| 1. |
- Eneroth, Hanna, et al.
(author)
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Environmental impact of coffee, tea and cocoa – data collection for a consumer guide for plant-based foods
- 2022
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Reports (other academic/artistic)abstract
- In 2020, WWF launched a consumer guide on plant-based products targeting Swedish consumers. The development of the guide is described in a journal paper (Karlsson Potter & Röös, 2021) and the environmental impact of different plant based foods was published in a report (Karlsson Potter, Lundmark, & Röös, 2020). This report was prepared for WWF Sweden to provide scientific background information for complementing the consumer guide with information on coffee, tea and cocoa. This report includes quantitative estimations for several environmental categories (climate, land use, biodiversity and water use) of coffee (per L), tea (per L) and cocoa powder (per kg), building on the previously established methodology for the consumer guide. In addition, scenarios of consumption of coffee, tea and cocoa drink with milk/plant-based drinks and waste at household level, are presented. Tea, coffee and cacao beans have a lot in common. They are tropical perennial crops traditionally grown in the shade among other species, i.e. in agroforestry systems. Today, the production in intensive monocultures has negative impact on biodiversity. Re-introducing agroforestry practices may be part of the solution to improve biodiversity in these landscapes. Climate change will likely, due to changes in temperature, extreme weather events and increases in pests and disease, alter the areas where these crops can be grown in the future. A relatively high ratio of the global land used for coffee, tea and cocoa is certified according to sustainability standards, compared to other crops. Although research on the implications of voluntary standards on different outcomes is inconclusive, the literature supports that certifications have a role in incentivizing more sustainable farming. Coffee, tea and cocoa all contain caffeine and have a high content of bioactive compounds such as antioxidants, and they have all been associated with positive health outcomes. While there is a strong coffee culture in Sweden and coffee contributes substantially to the environmental impact of our diet, tea is a less consumed beverage. Cocoa powder is consumed as a beverage, but substantial amounts of our cocoa consumption is in the form of chocolate. Roasted ground coffee on the Swedish market had a climate impact of 4.0 kg CO2e per kg powder, while the climate impact of instant coffee powder was 11.5 kg CO2e per kg. Per litre, including the energy use for making the coffee, the total climate impact was estimated to 0.25 kg CO2e per L brewed coffee and 0.16 kg CO2e per L for instant coffee. Less green coffee beans are needed to produce the same amount of ready to drink coffee from instant coffee than from brewed coffee. Tea had a climate impact of approximately 6.3 kg CO2 e per kg dry leaves corresponding to an impact of 0.064 CO2e per L ready to drink tea. In the assessment of climate impact per cup, tea had the lowest impact with 0.013 kg CO2e, followed by black instant coffee (0.024 kg CO2e), black coffee (0.038 kg CO2e), and cocoa drink made with milk (0.33 kg CO2e). The climate impact of 1kg cocoa powder on the Swedish market was estimated to 2.8 kg CO2e. Adding milk to coffee or tea increases the climate impact substantially. The literature describes a high proportion of the total climate impact of coffee from the consumer stage due to the electricity used by the coffee machine. However, with the Nordic low-carbon energy mix, the brewing and heating of water and milk contributes to only a minor part of the climate impact of coffee. As in previous research, coffee also had a higher land use, water use and biodiversity impact than tea per L beverage. Another factor of interest at the consumer stage is the waste of prepared coffee. Waste of prepared coffee contributes to climate impact through the additional production costs and electricity for preparation, even though the latter was small in our calculations. The waste of coffee and tea at Summary household level is extensive and measures to reduce the amount of wasted coffee and tea could reduce the environmental impact of Swedish hot drink consumption. For the final evaluation of coffee and tea for the consumer guide, the boundary for the fruit and vegetable group was used. The functional unit for coffee and tea was 1 L prepared beverage without any added milk or sweetener. In the guide, the final evaluation of conventionally grown coffee is that it is ‘yellow’ (‘Consume sometimes’), and for organic produce, ‘light green’ (‘Please consume). The evaluation of conventionally grown tea is that it is ‘light green’, and for organic produce, ‘dark green’ (‘Preferably consume this’). For cocoa, the functional unit is 1 kg of cocoa powder and the boundary was taken from the protein group. The final evaluation of conventionally grown cocoa is that it is ‘orange’ (‘Be careful’), and for organically produced cocoa, ‘light green’.
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| 2. |
- Arnesen, Erik Kristoffer, et al.
