To Örebro University

Since lack of culture-specific foods in dietary assessment methods may bias reported dietary intake, we identified foods and dishes consumed by residents not born in Sweden and describe consequences for reported foods and nutrient intake using a culturally adapted dietary assessment method. Design consisted of cross-sectional data collection using (semi-)qualitative methods of dietary assessment (and national diet survey instrument RiksmatenFlex) with subsequent longitudinal data collection using quantitative methods for method comparison (December 2020-January 2023). Three community-based research groups were recruited that consisted of mothers born in Sweden, Syria/Iraq, and Somalia, with a median age of 34, 37, and 36 years, respectively. Women born in Syria/Iraq and Somalia who had lived in Sweden for approximately 10 years, reported 78 foods to be added to RiksmatenFlex. In a subsequent study phase, 69% of these foods were reported by around 90% of the ethnic minority groups and contributed to 17% of their reported energy intake. However, differences between the three study groups in median self-reported energy intake remained (Sweden 7.19 MJ, Syria/Iraq 5.54 MJ, and Somalia 5.69 MJ). The groups also showed differences in relative energy contribution from fats and carbohydrates, as well as differences in energy intake from food groups such as bread and sweet snacks. We conclude that a dietary assessment instrument containing culture-specific foods could not resolve group differences in reported energy intake, although these foods provided content validity and contributed 17% of energy intake. The dietary habits collected in this study serve to develop new dietary assessment instruments.

We aimed to extend a web-based dietary survey instrument (RiksmatenFlex, developed by the Swedish Food Agency) with culture-specific food items for two of the largest migrant populations living in Sweden.  We interviewed 44 women born in Syria and Iraq (referred to as ‘Middle-Eastern’, ME) and 38 from Somalia (SO).  The study included also a Swedish-born group (not reported on here).  We asked participants to self-administer a 24-hour diet recall (24hDR) in RiksmatenFlex, followed by an interviewed 24hDR.  Translation of study materials (except RiksmatenFlex) were available.  Interpreters were arranged on request.

Participants’ mean age was 36 years. We compared self-administered with interviewed 24hDR for 19 and 6 participants from the ME and SO groups, respectively.  Three main reasons for not completing the self-administered 24hDR were: misunderstanding instructions, login or instrument; not having seen mails/SMS; no time.  Three participants reported the wrong day. Mean difference (standard deviation) in energy intake was +2.30 (2.11) MJ and ‑0.65 (3.87) MJ for the ME and SO respectively (see Bland-Altman plot). Based on 82 interviewed 24hDR and additional questions, we identified 78 foods and dishes for which we created nutrient profiles, portion size descriptors as well as prompting questions for foods commonly consumed together.

Interviewed 24hDR were superior to self-administered 24hDR when using RiksmatenFlex, since comprehension issues could be overcome and the interviewer could search for alternative foods. The extended food list was tested in a subsequent study.

We aimed to extend a web-based dietary survey instrument (RiksmatenFlex, developed by the Swedish Food Agency) with culture-specific food items for two of the largest migrant populations living in Sweden.  We included 41 women born in Sweden (SE) and interviewed 44 born in Syria and Iraq (referred to as ‘Middle-Eastern’, ME) and 38 from Somalia (SO).  We asked all participants to self-administer a 24-hour diet recall (24hDR) in RiksmatenFlex, followed by an interviewed 24hDR for the ME and SO groups.  Translation of study materials (except RiksmatenFlex) were available.  Interpreters were arranged on request.  We used the interviewed 24hDR for the ME and SO group since response on the self-administered 24hDR was low.

Reported median (M) daily energy intake (DEI) was 7.22, 5.72 and 5.67 MJ for the SE, ME and SO groups respectively.  Breakfast and lunch were common (89-93% and 84‑93%) of which breakfast provided a M of 22% contribution to DEI.  However, lunch contributed a M of 40% and 33% to DEI among ME and SO compared to SE group (M 21%).  Dinner was eaten by 98%, 68% and 84%, but of similar percent contribution to DEI (M 28%).  Remaining eating and drinking occasions contributed M 21% and 18% to DEI among ME and SO compared to SE (M 29%).  With data-entry bins of 1 hour, we observed no significant differences between groups in number of hours with reported foods.

