Nordic monitoring on diet, physical activity and overweight

In July 2006, the Nordic Council of Ministers adopted a Nordic Plan of Action on better health and quality of life through diet and physical activity. As an important element in the common Nordic Plan of Action, the Nordic Council of Ministers decided to develop a common Nordic monitoring of diet, physical activity and overweight. In 2007, a Nordic working group was established to carry out this development. The Nordic Plan of Action emphasizes that the monitoring should be simple and low cost and preferably based on indicator questions.

The monitoring project consists of three parts.
Part 1 describes a common Nordic method for collecting representative data, including description of sample size and characteristics, as well as practical considerations of the implementation of the monitoring in the Nordic countries.

Part 2 validates the suggested methods against an objective method (physical activity) or existing survey methods (diet). A network on childhood growth is also established in the part of the project.

Part 3 will be the first collection of data in all Nordic Countries, if financing is provided.

The working group consists of scientists from Nordic research institutions and has held two meetings and a combined workshop and meeting in 2008. Before, between and after the meetings the working group has worked together by e-mails.

The working group has finished part 1 of the project and has with funding from NICe and NKMT started a validation study running in 2009-2010. It is suggested that the future monitoring is conducted as a telephone interview based on indicator questions.

In 2009, the validation study will take place in Iceland, Denmark, Norway and Finland. Diet indicators will be validated in Iceland and Denmark and physical activity indicators will be validated in Iceland, Finland and Norway.

Also in 2009, a network of monitoring child growth the Nordic countries will be established. The aim of the network is to coordinate and harmonize central monitoring using the same measures, standards and way of analyses and to compare the development in overweight in the Nordic countries.

Objective of the validation project
The objective is to validate indicator questions on diet and physical activity among children, adolescents and adults and to establish a network on monitoring of childhood growth.

Hypothesises: 1) The validation study will show that the indicator questions on diet reflect the nutritional quality of the total diet assessed by a reference method; and the indicator questions about meeting the recommended level of physical activity reflect the objectively measured physical activity. 2) The network will facilitate improvement in monitoring childhood overweight and obesity in the Nordic Countries.

Plan for validation project
The project is covered by four work packages. WP1 will cover the activities regarding validation of the diet indicator questions, WP2 will cover the activities regarding the physical activity questions, WP3 will cover the activities regarding the network on monitoring childhood growth and WP4 will cover the coordination within the project, the communication about the project and finally gathering the results of WP1, WP2 and WP3 (see additional information box).

Validation diet (WP1)
It has been decided that Iceland and Denmark validate the diet indicator questions. The indicators on diet will be measured by a short food frequency questionnaire (FFQ) and validated against a reference method, which is planned to be a food record. It is planned that a pilot study will be conducted in spring 2009 and the data collection will take place in August-November 2009.

Validation physical activity (WP2)
It has been decided that Iceland, Finland and Norway validate the physical activity questions. The level of physical activity will be measured by a questionnaire indicating participation in moderate and/or vigorous intensity physical activities and exercise. The self-report questionnaires will be validated against objectively measured physical activity by using 7 to 14 days monitoring of PA by accelerometers.

Network on childhood growth (WP3)
Included in the validation study is also the establishment of a network of monitoring child growth in the Nordic countries. The aim of the network is to coordinate and harmonize central monitoring of child growth using the same measures, standards and way of analyses and to compare the development in overweight in the Nordic countries.

Coordination and communication (WP4)
Coordination within the project and communication about the project will take place through project group meetings, project group e-mails, common e-mails to reference group, national meetings for reference group members and information on web sites.

Timetable
Spring 2009: completion of common questionnaires, including translation and retranslation, pilot study
During 2009: data collection, data processing and analyses
During 2010: final analyses, report medio 2010 and scientific paper and project report by the end of 2010

All work packages are running the whole project period. The work packages are coordinated by the project group, where all WP leaders are represented. This will ensure sharing of information from WP1, WP2 and WP3. WP1 and WP2 run in parallel, since the validation studies on diet and physical activity are conducted by different institutions in the Nordic countries, as shown in additional information. Results from WP1 and WP2 are finally gathered in WP4 and presented in a common report, since both indicator questions on diet and indicator questions on physical activity should represent the future common Nordic monitoring system. Results from WP3 will also contribute to the proposal for a common Nordic monitoring system, since inclusion of a few general health parameters will be discussed in WP3. The Network group of WP3 will benefit from WP1 and WP2, since the project manager and WP1 leader are members of the network group, regarding the discussion about development of indicators of diet and physical activity to be used in monitoring programs in schools.

Objectives and target groups for communication activities
The objective of the communication activities are:

To disseminate the results of the project to a broad audience to ensure knowledge of the results, especially decision makers in the Nordic countries.
To give decision makers the best possible scientific background for deciding to finance a common Nordic monitoring system.


Target groups for the communication activities
Report to NKMT and NICe will disseminate the results, especially to the Nordic Council of Ministers and Nordic Food and Health authorities, but also politicians, commercial actors, scientists, NGO´s and the public. Web articles will disseminate the results primarily to the public and the press and a scientific article will disseminate the results to the scientific world.

The NKMT has interest of the results to be able to present plans for a common Nordic monitoring of diet, physical activity and overweight to the Nordic Ministers in the summer of 2010. The project will give technical and science based advises in relation to that, if needed.