(author)
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The Nordic Nutrition Recommendations 2022 : structure and rationale of qualified systematic reviews
- 2020
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In: Food & Nutrition Research. - : SNF Swedish Nutrition Foundation. - 1654-6628 .- 1654-661X. ; 64:0
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Research review (peer-reviewed)abstract
- Background: Qualified systematic reviews (SRs) will form the main basis for evaluating causal effects of nutrients or food groups on health outcomes in the sixth edition of Nordic Nutrition Recommendations to be published in 2022 (NNR2022).Objective: To describe rationale and structure of SRs used in NNR2022. Design: The SR methodologies of the previous edition of NNR were used as a starting point. Methodologies of recent SRs commissioned by leading national food and health authorities or international food and health organizations were examined and scrutinized. Methodologies for developing SRs were agreed by the NNR2022 Committee in a consensus-driven process.Results: Qualified SRs will be developed by a cross-disciplinary group of experts and reported according to the requirements of the EQUATOR network. A number of additional requirements must also be fulfilled, including 1) a clearly stated set of objectives and research questions with pre-defined eligibility criteria for the studies, 2) an explicit, reproducible methodology, 3) a systematic search that attempts to identify all studies that would meet the eligibility criteria, 4) an assessment of the validity of the findings of the included studies through an assessment of ‘risk of bias’ of the studies, 5) a systematic presentation and synthesis of the characteristics and findings of the included studies, and 6) a grading of the overall evidence. The complete definition and requirements of a qualified SR are described.Discussion: Most SRs published in scientific journals do not fulfill all criteria of the qualified SRs in the NNR2022 project. This article discusses the structure and rationale for requirements of qualified SRs in NNR2022. National food and health authorities have only recently begun to use qualified SRs as a basis for nutrition recommendations.Conclusion: Qualified SRs will be used to inform dietary reference values (DRVs) and food-based dietary guidelines (FBDGs) in the NNR2022 project.
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| 3. |
- Arnesen, Erik Kristoffer, et al.
(author)
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The Nordic Nutrition Recommendations 2022 : handbook for qualified systematic reviews
- 2020
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In: Food & Nutrition Research. - : SNF Swedish Nutrition Foundation. - 1654-6628 .- 1654-661X. ; 64:0
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Research review (peer-reviewed)abstract
- Background: Systematic reviews (SRs) constitute a major part of the Nordic Nutrition Recommendations (NNRs). The step-by-step procedure used to develop SRs has evolved considerably over time and is often tailored to fit the exposure and outcomes in focus.Objective: To describe a detailed procedure for developing qualified SRs commissioned by the NNR2022 project.Design: Scrutinizing procedures of recent SRs commissioned by leading national food and health authorities or international food and health organizations.Results: The following eight steps must be included when developing qualified SRs for the NNR2022 project: 1) define research question, 2) protocol development, 3) literature search, 4) screening and selection of studies, 5) data extraction, 6) assessing risk of bias, 7) synthesis and grading of total strength of evidence, and 8) reporting according to certain standards.Discussion: This guide is based on the guidelines developed for the fifth edition of NNR but includes some important new domains in order to adhere to more recent, authoritative standards.Conclusion: All qualified SRs in the NNR2022 project will follow the protocol described here.
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| 4. |
- Christensen, Jacob Juel, et al.
(author)
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The Nordic Nutrition Recommendations 2022 : principles and methodologies
- 2020
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In: Food & Nutrition Research. - : SNF Swedish Nutrition Foundation. - 1654-6628 .- 1654-661X. ; 64:0
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Research review (peer-reviewed)abstract
- Background: The Nordic Nutrition Recommendations (NNRs) constitute the scientific basis for national dietary reference values (DRVs) and food-based dietary guidelines (FBDGs) in the Nordic and Baltic countries.Objective: To define principles and methodologies for the sixth edition of NNR to be published in 2022 (NNR2022).Design: The principles and methodologies of the previous edition of NNR were used as a starting point. Recent nutrition recommendations commissioned by other national food and health authorities or international food and health organizations were examined and dissected. Updated principles and methodologies were agreed by the NNR2022 Committee in a consensus-driven process.Results: An organizational model with ‘checks and balances’ was developed to minimize the influence of subjective biases of the committee members and experts. Individual chapters on all included nutrients and food groups will be updated as scoping reviews. Systematic reviews (SRs), which are the main basis for evaluating causal effects of nutrients or food groups on health outcomes, will be embedded in each chapter. A NNR SR Centre will be established for performing de novo SRs on prioritized topics. To avoid duplication and optimize the use of resources, qualified SRs commissioned by other national and international organizations and health authorities will also inform DRVs and FBDGs in NNR2022.Discussion: The evidence-based methods defined in the NNR2022 project are compatible with most contemporary methods used by leading national food and health authorities. Global harmonization of methodological approaches to nutrition recommendations is strongly encouraged.Conclusion: Evidence-informed principles and methodologies underpinned by SRs will ensure that DRVs and FBDGs defined in the NNR2022 project are based on the best available evidence and as far as possible free from overt bias.
