (b (SE): 0.04 (0.04), p < 0.001 for middle education; 0.07 (0.04), p < 0.001 for high education), with high education as the reference group. Similar results were observed for income level. In the subset population, total and fatty fish were positively associated with plasma EPA and DHA (p < 0.02 for all). Lean and other fish intake were positively associated with only DHA (p < 0.008 for all), but not EPA, while fried fish was not associated with either EPA or DHA in plasma (p > 0.1 for all).

Conclusions:
Lower SES was associated with higher intake of fried fish, which did not seem to be associated with the fish-based EPA and DHA in plasma. Both nutrition education and food price policy could be implemented to increase the awareness and shape people's choice on types of fish.

Key messages:
People with low socio-economic status are consuming the type of fish that is not associated with fish-based omega-3 fatty acids, so nutrition education focusing on avoidance of fried fish is needed. Food subsidy programs promoting intake and increasing affordability of healthier fish are needed to improve the nutritional awareness and status of our population.

Background and objectives:
Whole grains have been deemed a core component in diets promoting human health and environmental sustainability. Yet, research is scarce on whole grain intake in relation to overall diet quality and diet sustainability. We aimed to examine the association of whole grain intake with overall diet quality and key components of sustainable diets (fruits, vegetables, legumes, red and processed meat, plant-based and animal-based proteins) in Finnish adults.

Methods:
Our data comprised 3127 adults (58% women, energy underreporters excluded) aged 18 À 74 years participating in the population-based FinHealth 2017 Study. Dietary intake was assessed by a validated 134-item food frequency questionnaire. Food, nutrient, energy and whole grain intakes were calculated utilizing the Finnish Food Composition Database.
Overall diet quality was examined by the modified Baltic Sea Diet Score (excluding cereals). Associations were assessed by linear regression analysis adjusted for relevant confounders.

Results:
Whole grain intake was positively associated with overall diet quality and fruit consumption (p < 0.001) in women and men. 15th A positive association also occurred with plant-based protein intake (p < 0.001, women and men). Yet, whole grain intake was inversely associated with legume consumption in women (p = 0.001), while no association was found in men (p > 0.05). The association between whole grain intake and the intake of animal-based proteins and red and processed meat was inverse (p < 0.001) in both sexes. No association was found between whole grain and vegetable intakes (p > 0.05).

Conclusions:
Our results suggest that whole grain intake is associated with healthier diets and more sustainable protein intake in Finnish adults. However, challenges in furthering healthy and sustainable diets in the population may occur regarding legume consumption. Legumes are especially important in plant-based diets as they complement cereals as a source of essential amino acids.

Key messages:
Higher whole grain intake may indicate higher overall diet quality and more sustainable protein intake in Finnish adults. Legume consumption requires further attention among Finnish adults with high whole grain intake despite their generally higher overall diet quality and more sustainable protein intake.

Background:
Nutrition is a well-established risk factor for cardiovascular diseases (CVD) that can be leveraged by public health prevention strategies. In addition to dietary guidelines, frontof-pack nutrition labels (FoPNL) can help consumers make healthier food choices. Nutri-Score, a scientifically validated 5color FopNL based on the nutrient profile FSAm-NPS has been adopted by several European countries but remains optional under current EU labeling regulation, which is to be revised end of 2022. Scientific evidence is therefore needed on the relevance of the Nutri-Score at the European level. Our objective was to study the association between the consumption of food as graded by the FSAm-NPS and CVD risk in a large European population.

Methods:
This prospective analysis was conducted on a case-cohort comprising 13,308 participants without CVD risk factors at baseline, among which 5,326 first incident cases of CVD from the EPIC-CVD study (8 European countries). Food intakes were assessed using country-specific dietary questionnaires. The FSAm-NPS was calculated for each food based on its 100g content in energy, sugar, saturated fatty acid, sodium, fibre, protein, and fruits/vegetables/legumes/nuts. Multi-adjusted Cox models were computed.

Results:
Overall, associations were observed between the consumption of foods with a higher FSAm-NPS score (lower nutritional value) and a higher risk of myocardial infarction (MI; HR1-SD = 1.12 [1.05,1.21]; HRQ5/Q1 = 1.23 [1.00,1.52]). Associations with stroke were not significant. Overall, associations were more particularly observed in men.

Conclusions:
In this large European population, a higher risk of MI was observed in individuals consuming on average a diet with higher FSAm-NPS foods (reflecting consumption of foods with a lower nutritional value/less favourable Nutri-Score). This adds to the evidence on the relevance of Nutri-Score as a public health tool to help consumers choose healthier food products.