We conclude that eating times and meal size differ between the study groups.  These observations have clinical relevance and may raise awareness among healthcare staff when giving advice about e.g. diabetes.

We updated a web-based dietary survey instrument (RiksmatenFlex, developed by the Swedish Food Agency) by extending it with culture-specific food items for two of the largest migrant populations living in Sweden.  After our diet inventory study, 78 out of 123 women continued and an additional 28 were recruited.  They were interviewed three times between May and December 2022.  On request, the 24-hour diet recalls (24hDR) were in Arabic. We hypothesized that our addition of culture-specific food items would make any between group difference in reported daily energy intake (DEI) smaller.

At least two of three 24hDR were completed by 35 women born in Sweden (SE), 30 born in Syria and Iraq (referred to as ‘Middle-Eastern’, ME) and 26 from Somalia (SO). The median (interquartile range) in DEI was 7.13 (5.81‑8.45), 5.52 (4.17‑7.21) and 5.65 (4.60‑7.47) MJ/d for SE, ME and SO respectively.  Of the 78 culture-specific foods added during the diet inventory study, 46 were reported. These foods were reported by 3 participants from the SE group, and by 29 (97%) and 22 (85%) of the ME and SO groups respectively. Among the ME and SO groups, culture-specific foods contributed maximally 75% to the reported DEI in a single 24hDR. Based on minimally two 24hDR, a median of 0%, 15% and 15% of the DEI was accounted for by these foods among SE, ME and SO groups respectively.

Reported DEI among ME and SO groups remained lower compared to the SE group. Factors other than culture-specific foods, such as weight consciousness, may have contributed to differences in reported DEI using RiksmatenFlex.

Studies have shown that probiotics can decrease the symptoms of respiratory tract infections as well as increase antibody responses following certain vaccinations. We examined the effect of probiotic supplementation on anti-SARS-CoV-2 specific antibody responses upon SARS-CoV-2 infection as well as after COVID-19 vaccination. In this randomized, triple-blinded, placebo-controlled intervention study with a parallel design, 159 healthy adults without prior SARS-CoV-2 infection or COVID-19 vaccination and any known risk factors for severe COVID-19 were randomly allocated into two study arms. The active treatment arm consumed a probiotic product containing a minimum of 1 × 108 colony-forming units of Limosilactobacillus reuteri DSM 17938 + 10 μg vitamin D3 twice daily for 6 months. The placebo arm consumed identical tablets containing only 10 μg vitamin D3. Anti-SARS-CoV-2 specific antibodies and virus neutralizing antibody titers were analyzed from blood samples collected at baseline, after 3 months, and after 6 months. Differences in serum antibody titers between the two study arms were tested with independent t-test using log-transformed values. In the intention-to-treat (ITT) analysis, SARS-CoV-2 infected individuals in the active treatment arm (n = 6) tended to have higher serum anti-spike IgG (609 [168-1480] BAU/ml vs 111 [36.1-1210] BAU/ml, p = 0.080) and anti-receptor binding domain (RBD) IgG (928 [212-3449] BAU/ml vs (83.7 [22.8-2094] BAU/ml, p = 0.066) levels than individuals in the placebo arm (n = 6). Considering individuals who were fully vaccinated with mRNA-based COVID-19 vaccines, the active treatment arm (n = 10) exhibited significantly higher serum levels of anti-RBD IgA (135 [32.9-976] BAU/ml vs 61.3 [26.7-97.1] BAU/ml, p = 0.036) than the placebo arm (n = 7) >28 days postvaccination. Supplementation with specific probiotics might improve the long-term efficacy of mRNA-based COVID-19 vaccines via enhanced IgA response.

This study compared accelerometer-assessed habitual physical activity (PA), sedentary time, and meeting PA recommendations among 102 youth with disabilities (7-20 years) in four subgroups-physical/visual impairments, intellectual disability, autism spectrum disorders, and hearing impairment-and 800 youth with typical development (8-16 years). Low proportions of youth with disabilities met PA recommendations, and they generally were less physically active and more sedentary than youth with typical development. The hearing impairment and autism spectrum disorder groups were the most and least physically active, respectively. Older age and to some extent female sex were related to less PA and more sedentary time. Considering the suboptimal levels of PA in youth with disabilities, effective interventions directed at factors associated with PA among them are needed.