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| 5. |
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| 6. |
- Eneroth, Hanna, et al.
(author)
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Dose-effect of iron-folic acid and multiple micronutrient supplementation on hemoglobin concentration in pregnancy
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Other publication (other academic/artistic)abstract
- Maternal multiple micronutrient supplementation has been suggested as an alternative to the 60 mg iron-folic acid supplementation recommended by the WHO. The effect on hemoglobin (Hb) concentration during pregnancy per capsule of multiple micronutrients has not been evaluated. To investigate the response of type of prenatal supplement on Hb concentration in pregnancy we used data from the MINIMat trial, Bangladesh, where pregnant women were randomized to food and micronutrient interventions. The daily micronutrient supplements starting at week 14 (baseline) were: 60 mg iron+ 400 µg folic acid (Fe60Fol), 30 mg iron+ 400 µg folic acid (Fe30Fol) and 30 mg iron+ 400 µg folic acid+ 13 other micronutrients (MMS). Hb was measured at baseline and week 30 (follow-up) by HemoCue® (n=2377). Intake of capsules was estimated by a device (eDEM®) recording the number of openings of the cap of the supplement bottles.We evaluated dose-effect associations in linear regression models and adjusted for potential confounding. Disregarding type of supplement, the Hb concentration increased with increasing capsule intake (β=0.09, p<0.001). The dose response levelled out at 60 capsules of Fe60Fol. Both anemic and non anemic women responded to supplementation but Hb increase per capsule was higher in anemic women (β=0.065, p=0.19 for interaction between anemia and capsule intake). Despite that the maximum potential Hb was reached, both for anemic and non-anemic women at intakes above 60 capsules, prevalence of anemia was high after supplementation (36%) indicating other causes of anemia than iron deficiency.
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| 7. |
- Eneroth, Hanna, et al.
(author)
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Duration of exclusive breast-feeding and infant iron and zinc status in rural Bangladesh
- 2009
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In: Journal of Nutrition. - : Elsevier BV. - 0022-3166 .- 1541-6100. ; 139:8, s. 1562-1567
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Journal article (peer-reviewed)abstract
- There is a concern that exclusive breast-feeding (EBF) for 6 mo may lead to iron and zinc deficiency in low-birth weight (LBW) infants. We assessed the association between duration of EBF and infant iron and zinc status in the Maternal and Infant Nutrition Interventions in Matlab trial, Bangladesh, stratified for normal birth weigh (NBW) and LBW. Duration of EBF was classified into EBF <4 mo and EBF 4-6 mo based on monthly recalls of foods introduced to the infant. Blood samples collected at 6 mo were analyzed for plasma zinc (n = 1032), plasma ferritin (n = 1040), and hemoglobin (Hb) (n = 791). Infants EBF 4-6 mo had a higher mean plasma zinc concentration (9.9 +/- 2.3 micromol/L) than infants EBF <4mo (9.5 +/- 2.0 micromol/L) (P < 0.01). This association was apparent in only the NBW strata and was not reflected in a lower prevalence of zinc deficiency. Duration of EBF was not associated with concentration of plasma ferritin, Hb concentration, or prevalence of iron deficiency or anemia in any strata. Regardless of EBF duration, the prevalence of zinc deficiency, iron deficiency, and anemia was high in infants in this population and strategies to prevent deficiency are needed.
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| 8. |
- Eneroth, Hanna, et al.
(author)
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Infant anaemia is associated with infection, low birthweight and iron deficiency in rural Bangladesh
- 2011
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 100:2, s. 220-225
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Journal article (peer-reviewed)abstract
- Aim: To estimate the prevalence of infant anaemia and its association with iron deficiency, growth, infection and other micronutrient deficiencies. Methods: Using data from MINIMat, a randomized maternal food and micronutrient supplementation trial, we assessed the associations between anaemia (haemoglobin < 105 g/L) in 580 infants at 6 months and deficiencies of iron, vitamin A, vitamin B12, zinc and folate, infection and anthropometric indices. Variables associated with anaemia in bivariate analyses were evaluated in logistic regression models, adjusting for potential confounders. Results: Anaemia was found in 46% of the infants, and among these, 28% had iron deficiency (plasma ferritin <9 μg/L). Elevated C-reactive protein (>10mg/L) (OR = 2.7, 95% CI: 1.6, 4.7), low birthweight (OR = 2.3, 95% CI: 1.5, 3.5) and iron deficiency (OR = 2.2, 95% CI: 1.4, 3.6) were independently associated with increased risk for anaemia. We also observed a seasonal variation in anaemia not mediated through the other factors studied. Conclusion: In a cohort in rural Bangladesh, anaemia at age 6 months was common and associated with infection, low birthweight and iron deficiency.
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| 9. |
- Eneroth, Hanna
(author)
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Infant Anemia and Micronutrient Status : Studies of Early Determinants in Rural Bangladesh
- 2011
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Doctoral thesis (other academic/artistic)abstract
- Anemia and micronutrient deficiencies in infancy are common in low-income settings. These are partly due to maternal malnutrition and may impair child health and development. We studied the impact of maternal food and micronutrient supplementation, duration of exclusive breastfeeding (EBF), growth and infection on infant anemia and micronutrient status. In the MINIMat trial in Matlab, Bangladesh, pregnant women were randomized to Early or Usual promotion of enrolment in a food supplementation program and to one of three daily micronutrient supplements. Capsules containing 400µg folic acid and (a) 30 mg iron (Fe30Fol), (b) 60 mg iron (Fe60Fol), (c) 30 mg iron and other micronutrients (MMS) were provided from week 14 of gestation. Capsule intake was assessed with the eDEM device recording supplement container openings. Blood samples (n=2377) from women at week 14 and 30 were analyzed for hemoglobin (Hb). Duration of EBF and infant morbidity was based on monthly maternal recalls. Infants were weighed and measured monthly. Blood samples (n=1066) from 6-months-old infants were analyzed for Hb and plasma ferritin, zinc, retinol, vitamin B12 and folate. In women, Hb increase per capsule reached a plateau at 60 Fe60Fol capsules, indicating that nine weeks of daily supplementation produced maximum Hb response. Anemia was common (36%) at capsule intakes >60 indicating other causes of anemia than iron deficiency. In infants, vitamin B12 deficiency prevalence was lower in the MMS (26.1%) than in the Fe30Fol group (36.5%), (p=0.003) and zinc deficiency prevalence was lower in the Usual than in the Early group. There were no other differential effects of food or micronutrient supplementation on infant anemia or micronutrient status. Infants exclusively breast-fed for 4-6 months had a higher mean plasma zinc concentration (9.9±2.3 µmol/L) than infants exclusively breast-fed for <4 months (9.5±2.0 µmol/L), (p< 0.01). No other differences in anemia, iron or zinc status were observed between EBF categories. Infection, low birth weight and iron deficiency were independent risk factors for infant anemia. Regardless of studied interventions, prevalence of anemia (43%), deficiency of zinc (56%), vitamin B12, vitamin A (19%) and iron (22%) in infancy was high and further preventive strategies are needed.
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| 10. |
- Eneroth, Hanna, et al.
(author)
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Maternal multiple micronutrient supplementation has limited impact on micronutrient status of Bangladeshi infants compared with standard iron and folic acid supplementation
- 2010
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In: Journal of Nutrition. - : Elsevier BV. - 0022-3166 .- 1541-6100. ; 140:3, s. 618-624
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Journal article (peer-reviewed)abstract
- Knowledge about the impact of maternal food and micronutrient supplementation on infant micronutrient status is limited. We examined the effect of maternal food and micronutrient supplementation on infant micronutrient status in the Maternal and Infant Nutrition Interventions in Matlab Trial. Pregnant women (n = 4436) were randomized to Early or Usual promotion of enrollment in a food supplementation program. In addition, they were randomly allocated to 1 of the following 3 types of daily micronutrient supplements provided from wk 14 of gestation to 3 mo postpartum: 1) folic acid and 30 mg iron (Fe30Fol); 2) folic acid and 60 mg iron; or 3) a multiple micronutrient including folic acid and 30 mg iron (MMS). At 6 mo, infant blood samples (n = 1066) were collected and analyzed for hemoglobin and plasma ferritin, zinc, retinol, vitamin B-12, and folate. The vitamin B-12 concentration differed between the micronutrient supplementation groups (P = 0.049). The prevalence of vitamin B-12 deficiency was lower in the MMS group (26.1%) than in the Fe30Fol group (36.5%) (P = 0.003). The prevalence of zinc deficiency was lower in the Usual food supplementation group (54.1%) than in the Early group (60.2%) (P = 0.046). There were no other differential effects according to food or micronutrient supplementation groups. We conclude that maternal multiple micronutrient supplementation may have a beneficial effect on vitamin B-12 status in infancy.
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